AHLA's Speaking of Health Law
AHLA's Speaking of Health Law
AHLA Convener on Racial Disparities in Health Care, Part 4: Social and Political Determinants of Health
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 4, Dawn Hunter, Deputy Director, Network for Public Health Law, and Ruqaiijah Yearby, Professor, St. Louis University School of Law, moderate this discussion about how social and political determinants of health are shaped via institutional practices, training, and workforce; investments in spending to improve health equity; and data collection policies and practices.
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.
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:Alrighty, it is 1 45 Eastern Time and I think everybody is back. Um, so why don't we get started for, uh, with our panel on social and political determinants of health. Uh, as I mentioned, I'm Rakaia Ybe, a professor of law at St. Louis University. Um, and, uh, I will be moderating this panel with Dawn Hunter, who is Deputy Director at the Network for Public Health Law. We have, uh, Dean and Dr. Dana Bowen. Matthew here, who is the Dean of the George Washington Law School. We have Jay Na, Dean Garcia, who is Executive Vice President and Chief Operating Officer at the Trust for America's Health. We have Samantha Ben Weber, who is a program analyst with the Centers for Disease Control and Preventions Public Health Law Program. We have Professor Scott Bur, who is professor of law and Director of the Center for Public Health Law Research at Temple University Beasley School of Law. Uh, we have, uh, Edward Ellinger, who is acting chair at HH S'S secretary's Advisory Committee on Infant Mortality. And Sarah Dia, who is Chief Executive Officer at, uh, change Lab. And again, I apologize if I mispronounced anyone's name, please correct me. And with that, I'm going to turn it over to Don Hunter.
Speaker 3:Hi everyone, and thanks so far for a great discussion. And I think you'll find that we're about to enter a panel that will combine some of the elements of each of the previous panels. We have a really nice transition from this last panel in particular where we heard about some of the barriers to vaccine equity that are also more broadly barriers to health equity. And as we developed the vision for this panel, we had a lot of ideas, but they generally censored on the role of law and policy and shaping the social and political determinants of health via three kind of key areas, institutional practices, training and workforce investments in spending to improve health equity and data collection policies and practices. So these are the ideas that we had, but we wanna start out by asking you from your perspective, what even are the social and political determinants of health, and what is the most important issue in this topic area that the audience should know about and who wants to kick us off? I know Dean Matthew was, was really touching on this at the end of the last panel, and it might be nice to lead off there,<laugh>.
Speaker 4:Okay. I I, I, I'm happy to start off also because I'm going to, uh, duck out of this panel a little bit earlier. But I'm looking around the room and I know a lot of people on this panel have a lot better handle on this than I do. So I'm gonna take the 35,000 foot level, um, and, uh, continue my role as provocateur. Uh, one of the things that I, um, I know that Scott and, uh, Nadine and others are going to drill down on is the empirical connection between law and health outcomes. I wanna talk a little bit more theoretically about a miss, um, that we, uh, have not paid a lot of attention to. And, uh, I hope Sarah Dega will back me up on this because, uh, I know that the, uh, change lab solutions has been very active on this. Um, and that is the use of civil rights law to address health disparities in every single one of the social determinants of health, right? So anybody who's very serious about health disparity should also be very serious about voter suppression right now. So if we are seriously interested in changing the fact that communities of color live in more polluted places, so they breathe dirtier air and drink dirtier water, if we are seriously concerned about the income gap, that not only, uh, is the result of residential segregation, uh, but is also the result of educational segregation that persists throughout the United States, thereby under preparing people to compete in the labor market. And we do see the connection between those civil rights disparities and the very plain disparities in morbidity and mortality that we are seeing not only in the outcomes with respect to Covid 19, but in the solutions with respect to Covid 19. Right? As I said on the earlier panel, and I just have to say it again in case there's a different audience here. White people are the only people who have more vaccine prevalence than they have death disease. In cases, African Americans die more, get hospitalized more, get diagnosed more with Covid 19 than they get vaccine. Same with indigenous populations, same with Asian populations, same with Latino populations. The only people who are getting more vaccine than they're dying are white people. That is white supremacy. And it is no surprise to those of us that have been doing disparity work for 10, 15, 20 years. So, although it is true, the Covid 19 pandemic blows all other use cases out of the water, this is unusual, extraordinary, exceptional. There is nothing new under the sun here. And unless we get serious about racial discrimination in each of the social determinants of health, we are not serious about health disparities.
