AHLA's Speaking of Health Law

AHLA Convener on Racial Disparities in Health Care, Part 1: Introduction and Definitions

July 23, 2021 AHLA Podcasts
AHLA's Speaking of Health Law
AHLA Convener on Racial Disparities in Health Care, Part 1: Introduction and Definitions
Show Notes Transcript

AHLA hosted a one-day virtual convener on April 12, 2021 where participants discussed all aspects of health disparities and equity in health care, social determinants of health, the impact of law on these issues, and what can be done to address these issues now and in the future. 

In Part 1, Vonne Jacobs, Principal & Founder, PHAROS Healthcare Consulting and Creating Equity, LLC, moderates this introduction to the convener, which defines key terms such as racism, diversity, equity, and inclusion.

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

To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.

Speaker 1:

On April 12th, 2021, A H L A , hosted a one day virtual convenor, where a panel of distinguished participants discussed important aspects of racial disparities in equity, in healthcare , social determinants of health, the impact of law on these issues, and what can be done to address these critical issues. This five part series presents each recorded session of the convener full video and audio of the proceedings are available@americanhealthlaw.org slash racial disparities in healthcare .

Speaker 2:

Well, good morning, everyone. I'm David Cade . I'm the c e O of the American Health Law Association, and it's my pleasure to welcome you today to our health disparity and equity and healthcare convener. I think that we all arrive today with an excitement and passion about this issue and can't wait to dive in. So let me introduce you to Cindy Reese , the President-elect of the Board of Directors of A H L A , who will kick off today's activities. Cindy is a partner with Berry and Sims in Nashville, where she works primarily with acute care and psychiatric health systems, physician practice management companies, and population health management organizations among others in her practice. Cindy shares your passion and works with clients who are on the front lines addressing health disparities and inequities in healthcare . Cindy, the mic is yours.

Speaker 3:

Thank you, David. Uh, good morning everyone. Um, welcome to all the participants in and those who will later view the A H L A convener on racial disparities in healthcare. As some of you may know, a H L A has created a D e I hub on its website, which includes information to help our members and the public stay informed on the critical issues surrounding diversity, equity, and inclusion in healthcare. With the goal of providing in-depth analysis and furthering conversations necessary to facilitate change, we hope that the d e I hub will be helpful to you. And as a note, the the recording from this convener will be available on that hubs. Well , the moderators of the convener have spent the last several months working with a H L A staff to develop the critical topics to be addressed today and to identify thought leaders who are experts in their respective fields in public health, social determinants of health and health equity. Today's participants are law professors, current and former federal and state government officials and leaders of nonprofit and for-profit organizations that are making a difference in addressing healthcare inequities. The moderators will introduce the participants of each segment of the, the convener as their session commences, but I will now introduce our moderators and then we will begin the first session. Drew Aria is the Vice President of Diversity, equity and Inclusion at Advocate Aurora Health, a nonprofit multi-facility health system in Illinois and Wisconsin. He cod drafted the system health equity statement on Covid vaccine outreach and distribution, and led the initiative that established 55 community-based flu clinics providing over 7,000 vaccines in underserved communities. His work focuses on health equity and intersects with language services, data analytics, civil rights, clinical operations, policies and procedures, and community health and relations. Don Hunter is a deputy director at the Network for public health law. Prior to joining the network, Ms . Hunter worked in state public health at the New Mexico Department of Health, where she started as a Robert Wood Johnson Foundation visiting attorney in public health law Through the network. She also served as Director of Health Equity Policy Director and Deputy Cabinet Secretary Von Jacobs is principal and founder of Creating Equity, a global strategic advisory services firm that helps individuals and organizations design and implement simple practicals and solutions to complex problems through the firm's health services division, also known as Pharaohs Healthcare Consulting, Vaughn provides strategic and operational advisory services and support to healthcare organizations working in rural and other underserved communities. Myra Salvi is a partner at Ice Miller, l l p , where her practice focuses on advising clients in healthcare, regulatory, and compliance matters. She is the firm's partner in charge of diversity, equity, and inclusion. Rakaa Ybe is a professor at the Center for Health Law Studies, William c Weel Center for Employment Law at St . Louis University School of Law. She is also the executive director and co-founder of the Institute for Healing Justice and Equity . Professor Yuri pre previously worked at the US Department of Health and Human Services as an assistant regional <affirmative> , and I believe we covered everybody. So we'll go ahead and get started with the first session.

