>> So thank you, everybody for joining us today for the Center for Public Health Practices, Unmasking COVID-19 Health Inequities. We're really excited to see the registrant list over 80 folks, so we're really excited to have everybody here today. Before I go into introducing our panelists, I wanted to go over a couple housekeeping items first.

So this webinar is being recorded, and we will send out the recording to all registrants following the webinar. Participants are in listen only mode and we do not have the chat box option available but, we do have the question and answer kind of box open. So if you have questions for the panelists, please include your questions in the Q&A chat box, okay?

So shortly here we will have Jennifer Beard. She will be our moderator for the webinar today. She's ran into some technical difficulties this morning. So I'm gonna get us started this morning. We'll also be joined by Dr. Amy Fairchild, who is the Ohio State University College of Public Health's new Dean.

So we're excited to have her today and provide a little bit of a keynote opening to the presentation as well. Then we have Dr. Sampilo. She is a pediatric psychologist out of the Cleveland Clinic. And then we also have Alexandria or Alex Jones. She is the Assistant Health Commissioner and Director of Prevention and Wellness at Franklin County Public Health.

So at this time, I'm gonna go ahead and let Dr. Sampilo introduce herself. And then we'll have Alex if you want to go ahead and provide a little brief introduction to yourself as well. And then hopefully we'll have Dr. Dean Fairchild next.
>> Wonderful, thank you. So thank you all for being here today.

I'm excited to be here. As Colleen mentioned, my name is Dr. Marilyn Sampilo. I'm a psychologist at Cleveland Clinic. I'm also their Health Equity and Social Justice Lead for the Center for Pediatric Behavioral Health. And so my work is predominantly doing both clinical work for behavioral health issues in children and adolescence, but also attending to issues of health equity, specifically behavioral health equity, which is currently definitely an issue that we care about specially in light of recent events.

I'm so happy to be here and excited to be speaking with the other panelists today.
>> Good afternoon, everyone. Thank you so much for having me. Very excited to be here. So, my name is Alex Jones. As was mentioned, I work with Franklin County Public Health. I've been there since about June of 2018.

I serve as Assistant Health Commissioner, so I oversee our areas of communicable disease. So certainly infectious disease and control is in the spotlight, but in addition to that, we also do maternal child health, immunizations, school health services. So very excited to be here and be a part of this panel and learning from the discussion as we go as well.

Thank you.
>> Thank you. And I see, Dr. Fairchild has joined us. Dr. Fairchild, would you like to go ahead and introduce yourself? And then I made you co-host, so if you have a slideshow, we can get that up and running too.
>> Okay, sure. And are you ready for me to go ahead and start?


>> I am. Yep.
>> Okay. All right. Well, excellent. Thank you. Let me see if I can get this running first. Share screen. So are you able to see my screen?
>> We see the CarmenZoom website up.
>> All right, so hold on. Okay, I'm sharing, let's see.


>> There it is.
>> Are you able to see me now?
>> Yep.
>> And are you seeing the full view or the notes view?
>> Yeah, we see the notes, we see the next slide too.
>> Okay, so let me see if I can do this. Now is that what you need to see?


>> Perfect, perfect.
>> Okay, all right. Well thank you so much and see if I can get set up to do all of this at once. Just a smidge. So I think our moderator is still trying to get on but I hope I won't get too far and Colleen you will help us along if need be.

I just wanna thank everybody for joining this morning. If I forgot to introduce myself, I'm Amy Fairchild. I'm Dean of the College of Public Health. As of July 1, I will have been here for one year and it's been a tremendous pleasure to be here at OSU. It has, as you can imagine, been the experience of a lifetime in this period since spring break when we began to teach all of our courses virtually and of course we can't begin today and I can't begin my session with you, without framing and in terms of our intersecting national crisis.

Not only COVID-19, but racism as a public health issue. Now of course those of us who are in public health knew about the catastrophic intersection ages before two black men, George Floyd and now Rayshard Brooks, were killed in police custody. We knew it before before Ahmaud Aubrey was murdered while he was jogging.

It's something that we have known not just for decades, but for centuries and we know that racism, along with a whole other host of isms are not simply risk factors for public health outcomes. They shape the public health opportunities for people, and they shape the choices that not just that we make but that we're allowed to make in this society.

In the case of COVID-19, you've all heard it. Our collective mantra has been we are all in this together. And it was entirely predictable for those of us in public health, that despite the population wide nature of the policy measures adopted, that it's clear that we're not all in this together.

That the patterns of disease and death have reflected longstanding inequities. Blacks and Hispanics have been over represented among those who become ill and die. In New York City, for example, deaths are nearly twice the rates of whites and Asians, deaths among African Americans. In Chicago where less than one third of the population is African American, more than 70% of the deaths, have been amongst people who are black.

In Louisiana, where blacks represent less than a third of the population, 70% of the pandemic related diseases have been amongst African Americans. But what and how we see these data, so often depend not on the data themselves, but on history. Either explicit or implicit, depend on this history that we have in our heads.

Helps us make sense of those data. What are the story that we tell ourselves to understand these inequities of these disparities? The writer and social critic, James Baldwin, in a landmark 1963 book, called the Fire Next Time, argued that an invented past can never be used. It cracks and crumbles under the pressures of life like clay in a season of drought.

There are some things about the past that are not invented. Not everything thing is open to interpretation. But it is well known among historians that each generation writes its own history. That's a quote from the great, Eric Foner, who is one of the preeminent historians of America in the reconstruction and post reconstruction period.

We have multiple conflicting narratives of how we have arrived at this point in this country now. We have narratives of blame and neglect that are centred on disease. And we see those often told as a story of gods and monsters. But even just a look, so the Tuskegee Syphilis study which was the 40 year long study of men in Macon County Alabama who had been initially offered treatment for syphilis, and then actively kept from treatment as the study progressed, it has been sort of emblematic of that history of of gods and monsters.

And it's often told as a story of the unblemished heroes, who was a white man, who discovered this, who saved the day and is a story of rabid, racist, and abject victims. But as you can see from this piece in Jet magazine, that came out in 1972 when the study was broken, there's a more complicated history behind the Tuskegee Syphilis study.

It began in fact as an effort to treat an underserved population and in the context of the great depression, and public health officials seized on an opportunity to continue to do what they thought was a good thing and informed by racist ideas it turned into an abomination which as I say, individuals are actively kept from from seeking out treatment.