Speaker 3:Well, thank you for queuing us up on voter suppression in particular, we're gonna talk a little bit about civic engagement and the next panel, um, but maybe I can ask Sarah to comment on the piece that you comment on, what we're, what we're missing, which is the use of civil rights law to fight discrimination in all of these areas that you've been mentioning. Sarah, do you wanna chime in here?
Speaker 5:Sure. And thank you Dean Matthew, for, for queuing cueing me up here. And a lot of the comments that you said earlier, I think are just absolutely right on. So I just wanna underscore what you've, what you've been saying, and also allude to something that Francis mentioned earlier around critical race theory. Um, I think that, you know, as lawyers, as health, um, working in the healthcare field as advocates, we tend to kind of think within our own silos. And I think what Covid has really lifted up is that we can no longer think in these silos. We re we really need to take that extra step in terms of working together and really understanding and leveraging each other's strengths. So we did publish a paper, um, that just came out in UCLA Law Review, um, this past year where we look at the things that we can learn, the strengths that we can learn from the social movements that are happening, black Lives Matter, the Me Too movement, really understanding that place of power and the role that community needs to play, um, within helping us understand decision making and actually helping to participate in decision making, helping to lead decision making. And then in the public health perspective, using that data, the data is not the ends, right? We don't just stop with the data. We need to actually utilize the data to help derive where do we identify where the resources and the investments need to go. So the answer is not in the data. The data is a tool in order for us to understand what needs to change. But I think we get so caught up in like, we gotta have more data. No, it doesn't end there, but we need to really embrace and understand what public health has been doing for a long time, which is looking at that population data and really understanding it, but going deeper and looking at it from disaggregating that data and really understanding the, the depths and the, and the breadth within that in within that information. And then the last piece is, this is where the lawyers I think really come into play and where we do bring a strength into this conversation, which is the important role that laws and policies play in either, um, reinforcing systemic racism or as a means to address systemic racism. So the legacies of segregation have not been erased and have not actually been addressed because all we do is continue to look forward. But as we mentioned earlier, we need to actually look backwards. We need to understand the impacts that this, that segregation that, um, that racism has played, that exclusion that slavery has played within our society to then be able to understand how do we redress and how do we move forward. So raha, professor Ybi, you mentioned truth and reconciliation. We need to have those discussions. We need to make space for that. And I do think that cities and counties declaring racism as a public health crisis actually opens the door for us to have those conversations. But again, that's the first step in order to then identify what, what do we need to do next? Um, so really understanding the role that civil rights can play, what are the tools? And also recognizing that a lot of those tools have been blunted over the years. Um, Dr. Matthew, I mean, uh, Dean Matthew, I know your bo your book, for example, has really lays out a really nice framework for understanding how do we actually strengthen those civil rights tools over time. So I think we are on the precipice. Um, we have a lot of leaders who are acknowledging race, um, who are acknowledging disparities and inequities in our society. And I do really think that this is the moment to move, to take what tools we have and to really move the comment, the conversation forward.
Speaker 3:Sarah, all excellent points. Um, I'm gonna pull out one thing that you said in particular, which is using data to drive resources in investments. And I'm gonna ask Scott to join us in on this part of the discussion right here.
