Conversations with Health Law Leaders: Political Determinants of Health

David S. Cade, Executive Vice President and CEO of AHLA, sat down with three prominent health law leaders on May 25, 2021 to discuss how we, as a community, can improve equity in health care and health law practice. In this episode, Daniel E. Dawes, J.D., Director of the Satcher Health Leadership Institute at Morehouse School of Medicine, speaks to the political determinants of health. Dawes is a widely respected lawyer, author, scholar, educator, and leader in the health equity, health reform, and mental health movements.

Watch the full conversation here. Access full video and audio recordings of the proceedings at americanhealthlaw.org/racialdisparitiesinhealthcare. 

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Transcript

Speaker 1: 0:14

On May 25th, 2021, David Cade, executive Vice President and CEO of a H L A, interviewed three prominent health law leaders about how we as a community can improve equity in healthcare and health law practice. This three part series presents each recorded interview, full video and audio of the proceedings are available@americanhealthlaw.org slash racial disparities in healthcare.

Speaker 2: 0:41

Well, first off, welcome Daniel. Uh, take a moment just to give us your name and title. Sure.

Speaker 3: 0:47

I'm Daniel Dos, I'm the Executive Director of the Satra Health Leadership Institute at Morehouse School of Medicine.

Speaker 2: 0:53

That's great. That's fantastic. And tell Dr. Satra I say hi.

Speaker 3: 0:57

I sure will.

Speaker 2: 0:59

You did a podcast, um, a webinar, I think, for us mm-hmm.<affirmative>, and in that sharing, and in your book, you introduce us to the political determinants of health. Yes. Would you take a minute and help us in the audience understand where your thesis came from mm-hmm.<affirmative> and how you see it applying to today?

Speaker 3: 1:24

Absolutely. So, you know, we've been in this movement around the social determinants of health, right? These structural conditions in which we are born into, we live in and we die in. And these structural conditions really dictate the majority of our health outcomes, right? Scientists, social scientists, and others have, um, put a 40% impact on the social determinants of health, about 30% for behavioral health, um, 10 per 10% for healthcare and in genetics, um, afterwards. But when you think about every social determinant of health, whether it's transportation, housing, education, employment opportunities for every single social determinant of health, there was a preceding legal, regulatory, legislative or policy decision that resulted in that structural condition or that social determinant of health. And so, I kept saying to the greats in the social determinants of health movement, that, you know, I think we haven't gone as far upstream as we need to because we haven't connected the social determinants of health to their legal and policy routes. We must do better because only policy can fix what policy created in the first place. Right? So, as I went back now, and I was doing my research, I thought, this is really interesting When you look at the policies, when you look at the laws in this country, and you put them in three buckets. So I define political determinants of health as basically a systematic process of one, structuring relationships, two distributing resources, and three administering power. And they operate simultaneously in ways that mutually reinforce or influence one another to advance health equity or to hinder health equity. More likely. We, what we have seen in this country is that, um, most of the time the political determinants of health have actually led, uh, to creating perpetuating and exacerbating, uh, racial and ethnic health inequities, as well as in inequities plaguing other marginalized groups, LGBTQ plus people with disabilities, et cetera. So, I wanted to understand the root causes, the causes of the causes of health inequities in this country. And I wanted folks to understand the political connection.

Speaker 2: 3:51

So, Danny, I understand that we might have created this in this country. My question is, in your research, did we create this, these social determinants of health, these political determinants of health mm-hmm.<affirmative>, consciously, unconsciously, did we find our way over the decades and centuries in a haphazard way to create this? Or was it intentional, do you think?