Speaker 4:

Thanks, Cindy. Uh, my name is Von Jacobs. Welcome you all this morning to this convener. We're gonna start the day , um, pretty straightforward. You know, I believe that you cannot solve a problem if you do not know what it is . So we're gonna start by talking about exactly what is the problem we're all committed to trying to solve. Um, participants in this section of the convener are, I'm gonna read these . Uh, France has been serving as Indian County , um, for over a decade. She has served in various capacities from clerking for tribal Supreme Courts, and working for the United Nations special reporter for the rights of indigenous peoples to representing tribes as in-house counsel and special prosecutor. She joined the Indian healthcare field in 2015 to advocate for better healthcare in Indian country, as well as educate tribal members and communities on their alternative healthcare options. She joined the National Council of Urban Indian Health in 2016 as the policy analyst in Congressional Relations Liaison, and later became director of Governmental Affairs as of August, 2017. She's now the N C U I H S Chief Executive Officer. Also joining us, Andre Gonzalez, vice President, chief Diversity Officer for Fred Health . He's responsible for overseeing the integration of diversity initiatives throughout the organization, including expanding workforce diversity and strengthening community relationships. Um, Francis Mills provides leadership for the Cleveland Office of Minority Health and the Healthy Cleveland Initiatives, whose programs inform, educate, and empower individuals, organizations, and communities on chronic health issues impacting persons of color. And finally, professor Heather Walter McCabe holds a joint appointment at Wayne State University Law School and Wayne State University School of Social Work. Her research is done at the intersection of law, social work, and public health , um, where she translates complex legal issues and research findings across multiple professions to make the information accessible for use by practitioners and advocates in improving population health. Thank you all for agreeing to be a part of this , uh, portion of the program. I'm really excited to engage with everyone. And the first thing I wanted to ask is, let's get some common vocabulary, like what is the difference between bias discrimination and racism and others on the , um, convener, if you want to join in, please feel free to do so. I'm gonna throw this first question out , uh, to Professor Walter McCabe. Uh, let's start with a , with a little bit of instruction, but, you know, words mean things and I hear these words used a lot interchangeably, but they are not the same thing. So I'd like to get your thoughts, sort of what's the difference between them, bias, discrimination, and racism, and maybe even a little thought about which of these, or all of these, are we really trying to address

Speaker 5:

The phrase of 2020, right, your Honor.

Speaker 4:

Yes . Couldn't have a , you couldn't have a virtual program without it.

Speaker 5:

Absolutely. So I , I just thought I'd get that one started out , out of the way. Right. So I, I actually , um, wanted to start with , um, uh, Dr. Camara Jones , uh, has a , uh, has a, a nice definition of racism. Um, racism is a system of structuring opportunity and assigning value based on the social interpretation of how one looks, which is what we call race. That unfairly disadvantages some individuals and community unfairly advantages other individuals and communities and SAPs the strength of the whole society through the waste of human resources. And there are, there are other ways to define that, but, but one of the things that I like about it is it talks about the impact on the whole community, not simply on importantly, but not only on those impacted , um, to, to make this clear why racism itself , uh, is something that should be above importance to everyone. And it really addresses, not simply at the individual level, but the structural level, how racism really makes an impact across the board. Mm-hmm . <affirmative> . Um, and so I wanted to start with that. Um, and Dr. Jones has done a lot of work in this area, but, but I like that definition , um, because I feel like it's very inclusive of the many facets of racism. Um, and so that's, and , and makes it also easy to think about how it impacts health and, and health equity. And so, I don't know if others wanna take other areas or if you want me to go on, does anybody else wanna do bias , um, and, and discrimination? Or would you like me to continue? All right . Hearing, hearing nothing , um, bias , um, and discrimination. So, bias and discrimination, discrimination is more the actual , um, action of , um, when racism is played out , um, in, in, in an interaction in discriminating can happen at the individual level. Um, and discrimination can also be part of a built, baked into some of the structures that we see that disadvantages. And it's that part of racism piece that talks about the disadvantage that we see , um, put forth towards impacted communities. And here we're talking about , um, racism specifically , um, against black communities. I'm actually going to let one of the other panelists take bias because I've lost my notes on that and I wanna make sure it gets its full due . Does , uh, do others have a good definition for bias that they bring to the table today?