But it's also told as a story as I said about victims. In fact, many of the men in Macon County, Alabama and you see them up there in that picture were landowners. They were folk who understood how to navigate the Jim Crow South. They may well have understood what they were not and were not getting in the context of that study and they knew how to navigate this system.

So it was, which is not to say that they were complicit in it, but they were savvy. And to think of this history merely in terms of heroes and victims, is the wrong way to think about it. But it is nonetheless a history that has shaped a community's perception of the healthcare system.

And we certainly saw this in the context of of AIDS in which the patterns of disease that we began to see not only in gay men, first on East and West Coast of the United States beginning in 1981, but then in individuals who injected drugs and then in black and brown communities seemed to underscore this history of denial of care and denial of treatment, particularly, in an era in which the president of the United States several years even say the word AIDS out loud.

So we also have narratives that come out of the era of the Great Society. The years in which Lyndon Baines Johnson was president, we saw some expansion of the welfare state. But we also saw during that period, a disintegration of the black family because of the nature, the ways in which welfare became constructed, or at least we see narratives of the disintegration of the black family that come out of the work of Daniel Patrick Moynihan, who was a senator at the time.

We see stories about belief in the rise of welfare queens and people who exploit the system and take advantage and certainly in a way that affects all of us in the United States. The rise of narratives about personal responsibility for public health. We see this particularly in the 1970s, this notion that, well, infectious diseases have declined.

And it's chronic diseases that we now have to worry about. And chronic diseases, we are the ones who are at fault if we get heart disease or diabetes or obesity. And it's because of our moral failings or because of our individual choices that we see the patterns of disease that we see.

And the problem with this narrative is that it limits our focus. It limits on what we as individuals can select and not on the ways in which our choices, our social services, the way we've chosen to allocate resources, and certainly, the discussion about how we allocate resources between, say, the police force and the public health system is one of the things that we are intensely debating as a society right now.

It limits the ways in which we can see how our choices are so strongly structured. And I'll give you one example here of lead poisoning. It was often framed as an issue in the years after the Great Society, it often framed as an issue of negligence urban mothers.

So you had communities living in homes that the walls were literally covered with what lead paint. It flakes and it peels. It becomes a fine dust. It because it's got lead in it. Lead is sweet. Sometimes kids would eat big lead paint but it was also in the air.

It covered everything in the house. But it was framed as a disease of mothers not taking care of and watching their children, or even worse yet as a disease called Pica, affecting black and brown babies. This was a disease that was believed to be that these kids had a compulsion eat lead.

And of course, it's a story that's constructed by a lead paint industry which very well knew that lead was a powerful neurotoxin and didn't want to take responsibility for having covered the walls and paint. The community in strong contrast, framed that it's a different kind of narrative. They framed that there's a narrative involving a failure to build new housing as a form of oppression.

And communities begin demanding accountability to the community, new housing, testing and treatment problems. And that then takes us into a third narrative. And there are many more than three narratives. But I'm just highlighting three that are particularly relevant to thinking about our public health challenges now, and in the future as we move forward.

And then there are narratives that come out of the civil rights era, and we're seeing so many of these narratives recharged with new kinds of energy and passion and conviction and broad support behind them. Again, I think, we haven't seen since the civil rights era. So narratives about A right to, not just a right to life, but a right to everyday life.

A right to be able to job just like everybody else. A right to have the same kinds of protections and prospects when you encounter a police officer just like everybody else. A right to participate in consumer society, a right to education, and of course, voting rights. So the intersection of COVID-19 and police brutality forces us to grapple explicitly with the connection of the social and economic experience in public health.

And so, here's where I wanna come back to Baldwin to help us as we think about the narrative that we're gonna use moving forward and that we're gonna try to build a shared understanding about. So the beginning of this quote is, the right to accept one's past, one's history is not the same as drowning in it.

So what we need to take from the past is a sense, yes of unfair burdens, of atrocities. But also one that allows us to draw from these other narratives of community demand for rights, community self-control. And use that to define our way forward and help chart a course forward.

And our collective memory of the past, our shared narratives matter. I would argue as we think about how we're gonna respond to public health issues today. So then, in addition to giving some thought to the narratives about how we got to this moment. And how we need to think about the health of an African American and other minority or economically distressed and historically marginalized populations.

The Hispanics, documented and undocumented immigrants, Asian Americans, rural communities, the industrial-working class. As we begin to think about this, we need to think about narratives about whether our challenges are framed fundamentally as a problem of personal choice or fundamentally as a problem of access to some basic rights and risks and resources.

So particularly in the context of COVID-19, we have to contend with another set of narratives that are emerging around this pandemic. So we all know these to some extent. It's just a hoax. It's no different than a cold. It's just an effort of the liberal left to attack political opponents.

The rise in cases is purely a function of increased testing. But the narrative that I wannna focus on is that third narrative I highlighted, the narrative of rights to think about how it can help us think about this particular moment in time. This is particularly important for those of us in public health and medicine and health services research, because we have to think about, rights in terms that go beyond a right to access the health care as vital as that is.

So one of the things that strikes me as being remarkable about this moment is that, I'm sweeping though they were. Because nearly what nationwide social distancing measures focus not on individuals or groups but population as a whole. They had on the surface a kind of noteworthy of quality.

So there's a rather famous public of ethicist named Margaret Batten. And she described what she calls victims and vectors that we shift in our lives from sometimes being a vector of disease to sometimes being a victim. And it seems to me that one of the other things that's also remarkable about COVID-19 as we kind of exist in both of these spaces at the same time.

We're both victims in the sense that we are all feel susceptible, that we're we've all been under some kind of lockdown. And but at the same time, we all have the potential to be vectors particularly as we think about what seems to be the increasing importance of asymptomatic or pre-symptomatic transmission.

We have so much of society falling in to both of these categories at the same moment in time. So we've all been through a period in which around the country all schools have been closed. Nobody could go to a bar or restaurant. Nobody could go to a movie theater.

Nobody could go to church, go out to a bar, to congregate at sporting events. And which so many people who have not experienced unemployment, have not experienced the consequences of lack of access to paid sick leave or the lack of access to welfare benefits have suddenly seen our society in a new way.