Speaker 3: 4:21

So it was intentional. Um, and let me take us back 400 years, right? I'm not gonna start at 16, 19. I'm gonna start a little bit after you can<laugh>. Okay? But I'll start at the time when, um, you had basically slave owners who, um, wanted to sustain their business interests, right? Sustain their model of slavery. And, um, in order to do so, they needed to have the force of law behind that. And so, uh, these business interests, uh, worked with the policy makers with, in Massachusetts, the first colony that legalized slavery. We saw then an effort, uh, by these, um, business interests in, uh, making sure that they also codified that practice in law with, uh, Connecticut, the New York, and other colonies. But as if that weren't enough, they went even further, right? To restrict African Americans or enslaved black folks, as well as indigenous groups from being able to address their social determinants of health. They immediately went about after legalizing slavery to create laws that restricted their movement. Um, many black, uh, individuals at the time were prohibited from moving beyond a one mile radius on the plantation. They were prohibited by law from growing their own food, from raising their own money. These laws explicitly prohibited them from learning to read and write. The list goes on, and we know that these policies were then recycled from one generation to the next, from the 16 hundreds into the 17 hundreds into the 18 hundreds when Jim Crow reared its ugly head with a vengeance. Um, and then we saw the proliferation of laws again, right? Although there was an attempt in the 18 hundreds under Abraham Lincoln, uh, to address those political determinants of health inequities, uh, we then saw that that was a short-lived movement. And, um, and the forces, those racist forces where their ugly head and used the law to again, concretize these inequities in our structures, in our systems, in our communities. Over time. We know then there was an attempt to move from facially discriminatory laws, right? Explicitly racist laws on their face to what we call facially neutral laws, right? In the early 19 hundreds, under the Franklin d Roosevelt administration, although there were some policies that were created, the New Deal and others, uh, intended to elevate, um, health and the social determinants of health, there was unfortunately an attempt at that time to also create policy that, um, disproportionately impacted communities of color. So, the Homeowners Loan Corporation Act as one example at that time in the 1930s where Franklin d Roosevelt signed this law into saw, signed the bill into law, and, uh, they worked with policymakers in over 200 cities in the state, um, legislatures and of course, um, at the local level. And they were charged with, um, going out and grading the neighborhoods in these cities from an A, B, C, or D right color coded with either green being the most desirable. These were your affluent white communities. B communities were your blue communities. Those, um, were your middle class white communities. The C communities were your yellow communities. Those were your undesirable quote unquote, uh, immigrant communities. So largely Mexican, Cuban, Jewish, um, Italian, German, uh, communities. And then, uh, lastly, your decom communities were your red communities. This is where we get redlining from. And these were called, these were classified as hazardous communities. So it took a policy that created this report of over 200 cities. The report then was used to create additional policies, right? That, um, essentially starved these black and brown communities of the resources that they need to not only survive but thrive in our society. We then saw the proliferation of other laws. Right. After that, we went through another World War ii. And at that point, um, talking about infrastructure today, it was interesting because at that time, um, president Truman and his administration, although trying desperately to pass comprehensive health reform, uh, went about, uh, creating the Highway Act, right? And the Housing Act and additional infrastructure bills, uh, throughout the decades. Those, again, were facially neutral. They didn't explicitly say that, um, you know, black and brown folks can benefit from these social and economic policies, but once they were implemented, they had the same effect. So when you think about neighborhoods today, right? For many of us who grew up in these neighborhoods, black and brown communities, um, or work in, in these communities today, live in these communities, you may have noticed, um, a major highway splitting right through these neighborhoods, right? Or train tracks that have cut the neighborhood in half, right? Mm-hmm.<affirmative> or what bus depots disproportionately placed, if you're in New York City, in Harlem, six of the seven bus depots were placed in Harlem. And the list goes on today. We know black and brown individuals have the highest rates of asthma. And through public health research, we've been able to identify and link it to these social determinants of health, right? These structural conditions in which these individuals live in. But again, I'm trying to get folks to go one step further. And this is where the law is incredible, because we know that if you venture further upstream right, than the midstream level of social determinants, you will find that for every single one of these highways, these bus depots, these parking lots, these train tracks, there was a preceding legal decision that created these structural conditions that then what created the poor health outcomes that we see today, the higher rates of asthma breathing in the most polluted air today. Right?

Speaker 2: 10:06

So, one way that I, as I, as I hear the history Yes. Is to then try to get rooted in understanding how do we get out of this? Because in the history we have created mm-hmm.<affirmative> a structure. That's

Speaker 3: 10:23

Right.