Speaker 6:Well, thanks. Although I, I think you guys have, have, have, uh, inspired me, let's put it that way. So much, so many comments and so many brilliant points throughout this, this evening that I've been listening to. And it's sort of driven me away from my usual point, which is we need to study the effects of laws on health. We need to, you know, if we had been properly studying the effects of laws on health, we, it wouldn't have taken 50 years to find out that the Fair Housing Act didn't put much of a dent in segregation. We would stop looking to fake solutions and depending on them for so long, we might have realized earlier, the degradations of the War on Drugs Controlled Substances Act was passed in 1973. Um, and, you know, it's, it's 30 years before we get to New Jim Crow. But I can't resist taking a bigger answer to this whole question set of questions that you posed because I, you know, I too am a big fan of Kamara Jones and was reflecting on her allegory of the garden. The idea that, you know, she had these two garden plots, one that she nurtured with new soil and fertilizer and water, carefully got these beautiful flowers. And another which just had old soil, never been cared for, actually probably been the dumping ground for junk and chemicals. And it barely supported any healthy growth. And, you know, her point was, you know, you can't flowers grow into soil. If you want healthy flowering, you gotta have healthy soil. And until we really look at those, that soil the underlying social conditions, we're not gonna have healthy growth that's equitable across all parts of our population. So for me, the fundamental imperative that we, that that is actually sort of happening now, a little bit in which we cannot lose, is to make long-term substantial changes to the policies that drive inequities. And that could, if they were reformed, maybe turnaround some of the inequities and disparities. We are in a society now that has for the last 40 years, done everything possible to make rich people richer, uh, and has successfully created the greatest inequality and the lowest social mobility in our country in a century. And in keeping with the, you know, the old physical law, that high water is always worse for those on the lowest ground. This general inequality has been desperately hard on people of color, and particularly people whose family trees in America are rooted in enslavement and generations of consistently hostile day jury racism. And I think this is an important point. I think critical legal studies in law schools a great topic. We all ought to have it. We don't all have it. But even more than that, we need legal history. My students come to law school with this kind of vague notion that Lincoln and the Civil War freed the slaves. And there were a couple of like bad moments in there, you know, p plea Ferguson and all. But then Thurgood Marshall came along the Supreme Court, you know, got rid of segregation and racism and everything's been great since then. You know, mostly, uh, they have no idea. They have never been taught about the consistent and unrelenting use of law to subordinate black people in America, um, that has gone on without cease, without cease to this day from the Civil War. Um, so, I mean, obviously one of the first things we have to do is just stop doing racist things to black people through the law across the board, as many commentators have already spoken about. But I think every policy reform discussion that we have also has to lead us back to three deeper questions that we need to ask about every policy are social resources, um, being devoted to investments that create and security and opportunity for most people in this country. Not the 1%, not the top 10 or 20%, but the vast majority of people who are, you know, not doing so well in this country of all races. And then secondly, doing that, taking up Dean Matthew's point, are we ensuring that racial disparities are being redressed and not perpetuated in these reforms? Cause we could easily fix a lot of things for some people and make things worse for other people, as, as Dean Matthew said. And finally, our enough resources being collected to make the necessary changes. We are talking about serious redistribution of wealth in this country. So if we are not talking about major tax reform, both in individual and corporate tax and tru inheritance taxes and so on, if we're not talking about huge investments in housing and education to get rid of homelessness, to get rid of substandard housing, to get rid of poor education, if we are not talking about taking this germ of a guaranteed basic income that we saw in Covid and making that a basic entitlement for all Americans, then, then I don't think we're serious. Uh, I don't think we're gonna succeed because we cannot bring social justice for anybody, as is said, without, um, substantial economic justice for everybody.
Speaker 3:Scott, that's difficult to follow. Great. Your, your points are great there. And I wanna ask, uh, ed or Nadine, if you wanna jump in here and talk about, you know, what this looks like on the ground in, in terms of targeting resources to impact population health?