Speaker 4:

I don't know if , uh, Francis Mills or , uh, Andreas, do you have something you wanted to share on that maybe?

Speaker 6:

Sure. So bias is the prejudice in favor of or against people or groups compared with another , uh, something that is really important, and it's part of the work that I lead here at freighter in the medical college and have done it for the last 20 years working in healthcare, is that as we do a little bit of level setting here is the notion that we all bring our biases, right? We all have biases mm-hmm . <affirmative> , and I think it's important even for those of us who do this work , uh, professionally to admit , um, to that reality. Cuz I think what it will do is it will minimize right , and reduce , um, some of the walls that might exist, right? And people might not be as defensive as we come to the table, right? To address or co-create the solutions that we need. But that's actually how we define , uh, bias here for , uh, for our health network. And certainly it's one of the key areas that we are addressing, both from a clinical standpoint as well as from an educational standpoint, to ensure that our staff members understand what their biases are, and certainly that they're addressing that. So certainly that's not , uh, minimizing, right? The role that bias can play in del in the delivery of care to our diverse communities that we serve.

Speaker 4:

No, thank you, cuz I really do appreciate that. Um, you know, some friends and I who do this work, we say, if you're breathing, you're biased. We all have these belief systems, right? We've all sort of put together this way. We think the world works or should work, and we're all operating from that. So there's that individual component. Then there's , uh, professor, I think you talked about sort of discrimination being the actions that people take, maybe based on some of those beliefs about, you know, the assumptions we're making about people and, and what should or shouldn't be. And then racism be being the structural, systemic sort of outcome as all of those things build on each other, right? And so when we talk about health equity in particularly and , and addressing disparities in healthcare , I guess that's really sort of the next question, right? I see those, you know, I see bias discrimination and racism as being juxtaposed against health equity. I don't know , uh, Francis Mills, I don't know, maybe you have a , you know, being someone whose job is really centered on this, if you have any thoughts about, well, what then does health equity look like when it's juxtaposed against these ideas of bias and racism and, and discrimination? Or is that even the right context for this conversation?

Speaker 7:

I think it certainly is the right context for the conversation, and I too am have a huge , uh, respect for Dr. Kamara Jones and look at her definition of equity, because it provides a measure of responsibility. It's the assurance of the conditions for optimal health for indivi individuals. And so what health equity looks like is that when, when it comes to race or ethnicity or gender poverty, sexual orientation , um, that those things do not dictate access to care, level of care, quality of care that individuals are receiving. And so when we get to a place where we achieve health equity, we'll see disparities begin to dissipate.

Speaker 4:

Okay . Um, I don't know if the other, Francis , I don't know how I'm gonna have to try to figure out how to handle both Francis , but, you know, given that, you know, you specifically serve Indian country and, and that being a unique setting, what does health equity maybe look like from your perspective? Or is this, you know, what does this conversation sound like in tribal communities? Is this something that is being discussed, addressed , um, and maybe talked about in a way that we aren't mentioning here?

Speaker 8:

Yeah, thank you for asking. So I, I definitely see , um, so in our communities it's a bit different. The way we've prioritized is a bit different. And so in the Indian health system , um, we look at, I mean, equity does look different and priority looks different for us. Priority is prioritizing our elders, prioritizing our , um, culture holders , um, our native , uh, language speakers. And so it does look a little bit different than it would in , uh, you know, in mainstream, I think America. Um, but I think , um, in , in , you know, in our, some of our facilities, I mean, we have Indian health facilities and they do serve non-natives , um, but they do prioritize the natives. And so I think that on that doesn't serve all of Indian country, but it does serve some. But I think yeah, true health equity is, is to ho hopefully have access. Um, I think access is one of those, the biggest issues that a lot of our communities together , um, face the similar issues. Okay .

Speaker 4:

Access. All right . So in thinking about sort of what health disparities look like and sort of the lack of equity in the healthcare system looks like, and all of the work that you are all doing to try to address that, you know, I think about things like, you know, again, the words that we use, diversity, equity, inclusion, you know, and even something as, you know, foreign or maybe even radical as justice, right? You know, health justice, and what are we actually aiming for? What are we, what are , you know, Andreas, in your organization, you've done so much work in sort of developing an infrastructure and programming. What are you aiming for as an organization?