Speaker 2: 10:24

And some would look at the outcomes to say, yeah, there are problems in communities, the social determinants of health, there are problems. Yes. Not understanding the root cause. Mm-hmm.<affirmative>, we understand the root cause. Mm-hmm.

Speaker 3: 10:36

<affirmative>,

Speaker 2: 10:37

Does that not create greater complexity? And here's the question for right now, if you just look at the outcomes, we would say, this is a healthcare issue. Mm-hmm.<affirmative>, social determinants of health. Health, you can fix this in the hospital and healthcare systems.

Speaker 3: 10:53

Yes.

Speaker 2: 10:54

Your thesis, it helps us understand how we got here. Yes. It's not just a health crisis. Right. It's a cultural crisis. It's a community crisis. It's a political crisis. That's

Speaker 3: 11:05

Right.

Speaker 2: 11:06

Understanding that, does that not make getting out of this solving this much more complicated?

Speaker 3: 11:15

Well, the system was designed to be complex, right. And complicated. So, um, it can be a frustrating, uh, process, frustrating system. Um, these systems, we know they're multi, uh, systems in which create, um, these health inequities. And so, yes, you deal with one, let's say healthcare. That alone is very complex. Right. But when you add these other systems, it does add additional layers of complexity. That's not to say, though, that we shouldn't be tackling them and getting to the root causes, because again, I do believe that only policy can fix what policy has created and perpetuated and exacerbated over time. So it's gonna take us understanding these levers, right. Policy levers, legal levers that have been pushed and pulled for centuries in this country. Right. To understand how to repair the past moving forward. Yes.

Speaker 2: 12:09

So in that repair, and getting back to your, to your last point, take asthma.

Speaker 3: 12:14

Yes.

Speaker 2: 12:16

It's a crisis in many communities, and it has been Yes. For generations. It's not just a healthcare crisis. It's not, which therefore means we cannot solve or address the asthma crisis in this country through the lens of healthcare alone. Correct. Right. It ties to transportation. Yes. It ties to the other infrastructure issues that you mentioned. And do you see us coming together to solve that? Or are we gonna be a society that continues to look at these issues through that narrow healthcare lens and not recognize that it's a larger, complex issue and bring the relevant parties to the table?

Speaker 3: 13:01

Well, I will say, you know, kudos to the American Health Law Association, right? Um, and to our leaders, um, here in this country who are now recognizing, um, the impact that these multiple interacting determinants of health have on the health outcomes that we see further downstream. You are absolutely right. It's not just healthcare. It's climate change. It's all of the above. Right. And thankfully, I believe we have leaders today who understand this, appreciate the impact that it's having. They can see it now in real time during this quadruple pandemic that we are living in with Covid 19, this racial and social reckoning, the mental health crisis, this economic crisis. Um, and now because of this period, folks are waking up to what many of us in this health equity movement, this underlying movement, have noticed for decades, right? Mm-hmm.<affirmative>, we've seen this, we know it wasn't a surprise when we see these poor health outcomes today, the fact that African Americans lost nearly three years of life expectancy, or that Latinx individuals lost two years compared to the rest of the population. It's not a surprise that we saw what almost 80% of racial and ethnic minority children, or actually of the children who've died from covid, 80% were racial and ethnic minority. Right. And that African Americans indigenous populations have higher death rates. None of that's surprising. But today, what gives me hope is that we do have leaders. We have the Biden Harris administration, the first administration in US history, um, that has recognized, right? And that has prioritized health equity, centering equity as the foundation for all of their policy, um, efforts moving forward. That gives me hope because they recognize it's gonna take better coordination among the agencies, whether housing and urban development, um, health and human services, transportation, you name it, coming together and thinking right, more comprehensively about what needs to be done to address these issues. So I do have hope that I'm seeing some movement now, whereas before you talked about social determinants of health, folks were still on the fence, right? To a degree mm-hmm.<affirmative>. And that's, you know, previous gener, uh, previous administrations, both Democrat and Republican. But today, we now have an administration that recognizes and understands the urgency of this crisis or these crises that we're in and are going to be doing something about