And because of federal officials and both Democratic and Republican governors across the nation made these persuasive arguments based in science. The majority of Americans remain supportive of the measures that were taken. So these are data from Pew Research Center study on April 16, 2020, but I think for the most part, they still hold 65% of those who interviewed expressed concern that reopening the economy of this country too quickly, would allow the virus to continue spreading.

And that was a viewpoint held not only by Democrats but also by the majority of public Republicans who Pew surveyed. And so as a result, this collective experiment that we've been involved in the stay at home orders that left at some point 95% of the country in some form of lockdown have enjoyed relatively broad support.

And it's only been recently that we have seen some of these orders tested in court. In Ohio, is certainly one of the places where they're being challenged and tested and in some instances, they've been struck down. And that change of course is connected to political efforts in the streets.

So a group called freedom works and Tea Party Patriots and other groups that have been historically hostile to government intervention, some with potential ties to President Trump's reelection team have been organizing protests in the name of rights. Said we were gonna talk about this rights narrative, but it's this kind of personal responsibility narrative.

This piece of it, at least. So revealing of the even though I've talked about the remarkable man of buying, revealing of the divides in America. In the Pew polling, those individuals amongst those individuals who described themselves in very conservative, 65% were concerned that the economy was reopening too slowly.

The Facebook page of a conservative group that claimed 2 million likes posted a statement that read heavy-handed government orders that interfere with our most basic liberties are certain to do more harm than good. And we've all heard this. A number of times over the course of the past weeks or months that the cure can't be worse than the disease.

These protests have been relatively small and it seems in the majority of instances. And they are possibly the outcome of what's called astroturfing as opposed to a grassroots effort that's coming organically from below. It seems that they may have been organized more centrally by Washington conservatives rather than again being these sort of local grassroots movements.

And they've certainly been amplified by our current administration. So in Michigan, we've had protesters chanting lock her up in reference to Democratic governor Gretchen Whitmer. In Minnesota, there's a been a group called Liberate Minnesota. It's based in in St. Paul. Has demanded what they called the Democratic governor's lockdown an intense lockdown and they protested at his home.

Republican governors too have also felt the heat from a small but vocal group of protesters. We probably all recognize this photo over to the right. That's of the individuals pressed at the windows of the Ohio State House. And of course here in Ohio, most recently, health commissioner Amy Acton has been subjected to blistering personal attacks and hectoring by opponents both in the statehouse but also outside her home.

And she still has a position in the governor's office. But we now have a health commissioner that doesn't have either a medical or public health background in Ohio. We've seen the same thing in Colorado and the same thing in Texas. So I'm not gonna continue to sort of list the protests that we've seen around because I'm having a hard time keeping track of them.

But if that's one strand of the narrative of rights, there's another important strand of the narrative of rights that also begins to connect this to the protests over the killing of George Floyd and Rayshard Brooks. So the broad consensus supporting the centrality of social distancing as a strategy for interrupting viral spread was reflected in the fact that when many defenders of individual rights, such as the American Civil Liberties Union, the ACLU, addressed the practice it wasn't as a matter of intrusion on my liberty to do what I want, my liberty not to be at home.

Rather it was the failure to guarantee a right to the protections offered by social distancing. That was a matter of deep concern. So homeless populations have been one group we have advocative argued have not been given the right to social distancing. And the importance of this right to protection has also been at the heart of calls for non dangerous prisoners confined to settings to be released, settings that can't offer space.

And we have seen just as cruise ships and nursing homes we've seen COVID-19 spread like wildfire throughout prisons. Which of course are connected to this period during the Johnson administration. But particularly the Nixon administration and the Reagan administration. In which we saw mass incarceration as a phenomenon really rise in The United States in a large measure driven by the war on drugs and the war on crime.

But certainly having very deep roots in American history in the period after Reconstruction and the Jim Crow era in which African Americans were subjected to a new kind of bondage. We have seen an expression of rights in the context of COVID-19 when it comes to voting. So a demand for not having to stand in lines that put people at risk of infection, but a right to different means of access to the democratic process.

And so it's vital to see, and when I say by way of beginning to wrap up, a demand for broader rights as lying at the heart of all of our public health crises. COVID-19, opioids, obesity, diabetes, violence, mass incarceration. One of the ways I often frame what I see as a fundamental, not just a, the fundamental intention in public health is captured here.

That we tend to be caught in this tension between seeing the state as intruder. As the one who requires you to stay at home, the one who requires you to wear your mask, who requires you to get your vaccination, to eat you broccoli. And the state as provider, provider of social distancing, provider of vaccines provider of treatment, provider of educational opportunity, so housing.

We as a society need to focus more on the provider aspect. And we may have an opportunity at this intersection of COVID-19 and the recognition that racism is a public health crisis. Yes, we wanna talk about the right to social distancing. We wanna talk about the right to personal protective equipment.

Not just for healthcare providers, but for those in high risk jobs like meat packing and custodial work, for example. But we also, in public health, we have a particular obligation to think about the state as the protector and provider of even broader rights of equal treatment under the law.

Of wages and benefits, of providing access to a right to vote. That's a right to have a voice and that's what we see when we see these protests in the streets. This is a way of expressing what is that had been long neglected in groups that have been long silenced.

Protesting in the streets is a way of creating political momentum and bringing issues to light for the broader population. So as we think then about how we're gonna move forward in this moment, I want to jump back to 1848. I started with a little history and I want to end with a little history.

Many of you may know Rudolph Virchow as the father of cellular pathology. He was part of the European revolutions of 1848. These were the uprisings in Berlin, Paris, Vienna, Warsaw, Budapest, Prague, major Italian cities, cities across Europe. Those of you who are members of APHA, the American Public Health Association, may know that there's a an 1848 Society.

It's a really great section within the American Public Health Association. I encourage you to check them out if we ever have meetings again face-to-face. But Virchow, who actually he was a physician and he actually helped man the Berlin barricades in 1848, and described them as shaking to the foundation all elements of the state.

In a way that indicated that it was time for radical changes in the prevailing conceptions of life. So Virchow saw, framed the need for public health to think very broadly. So he wrote this also in 1848, he wrote Is very famous report on a typhus outbreak. And in this report, so the last few pages of which are really important historically.

