400 Years of Inequity and the Impact on Today’s Public Health | Michigan Public Health


>>Thank you for joining
us today for our event. Four Hundred Years of
Inequity and the Impact on Today’s Public Health. I’m Nicole Burnside,
our school’s Diversity, Equity and Inclusion
Program manager. And I wanted to start
off by setting the stage. This October marks 400 years since the first enslaved
Africans were brought to Virginia in 1619. A movement called 400 Years
of Inequality is taking place across the country to highlight
and acknowledge the ways, in which slavery has
created lasting inequalities in our society. Here, at the School of Public
Health, it is our responsibility and our honor to be a
part of this movement. And at today’s event, we look
specifically at how slavery and it’s legacy have
shaped public health in black communities. We are lucky to have our
three distinguished panelist and an excellent
moderator with us. While our conversation today
will focus on the experiences of black communities in America,
it is also important for us to acknowledge native
inhabitants of our land and their experiences. The University of
Michigan is located on the traditional territory
of the Anishinaabe people. In 1817, Ojibwa, Odawa and Bodewadmi nations made the
largest single land donation to the University of Michigan,
offered ceremonially as a gift in the text of the Treaty
at the Foot of the Rapids, so that children
could be educated. Through these words
of acknowledgement, their contemporary and
ancestral ties to the land and their contributions to
this University are renewed and reaffirmed. Now, to kick off
our programming, I would like to introduce
our Dean, Dean DuBois Bowman. [ Applause ]>>How’s everyone doing? [Multiple speakers]. Alright. Thank you, Nicole. And welcome to everyone. And to the panelists,
thanks for joining us. Certainly, look forward to
hearing your remarks later in the program, in
just a few minutes. So, first, I’d like to start out
just by stating that diversity, equity and inclusion
are really central to who we are as a school. As a school, we’re our strongest
when we have faculty, staff, students from diverse
backgrounds, experiences, values and perspectives. It’s essentially what
drives excellence. But being in the field of public
health, DEI and the importance and significance of DEI go well
beyond these two buildings. At the core of what we do, we
strive to create a healthier, more equitable world for
all with emphasis on all. And we know that there often are
deep inequalities when it comes to the health and wellbeing
of different communities. And the 400 years of
inequality movement and this event today provide us
with an important opportunity to pause and reflect
on how slavery and racism have impacted
African American communities. And not simply from a
historical perspective, but also because those impacts
are still being felt today. As one classic example,
infant mortality. In the United States
infant mortality rates for African Americans are
more than twice what they are for other ethnic
and racial groups, except for Native Americans. This gap is not new. In fact, it’s persisted
for more than 100 years, effectively since good sound
record keeping were available. Long after slavery ended,
law and policy continued to be crafted and
implemented in ways that restricted African
Americans from accessing public
health services, stable and safe housing
and basic social services. In the public health systems
that are supposed to support and protect all of us have not
always done so for all of us. I’ve spoken a couple
of times to our School of Public Health
community about my mentor, the late Dr. Bill Jenkins. Dr. Jenkins was an
epidemiologist and a biostatistician,
who dedicated his career to recruiting students of color
into public health professions. When I was an undergrad, it was
a conversation with Dr. Jenkins that opened my eyes to the
field of biostatistics. And later, inspired me
to pursue public health. The reasons why Dr. Jenkins
was so dedicated to mentoring and fostering students
like myself where for one, by the time he received
his doctorate in public health there were only
three other African Americans in the country that
held that credential. But secondly, because of
an experience that he had that deeply impacted
him early in his career. Working as a young statistician at the United States Public
Health Service in the 1960’s, Bill learned about
the Tuskegee study. During which, as
many of you know, the government studied the
unabated progression of syphilis in black men without
their consent. Participants were told
they had bad blood. They were not told
that they had syphilis. Participants were
not given medication, even though medication
was readily available. I know that one of our
panelists, Dr. Howell, will be talking more, in more
detail about this in just a bit. But after learning
about the study, Bill, going back to my mentor, wrote
to several reporters to try to expose this injustice. But the story was not
picked up by the media. Eventually, a colleague, another
health service epidemiologist was able to work with
the Associated Press to expose the study. And then, later, it was halted. But only after 40
years of being active. After the study was made
public, Bill fought to ensure that the participants
and their families, which were also directly
impacted, received the medical
attention that they deserved. And he went on to then dedicate
himself to reducing disease and illness and health
inequalities among African Americans and people of color, in part by being a
dedicated mentor. I should also say that he was
one of those who advocated and ultimately got an apology
from the Federal Government, by then President Bill Clinton. As you’ll hear from our
panelists today, there continues to be deep disparities in
our country when it comes to the health in African
American community. And if we’re going to
move forward to address and rectify the situation,
we must reflect and understand the past and
vigorously address root causes. So, I thank you all
for being here, a part of this important
conversation. I’m glad we can be a
host for convening here in the School of Public Health. I’d like to thank Nicole, the
school wide DEI committee, the department DEI committees
for your work and partnership in pulling this event together. And I’d also like to thank
the panelists for joining us. Now, I’d like to
call up, Deb Watkins, Research Assistant Professor in
Environmental Health Sciences, who will introduce the panel. [ Applause ]>>Thank you, Dean Bowman. I’m thrilled to introduce our
panelists for today’s event. And we are super excited
that they could be here with us today to
share their work. First, we have Joel Howell, a
professor here at the School of Public Health in Health
Management and Policy. He’s also a professor
of Internal Medicine at the Medical School. And a professor of
History at LSA. Dr. Howell has researched
the history of medical experimentation
on black individuals. As you heard, he’s written
about the Tuskegee study, as well as J. Marion Sims, who