Speaker 2: 15:25

It. And I know in your research, yes, you have taken us back to help us understand you've also been a soldier in this journey for decades. And you see now there's a window. Yes. I don't know how long the window will be open. Yes. You've seen the cultural competency discussions in past administrations, again, with a lens on healthcare to solve these issues. Yes. And now you've seen a, another awakening where, where, as you said in the Biden Harris administration, there seems to be more a awareness and an openness Correct. Uh, to bring the parties together to, to tackle this. Yeah. But you also hear that there's opposition to that. Yes. So, again, I, I appreciate your optimism, but I want to test it

Speaker 3: 16:11

<laugh>.

Speaker 2: 16:12

And maybe the one way to test it is to say, as we are getting out of the Covid cloud Yes. And people are hungering to get back to normal, are we gonna forget what we learned and experience through Covid and then the window for change shrinks? Or do you think that it's been ignited and we will see the change that you want? So where do you see us in 10 years?

Speaker 3: 16:39

So I am hoping that this is not just a moment, but it is a sustained movement going forward. And what gives me hope is when I think back, um, of the few times in our history when we did have health equity leaders, champions like yourself and others who understood Right. The moment in history that they were in and recognized that they had to, once that door opened, right? They had to grab the opportunity because they knew that once it revolved, right, once it left, it may never come back in their lifetimes. So let me take us back then to 1789 when the US government, our constitutional republic was formed. Um, and health equity leaders, abolitionists and others, mental health reformers, advocates for homeless individuals came together and they said they strategize and they pleaded, um, with our government, they basically, um, recruited Benjamin Franklin at the time and said, Benjamin, would you use your power and influence, right, to affect these changes, to push your colleagues in this new government of ours, uh, to, to provide for the general welfare of the people. And Benjamin Franklin, although he'd been a lifelong slave owner, right? Mm-hmm.<affirmative>, um, he thought about it and he says, you know what? As he had matured, he had matured in his thinking and realized that slavery was a evil institution. And so he said, yes, I will end my name to this cause. Well, to make a long story short, he lends his name to this petition. They made these arguments in, um, to the government, to Congress in particular, to stop the separation of enslaved children from their mothers. The breakup of these enslaved families to provide the necessities of life, clothing, adequate food, to provide medical care, right. Education and true employment opportunities. And, um, once it got to Congress, if you think that we are having a very contentious debate over health reform and health equity today, it was equally if not more contentious folks, that, how dare you, Benjamin, bring up this issue when you know that we're just getting settled as a government? Why would you bring this up? Well, Benjamin Franklin ignored him. The Senate decided, you know what? We're not gonna validate his petition with a response, but the House said, we can't let him get away with this. And so they went about bullet by bullet responding to Benjamin Franklin and originated this confederation argument, right? That well, oh, well, it pains us, you know, and, and, um, we want to help these, uh, marginalized and vulnerable populations. The Constitution doesn't afford this, uh, the opportunity to do so that's best left to the states. They are closest to the people closest to the pain. So they know what's best for the people that reside in their jurisdiction. Well, unfortunately, by the time Benjamin Franklin got the congressional response, he passed away. And that was the first time in US history that the light of health equity had dimmed in public policy. It would take us 75 years later for the political stars to align under President