He wrote that what we need now goes even beyond medical or education reform. He called those mere palliatives, preventing disease, he wrote. So in essence he was talking about public health. He wrote, requires full and unlimited democracy. That's what the revolutions of 1848 were about. That's what he saw as the underlying cause of disease outbreaks.

It was about people who didn't have access to voice, who didn't have a say in the political system. Who didn't have a say in how resources are collected and distributed. So this text, this statement in 1848 is one of the foundational texts in social medicine, which begin really in this country in the 1950s.

To begin to see disease, the causes of disease in social, political and economic conditions and decisions, not in personal choice. The personal choice narrative has had a lot more sway in this country. Not necessarily in your European countries, but in this country. But let's think back to this idea of access to full and unlimited democracy is being an argument for changing the rules of the game when it comes to public health.

And that's what's at the core of our dual crises. People and problems too long silenced, the rules of the game being being rigged for too long. So I would suggest as you begin your time with us to think not just in terms of public health, but in civic health.

How does our democracy enhance our health, how do they connect and align? Yes, we need public health solutions, but we also need to ensure civic engagement and participation to help achieve those solutions. And in the process, we need to grapple with our history to create a shared narrative of how we got here.

To create a shared narrative in which a broad conception of rights is central. And that's what's gonna help us chart a path forward. So with that, I'm gonna open us up, stop sharing and send this back over to our moderators. If I can figure out how to get my cursor over to this side, uh-oh.


>> I think we may have made a transition on your behalf, Amy.
>> Thank you, good.
>> Okay, thank you so much for that, Dean Fairchild. You captured so many important elements. I'm Jennifer Beard, assistant dean at the College of Public Health. And I wanna say thank you to all of you for your patience as I was experiencing technical difficulties which happen in this world where we are more reliant on our technology than ever before.

But I am pleased to be here with you all and want to thank you for joining us for this afternoon's discussion. Thank you, Dean Fairchild for creating the important context regarding the narrative that gets established in this important moment. And I think your point regarding the unique opportunity and momentum in this current moment of multiple crisis is a good place to start as we focus on the state as provider.

As we focus on our civic and democratic responsibilities. And as we think about for our panelists, our respective communities that we represent. And I'll start with the first question I think from there is thinking about our respective communities. And if you all could respond to us and I think we'll start with Miss Jones.

To tell us what are some of the inequities and disparities that you are seeing in your respective community related to COVID-19?
>> Yes, thank you Dr B.
>> Dr Sampilo and Dean Fairchild, you may respond after, I'm sorry.
>> No, my apologies there. Thank you Dr Beard, so for us within Franklin County Public Health, our jurisdiction.

So here in Franklin County, we have two local health departments, ourselves, Franklin County Public Health and Columbus Public Health. So together we serve over 1.2 million individuals. So within Franklin County Public Health jurisdiction, which includes, I know it's probably a lot of you are maybe familiar with Columbus, so we serve all of the county, except for the cities of Columbus and Worthington.

And then we also have some contract cities within some other surrounding counties. So thinking about Pickerington, Dublin, those cities as well. So for us here in Franklin County within our jurisdiction we estimate that we have about, actually the most recent number, about 25% of our population identifies as non-white, non-Hispanic.

And then with black non-Hispanic, we're about 12%. However when we are looking at COVID-19 related cases and deaths, we are certainly seeing a disparity there. So with our run of COVID cases, even though our non-Hispanic white population only represents only 25% of the population, we're seeing 52% of the cases within that population.

And also a similar trend for our black non-Hispanic, we are seeing double the amount of COVID cases, around 26%. And this trend unfortunately is something that we are also seeing as it relates to COVID related deaths as well in both of these non-Hispanic white populations. I'm sorry, outside of the non-Hispanic white population.

So certainly for us at Franklin County Public Health, this is a concerted effort and an area of of concern and also action with that. So we are having these harder conversations, making sure that we are bringing all the players to the table. As Dr Fairchild mentioned, those who perhaps haven't had their voices heard in the past.

So making sure that using this most recent disparity and we know that there's other disparities to bring light to, these inequities that we're seeing. And knowing that there's not a reason to have these inequities outside of the isms, specifically the racism.
>> Thank you so much, Dr Sampilo?


>> Thank you and I greatly appreciate Miss Jones's data that she presented for Franklin County. So I'm in Cleveland and one of the communities that I work broadly with is the Hispanic and Latino community. Just as we frame population and so the things that we are seeing are typically a series.

So we need that prior to COVID already among Hispanic and Latino populations as well as our black community that were in need of medical care, but were likely to see in healthcare for a variety of reasons structural barriers. So this disparity had already been there before COVID. And then having the initial impact of COVID and we started to see those disparities widen or those gaps widen.

And so what we're seeing is that psychological distress among communities of color. During this pandemic has been higher or those rates of psychological distress have been higher for communities of color, because they report more distress related to health and economic consequences associated with the pandemic. So when you're concerned about job loss, financial stress, job disruption, those kinds of things take a psychological toll and/or enact stress for these populations.

And because they're over represented in those populations concerned for those issues, you start to see that psychological distress crop up more. And so we're concerned, really, with the gap in behavioral health in terms of treatment access, as well as treatment engagement and retention for these populations. And are concerned with how that will play out as this pandemic continues.


>> Thank you so much, Dr. Sampilo for that important consideration regarding the gaps in behavioral health. There was some disruption in your feed at the beginning of your presentation. I'm not sure if you were sharing data with us, but we were not able to hear probably the first 60 seconds of your response.


>> My apologies, we have specific data in terms of we have national data related to those behavioral health disparities that do track in terms of Ohio. So among our Hispanic and Latino populations and our black community, they are reporting higher rates of distress compared to their white, non-Hispanic counterparts.

So we have some data nationally that suggests that even for Hispanic and Latino specifically, when they rate their stress level on a one to ten scale, according to the American Psychological Association just released a report on stress in America. Eight out of rate their stress level between eight and ten on that scale.

And so we see that stress level, sort of those data sort of track in different states nationally. And then we also see the same preponderance of concern for the black community, given that their rates of psychological distress do tend to be higher than the white non-Hispanic population as well.


>> Thank you so much for that. Dean Fairchild, would you like to respond to that question as well?
>> So Jennifer, I was having some problems as well with audio and I ended up getting bumped out. So can you repeat the question?
>> So the question is related specifically to disparities that you are seeing in your respective community related to COVID-19.