experimented on enslaved women. Next, we have Eboni
Taylor, Deputy Director of Mothering Justice,
which is a black women led, nonprofit organization here in
Michigan that empowers mothers of color to advocate
and influence policy. Mothering Justine engages
mothers and policy makers around a number of issues,
including paid sick time for all workers,
affordable childcare, infant and maternal mortality,
maternal incarceration. Finally, we have Holly Hartman. Holly is a doctoral student
here in School of Public Health in the Biostatistics Department. Holly co-led a study that examined why prostate
cancer mortality is higher among black men. Her thesis work is on
designing clinical trials to more effectively represent
how clinicians prescribe medication for rare diseases. So, thank you all for
being with us here today. To begin, each of our panelists
will give a short presentation to introduce their work and highlight how historical
inequalities have created health disparities in their
respective disciplines. After that, we will have
a moderated discussion with some time at the end for
questions for the audience. So, I know, for those
here in the room, you received a notecard
and pen when you walked in. As you listen to our panelist’s
presentations, please write down any questions
that come to mind about their research
and our topic today. For those of you watching
through our live stream, we want to hear from you too. Please submit your questions
to [email protected] And we will collect
the notecards and the emailed questions
right before our moderated discussion begins. So, we will try to get
through as many as we can. So, now, we will begin
with the presentations. And we will begin
with Dr. Howell. [ Applause ]>>Okay. Let’s see if
we can get this working. I am not seeing my presentation. This man was a subject in
the experiments done in and around Tuskegee,
Alabama, from 1932 to 1972. I wish I could tell
you his name, tell you something about him. Unfortunately, I cannot. I do know that he was
a descendant of one of the many African
Americans who were enslaved in the U.S. South
before the Civil War. This is a rather brutal
and unsettling picture. But it’s meant to
emphasize the roll that the medical
profession played in the institution of slavery. They played a critical roll in
the economics of the system, as you see here in
assessing the monetary value of a human being,
an enslaved person. As many of you know,
the importation of slaves was cutoff in 1808. But the south’s cotton-based
economy continued to expand. Plantation owners needed
more enslaved people to work the fields, thus
the increased importance of childbearing. With pressure for people to have
children, often far too young, which led to terrible
complications of childbearing, such as vesicovaginal fistula. Vesicovaginal fistula is a hole between the vagina
and the rectum. The horrible consequences of
this lesion that is caused by prolonged childbirth,
prolonged laboring, particularly in young women, is
described here by a physician, J. Marion Sims. Now, because it affected women
and affected their ability to have children, it was a
considerable economic importance to slave owners. And J. Marion Sims set
out to find a cure. This is the hospital in
which he experimented on women from 1846 to 1849. Thirty women were
kept in this hospital. I wish I could tell you their
names or something about them. We have three names only. Lucy, Betsy and Anarcha. They were operating on over
and over and over again. Some of them as many
as 30 times. Obviously, without anesthesia. Obviously, without antisepsis. And most obviously,
without consent. This is the paper that Sims
wrote describing the cure that he discovered. He moved north and he
opened the first hospital for women in the United States. Despite the sorted nature
of these experiments, J. Marion Sims went
onto a career of great fame and fortune. He was the president of
many important institutions, including the American
Medical Association. He was hailed and still
is hailed in some circles, as the father of gynecology. And he was the first
physician in the United States to have a statue
erected in his honor. This statue was on the Upper
East Side of New York City. We’re going to come back to it. The Civil War brought
the end of slavery. But it did not bring
the end of racism or of racialized experiments,
as Dean Bowman eluded to in his introductory remarks. We’re going to move, stay in
South Alabama, and go not far from where Sims did his research to the small town of
Tuskegee, Alabama. Tuskegee in 1932
was still dominated by the cotton industry. And by sharecropping. And it was in that setting
that the Public Health Service, the Public Health
Service setup a study to determine the natural
history of untreated syphilis in 400 African American men. They wanted to study what
happened to them during life. And then, to study autopsy
findings that resulted. In the years that follow, Public
Health Service physicians came down to examine the
men on a regular basis. They drew blood,
as you see here. And also, did lumbar punctures. Despite the fact that as members
of the Public Health Service, they were the people charged
with preserving the health of the people in this country. They lied to the men. And they prevented them from getting what treatment
existed in the 1930’s. The therapeutic landscape
changed dramatically with the advent of the widespread
availability of penicillin. And you might have
thought that ready access to an effective cure would have
led the Public Health Service to stop the experiment
and treat the men. No. The experiment went on. What about ethics codes? After the Second World War,
highly publicized trials of leading German doctors for
atrocities in the holocaust led to ethics codes, such
as the Nuremberg Code, which states [inaudible],
the voluntary consent of the human subject is
absolutely essential. These ethics codes were written
by people in the United States. But seemed not to apply to the Tuskegee experiments,
which went on apace. You may be thinking, surely these experiments would
have ended whenever anybody knew what was going on. Well, look at this paper. The title, Untreated
Syphilis in the Male Negro. Hardly obscure or
hard to understand. Where was it presented? The annual meeting of the
American Medical Association. You can’t think of a
much higher profile place to present the results. And look at the authors. All senior Public
Health officials. No, my friends, this
experiment was never a secret. The results were published
in major medical journals that went all around the
United States to libraries and physicians, such
as this one. Again, the Study of
Untreated Syphilis, in which they discovered
that the effects of not treating a treatable
disease previously thought to be a decrease in life
expectancy of 17 percent, were actually more
like a decrease in life expectancy
of 20 percent. That’s what these men were
proving with their lives. The Civil Rights
Movement, not something that one slept through. Here’s Dr. Martin
Luther King Junior in Washington D.C.