Speaker 7:Yeah, Don, let me, let me jump in. Uh, it's nice to be on this panel of great legal minds. Uh, and, and I don't have a great legal mind. I'm a, I'm a physician who's been in practice and working in public health field. But Dawn, I wanna get back to your original question to this group is what are the social determinants of health? And I also wanna, I'm glad I'm following up, uh, Dean Matthew, cuz I, I want to highlight the fact that she said so eloquently that if we're not focusing on equity and particularly structural racism, it's public health malpractice. I mean, it is, that is central to what we're doing. It's public health malpractice if we don't focus on that. And what I really like about the whole issue of social determinants of health is that most people in the general community think that if you just made good personal choices about diet and physical activity and exercise and had good medical care, you'd be healthy. That's, that's the common mantra. That's the worldview. And we know increasingly that it's really where the conditions where you live and work and grow to school and worship, that really impacts your health. And those are the, those, the things in those communities that impact your, are beyond your individual control. They are social control. That's where it gets away from this whole idea of the individual being responsible. And, you know, I, I certainly think individuals need to take some responsibility, but the big issues are really social. And so social determinants of health are the things that impact your health that are beyond your individual control. And those things are really structured based on policies and systems and environments that have been put together over the years that have been based on a, a structurally biased racist perspective. And, and for us, you know, and I always argue, you know, I'm always asked, you know, why is an old white guy, uh, talking about equity? Because we're all in this together. And I think those of us, and it really struck me when I was a state commissioner of health back in 2014 as a privileged heterosexual male physician, white physician, to say that structural racism was the centerpiece of the problems that we're having in Minnesota related to disparities. Made a big difference. It opened up the conversation for folks and, and the communities of color said, thank you for identifying what we've known all along, and now we're gonna hold you accountable for making some differences. And this is where, you know, we need to get communities engaged and we need to have the communities hold public officials accountable. And then this gets at the voting things, which we're gonna talk about on the, on the next session.
Speaker 8:Um, well thanks, uh, Don, for opening us up. And, and, um, just to b build on what, uh, everyone has shared, it's really been great to listen to all of these panels, uh, today. Um, you know, where, where Ed just left off with regards to talking about the social determinants of health and, and, and I come at it as well from a public health and, and health equity, uh, lens and, and perspective, um, is, is understanding too and not conflating, um, the issue of, of social determinants and equity because all of us, right, um, experienced the social determinants of health with regards to the conditions in which we're born and, and live and, and worship, et cetera. Um, but that there are those wider set of forces, um, that actually shape those conditions. And, and that was something that, uh, others have mentioned with regards to, uh, issues. Like who is, who holds power, uh, in communities to be able to make those decisions. And that then that then brings us to Don what you earlier asked about the political determinants of health. And I'm sure many of you, if, if, if you have not have read, um, uh, Daniel DA's book on the political determinants of health and where he structures and talks about the elements of voting of government and policy as being those three key elements within the, the political determinants of health. And so it ties to, uh, those social determinants of health because we all experience'em. But what we're seeing, and and certainly the Covid 19 pandemic, uh, has, has shined a bright light. We, in, in, in the health equity movement, knew that these inequities existed, but shine a bright light and have, have also exacerbated those inequities. And we see them not only in health outcomes, but certainly in the social and economic conditions. And we, we then consider how do those conditions come to being? And you think about then really those levers and those dimensions of, of, of voting of government and thinking about government structure, um, policies that have been perpetuated over generations, not only at the federal level, but also at the state and local level. And then consider as well the policies themselves. And, and looking at how you examine, so an entity like government that can examine, should a policy actually be dismantled because it is having an inequitable outcomes on populations? Uh, should there be a new policy that is created or should policies be continued? And so I think there, there is this intersection between the two. And, and, um, I appreciated the point, you know, the national academies of, of science, engineering and medicine had a p uh, had a report in 2017 that affirmed that point. We hear this often when we're speaking to, uh, policy makers or others about this. It's individual choice or it's, it's, it's randomly occurring and, and understanding that these health inequities and these health injustices that we are seeing, they're not the, the result of, of individual choice in a random occurrence. That these are generations of inequitable structures and systems and policies and norms that have been accepted that are perpetuating these inequities and are, are now having a collective impact, uh, that are certainly disproportionately impacting communities of color.
Speaker 3:Um, so to follow on that, I wanna go back to actually ask, um, Melanie, because you were talking a little bit about this from an institutional perspective to build on what we were just hearing Nadine say about what it looks like to then address the social determinants of health in, in the institutional setting that you're in.