>> Well, so I covered just a little bit of this, but I tend to frame the disparities, it's kind of a triple whammy. So some communities tend to be in occupations that put them at higher risk. And now, based on what I heard, you would say it's a quadruple whammy.

Sort of higher anxiety, this sort of greater risk based on occupation, greater risk of severe outcomes. And then folks who are less likely to have had access to paid health leave or health care. So and if you then look at these are the populations and I don't know what comes after quadruple, something times five.

That these are the populations that are more likely to be imprisoned, which again, puts them at much higher risk for not just COVID infection, but all kinds of both physical and mental health outcomes. And not just people in prisons, but some of those communities that have very high rates of hyper incarceration.

There's great research that demonstrates that community health, as a whole, even if you don't have someone in your family who has been incarcerated, if you live in a community with very high rates of incarceration, your mental health outcomes are worse.
>> Thank you and beyond quadrupled are the adverse outcomes, I think, that we are seeing in both physical and mental health in the communities of color.

So relatedly, what in your opinions are the next best steps for addressing racism in public health and healthcare? Why don't we start with Dr. Sampilo for this question.
>> Thank you, I'm happy to chime in on that one. So when it comes to healthcare, for sure, I think one of the things that we really need to be looking at to address racism is that we basically embrace an anti-racism framework into our healthcare organizations and that means from top to bottom.

So that means in terms of strategic planning that we have both an equity lens, but also this lens on anti-racism infused throughout the planning, as well as sort of the implementation of the strategies. And I think that's where we really need to support and embrace that on the front end.

Instead of maybe being more reactive to some of these issues, that may mean more proactive in terms of how do we really see these gaps in terms of race? How do we see these gaps in terms of marginalized groups play out in terms of our healthcare? So that involves sort of that overarching themes to sort of do that throughout the organization from top to bottom.

And really take that limit from the sort of a day to day structuring standpoint for healthcare. I think it really comes back to also making sure that anti-racism work, anti-blackness work, is infused in terms of education throughout. So it's not just treated as a yearly training on cultural competence or anything along those lines.

But it's treated as ongoing skill development that both professional staff, here at Cleveland Clinic we call them caregivers. So caregivers, as well as non-professional staff are engaged in this work and sort of can speak to these issues in a way that's valued at the institution. Really need to embrace that, I think, from a sort of day to day, ground level approach to be sustainable throughout.

And to have the individuals working within healthcare, from leaders down to staff members, embracing that as well in their day to day functioning.
>> Thank you, comprehensive, sustainable, and ongoing sounds like an appropriate approach, Miss Jones?
>> Thank you, I absolutely agree. Those were all great examples. And I think something that we would similarly echo here at Franklin County Public Health.

Our board of health, we recently declared racism as a public health issue. And with that declaration came not only external strategies, but also internal strategy. So similar to what's happening at Cleveland Clinic, it's not enough for us to be public facing and to have these conversations externally about these policies and practices and procedures.

That we need to be doing them internally as well. So in addition to making that declaration and having equity as our north star and our goal for all of the work that we do at Franklin County Public Health. We are working toward making sure that we have staff trainings that people know what the expectation is of them.

So that it's not a check mark, but really what people are expected of them on a day-to-day basis as they are within the community and representing the agency. So for us, thinking about for public health and health, we are not immune to these conversations. As Dr. Fairchild mentioned earlier about the Tuskegee experiment, that was a public health led experiment.

So we have structural and racial biases and practices within our own fabric as well. So I think it's really important for us to do the work and to make sure that similarly from top to bottom that everybody knows their place and how they are going to be deliberately anti-racist in these narratives, both internally and externally in the community.


>> Thank you Dean Fairchild.
>> So thank you both for those answers and as I listened to you, what I reflect on is it's kind full and unlimited democracy is really where you want. So as important as it is to have an anti racist mindset infused every place where people get care.

We have to think beyond the point where people get care. We have to think about public health as being even farther out on the front lines and I would say really seeing a public health in all type approach. So one of the things when I look at, I recently look at the Columbus City budget.

And I was struck that the budget, one of the strategic priorities is public health and public safety. So these two things in our city budget are integrated in the budget. Now the vast majority of funds go to the police and a fraction, so about 67% of the budget goes to public safety, about 37% of the whole budget is for policing, and this is in our city.

And less than 10% of the budget is devoted to public health, education, parks and rec, the things that kind of create those conditions. And so I like the direction that that's going, where they're trying to get the public health perspective integrated into the public safety perspective. But we really have to have that perspective in everything in addition to having an approach that allows us to have very different kinds of encounters.

Because anytime in which we are given the history of the way public health has been funded in this country. One of the interesting things if you think about the Tuskegee syphilis study is we hear Tuskegee evoked again and again and again. This is another Tuskegee, this is another Tuskegee.

And it's not necessarily because we have replicated the same thing again and again and again, sometimes perhaps we have, but because we have not created the conditions whereby we are not trying to meet extreme need with few resources. So racism is part of the origins of Tuskegee, but also trying to do the best you can in a context where the needs are extreme and the resources are so limited.

So those two things allow you to make these deadly compromises, these deadly assumptions. And that's what happens again and again and again. And until we have a sort of a broad sense of public health, as demanding that we all have access to some very basic needs that set us on a future, that give us a wide range of choices that aren't gonna eliminate inequalities but that might go a long way to eliminating inequities and health disparities.

I think that's the thing we need to think about. So it really does, I mean just concretely, it takes looking at budgets. And asking how are we allocating resources? Are we allocating them to the things that are gonna prevent people from having those patients in the first place?


>> Thank you Dean Fairchild, yes, that allocation of resources is such an essential consideration. And speaking of allocation of resources, let's talk about the allocation of human resources and energies. One of our registrants asked an important question and your opinions would be helpful here. What are your recommendations for community members who want to help address racism within their communities that is adversely affecting our physical and mental health in those communities?

Ms. Jones?
>> Yes, thank you for that question. And that's such a great question, and I think the first and foremost thing I would encourage them do is to to get involved within their communities. I think sometimes individuals feel that perhaps they don't have the voice or that perhaps their policymaker legislature they don't necessarily want to hear from them or that they won't be taken seriously.

But really you are the constituent and so speaking from a public health entity or from our policy and lawmakers that your voice is valuable, and unless you are speaking up for what your beliefs are and what kind of change you want to see. I just don't want people to discount that.