You would’ve thought with the Civil Rights
Movement, with everybody knowing about the experiments
that somebody in the Public Health Service,
somebody would’ve said, well what’s going
on down in Alabama? We ought to do something
about this. It didn’t stop then. The experiments finally
ended in 1972. Again, Dean Bowman
mentioned this. When the Associated Press
finally picked up the story. This is one of many cartoons
and editorial comments that appeared at the time. The Public Health Service
in their report agreed that the men had been lied to. But insisted with
a straight face that there was absolutely
nothing racial about the experiments. Yes, that’s the proper reaction. President Clinton
in 1997 apologized in strikingly strong language. And for a President of the
United States, he said, and I quote, what the
United States Government did was shameful. And I am sorry. Most of the men at that point
were either dead or too ill to come up to Washington
D.C. One was not. Herman Shaw depicted in
this picture, made the trip up to D.C. and heard
the apology. What are the implications
for today? Mistrust to the healthcare
system is a big one. This is a poll done by
the New York Times showing that about a third of black
Americans think it’s true or possibly true that AIDS
was deliberately created in a laboratory to
infect black people. I don’t think that’s true. But I think if you know
what happened at Tuskegee, it’s not hard to see how
somebody would believe that that could be true. Here’s another bit of
research in the National Bureau of Economic Research, estimating that after the experiments
were widely publicized in 1972, African American men were less
likely to seek medical care, presumably due to a distrust
of the healthcare system. They estimated a 1.4-year
decrease in life expectancy. That’s about a third of the black/white
discrepancy at that point. Today, the Sims statue
has been moved away from it’s position
on Central Park. There is an Institute for Ethics
at the Tuskegee Institute. We now have a national
system of IRB’s that came out of the Tuskegee experiments. But as denoted historian,
Vanessa Gamble, asks, what’s Tuskegee got
to do with it? The problems have not gone away. We need to see Sims and
Tuskegee not as the cause, but as symptoms of the
underlying problem. We need to learn
from what happened from the gentlemen whose picture
was up there a second ago and many others, as we attempt
to combat structural racism in today’s healthcare system. Thank you. [ Applause ]>>It is so great
to be back here at the University of Michigan. I went here as an undergrad. And I’m also an alum
of the Ford School. And so, it’s really great
to be back here and to talk about this very important topic. So, thank you for having me. Okay. Let’s see how this goes. The 20 seconds per slide. Okay. On the left-hand
side, on the left-hand side, are a child’s iron shackles. On the right-hand side is
an iron ballast block used to counterbalance the
weight of enslaved Africans. This is a Virginia Law in
1662 stating that the race of the child followed
the race of the mother. Meaning, enslaved black women
gave birth to generations of children of African descent
who are now seen as commodities. We cannot talk about
black maternal health without discussing capitalism,
patriarchy, and white supremacy. Capitalism started with slavery. Right before the Civil War, the Mississippi Valley had
more millionaires per capita than anywhere else in the
U.S. Cotton grown and picked by slaves was the nations
most valuable export. White supremacy coupled
with white ownership of black bodies is one of
the basis in the struggle for black maternal
health and motherhood. Today, it includes
daily resistance against antiblack racism,
violence and institutional and systemic barriers
to basic needs. Patriarchy. The patriarchy was very
present in the relationship between male slaveholders
and enslaved women. Most evidently in the
rape of black women and forced gynecological
experimentation, which we heard some of already. We see patriarchal attacks today with male legislatures
governing black female bodies and all female bodies
around reproductive health. When Congress ended
participation in the international
slave trade, the only way of increasing slave labor
was through new births. If enslaved mothers did not bear
sufficient numbers of children to sell, trade and take the
place of aged and dying workers, the south could not
continue as a slave society. The expectation increased among
members of the owning class. That is, enslaved
women would contribute to the economic success
of the plantation. Not only through
productive labor, but also through procreation. This had impacts on the way
owners thought about the future of slavery and the way
doctors practiced medicine. Wet nursing was the
exploitation of enslaved women at the intersection of
labor and reproduction. Enforced wet nursing
was a distinct aspect of enslaved women’s
commodification. White women used this as a tool
to manipulate black motherhood for a slave holders benefit. In the book, Killing the
Black Body, Race Reproduction and the Meaning of Liberty,
the author explains punishment for black pregnant slaves,
which included them lying face down with their pregnancy
bellies inside of a hole and being whipped. For black women, not even
childbearing could serve as a reprieve from
physical punishment. In the United States, black
pregnant women are three to four times more
likely to die from labor and delivery complications
compared to their white counterparts. These numbers are not
too far off from the rate that black mothers
died during slavery, which is obviously very telling
that we’re today, in 2019, not too far from these numbers. Excuse me. The involvement of doctors with enslaved women’s
reproductive health represented an expansion of the
slaveholders domain. Black women struggled to