Speaker 9:Sure. So I, um, am a public health professional first. Um, but now I'm a lawyer and I'm practicing in a, a pharmaceutical biotech company who has publicly made, you know, their commitment to addressing disparities in care and racial inequity in healthcare. Um, and I think one of the ways in which we have made our commitment firm is acknowledging that, you know, the social determinants of healthcare are, they do impact, um, you know, the, uh, people of color. And one area in particular we focus a lot on is childhood trauma. And we have committed over$20 million just in the last year to efforts to really address the impact of childhood trauma on children of color in particular, who are disproportionately impacted by trauma and how that has an impact on their overall health outcomes. And so I think taking steps like that are, is an important first step, um, in addressing, you know, um, the health equity or health inequities in our, in our community. And I, I guess more broadly, I think, you know, as we're talking about the role of academics, the role of, of, of, of government agencies, something that Dean Matthew said that I really appreciate is that this app, like the way that we're tackling these issues really is a multi-disciplinary approach and does really require the input and effort of various, um, entities including the pharmaceutical and biotech and medical device communities. I think they're often kind of looked to sometimes as a source of some of these areas or some of these issues. But I, I think that there is a role that attorneys like myself have too in holding our leadership accountable to putting their money where their mouth is in putting their money, where their commitments are. And so the ways in which they've supported something like childhood trauma or the ways in which we leverage our packs to support laws that might have a disproportionate impact on communities of color and really leveraging my seat at the table to speak up and talk about the impact of you supporting certain tax incentives that might benefit you as a company, but are gonna have a significant serious impact on the health and wellbeing of our black communities. And so there's lots of ways in which I think we can leverage our voices as lawyers too, sitting at the table, not just through laws, but also speaking up to our leadership about the impact of things that they're supporting and this adverse impact
Speaker 3:On our communities. Well, I'm gonna ask Sam to jump in here and share your perspective too. How are we leveraging our voices to address some of these social conditions and what does that mean? Social conditions versus social determinants in the, in a healthcare setting, in, in a p in a public health setting?
Speaker 10:Thank you very much for, um, uh, for allowing me to participate, uh, on the panel. Um, it's been a really robust and enriching conversation over the last many hours, and I've really enjoyed it. Um, I just wanna go back, um, I'm sorry, Don, I may not totally answer your question. Um,<laugh> totally
Speaker 3:Fine.
Speaker 10:But I wanna go back, um, to, uh, this, uh, idea of defining the determinants of health. And, you know, one of the things I've been thinking about a lot is, um, do we need that language? Do we need the language around social and political determinants of health? Whose imagination does that capture? Does that really help ordinary people, people who are not in public health practice, people who are not lawyers, um, to sort of fully grasp the idea that social conditions where you live, the experience you have, the access to tools and resources of power, um, does that get you better health? Um, does that language sort of help people to sort of internalize the idea and then think about how they can, um, help to move the needle around, um, uh, uh, around social conditions and improve health? Um, it's, it's something that I grapple with a lot because I think to to your point about sort of, um, moving the needle on this issue, part of the story here that I think is, um, one that people within health and public health practice need to engage with, but also lawyers who have a tremendous, um, number of tools in our toolkits around engagement with people is that, um, you know, we have to figure out the communication story, right? Like, how do you tell the story about the ways that laws have have harmed people in a way that's accessible? You know, to, to, um, Scott Scott's point about sort of what law students don't know when they come into law school. That's a problem that exists across all disciplines, across the entire population, right? We just don't have an historical sense, but we also don't have a sense of what it means when people talk about inequities or inequality or, um, poor conditions and, and populations that get to disproportionately harmed. We don't really know how to trace, right? Um, federal laws, local laws, um, state laws, we, we haven't figured out how to sort of, um, trace the way that the legal infrastructure has directly and acutely impacted people's conditions and lives like the decisions they make, the resources they have, the places they go, their sense of their opportunities. And to me, that is a big part of the story of capture of like moving the needle on structural racism and moving the needle on the discourse around, um, determinants of health. Um, and, and, um, and advancing health equity. Um, the, um, so I I, I started by saying, do we really need to talk about determinants of health? But one thing I wanna say is, um, you know, the point that I think we need to figure out a way to be able to articulate for people, all people, including people within the legal discipline itself, is that law is a concrete determinant of health, right? Lots of us talk about this, um, you know, who work in the public health law space, talk about this, you know, Sarah and Scott have