So we would certainly encourage you to do that. All of our entities have public meetings. So by all means, please participate in those public meetings, whether it's a health department or perhaps you have an interest in housing, education, transportation, criminal justice. As we know that there are some reforms that are being proposed and certainly I think our voices are more crucial than ever at this point in time.

So certainly want you to and you don't have to be a certain profession. You don't have to be a certain age. Your lived experience is the most, I think the strongest message and it's those personal stories and those lived experiences that perhaps the lawmakers and even us in governmental agencies don't have.

So we certainly encourage that type of participation.
>> Thank you, Dean Fairchild, what are your recommendations?
>> Well, I would echo that same thing and as effective as the lived experience is in these settings. There's a famous quote, that what is it that anecdote isn't evidence but it's policy.

At the same time we in public health do have access to evidence and in a context in which science is increasingly under attack and this is not new, this has been happening really since the Obama administration. Science is increasingly under attack from one side of the political spectrum, but we still have to be advocates of science.

And I think too, we have to we have to acknowledge our values, and the ways in which values inform all of our science, all of our evidence, and be explicit about that. Both when we act as evidence stewards, but also when others enter the policy arena. Let's call it our values, that that's the way we navigate.

That's the way we steer. That's how others navigate and steer. And, so we should engage in a science based, evidence based discussion. But with an understanding that public health cannot be divorced from politics, and it cannot be divorced from values. And so we have to be cunning and conscious of you use both to try and change the narrative about science and evidence in this country as well.


>> Cunning and conscious for science, I've made a note of that. Dr. Sampilo.
>> Yes, definitely I would echo on what the other panelists have said. The other thing that I would definitely suggest is, you know, even just starting from home so from level one, we really are encouraged for family caregivers seeking out early shows have been around for 400 years, generations have passed down sort of these beliefs or attitudes and we want to make sure that we also are preparing sort of that next generation to sort of continue the fight for equity and equality.

And so talking about those issues at home with your family is a great way to sort of Be doing some of this work as well. And then also like individually I know that we are all individuals and maybe in individual places in terms of our journeys for social justice.

Some of us may be ready for active engagement and some of us may be more in a I need to learn more, I need to listen to really understand some of the issues. And so one of the things that a really concrete tool that I found useful are these 21 day racial equity habit building challenges, where you can sort of help develop that habit for that sustainability because we need people to continue in this fight long term, right?

People engage but we want them to be engaged over the long haul. And so we want people to jump on this ride with us. And so that kind of equity building habit challenge can keep people engaged sort of taking a step, one day at a time to help get them to a point where some of their efforts are sustainable.

But certainly I would also echo what the other panelists have said in terms of civic engagement, advocacy, and promoting the science of it all.
>> Thank you so much. There's so much opportunity for us to engage at various levels and I agree that building the equity habits are so essential.

I'll take this opportunity to do a bit of a plug. We have a vast list of resources available for those of us who are. Are seeking those the guidance and various opportunities to build our equity muscles at the College of Public Health website. So please, if you are looking for resources you'll find many there.

Our next question to our panel and we'll start with Dean Fairchild on this one. How do you think balancing the urgency of protest and the threat of viral spread during COVID-19 can be addressed?
>> That is such a thorny question for public health, because I mean, particularly this political moment Because, you know that sort of the need for social distancing is punished.

The need for masks is being challenged, masks are being politicized. And so to that message with protests can have the consequence of undercutting our credibility as a field. And at the same time, the thing that people are in the streets yelling about is the core value that we espouse.

It's equity, it's justice. It's being heard, it's participating and so, it could be a more funny question for public health. So I think what we have to do, I think it's all to say let's be creative about how we do it. So the street is one way, but are the other creative ways to participate, to get attention, to engage virtual protests, writing campaigns?

There is a 500 letters appearing in your office, 1500 letters appearing in your office, 2000 letters appear in your office, 10,000 letters appearing in your office, or emails. So I wouldn't discount the power of other means, other avenues of engagement. And, these are gonna have to make particularly in public health and so what I would say as public health as people who care deeply about public health, and they care deeply about both of these make choices to sort of you're an ambassador of public health always.

And if you feel like you cannot be true to yourself without putting your feet on the streets, then protect yourself. Carry hand sanitizer, try to maintain that six foot social distance. Try to educate the people around about the needs for self protection. At the same moment that you are living your voice to a the root of everything we do.


>> Thank you. I'm gonna ask a quick follow up. You broke up just a bit as you were giving the list of alternative approaches to making your voice heard. Was it virtual protests that you
>> Yeah, I think for instance virtual protest, but socially distance protest. So I think about here with the College of Medicine students what the students in the College of Veterinary Medicine students had some silent protests where they were spaced six feet apart wearing masks.

Students stood in silence or melt in silence for the period of time that the police officer on George Floyd's neck. So there are ways to do it to creatively, to let people know what's gonna happen. Writing campaigns, email campaigns, virtual events. And I'm not the most creative person in this regard.

But I think that there probably are people listening who are and I think that's what we need to is without suggesting that there's not a role for people in the streets. But don't assume that's the only avenue to be heard.
>> Thank you. Dr. Sampilo.
>> Yes, definitely.

I think that's a tough balance, but certainly, I think, the recommendations really haven't changed. But, we say try to be mindful of what's essential. And for some individuals, the need to protest, the need to have their voices heard in that way is is by definition for them essential as Dean Fairchild sort of mentioned it goes to their value system.

And so being mindful of being able to be true to themselves and be true to that idea of this is what I have to do for generations beyond me, right? It may be unlikely to see change immediately but we are still seeing some changes immediately too, so there's also that.

They're advocating for sort of the generation beyond them as well, but they're also starting to see some changes immediately in different systems in response to their protesting, so seeing the benefit of that as well. The other thing from just a behavioral health standpoint is one of the things that we know is when we are experiencing significant psychological distress, when we are experiencing significant issues around mental health.

One of the ways that we say that you can kind of help yourself feel better is to engage in ways that help others. And so this may also be, driven by some of that need to, take care of themselves in a capacity by doing what's necessary in their viewpoint.