Abraham Lincoln. And now the same arguments were raised by the radical Republicans at the time, right? The Lincoln supporters. And, um, they argued for not only stopping, um, or, you know, abolishing slavery, but to provide these necessities, these social determinants of health. And for two years during the Civil War, they finally succeeded in negotiating the most comprehensive health policy in US history that addressed all of these social determinants of health that we've been talking about. And, um, fortunately, president Lincoln was able to sign it, but there was one contentious provision that was the provision to provide medical care to these now freed people, right? And to poor whites who had been displaced as a result of the Civil War. Um, well, unfortunately, as history tells us, four weeks after signing that bill into law, the Freedman's Bureau Act, uh, president Lincoln was assassinated, but his supporters not wanting to squander that crisis, right? Wanting to leverage the opportunity it presented, said, well, up upon reading this law, we believe that it actually does afford us the opportunity to provide black freed people and poor whites access to health services. And so they went about establishing Friedman's hospitals and clinics, um, historically black colleges and universities and so forth around the country, as we have seen though, during this quadruple pandemic, racism doesn't sleep right. The opponents of health equity are unrelenting in their attempts to undermine efforts to stretch that umbrella of inclusivity just a little bit whiter. As we all fight for more equitable, inclusive, and healthier society. We know that there are folks undermining that at every attempt they did the same thing. And after seven years of being on the books, that law was repealed. Unfortunately, it would then take us 150 years. So as I'm talking, I could see it in your eyes, you're probably thinking, well, that doesn't seem very hopeful, Daniel. You're talking about 75 years, then you go to 150 years. But I'm gonna get to the point, the point is, after 150 years, the stars did align again, and at this point, we were able to work with the Obama administration on creating America's most inclusive, most comprehensive and equity focused law, the Affordable Care Act. Right? That included 62 provisions. Well, where are we today? Yes, we've been rattled a little bit. Um, there have been attempts to undermine the progress that has been made over the last 40 years in terms of advancing health policies relative to mental health, um, disability, racial and ethnic, uh, minority health, et cetera. We haven't seen progress, but we have come and come up to a period where there was, um, an effort to undermine many of those. What gives me hope, though, is what I saw last year in 2020, when this pandemic was striking after George Floyd's death and Breonna Taylor's death, and all of these terrible moments in 2020 where you saw young people, this generation of millennials rising up. And I had the opportunity to speak with Congressman John Lewis before he died. Ambassador Andrew Young, who's been an incredible hero and a mentor to me, uh, fought with, uh, Martin Luther King Jr. During the Civil Rights Movement and other leaders, right? Um, and what they said to me gave me incredible hope. They said, unlike the Civil Rights Movement, where they felt like it was mostly African Americans on the streets protesting and fighting for these changes. Now, when you look on your television screens, right, what do you see such a first group of young people fighting, right? In many instances, you would see predominantly white and other, um, communities, right? Fighting for equity and fighting for, um, black lives and other lives, right? So it has been refreshing to see the change in attitude where I couldn't even say the R word racism. People would look at you and say, oh my gosh. So everything is racist. Now. You see folks who are bolder, who are ready to create systemic change. They are no longer comfortable with merely nibbling around the edges of the problem of inequities in our society. They want true change, and they are hellbent on realizing that.