assert their own customs. Rather than acquiescing,
black women attempted to regulate birth to a core
with their own notions of timing and frequency of motherhood, which was essentially
the only power, if you want to call that power. It was the only power
that they had. According to a ProPublica
and NPR survey of over 200 black mothers,
the feeling of being devalued and disrespected by medical
providers was a constant theme. Over and over black women shared that medical providers
equated being African American with poor, uneducated,
noncompliant and unworthy. But we obviously
are very worthy. Mothering Justice
through our focus groups on black maternal health
experiences found that more than 50 percent of
participants felt ignored and invisible during prenatal
care leading up to the, leading up to delivery
and postpartum. Which is consistent
with numerous studies that show pain is often
undertreated in black patients. In September 2017,
professional tennis player, Serena Williams’ maternal
health crisis demonstrated that black women’s reproductive
health can be jeopardized, suspect, dismissed
and at risk of demise, even for the very talented,
wealthy and well known. So, we can only imagine
how it is for an average black
woman expecting. Only recently has the news
media given greater attention to the U.S. maternal health
crisis, spurring awareness and actions by lawmakers
and health professionals. In 2017, ProPublica and
NPR launched Lost Mothers. And thereafter, coverage
from New York Times, CNN, and other major outlets emerged. Black Mommas Matter Alliance is
a black woman led cross sectoral alliance that centers
black mommas to advocate, drive research, build
power and shift culture for black maternal
health rights and justice. BMMA envisions a world where
black mommas have the rights, respects and resource, respect
and resources to thrive before, during and after pregnancy. One of the most fundamental
problems underlying the maternal mortality crisis in the U.S. is
the shortage of reliable data around what kills
American mothers. So, in 2017, the House approved
H.R. 1318 Preventing Maternal Deaths Act. And in 2018, Senator Harrison
Booker took it a step further with bills around disparities. In April of 2019,
Congresswoman Underwood and Adams launched the
Black Maternal Health Caucus to improve black
maternal health outcomes. The Black Maternal
Health Caucus wants to establish black maternal
health as a national priority and explore and advocate for effective evidence-based
solutions for black mothers. And Mothering Justice, our
Mommas agenda includes black, includes issues that black
mothers want solutions around. Including the prioritization
of black maternal health. One of the solutions
that our Mommas want to see is an increase
in state funding for home visiting
nursing programs. The history of violence and
neglect, criminalization, housing and environmental
security, the daily stress of racism, which I’m
sure you’ve all heard of as being called weathering,
and the long time devaluation of black motherhood in American
society are all but a few of the causes that
have brought us here. And I believe changes
in Washington D.C., hence the picture, can help
set the pace for recovery. And if I can just say, lastly, I would to acknowledge
previously unstated data and excerpts from the Center
for American Progress, New York Times, Self Magazine,
PBS, and Birthing a Slave, Motherhood and Medicine
in the Antebellum South. Thank you very much. [ Applause ]>>There are racial inequalities
in almost all types of cancer, where black people have worse
outcomes than white people. Prostate cancer is one
such type of cancer, where there’s an
extreme difference in prostate cancer mortality
between black men and white men. At the population level, black men have an estimated
30 percent increased hazard of dying of their prostate
cancer than of white men. This is an area with
ongoing research. In order to address this
disparity in prostate cancer, we must first answer why
there is an inequality, so that we can address
the root problem. Is this due to socioeconomic
status? Is this due to unconscious
or conscious racism in the healthcare field? Is it due to biological
differences in the tumor types? Racial inequalities can be a
difficult subject to study. Both in the context of
understanding the nuances of this very delicate topic,
but also statistically. We have to rely on
observational data. And observational data has
a lot of confounders in it. But what exactly
are confounders? We’re going to talk
through an example. Let’s say that we want
to know the difference between surgery and radiation. And we want to know which
one is a better treatment. However, mostly healthier
people receive surgery because it’s a very
physically stressful event. And doctors don’t
want to take the risk with less healthy patients. Then, this induces bias. Surgery might look like
it does better just because the patients receiving that treatment are
already healthier to start. If we don’t account for
this, then we might come to the wrong conclusion. The same could be
true with race. White men might have
better access to care, have, be more likely to be insured or even have general better
health before being diagnosed with prostate cancer. And all of those
things could lead to the better outcomes
that white men have. If we don’t account for these
differences, then we might come to the wrong conclusion. And then spend time and
resources addressing that wrong conclusion. Fortunately, there are
statistical methods that we can use that
help adjust for this. One common method that’s used in observational data is
called propensity weighting, where the covariates, like
insurance status or the stage of the disease, are
balanced between two groups by weighting people in the
study differently based on their own covariates. The end result is two groups
that should be comparable. So, if in our original dataset