And so, as Dean Fairchild mentioned, I would, obviously it's about balance. But we certainly wanna focus that if you're going out there, then we're focusing on harm reduction, and what steps do you need to take to keep yourself safe while at the same time again, honoring those values honoring what you've deemed essential from a socio-cultural standpoint and an individual standpoint.

But then also doing, what's important to you in terms of also navigating your own stress and mental health.
>> Yeah, thank you for that, Dr. Sampoilo for that that nexus of catharsis and safety is something that we have to consider as well. Miss Jones and then after that after we hear from Miss Jones on this question, we will move to we've been getting robust responses from participants with additional questions.

So we will move to some of the questions we've received during our panel today.
>> Thank you. So I absolutely agree with the other two panelists. And for us as we are going to this, over the last month over a month now with this reopening of Ohio I think we're moving toward more of a risk based strategy.

So thinking that, with everything that we do, whether it's expressing your versus limit, right and going out and doing active protesting, or going to a crowded grocery store or whatnot, that there's some risk that's involved. So absolutely, I think we are advocating the harm reduction strategies that were previously mentioned, with protests and with those types of gatherings.

Certainly the social distancing, wearing facial covering is more important than ever because as is noted that most of the time, you cannot maintain that six feet of social distancing, as well as making sure that if you're sick that people are staying home. So all of those messages that we have been putting out there.

And then also another area for consideration is that we know that, I believe earlier we were talking about asymptomatic carriers. And then our data we know that we have about 15% of our cases are actually asymptomatic positives. So even if you are feeling well but perhaps you go out you do your activity you're expressing your First Amendment right or whatever you're doing and then you come home and then perhaps somebody who's vulnerable or immunocompromised that even if you are not symptomatic, that there is still that chance.

So everything involves risk. And I think it's really our responsibility to ensure that people have the education and tools to make the best decisions for themselves and their families.
>> Thank you, Miss Jones. And again, thank you to all of the participants who are submitting questions via the chat.

We will now get to as many of those as we possibly can. And Colleen Fitzgibbons has been collecting those, Colleen.
>> All right, great. Thank you, Jennifer. Can everybody hear me okay? Okay, so our first question for the panelists. What can vulnerable populations do when their workplace is not providing protection slash accommodation for COVID?

For example, mask opportunities of social distance, no paid sick leave, etc. So, let's start with Dr. Fairchild.
>> So I think you need to tell your representatives that this is, whether you are registered to vote or not whether you are documented or not, you need to find a way to tell your representatives this is what's happening.

You need to find public health advocates. This is what is happening. So I mean, it's a matter of advocacy, but with the mindset that you shouldn't have to make the case alone. That you should try to create the broadest net that you can to help make for you.

You, so, think about this idea of charity is standing with standing behind for standing next to someone because I recognized that. There's a sort of,strikes gone bad in this country we don't have sort of the same kind of powerful labor movement like we have in some European countries.

So, there are risks to taking action against lawyers but we have to be aware of advocate in this country but I would say try to create the alliances, rate the social pressures that make this simply unacceptable not to offer the protection that's required based on level of risk somebody has.


>> Great, thank you Dr. Fairchild. Dr. Sampilo.
>> Sure, one of the things definitely that I also would echo is sorta that not going it alone, right, and so creating that social pressure. And for some of our populations that may be concerned about attracting attention. So I'm thinking our Hispanic and Latino population or immigrant population that may be somewhat concerned about making noise, if you will, due to issues of immigration or concerns regarding deportation and attracting attention in that way.

Making sure that their voices are heard, through partnering with their local community based organizations who have the trust of these communities. There are a lot of community based organizations and minority community based organizations who are doing on the ground work with these populations, with whom have the trust of those communities.

And so being able to also potentially use them as a resource to help leverage their voice a little bit with those concerns. And at the same time, use those same organizations also having a pulse on some of the issues that are facing those marginalized populations as well. It's going to be incredibly important in terms of trying to advocate for protections cuz we do need protections for our essential workers, not just our health care professionals, but our essential workers especially because our black and brown communities are over represented in those communities.


>> Thank you so much. Miss Jones?
>> Yes, absolutely agree. And for us at our health department and all of the 113 local health departments across the state of Ohio. We have been given the authority to basically investigate any type of situation where perhaps an employee is concerned about, perhaps not social distancing or other types mitigation strategies that have been placed within the public health orders that have been in effect since March in various different iterations.

So for any individual who was within our jurisdiction and I know other health firms have similar processes. They can actually report that anonymously if they choose online on our website and then we have staff of either a registered sanitarian or if it is a medical related office practice.

We have our public health nurses who respond to those to do some investigation and to follow up, to identify what is going on and to provide, education and to make sure that people have access to healthy, work site or a retail experience or etc other types of business opportunities as well.

So that's certainly something that we can do from a proto Matt Programmatic standpoint for constituents.
>> Thank you so much and Jennifer.
>> Yes, thank you Coleen. I just wanted to add to the important points that each of the panelists just made regarding this issue. The question we received a question from one of our registrants regarding how community members in general can participate.

So here is an area where we can all lend our voices to Dr. Sampilo's important point regarding not going it alone. So we know that our essential workers are in working environments such as grocery stores and restaurants and fast food. And when we as community residents are in those spaces and frequenting and patronizing those businesses when we notice that there is a lack of appropriate measures such as mass or social distancing.

We can certainly use our voices to call management or as was indicated, we can call Franklin County to to support those essential workers and getting the protections that are so critical to their health. So that's something that each of us can do.
>> So let me add to that we shouldn't be in those spaces without our masks on.

The evidence behind masks is quite clear. They are not about protecting ourselves but about protecting other people. So when we walk into one of those spaces without masks, we are sending the message. We do not care about your health. So we need to need to send that message first and foremost that your right to health is important to me.


>> I just like to chime in one point as well completely agree with everyone is is to also ensure that the this information being able to call Franklin County Public Health, being able to call these anonymous hotlines at that information to get to Miss Jones's point of education and making sure that that education is provided in different languages as well for our limited English proficient populations, and making sure that they're able to access that information to is incredibly important.

With all health messaging around these issues, but particularly related to this question as well.
>> Great, thank you, everybody. For our next question from from our Q&A box, so can panelists address representation in public health education and professions? At a minimum, shouldn't public health and health slash social service organizations be representative of the populations they serve?