written about this a lot. Um, but in terms of like articulating it, um, in, um, among the broader public, um, uh, among people within public health and outside of public health practice, that law determines health and law drives health, right? Um, I think we've gotta come up, we have to look inward, is what I'm saying. We have to look inward and think about ways that we can interrogate, um, the way that we think about and do public health law practice, but um, more broadly the way that we think about and do legal practice, right? Like, how does, how does public health thinking also inform the way that we, um, practice as lawyers and think about the law and interpret the law and how policymakers and communities think about and engage with the law. Um, and I think, um, you know, it's such a sort of 35,000 foot point I'm making, but it's actually really practical and concrete in so many ways, particularly because everyone here is, you know, engaging with students, engaging with the public, engaging with policymakers, engaging with people in private industry. And, you know, I think that is a conversation, an ongoing and robust conversation that we need to have and, and continue to have every day, all the time, um, about how we talk about this stuff, um, and how we, um, how we begin to articulate, um, you know, change making, right? How we trace the nexus between law and health and then what we do with that. Right? Um, so I'm gonna stop there.<laugh>,
Speaker 3:Sam, you're speaking my language here. Um, everything that you're saying I, you know, just is really spot on. Um, I was thinking, actually, one of the things I wanted to pose to the panel is really you, how do we talk about social determinants of health when we know that's a term that is a huge turnoff for some policy makers and some, you know, right? How do we talk about the impact of laws, you know, the, all the evidence that exists about the positive impacts of Medicaid expansion? And we still have states that hold are holding out and states that are trying to overturn ballot initiatives, right? Um, the impact of minimum wage increases on people of color despite the evidence of the success of all these laws, we still have, um, people saying, Hmm, yeah, I don't really think that's a thing. So, you know, I wanna pose that to other panelists. You know, what, how do, how do you suggest, you know, what are your suggestions for how we talk about this and how we approach this with people who maybe are just not quite there, but could get there?
Speaker 7:Dawn, that's, that's been one of the blessings, the side blessings of the covid epidemic and the racial violence that has spun off of here in my hometown, the, the murder of George Floyd. All of a sudden, people are recognizing that there is a large population in our society that is not getting their, is not part of the conversation, and that it's the economic policies, the social policies, the educational policies, the, the legal framework, the who's, who's at the legislature. It's all coming together and it's really tangible because they're feeling it in their community. They're feeling it by how safe it is walking down the street. They're feeling it by who's dying in their neighborhood. So this is the opportunity that we have to, to then craft our stories around the, the, the crisis that's going on right now about, uh, racial violence or, or still disobedience and, and racial injustice protests and covid v this is an opportunity. So that's where, trying to bring the stories around those two episodes,
Speaker 5:I really think it's as basic as it's about power. It's about power and opportunity. And I think there's a notion that w laws and policies are really can help to either emphasize who has the power or who doesn't have power and opportunity. And I think if we're talking about how do we talk to community, it's, it really is about how do we make sure that people feel that they have their own power, that they have a sense of agency, that they can actually participate in the process. And part of that to me is about dis sort of demystifying what the law and policy practices are, but it's also about making sure that government is accountable and that they do have policies and that they have an engagement practice that is actually really welcoming and that where people feel like they can meaningfully participate in making those decisions that are going to have an ultimate effect on themselves. And I think right now we do need to do the analysis and understanding, and there is a way to do that. There are practical ways of understanding and analyzing laws and policies to understand who will benefit from these laws and policies and who will not benefit. And those are things that we need to make sure that cities and counties and state and the federal government have as they are bringing down the big dollars right from lo building up local infrastructure or as they're thinking about rolling out racial equity initiatives. Um, and then also really thinking about the role of preemption, for example, and taking away that, that power or authority that locals may have versus states and federal governments. And the last point I wanted to make was just in terms of really having, I think it's important for our government levels to understand that they work best when they are in coordination with each other. And when they're not in coordination with each other, then that's when who is most affected is going to be community members. Government is the, on their role is to protect people's rights. There is no other entity who is going to protect our rights other than government. And so we need to have them understand that role and that responsibility, and we need them to be at the table and really co and, and having much better coordination and communication so that then we do community does feel empowered and is a part of that process.