black men have more severe disease than white men, after
the weighting the severity of the disease should
be equivalent, and we should be able to get an
unbiased estimate of the effect of race on prostate
cancer mortality. However, this propensity
weighting method does come with assumptions and I’ll talk about those a little
bit later as well. So, we used this
propensity weighting method in a large national population
cancer registry database called SEER. We were able to adjust for
variables like the stage of the disease and the
severity of the disease, as well as some socioeconomic
variables. We found that black men have
worse outcomes than white men in prostate cancer and are more
likely to die of their disease, even after adjusting
for all these variables. Other researchers
have also taken a look at this prostate cancer
mortality difference in observational datasets. And have come to the conclusion
that this difference is driven by a biological difference
in the tumors. Not necessarily anything
related to socioeconomic status or treatments received
or access to care. This is an area. There’s research
happening right now to try to understand what those
biological differences might be. Epidemiologists,
cancer biologists and clinicians are all trying
to understand what this, why there is this difference
in prostate cancer mortality, under the assumption
that it is not based in socioeconomic status,
but a biological difference. There is time, money
and resources being, trying to identify this
biological mechanism that’s driving cancer mortality. However, one of the
really big assumptions in propensity weighting
and many other methods for observational data is that there’s no unmeasured
confounders. This means that anything
that’s related to race and might be different between
black men and white men, that’s also related to
prostate cancer outcomes, has been measured and accurately and correctly included
in the model. But this is absolutely
not realistic. There are some things that
we just can’t measure. Like distrust of medical
professionals or chronic stress from unstable housing. Additionally, these observational datasets
quite simply don’t have a lot of data about the patients. Most don’t include
comorbidities or other diseases that the patient’s have. To address this, myself
and my collaborators at the University Hospital took
a slightly different approach to this problem. We looked at data from a
randomized clinical trial. The randomized trials that we
used enrolled approximately 20 percent black men. And enrolling black patients in
clinical trials actually isn’t as common as you might
hope it would be. But that’s a whole other issue. While the patients in these
trials received different treatments, we, they all
had equal access to care and received equal quality
care while in the study. Randomized trials also
have very strict inclusion and exclusion criteria. So, all the men in these
studies are fairly similar to start with. We were able to adjust for
the cancer severity, age, stage of the disease
and the treatments that they received using that same propensity
weighting method. We found no difference in prostate cancer
specific mortality between black men and white men. If this was a biological
difference, we would expect to see black men having
worse outcomes even in this very controlled setting
because we didn’t account for any underlying biology. We then, also, looked at
some data from the VA. Within the VA dataset
theoretically all men should have equal access to care, although they might not receive
the same care once they’re in the system. Additionally, the VA population
is much more heterogenous than the randomized
control trial because there’s no inclusion
or exclusion criteria here. We found the same thing. Black men and white
men had no difference in prostate cancer
specific mortality. So, what does this mean? This data strongly suggests that there is not a
biological mechanism that is driving this increased
prostate cancer mortality among black men. This. If there was a
biological mechanism, then we would expect black
men to have worse outcomes in the VA dataset and in
the randomized controlled trial dataset. But that’s not what we saw. This research highlights
how important it is to really understand
the assumptions of the methods that we’re using. Especially when we’re
looking at racial differences. The critical point
here is that some of these methods
have assumptions that we just cannot meet, no matter how dedicated
the researcher is or how clean the data might be. Unfortunately, we just
can’t measure some things. And we have to use methods
that account for this. This has resulted
in research focusing on a potentially incorrect
solution to the problem. The research being
done that’s focusing on identifying the biological
difference between black men and white men’s prostate cancer
that’s driving an increase in mortality might not
actually be necessary if the true underlying cause
is socioeconomic status or institutional racism. The time we spend chasing the
wrong solution can be deadly. This research suggests that
the problem that’s causing this increased mortality among
black men is actually systemic. The difference in outcomes
is related to access to care, socioeconomic status, and
other immeasurable factors. This means that we
have a lot of work to do addressing institutional
racism in healthcare. In the time that we. The longer we wait to
spend addressing this, the more black men will die
of their prostate cancer. Thank you. [ Applause ]>>Alright. Thank you all for three really
informative presentations. If any of you have questions,
please hold up your notecard and someone will come around
to collect it from you. And for those, again,
watching live, you can submit questions
digitally by emailing
[email protected] Okay. So, now, I would like
to introduce our moderator, Dr. Truman Hudson, Jr. Dr.