Speaker 2: 24:12

And one of the things that I think you're also highlighting is that, you know, perhaps a little bit different from Benjamin Franklin. Cause I wanted to know who's the next Benjamin Franklin. But one of the points you raised, Benjamin Franklin at that time was focused on the health inequities, some humanitarian issues of clothing and shelter. Yes. Fast forward here, it is a larger community, more integrated community addressing not just health inequity, right. Or the basics of food and shelter. Yes. But racism in this country. That's right. And that's the point I think that, that you're lifting up that that is giving you hope. That's right. You're seeing a community come together and address the racial inequities in this country. Yes. Which does impact health care, which does impact education. That's right. And jobs. And so, I, I can, I, I, I see the point you're raising is that larger issue is what's giving you hope and a benefit of that not only is addressing racism in this country. That's right. A benefit of that is health inequities. Mm-hmm.<affirmative> political inequities Yes. Will be addressed and are being addressed as a result of focusing on racism in this country. That's

Speaker 3: 25:32

Right. And it's not to say that we won't have, uh, continued, um, obstruction on this issue. Right. And folks putting barriers after barriers, uh, to slow down the movement. But I am hopeful because I'm seeing greater change than we have ever seen in this country. And that's what gives me hope.

Speaker 2: 25:50

I definitely see where your hopefulness come from, and I'm hopeful that it's contagious. I know when we've worked with you in the past, um, there's always a buzz from listening to Daniel talk. He educates us. He gives us hope. And, and I want to, to sit in that hopefulness. Uh, and so with that, I, I, I guess I'd like you to look into the future. You've spent a lot of time looking back in our past, and it does ground you. Yes. Uh, and it's hard to know, um, where we'll be in the future. I don't think anybody predicted that we would have such disruption on the social or racial side with the, the murder of Floyd versus the pandemic, which did, I think you would agree, put a big spotlight on the inequities in this country all around. So if you could guess where we'll be in 10 years, or you want to take the long view, the Benjamin Franklin view, 50 years, 75 years, I'd like to know where you think we will be. And you can answer it any way you want. Where we will be dealing with race in this country. Where will we be in our health, in our challenges with the disparities in healthcare? So you can pick whichever one you want. I want to kind of get Daniel's view of the future.

Speaker 3: 27:13

All right? So last year marked the first time in our country's history that the number of minority children in this country now outnumber white children. We know that in the next 20 years, maybe less, this country is gonna become a more, uh, racially pluralistic society. Right? And we know that from an economic and national security, I'm not even talking the moral argument. You know, we know that people, almost a hundred thousand African Americans were dying pre covid each year owing to health disparities. Right? But as we think about the future, if these communities or these individuals, right, racial minority groups are sicker and dying younger, they're coming from communities, from families that are struggling with poor health. Well, this raises all sorts of issues for our country economically and national security wise. We've seen that debate raging from the 1940s all the way until today. In fact, in 1946, there was a study, the generals, the admirals, um, at that time after World War II, recognized that they were having difficulty recruiting young people to serve in the military. And they said, wait a second. We've got to do something about this. So they did a study and found that between 17 and 24, 20% of young people at that time were unfit to serve in the military. 40% of those who were admitted into the military ended up leaving the military again, owing to poor health, right? Mental illnesses and so forth. And 60% of the hospital beds at that time were being occupied again, by these young people who had all sorts of health issues. So, so fast forward to 2009, as we were working on the Affordable Care Act, we took a lesson, rip a piece of history there, and said, let's do a study as well. And this time you had generals and admirals retired largely, who came together and did a study. And what do they find in 2009 that 75% of young people were unfit to serve in the military? We have higher rates of criminalization records, higher rates of obesity now, right? And the list goes on. Well, as we move forward, if we think for a moment that it doesn't matter, I don't really care about these communities. Well, here's why you should, because as they continue to increase in numbers, if we don't have individuals healthy enough, right, to work, to serve, et cetera, it's gonna raise all sorts of issues. So here's why I am helpful, and I'm positive about the future, because I think our economists are leaders, whether for self-serving purposes or whatever, they now recognize the demographic trends in this country and recognize that something must be done for the sake of our democracy. Right? And they are now putting in place, right? Programs. They're trying to think about policies, um, practices, et cetera, that will make it more fair for these groups to realize their full potential. I've had the opportunity to speak with business leaders when we talked about political determinants of health, who said, wow, good lord, I never even thought about that. But now, they too are waking up to this in healthcare. Major health systems are recognizing that you are an anchor institution. You do have an obligation, because guess what? You were part of the problem in the past, right? Where you prevented black and brown, uh, babies from being born in your hospital. There were bylaws on the books right at that time, or what discriminating when African Americans and others were trying to get healthcare services, you were a part of that problem, right? That led to the results that we see today. Why am I hopeful though? You now have folks, you talked about caring earlier, Dr. Satcher, David Satcher, who is my mentor and friend, often reminds me about this. That what we need now more than ever, are leaders who care enough. So first, you gotta care. You gotta care about these communities, right? But caring's not enough. You also have to know what has driven the results downstream. You gotta know, understand these political and social and other determinants of health, but you also need to recognize that this effort to advance health equity in America is not for the faint of heart. It really takes courage, right? You gotta be courageous to do something about it. And then lastly, as you have seen, we've talked about this long period in our history of efforts to address the political determinants of health inequities, how long it's taken. You have to persevere. You can't give up because once the political wins shift, right? What we have seen in our history is that advocates have lost that will that drive to keep moving. We can't lose that. We can't lose this moment. We have to create a movement and sustain that moving forward. So that's what gives me hope. I see a more healthy, equitable and inclusive society moving forward. And I think this generation, millennials, um, gen Xers and others are going to basically continue to pave that even stronger than past generations. We're able to,