Speaker 6:I would throw also throw in time and, and a little bit of self-care or, or patience with ourselves on the communications issue. I mean, you know, it's easy to feel like you're not getting the message across whatever language you use because change seems so slow and painful compared to the need for change and, and for the possibilities of change. But we have to keep in mind that the people who, who taught America to believe that government, who taught a bunch of Americans who loved F D R and were delighted with the new deal that, uh, the government is the enemy, um, and that, you know, the, the, the most, the best they can do for you is keep its hands off your Medicaid. They spent 30 years and billions of organized dollars telling that story again and again and again. When Barry Goldwater ran for president in 1964 and was trounced by Lyndon Johnson, people thought the idea that, you know, his attack, people thought his attack on government was absurd. Nobody was into that. But the people who supported him just kept saying the same thing until Reagan came along, until, you know, he had the enough of the enough, enough repetition. So, you know, I think it's, it, it's tr I absolutely agree with, with Sam that the, we don't need to talk about social determinants most of the time. Oftentimes, you know, we just have to talk about the terrible things that are happening cuz that really gets, people know that and they feel bad about that and they want change. If, if, you know, we have systems of, of, of, of policing that involve finding people into poverty, finding people into jail, burdening people with, you know, crushing court debt. We can talk about that on that level as such. It's just cruel to take people of a thousand dollars in their whole life and charge them$1,200 for a traffic ticket. Um, but I also think that we have to have a positive, inspiring vision. That's how systems change systems ultimately change with the big picture. And we have the best picture there is, there is nothing better than an equitable society where everybody is respected, where everybody has an equal opportunity and has a chance and has a, has can make a good life. Um, and there are lots of people who don't feel we have that now. Um, and, and, and we have the opportunity to offer that, uh, in, in, in, in contrast to people who think we should have a winner take all society where, you know, a few people win and the rest of us, well, you know, we're losers. We should, we should be able to sell that.
Speaker 8:And I think, I think there are elements, excuse me, Scott, I think there are elements too of, of, um, really knowing and understanding the audience, um, to, to whom you are speaking, um, and, and what drive, what might drive change. And, and I agree with the point that some things are going to, um, be able to move more quickly than others, or some points are gonna be able to move more quickly than others. But knowing what drives change and knowing how we communicate that, whether that's, um, through stories and narratives, whether that's through data, uh, and how we present data also with a framework that actually, um, promotes racial equity and doesn't stigmatize communities, uh, as well as looking at in, in many cases, making that economic and business case, especially in, in the case for, um, policy makers where sometimes that feels like it's the antithesis of what we would want to do because we're trying to come at this from a humanistic perspective, but understanding that there are gonna be these different, uh, ways in which we can explain these issues, um, and, and understanding and tailoring to the audience, and then taking an opportunity where there is something, there is some type of a social movement or something that may be expected or unexpected. You know, we can talk about the racial violence, uh, that, that we have seen and, and what the nation is currently experiencing, but racial violence certainly has, has existed for generations. But when we see this type of a movement now, how can we actually use this to lead to transformative change? And, and I think that, and, and, and to do so, I really appreciate it as well in a way that's interdisciplinary. Uh, because this is not something that public health can do alone or healthcare can do alone or, uh, in the legal profession. We have to come together across these various sectors, public and private, uh, as well as other sectors such as education and criminal justice, to see this as a holistic approach to really transforming and creating, um, healthier and resilient communities.
Speaker 3:This is a dynamic discussion. I just wanna point out really quickly, we're gonna have Heather, and then we're gonna have Sam, and then I'm gonna turn it over to Rakaia for any closing kind of comment or question. All right, Heather, take it away.