Hudson is a social economist, who has 29 years of experience
in developing, implementing, researching and evaluating
educational and community economic
development projects. He has a focus on
investigating systems that influence black
men’s health. He serves as the
contract manager and health link specialist
for a project at Wayne State University and
the Karmanos Cancer Institute that seeks to better
engage black men in patient centered outcomes
research related to cancer. He has served as a
lecturer at the University of Michigan-Dearborn,
Wayne State University, Central Michigan
University, Madonna University and the Wayne County
Community College District. Dr. Hudson, I’ll
turn it over to you. [ Applause ]>>Good afternoon everybody. [Multiple speakers]. Good afternoon. [Multiple speakers]. As stated, this subject is near
and dear to my heart in a lot of ways because I’m a black man. But also, in the 1990’s I saw
a lot of my fraternity brothers and black men dying
at high rates because of prostate cancer. And what I do recall is there
were screening protocols put into place at one time. And now, the screening
protocols have been removed. So, no longer are we
looking at trying to monitor and determine how we
get ahead of the game. Holly, question. When we look at engaging black
men in research, as leaders and partners around
cancer research. What do you think are some
of the best strategies to help address issues
around screening protocols that your physicians
say that you don’t need? But when you go as a black
man and you say, hey doc, I need to be checked because
my father had prostate cancer, my grandfather had
prostate cancer. And I think there’s
something there.>>Yeah. So, the
screening protocols of prostate cancer are pretty
interesting how they’ve changed over time. There’s actually some
research happening right now at the University of
Michigan Hospital regarding who exactly should be screened
and what the protocol should be. Because right now, older men
aren’t screened even though they have more severe
prostate cancer. So, I think what’s important when we’re visiting
screening protocols is to really examine the
data that we’re using. I mean, as I showed
in the presentation, is that observational data,
there’s a lot of things that we can’t adjust for. So, using some sort of randomized trial is
really important when looking at screening protocols. And then, in addition to that, making sure that the randomized
trials actually include and actively recruit a diverse
population, including black men. So, I think that it’s really
important to look at the data that we’re using
and the population that we’re looking at. Thank you.>>Joel, I have a
question for you. Your reference to
the structural racism and how structural racism kind of influences healthcare
decisions, as well as the delivery
of service. What are some strategies that
we can take as individuals in this room to address
structural racism? Because I think Eboni reference
to the government is one, one vehicle that we can use
to address structural racism. But what are. Based on your professional
experience, what can we do?>>Well, people in this
room are all part of the, an educational system
at one level or another. And I think that what we could
do is make sure that as part of our education for
everybody that comes through, we appreciate not
only the implications of structural racism,
but it’s causes. And you identified yourself,
you’re an African American man. I’m a white man. And as such, throughout
my career. I mean, I’ve been a
white man my entire life.>>You have?>>Yeah [laughter]. Ever since I was born. [Laughter]. You know, I’d like to think
that what I’ve accomplished, I’ve accomplished on the basis
of hard work and being smart. And being lucky. But I’ve also had
advantages all along the way. I grew up in a small town
in Columbus, Mississippi. Anybody ever heard of
Columbus, Mississippi? Yeah. So, it’s 12,000
people, northeast Mississippi. It’s the site where de
Sota crossed the Tombigbee. Now, you know pretty much. And Eudora Welty was born. There’s not a whole lot
to know about Columbus. But, you know, in the 1960’s that was certainly a poster
child for white privilege and aggressive racism. And it’s always, it’s
always stuck with me. And I was fortunate
enough to have parents who made me aware of that. And so, I think being,
being for all of us, being aware is terribly
important. Black people, white people,
brown people, anybody.>>And I would just add onto. I would just add onto
that and say that yes, it is super important for the
burden to not just be on people of color to have the conv, have conversations
around these issues. At Mothering Justice, we have a
fellowship program called White Women’s School. And we. And we. It’s a nine-month program. It’s actually an
international fellowship. We have women from
Australia, Canada, across the United States. And it’s all about teaching, talking about these
historical impacts that land us where we are today. We talk about how white women
and white people can show up around these issues
in true allyship. So, I mean, when we talk
about solutions, it can’t, the burden can’t just be in the
ownness, can’t just be on us to bear that conversation.>>Cool. So, while we’re talking
about bearing the conversation around inequities,
mortality rate, Eboni. When we look at infant mortality
in the black community, you brought out some
alarming statistics. As Public Health
professionals, training to get into the Public Health
profession, what advice would you give
to our young scholars here? What can they do to help
address the mortality issues around publication, around dissemination,
as well as practice?>>I would say, and I think, I think you meant
maternal mortality. Yeah, maternal mortality. So, I would say to get into
as many diversity classes as possible. We have, Mother and Justice
has actually engaged, actually U of M reached
out to us. U of M, U of M’s OB
department reached out to us to see how they can better
teach medical students around implicit bias and have. What do you call the
classes that are outside of your requirement classes?>>Electives.>>Electives, right. It’s been a while. It’s been a while. I said that. I said that. So, so, yeah, just getting into
as many classes as you can. Making sure that
your data is diverse. There’s an organization
called Data for Black Lives. And their whole thing is
like around, you know, not using the same traditional
methodologies to acquire data. So, I think, like,
bear a variety of data. Making sure that it’s, that
it’s, that it’s not biased. And taking classes
that will just, I think we all are impacted. We have our biases, right? So, how do you take your, how do you take individual
responsibility to, to, to get rid of those? Or at least to reduce them.>>Yeah, and I would also add, thinking about the structure
of structural racism. And the fact that healthcare
is only part of the solution. This is a conversation
I had this morning over in the hospital. If you really want
to make a difference, one of the things
we need to do is to improve the economic
conditions.>>Hm, yes.>>And reduce income
disparities, which is a big part of the, of the health problem. And I guess one piece of advice
I would give is for people to be politically active
and politically engaged in whatever way you think
is most likely to result in an improvement in
reductions in income disparity and reductions of poverty. And that’s going to have
a huge healthcare impact.>>So, if we, if we bit off the
conversation around politics and politically correct. We have a question from
the audience in regards to, please define black, as
compared to descendants of enslaved Africans, as well
as U.S. African born citizens, international are born blacks. So, who has something on that? Because I think that’s important
because language is changing. We’re at a space now where
we’re using our preferred gender pronoun. So, as an academician, I know I’m constantly
adjusting to language. But I think when Dean
and I went to school, we were African American,
Afro-American negro colored. Language changes. So, can we talk about
the difference? [Inaudible]. So, please define
black in comparison to, and compare to descendants
of enslaved Africans. And then it says, U.S.