Speaker 6:

It's a , it's a great question. I think , um, I would say, so I'm gonna start with the latter part of your question and we'll progressively work backwards here . Okay . Um, so I think what we're aiming for is really to create , um, or to ensure that there's health justice by way of delivering , um, on our promise, which is our , uh, mission to provide , uh, both culturally and linguistically equitable care to our communities. Um, so I think that that's really what we strive for, but certainly to your point or , uh, first part of the question, then it becomes important in terms of, well then how do you define diversity inclusion, right? To really build on that. And so I think that diversity and inclusion becomes the foundation in which we then build right towards creating health equity , um, and certainly delivering, right? Or ensuring that we have health justice. And so for us, diversity is being able to recruit. So from a recruitment, right, from a workforce standpoint, is ensuring that we are recruiting , uh, individuals from the communities that we serve and we know, right? And there's data that shows that when you have individuals from communities, right , um, that are mirrors the communities that you serve, certainly you tend to actually have greater treatment adherence. Certainly you can shorten length of say, right? Because there's that cultural proximity that exists on understanding and cultural competence on how to deliver care for those communities that you're serving, including by the way , uh, language preference, right? And understanding the issues that come with our ability to ensure or not ensure that we're providing that linguistically , uh, capability to all of our patients. And so for us, that has become extremely important. But I think something that is extremely critical to also address is that sometimes we use the term diversity and inclusion interchangeably, or we think that because we have diversity, we have inclusion. And the reality of it is you can have a lot of diversity and lack of inclusion are the other way around as well, where you can have inclusion, but of homogeneous teams, right? <laugh> are not diverse , uh, in essence, right? And so I think it's important to understand that, you know, in order for us, again, to deliver on our promise and philosophy of health justice, yes, we need to actually make sure that we're hiring individuals that certainly a mirror the committees that we serve, but as critically important, we need to actually create inclusion for them, which means that we are creating a culture in our case that is rooted in dignity and respect, where every single staff member that walks through those doors will know that you know, what you are valued in this organization, your opinions are heard and will count towards the co-creation, right? Of the solutions here. And it's part of the work that we have delineated. Um, if , if , if I could actually provide a , a really quick example here, even with our business resource groups, where we have gone down this path of having affinity based groups where these groups are actually helping us to address complex issues in the organization and really addressing it by providing solutions that really meet right, or can address those challenges that we're facing. And so I think that you cannot have, certainly, there's no way that we can deliver on our, and on our , um, health equity promise, right? And ensuring health justice if we are not certainly a , um, a recruiting diverse individuals, but also providing that inclusion where we're giving them, right? Ultimately that sense of belonging in the organization where they know that, you know what this organization gets me. I will be able to have a great career here. And certainly I am , um, certainly , uh, the organization is appreciative of the gifts and talents that I bring. And so ultimately for us, diversity and inclusion are important, but they're the foundation in which we have built then our health , uh, equity, and certainly we deliver on our promise of health justice as well.

Speaker 5:

Okay . And , and I , I, if , if it's okay to build a little bit on that when we're looking at health justice. Sure . I, I think it that it is important , um, to look at all of those issues within the healthcare system itself. And I think that, that , when you speak , um, about health justice , uh, one of the things that, that, that it brings up are all of those , um, areas outside the health system itself that may actually impact even who , how people get to us, like environmental issues in different communities or , um, just , uh, housing issues and, and access to , um, to safe housing even when housing is available. So I think that that one of the things that, as I hear the phrase health justice and think about , uh, that I think that that , particularly from the public health pers perspective, thinking about those broader issues that impact health on a daily basis and perhaps can even be a part of prevention before it becomes a problem, that if there were more equity , um, and less structural racism in many of those systems, that we wouldn't see people coming to the health system itself even in the same ways. So I think it's important as a part of our discussion today, that we, we , uh, particularly if we're thinking about it from a public health perspective, that we're thinking kind of broadly about some of these other issues as well as the important issues , um, which Dr. Gonzalez , um, brought up.