Speaker 11:Thank you. And I, I, I am going to try to not repeat the ideas that I think that I've heard from lots of my colleagues. Um, and I'm gonna go back to kind of something I said earlier about, um, the, the role of other disciplines and I think, um, um, uh, professor Garcia, you may have just mentioned this as well, or Dr. Garcia, I apologize, not knowing which, um, but, but I think the idea that we really need to, particularly as lawyers, we often are asked to come in as the experts or, um, the one to explain everything to other people. And I think it's really important for us to be, and, and this goes to, uh, what someone put up about the role of grace daring to fail. I really think we need to, um, be willing to listen to both people who are going to ultimately be the most impacted by some of the policies. And not simply leader, but having people at the table. Again, I'm gonna, I'm gonna be a real good record driving and helping to lead the conversation or leading the conversation. And I think Sam made a good point, um, um, uh, earlier about, uh, whether or not, um, we really know what we mean when we say community. How do we define that? And I think that's the conversation, um, that, uh, Sam Weber brought up that that really needs to be had as well. Um, but also other professionals. We're talking about messaging. Are we engaging with communication specialists or people who do political messaging? And maybe we are, but where we aren't, should we be? Um, uh, I, I said at the beginning, I do social work, social workers often are working directly in communities, and if ask could tell you who they see as leading voices and then going to the community and asking them if they see the same thing is important as well. And acknowledging social work sometime can function as an arm of the state as well in a negative way. So really considering all of those things. But, but, but thinking about those professions that are already doing some of the work that we as lawyers who are trying to craft policy could have taken off our plates as we do our work. And I think, you know, and, and, and, uh, uh, Scott Burris, I, I mentioned this earlier, but that transdisciplinary public health law really, I think does a nice job of touching on each of those issues that we all could, could from our own perspective take, um, and think about what that would look like. So I'll, I know we're short on time, but I just really wanted to make sure that that, again, the community piece, um, and, and, and, and Sam's wise admonition to think about what we mean when we say that and the transdisciplinary component, I think could, could really enhance what we're already working towards in public health law and policy.
Speaker 10:Um, just to sort of perhaps, uh, repeat myself, but also to, um, piggyback on some of the other comments. I do agree with what others have said about this being a rich opportunity for us to not only, um, think about how we can make change and move forward, but also, um, step back, right? And remember what we're doing right and why, um, where health fits in the larger story about how our society is structured and operates and functions. How do we centralize health in the larger story about who we wanna be as Americans, um, what it means to live in the society and to, um, engage with, um, the society and the government and the system and structure we have. And I think we're in a, um, a difficult, complicated, contested contestable, but also rich, um, time of potential and opportunity. Um, and so I I, I'm trying to focus on, um, being optimistic around that, uh, too. Um, and I hope that, um, we can, uh, center the sense of possibility as we think about how we look at our disciplines, right? Um, within the context of health and public health. Um, but, um, but also other disciplines. My sister's a transit planner and we talk constantly about, um, uh, transportation, you know, and how there's this tremendous overlap in the way that, and some of the challenges we see in our respective, uh, disciplines and how we can do more to advance equity. Um, so I'll stop there.
Speaker 2:All right. So I wanna thank everybody for this conversation. One of the things I wanna add, um, in the closing, which, uh, hopefully you will get to as we talk about civic engagement, is that when we think about the structural, social and political determinants of health, that when we talk about race, that we also have to connect people's other identities, uh, which at this, this time are also coming, uh, to play, particularly in states deciding to pass laws to prevent access to care for L G B T Q and trans individuals that when we think about racism, right, it is not just, uh, one individual, it is a part of individual's identities, including their sexual orientation, their gender identity, age, disability status. So as we think about these issues and laws and how they have played out, we have to think about how it's impacted all of these marginalized groups, particularly at the intersection. So with that, I wanna turn it over to Dawn. I know you're gonna start us on our next, uh, panel, and I wanna thank all of, uh, the panelists who, uh, participated in that panel. Thanks.
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