African born black. Yes. [Inaudible]. No, come. [ Inaudible ]>>Right. So, in the data
that I was talking about, all the participants
were self-identified. So, it was just a little
survey that they filled out and it identified their race. And we only included people
that self-identified as black, which does include, you know, people who might be from,
actually from Africa. And it might also include
some black Hispanic people. But we also, for the Population
Registry Database, we limited it to black, non-Hispanic. There is some research that
has been done about some of the differences between
African Americans or Africans who then come to America. And it’s interesting because
it very quickly becomes very similar unfortunately. There’s a lot of the just stress
in this environment for people who are black, regardless
of where they were born. And so, it becomes very
similar very quickly. But we didn’t look
at that specifically in this research topic. But that would be an
interesting expansion as well. Thank you.>>Anybody else want
to talk about that? Okay.>>But I think it’s still
important to still pick up. Because even in reading the
card and hearing the question, the card and the
question aren’t connected. How do we define black when
it comes to this research? [ Laughter ]>>As a historian, and
I’m looking historically, I mean one of the big messages
is, I mean this isn’t hot news to anybody in this
room, is that race is to a large extent
a social construct. And so, for the people
that I’m looking at, I’m looking at people
that are discriminated against because they’re
looked at and seen as black. And the. And I don’t think that discrimination
generally differentiates between where they
came from or, you know, what their actual
genetic roots are.>>I. That’s a super
loaded question. I really don’t. I don’t have a silver
bullet answer to that. I would just echo what my
fellow panelists have said, in that, you know, we’re. The weathering issue. I kind of touched on
it in my presentation. And I believe a professor
here at the School of Public Health coined it. But the chronic stress that
people of color, black people in particularly experience, I
don’t know that it differs much by whether, you know, I’m
a descendent of a slave that was brought here 400
years ago, or if I came here and was born in, I
don’t know, Jamaica. And I came. Or in an African
country and came here as a child or as a teenager. I think that, you know, there’s
that experience of just being in America and experiencing
chronic racism. And barriers to just living,
just living your life. So. [ Inaudible ]>>Alright. This question is near and
dear to some research. Yes? [ Inaudible ] Alright. Yes, ma’am. [ Inaudible ] I appreciate your
perspective on asset. Yeah. But I appreciate
your perspective on asset framing the discussion. Because in our current research
study that we’re looking at how to engage black men in cancer
research, which is a question that someone else posed. Black men are already engaged. It’s just how do we
define engagement. And how do we define
this question again. How do we define black? Because there are people that define themselves
quite differently. And what we found is
on a national level, there’s an organization
called [inaudible] Community, where they had 180 black
men across the country who were addressing
issues from public health, social determinate
[inaudible] health, as well as economic development. And they were making
major impacts and strides. And they were not being
lifted up in a lot of the formal research
and published studies. So, we only have
one-minute left. Because we’re closing up. And I see she’s giving
me the look. [ Inaudible ] Questions from the audience. Are there any other questions? Yes. [ Inaudible ]>>Hi, come forward. [ Inaudible ] [ Laughter ]>>Another loaded. So, I would love to see that. I would honestly be
shocked to see that. Let me start there. Because just as I mentioned,
before starting my presentation, I was here as an undergraduate
student and as a grad student. And even trying to repair and
fix the current situation, like the lack of diversity
at Michigan, like currently, present day, and their. I guess they would
call them efforts. But so, I don’t. I’m just. I would be shocked and
very surprised if they started to evaluate and look
back and think through how this university
has been impacted economically and otherwise by slave
labor or any, in any way by, like I said, slave labor. And so, I don’t know. I don’t know. [Laughter]. I’d be happy to see it.>>I would be shocked if a serious investigation
historical study didn’t find ways in which it was impacted. Since it’s, again, it’s not
an experience that was limited to the American South. It’s modulated differently
in different places. And one of the lessons of
history is that things change. And so, looking back, we can
appreciate where we were. We’re going to be different
10 years or 20 years. Guarantee it. I don’t know exactly how. And I think there is a
liberating feature in looking at the past and realizing
that things were different in the past, which means that things can be very
different in the future. And it gives us hope that
we can get somewhere.>>I was meaning like just for
clarity that I will be shocked if they started that process. Not. Okay. Okay.>>I understand. I’m [inaudible]. Alright. I’m just saying
obviously it would be extremely shocking to find that
there was somehow a bubble around Ann Arbor that all
of the pernicious issues that affected the rest of the
world somehow didn’t come in. That would be surprising.>>Yeah, I’m going to
agree with all my other, all the other panelists up here. I mean, I think that would
be a really amazing project and undertaking for the
University to start. I mean, I think even just
starting small and looking at the history of the School
of Public Health or, you know, even department wise would
be really interesting. And I think it would also help
inform like future movements that we should do,
future efforts that we should put forth. So, I think it would
be really interesting. I haven’t seen anything
like that happening. But I’m also, I’m
a student here. So, I don’t see everything