Speaker 2: 32:52

I I I, I do share your optimism,<laugh>, cautiously. And one of the things that I, I, I believe we will continue to do yes. Here at a HLA, is to create the forum for voices like yours and many others to come together who share in the knowledge share not only in the passion, but to roll up sleeves and work. Yes. Because it's hard. It is complicated. That's right. And I think back to, um, how fast this country moved after nine 11, a different crisis, if you will. But we fundamentally changed through policy how we travel. Yes. That may never change. You know, for those of us who remember air travel before nine 11<laugh>, um, where we are today is probably where we'll be for a while. Yep. But we changed policy. The business community changed. We also changed policy That's right Here in this pandemic, one of the things you highlight is you see a resurgence. It gives you hope. Businesses are changing. That's right. Preneur from the bottom up. That's right. The young folk and the enough. So young folk are interested in seeing change systemically. Yep. We're seeing that change. But the weak link may still be the big P policy. Yes. Because I don't know yet what the major policy change will be. Right. At least at the healthcare level to change how we support the public health infrastructure. Yep. That in your, in some of your research you highlight is a big gaping hole in our fabric that it's broken. That's right. And has been broken. It's been neglected. That's big P policy. Yes. At the federal end, at the state level. Correct. And again, for us, we're trying to create forums and opportunities for folks to come and share and learn. I suspect your optimism would rise a little bit if you saw action to address the public health crisis. That C O V again, put a big spotlight on. It was weak and broken for some time, but we weren't really tested. Right. And so, um, if you can, do you see your way clear to an infusion of support in our public health infrastructure over the next couple of years?

Speaker 3: 35:21

Um, I do. But again, it's gonna take, you know, all of us, um, collectively coming together, right. Um, in agreement, um, in efforts to push back and to ensure that we are developing policies that utilize an equity lens. Right? And, and I think we can do that. I think we do have folks who are now interested in employing that equity lens, uh, to big p policy, to public policy. I will say what we need to do a better job, um, in terms of, uh, the community, in terms of the populace. We have to do a better job connecting, you know, voting for instance. Right. And how that actually has an impact on your health. Engaging in this process is so critical. It's gonna dictate how healthy you are and how life, how long your life will be on this earth. We need folks to understand that not voting can mean the difference between life and death for you and your family. It is a major political determinate of health. Right. And understanding those levers. But it doesn't stop there. And I think a lot of us then, who are engaged politically will say, well, I voted I'm good. But this process is a continual process. A you have to engage at every aspect, right? Not only just selecting the decision makers, but working with them, applying the pressure. Right. So they know equity is so critical moving forward. It is so critical for our communities, right? And holding them accountable and at working with them because the people who are closest to the pain, right? And the problems of inequities should be the ones leading the solutions. They should be there at the table helping to craft these public policies. I think that's been an issue that we have seen where, why we haven't gotten the type of traction. But again, what gives me optimism or gives me hope, is you have an effort by more policy makers at the local, the state, and the federal levels who are interested in hearing the voices of community members and designing a policy with their input now. But we do need to do a better job as leaders to educate people about how these political determinants of health actually will dictate how long they live and the quality of life that they're gonna have on this earth. That's so

Speaker 2: 37:41

Critical. So one of the things for us mm-hmm.<affirmative>, and again, I want to thank you so much for spending time with us today, is we'll continue to lift up the voice, your voice. Thank you. The cause for racial justice and inequity. Um, I think one way I characterize it is we all have to be warriors. Yes. And tireless warriors and advocates, um, for the change that we seek.

Speaker 3: 38:04

That's

Speaker 2: 38:04

Right. So, uh, with that, you're always welcome here, Daniel come. You share your knowledge.

Speaker 3: 38:09

<laugh>, thank you very much. Well, I thank you for the privilege and the opportunity to share these remarks and to have this discussion with you.

Speaker 1: 38:23

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