Speaker 4:

I think you're making a really important point. Like, this is a very holistic conversation, right? You know, the work that you all are doing in this area is really about addressing the whole experience that we have as humans that impact our health, right? And this is where we got to this point. I was looking at some articles and I'd realized how many public health organizations, government organizations, academics, have declared racism as a public health crisis for the very reason that it impacts the whole of a human being. And then it shows up in our care, you know, centers and it shows up in our hospitals and other things. But , uh, like you were saying, professor, a lot of this is stemming from things that are outside of the care environment that are really broader social issues that we have. Um, and I think about, you know, in Indian country, again, all of the things that create the environment within which tribal entities are trying to take care of their people, right? You know, the infrastructure that has been lacking for decades and decades, that builds upon a lack of access and then builds upon, you know, people not being able to maintain preventative care and therefore having more complex issues, and then a provider walking into that trying to figure out what to do. Um, I'd just like to get your thoughts sort of on the idea of what it means to address racism as a public health crisis. Right? You know, now that we've had people make this statement, well, what does that actually do? Does it do anything? Does it mean anything or is it just , um, for being, you know, a little lack of cynicism, but, you know, is it just a marketing spin for 2021? Who wants to hit

Speaker 7:

That <laugh> ? I'll hit that one. Uh, we're, we're at a very interesting time in terms of these declarations that are being made all across the country. I know that Ohio is, is a state that I think we're up to 25 counties. Municipalities, health departments have made such declarations, and they are simply an acknowledgement , um, which is very, very important in terms of you can't begin to fix what you can't acknowledge. However, there has to be substantive action that follows , uh, to truly address racism as a public health crisis. And one of the areas I know I can share in the Cleveland Cuyahoga County area is that this whole discussion of how do we engage the community in the process as policy makers and as leaders, sometimes we're often paternalistic in our , um, application of what we think equity should look like for other people. Instead of simply asking people, what does equity look like in your given organization, in your community, in your hospital, and moving forward from that point, that's a , a place where people really get uncomfortable when you talk about diversity and inclusion. You know, I always say that diversity is who's invited to the party, but inclusion is who really gets to the table, who gets to eat the party favors, who gets to really participate in the decision making and planning process of what is going on in our systems. And so , um, here in Cleveland, we are trying to specifically not just call out racism as an issue that must be addressed, but that it has to be done in partnership with the community and to elevate, purposefully elevate those voices so that we can move in into the right direction. Because it hits, when we talk about health equity, you know, we are saying that we're trying to value, we're making every effort to value all people equally. And so that's one of the first things you've gotta declare if you're gonna fix it. And you've gotta include the impacted population and elevate their voice in the process because it's addressing equity is not a project, is not a program, but it's a , a process and an ongoing practice that is here and the past and the future all at the same time.

Speaker 4:

I , I like, I like what you said about this not being a project. Um, you know, I feel like we have a lot of conversations in about d E I that makes it feel like it's, if we check these four boxes, we're done racism's over, we're all good. I don't have to think about this or talk about this anymore. And what you're describing is a very different approach. And Dr. Gonzalez, I don't know if you had anything you wanted to add here.

Speaker 6:

Yeah, I was gonna say that I concur with Francis . You know, one of the comments that she made, and it's spot on , is, you know, I think that , um, you know, as I reflect on some of the efforts here, and actually Milwaukee mirrors Cleveland in many ways, we also have taken that same stance of , um, you know, certainly the city, the county , uh, and a number of , um, organizations as well, including ours as a health system, took that position of calling , uh, racism a public health crisis. Uh, but certainly to Francis point, it cannot just be flower rewards . You have to back that up with actions. And I think that for us, it was really important , um, to really understand and really engage the community in what we're calling community conversations. And so we've had them with the L G B T community, with the Hmong community, cuz we have the third largest Hmong community here in our state as part of the resettlements back in the seventies with our Latinx community, black African American community. And one of the things that we learned is that, right, as we know, many of our communities, they know what the solutions are, they understand what the issues are. And so if we can come in with humility , um, into this conversation, right, and engage them and build trust, then we are gonna be able, right, to not only understand that and gain that insight , but then it's gonna actually help us to understand what do we need to do as a healthcare system, right? To meet the needs of the communities that we serve in. So for us, it actually , um, ended up , um, in terms of the actions that we took to look at examining our own biases, we actually now have rolled out education for all of our staff. And not just in terms of just knowledge base or creating greater awareness, it's really about sustaining it in terms of behaviors and actions that we need, especially our providers, right? Uh, to understand and to sustain over time. It's also about our commitment, because we send a one to three for equity pledge from the American Hospital Association to understand are we stratify our data, right? And if we are, what is our data telling us, right? In terms of serving our communities? Um, and we have found out that certainly there's a lot of disparities across the board when we're looking at whether it's diabetes management, whether it's cardiovascular issues, whether it's actually something as simple as readmissions, right? So for us, it has been really important to understand , um, and certainly stratify the data and then use the data to then guide us in terms of the , um, um, opportunities that we have and solutions that we can create here. It's also about trading people with dignity and respect. And for us, that's foundational, that's paramount because it's one of our , um, certainly our values. And then fourth is about leading change by addressing all of this. And, and Francis made this point that it's actually, you know, you're part of the ecosystem, so who else do you need to bring in, right? From a social determinants of health model as well. So we work with a number of organizations, community-based organizations , uh, federally qualified health centers to really address this issues holistically in our community. And I think that that has become the , uh, proven formula for our system and for our community. Last comment that I'll make is that we went as far as not only putting this right and making this commitment, this anti-racism and anti-racist pledge that we've taken now has become a banner that we have actually in all of our facilities. So it's a great reminder, and from an accountability standpoint, it's great that we have done that because what it does is now it's holding us accountable to the promise that we have made to our communities at large, right? Whether , uh, whether it is our staff, whether it's our patients, whether it's a community at large that is coming through those doors as consumers perhaps, right? Or, or just to visit , um, family members or friends in our hospital systems. So that's part of what we have done here and how we're seeing that it's playing a greater role and really addressing , um, the issues in our, in our community here in the grid Milwaukee area.

Speaker 5:

Sorry, I think that that partnering both what , um, what the last two speakers have said, I think that those internal accountability mechanisms , um, and bringing people to the table who are actually going to be impacted by policies, I think that the idea, and I think that that , um, per perhaps , um, uh, Dr. Mills mentioned, mentioned this as well, that the idea that the community be part of not only being involved but at the table and even the agenda setting , um, is really important. And I think that as we're looking , uh, holistically across many areas of, of, of health justice, really being mindful of that. And I think , uh, a Professor Burris is gonna be on later. Um, but some of the models that, that he's put forth for doing transdisciplinary public health law really does recognize the need to have community at the table and thinking , um, across many different areas and maybe thinking differently about the way we've been doing policy. And I really think that as we are , um, engaging folks in health law and public health law really reminding and, and , and thinking about getting people to the table and not getting them to the table too late, getting them to the table so that they're the ones helping to set the agenda and in fact, probably leading the agenda setting , um, if we're doing it correctly and really want to be effective. Um, and they can be experts at all levels of this. Even things like , uh, implementation and evaluation, you can often see people in the community have innovative ideas about how to evaluate that we as, as traditional researchers may not even have thought of. Um, and so recognizing the expertise that the community brings to the table, valuing that, and, and I think as many people have said, listening and then acting on it, not simply hearing it. So I I just wanted to say, I think that both of what they've said , um, can be both in the healthcare setting and without, in those those areas that impact health itself.

Speaker 4:

Yeah, I think , I think what your guys are talking about is really powerful because what I'm hearing is that this is gonna require some organizational vulnerability, right? You're gonna have to not be afraid of the word racism. You're gonna have to not be afraid to bring people in when they tell you how you have not served them, how you have not met their needs, and not be afraid of that conversation, but be willing to engage in it so that you can get to the place where you build enough trust to be able to get input and design things that actually work. And I think from an industry perspective, and maybe particularly , um, you know, I'm coming at this from the legal side of the house, that's a hard thing to convince people to do, right? It can be a hard thing to say, I need you to sit still here and let people tell you how you have not served them, even though you think you've been doing all these wonderful things. And that's not to take away from all the wonderful work that you've done. But the important part that we have to do right now is have this conversation, and from a policy perspective as well as an organizational perspective, how do you get your leadership ready to do that? How , you know, what, what does it look like to bring into your c e o or to, you know, the head of your department or to the governor to say, Hey, governor, I need you to sit still and listen to the people that you are supposed to be serving and let them tell you how their needs are not being met. Is that a conversation that happens or are there, you know, strategies and techniques that you all have used because you've clearly found a way to have this engagement, but what did it take to get there?