that’s happening at a higher level. But I haven’t seen
anything like that.>>Wow, that was a good
setup for the next question because it’s about
engaging community. And it reads, the recently, the Center for American
Progression called the, called for midwives,
as the solution to black maternal mortality. What are your thoughts
about that? And what school based
interdisciplinary projects do you think could happen
in the school setting? So, how do we leverage schools
to help move this conversation?>>Yeah. So. So, as I mentioned, and I will
give, you know, U of MD a reach out to Mothering Justice to see
how they can better prepare, you know, students to deal with,
you know, different communities, particularly black communities. And so, I think, you know,
actually being proactive in reaching out to organizations
that are doing the work to help inform, to help
inform their students, to help inform their policies. I would love to see like the U
of M, U of M’s Medical School to say, you know what, it’s
going to be a requirement for students to take
classes on bias training or take some sort
of bias training. It’s going to be a requirement
to, you know, have a class around the historical
context of black women during, during, goodness gracious. Black women’s experience
childbearing, childbearing experiences. I think that our colleges and universities can
be doing so much more. And not only has U of
M reached out to us, but we’ve also reached out to
other universities, as well. Wayne State being one of them. Since we are centered. Since we are in Detroit
specifically, just to see how we can
continue the conversation and continue engaging, you
know, our future leaders and our future medical
providers and care providers. So.>>Just as a brief
point of information. In fact, in the Medical School, all the medical,
this isn’t nirvana. It doesn’t make things perfect. But we have a session for
all the medical students. It’s required to talk about
the Tuskegee experiments, where we spend an hour
talking and presenting. And another hour in small
groups unpacking some of the many issues. And there are many, many
issues we didn’t have time to get into today. So, there is something,
even if there is not enough.>>Yeah, I think that’s good. Yeah.>>And the fact that
they reached out to you, I think is tremendous.>>Yeah, yeah, it’s a start.>>I would like to thank Dr.
Hudson, Dr. Howell, Ms. Hartman, Ms. Taylor for coming
out with us today. Let’s give everybody a hand. Appreciate the conversation. [ Applause ] And this is just a
beginning of the conversation. And it’s nice to engage around, around our different
thoughts and. And so, as we uncover
and we try to find ways to become more diverse, equity,
inclusive here at the University of Michigan at the
School of Public Health, each time we unturn,
overturn one rock, it’ll be another
[inaudible] to work on. Because this is evolving. And as we are evolving and our
learning is evolving, you know, it’s important for us to
give each other this space around the conversation, around
where we may have differences, and have that opportunity to
have the conversation about it. So, I thank you for taking the
time to come out with us today and have this conversation. And, and as Dean Bowman said
earlier, this is just one event of many that we have scheduled
for around our school. And it’s essential that
we continue to talk about diversity,
equity and inclusion. And in fact, this
semester, our Diversity, Equity and Inclusion committees
have put together a series of workshops around a power
of the inclusive community. And the power of that is
also understanding our historical impacts. Each of us have a history. Each of us have a
background that we bring through these doors each day. And how do we take that as
public health professionals, faculty members and staff
members to help fuel us and propel us to create a
healthier, more inclusive world? We hope that including
the semester theme, we’re able to have a deeper,
more sustained conversation that span many months. We encourage you to take
what you learned today and continue the conversation
within our, within our school, within your departments,
outside of our school. Because what we learned
today is that it takes each and every one, it takes
each of us to be a part of how we treat each other. And also, looking at these
systems of inequality. Talk to your friends and family
about what you learned today. Continue engaging with
others around the topic of healthcare disparities. And it can be uncomfortable
at times. These conversations
are uncomfortable. But that’s how we grow. And we need to make space
for each other to grow. And it’s important that we
always and we continue to talk about diversity,
equity and inclusion. It is important that, just
echo it one more time, that we hear each other. Because sometimes these
conversations can be a little isolating. But let’s share the conversation
and build from each other. I encourage you to attend one of DEI events throughout
the school. One we have coming up
is on November 15th. It’s called One Workplace,
Many Experiences. In this workshop, participants
will explore how individual coworkers can experience
the same workplace in a widely varied ways. We will specifically explore how
workplace power differentials and privilege associated with social identities
come into play. I hope to see you there. I want to thank the
members of our schoolwide and our departmental
wide DEI committee. If any are here. I don’t see many. But if any of you are here,
can you just raise your hand? Or previous members. And I just want to thank them
for coming up with this idea, helping us in the Marketing and
Communications Committee think through the idea and
the planning for today. And if you’re interested
in getting more involved, please connect to one of
your DEI committee members within your department. And finally, I just want to
thank you for attending today in person and on the stream. You could’ve been
anywhere else today. But you chose to have
this conversation with us. And we sincerely appreciate it. And I invite you to join us
in the Community Room if you like for a refreshment. Thank you. [ Applause ]

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