Speaker 6:

I'll just jump very quickly and, and would love to hear from others here, all of our panelists, but phone , you're absolutely right. I mean, I think for us, it has been our CEO's , um, willingness to be vulnerable coming into the community and doing a couple things. Number one, acknowledging the role that not only healthcare has played in our bipo communities, but more importantly what Freighter has done, right. Um, in terms of our own accountability. And I think that that really has become critical for the community to know that, you know what, we're owning our own issues, right? We own , uh, the legacy of a lot of these issues that have permeated. You know, Milwaukee, when you think about it, Milwaukee is the second most segregated city in America. Um, and so we have a lot of issues here. And so certainly we can either continue to play that role or we can be one of those change agents that it's willing to put right that stake as we did on really calling this a public health crisis. And if so, then what are we gonna do differently and better? And so our c e O started doing that, and by way of acknowledging that and really coming with that humility into the community, it started actually then opening the dialogue. And as a result of then sitting around that table, right, not to speak, but to listen, then people understood that she was willing right, to sit , uh, patiently right, and quietly to really listen to what the community had to say, right, in terms of the issues , uh, and some of the solutions also that they have already , uh, co-created , uh, that certainly could be part of this , um, you know , uh, new pathway in the future. And so that is something that she has done for us. And as a result of all of that, we have seen that we're gaining greater trust in the community. So now it's becoming more of a dialogue and people are willing to engage with us in authentic dialogue, right? Those crucial conversations about, you know, here's what needs to happen or here's the issues, right, that we have been confronting. What is it that f freighter is willing to do, right ? And own and certainly also co-create with us as we move forward in this new , um, you know, with new , with a new , um, plan and reality , uh, for our communities at large. And so that is something that our C E o , um, certainly does. I'll mention one more thing, which is it's critical, right? Because it starts at the top with your leaders. And for us, our C e O treats diverse inclusion, health equity, health justice as a key imperative for our system, it is actually baked into everything that we do. Uh, so much so that she actually chairs our diversity council. And so it's actually, and then we have also tied compensation to all of our goals and efforts. So again, you know what, right ? What you do not track doesn't get done and what , where , you know, and so let's put also our write our dollars where our mouth is. And so that is something our c e o has boldly done. And I think that that has been also part of the game changer for us as a health network here.

Speaker 7:

I agree with, and Andreas , you know, it is the responsibility of our leaders getting them to the level of perspective transformation that they're willing to make that commitment and engage. And so one of the things that our mayor did was to require a certain level of racial equity training for all of his cabinet members, and how that training is filtering down into various offices and departments, but to really get leaders to see what the impact is , uh, to neighborhoods and cities or organizations. So the, the whole community is effective when we don't address health equity, when we don't address racial equity in the community. And so how we get there is really too , what's the bottom line in terms of dollars and cents? Because at the end of the day, we have to get to the hard place where we are doing that. Third thing that Dr . Jones talks about, providing resources according to need. That's the huge frontier that , um, organizations, that communities that leaders have to cross. How do we get to people to what they need based on who needs it? And so having those discussions about formula funding, having those discussions about , um, COVID rollout and, and who gets it and who doesn't, those have been critical conversations that could not have happened if leadership have not had a certain amount of humility to begin to even see the whole picture about the cost of racism.

Speaker 4:

Um, I don't know if anybody else here in the convener has anything they wanna add. Uh , we only have a couple more minutes for this session, so I wanted to create that opportunity if anybody else had anything they wanted to share or add to this discussion.

Speaker 9:

I wanted to jump in really quickly. I had put something in the chat just about truth and reconciliation, but I wanna , um, to piggyback off of what Francis said, it's not just about , uh, being honest, but it's also about financial support and investing in the communities , um, and connecting that with whatever we're doing. I think oftentimes we think of health as being separate from economics, and it's not. And so if you want community to play a role in decision making , evaluation and giving them power, then you also need to give them funding to respect the time, the expertise and creativity that they're bringing to the table.

Speaker 4:

Absolutely. Absolutely. And you know, one of my favorite sayings is budgets reflect priorities. Um, and so if you care about something, it, it's amazing when you can find money for things that you care about , um, personally as well as, as a, as a society. Um, we are at time and so given that we have so much richness to go through all for the rest of the day, I'm gonna , um, honor that. But thank you all so much for starting us off in a really powerful conversation. I'm excited about what the rest of the day has to hold. Um, thank you again, and I'm going to pass it along to the next moderator.

Speaker 1:

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