If anybody wants to go first Dr. Sampilo, does that work for you?
>> Sure, yeah, so definitely I think one of the things that we are continuing to work on are, how do we diversify our workforce? From a behavioral health standpoint, we are in a critical shortage of behavioral health professionals who are look like the populations that they serve.

So we do know that from getting people into the field there's a recruitment concern, a recruitment issue and having to address that by developing pipeline programs to make young people are aware of the opportunities in public health, in behavioral health, in health care. But at the same time, also thinking about sort of how do we build the capacity of the existing work force to be able to serve these populations more effectively.

So that goes beyond just cultural competence training, that goes to constant work towards cultural proficiency and making sure that our workforce has the adequate training has the adequate background to be able to effectively provide the services. And that's not just on an individual provider level but that also works at the institution and agency level.

Are you addressing your gaps? Do you have a process for identifying gaps in terms of that service delivery to those populations and being able to make sure that your existing workforce to provide that, but certainly to your point we definitely want to diversify our workforce. I think there's ongoing efforts to be able to try and do some work in that space but also thinking about how do we adequately prepare the existing workforce while we're building up that diversification.


>> Right, thank you so much. Miss Jones?
>> Absolutely, so I certainly agree with that, and I think those were something that we would certainly echo and for us thinking about our COVID-19 response, we have I think in the media, there's been a lot of conversation around contact tracers.

And so for us, we do have a workforce that we were needing to build up pretty quickly to be able to interview cases as well as trace individuals who might be who have been identified as being at risk for developing COVID-19 or being exposed. So for us, we were very intentional with our recruitment and how we are trying to attract and retain public health investigators to do this work.

So we are actively recruiting approximately 20 some individuals. And one of the key measures of this is that we wanna make sure that they represent the community that we serve. So in the earlier statistics I gave you we're seeing disproportionate numbers in our non-white, non-hispanic populations. And then also thinking about our immigrant populations and perhaps those who are English as a second language.

So why we have tools and things such as language line and interpreter services, I'm having somebody who can relate to you, and have that lived experience, or somebody from your same cultural background is invaluable to us. So that is certainly an area that we are focusing on within like I was saying, this public health investigator title, but then as well as, as we were looking at hiring, recruiting retention of our employees at the health department in general.


>> The pipeline starts here. And so we need to, if they're not in the pipeline, they're not gonna be sort of available to be hired. So it's really important for colleges of public health schools of public health to take this seriously but also to provide the kinda continuing education that's going to allow people who are in the community to begin to develop skills and extend training to foster these needs.


>> Great, thank you, everybody. Let me make sure. Okay, so we have one final question. And so I will ask this last question and then we'll ask the panelists for some of their final thoughts. So the last question is actually towards Dr. Sampilo in regards to the the 21 Day Challenge, can you tell us a little bit more about that challenge?


>> Sure, absolutely. So, there is research to suggest that it takes about three weeks to develop a habit. So if you think about like, if you're going to engage in more exercise or eating healthier, they say it takes about three weeks to develop that habit more consistently. So using that sort of framework they've established these different programs or different ways you can go about developing what we call a racial equity habit.

And so, you actually can Google Racial equity 21 day challenge I feel like they're sort of fit to the different organizations that may be engaged in that work. But there's certain ones that are more general for the general population, and essentially what it offers Is every day for you to track some sort of activity.

So being intentional about engaging in some sort of step towards racial equity, whether that's listening to a podcast to get information, whether that's reading some of the seminal works when it comes to racial equity or intersectionality from Kimberly Crenshaw, to really make some headway in terms of your awareness, knowledge, beliefs, attitudes, towards systems of oppression, power, and privilege.

And so those habit challenges are just great cuz they're pretty structured in terms of what you can do. And it sort of just gives you a nice little plan, if you will, to engage in that work over the course of three weeks, with the expectation or the intent that it'll establish the sustainable habit moving forward.


>> Great, thank you so much. So now I'm just gonna ask our panelists if you have some final thoughts for our participants. Ms. Jones.
>> Yeah, so I just want to say thank you again for this opportunity. So, for us or for me, really, COVID-19 has certainly put, I think though, rolled on its head a little bit, especially here locally, I can speak for our agency as well.

But I think for us, we can't lose sight that COVID-19 and the disparities that we are seeing are really, truly a symptom of a larger inequity narrative that we have within our country. So for us even though COVID-19 is a pretty all consuming response, we need to make sure that we are addressing and being intentional as it relates to addressing racism in our internal structures, as well as externally, especially as we look at some of our larger systems and look at our other structures and institutions.

So thank you again.
>> Thank you, Dr. Sampilo.
>> I definitely would echo Ms. Jones' point. There's a saying nothing about us without us. I've tried desperately to figure out where that quote originated from, but it's been attributed to various sources. So I apologize for not quoting the original source, but that quote, nothing about us without us I think is essential and central to the work that we're doing here.

In that those communities of color are marginalized communities, none of the progress or work can be done without centering their voices and having them sort of centered at the forefront of our efforts. So if we're making decisions or we're making choices for communities without their input without centering or amplifying their voice, then those efforts are likely to fail, not to be sustainable, and frankly won't result in the progress that we intend to see.

So definitely, if there's one thing from me today that you can take with you is that mantra of nothing about us without us and just following through with that in your work.
>> So I don't know who it was, but I'm pretty sure that comes out of the women's movement in the 1970's the nothing about us without us.

It's a great quote, I've used it many times. And so I would just, build onto the themes the other two fabulous panelists have laid out as they've closed up. Public health has never been. So we are the thing that you normally don't see unless it's not working. And now, we have this moment where unfortunately we see that the myriad ways in which public health is not working, not because public health doesn't work, but because it hasn't had the sustained attention that it needs.

So the challenge before us is how do we keep it in the imagination and popular mindset? How do we maintain it as visible without sort of losing attention as being? Because, the history is that as the collective sense of vulnerability, as the collective sense of threat begins to fade, money fades too.

So we have to seize on this moment. We can't wait. We can't go slow and we have to now they're gonna be lasting dribble, we have to keep these front and center. We have to keep public health visible.
>> Thank you so much to each of our panelists.

We appreciate your thoughtful perspectives. We appreciate you sharing your wisdom and experience and encouraging us to also be deliberate and thoughtful about seizing this important moment. I just want to again say thank you to all of the participants on today's webinar. And to remind everyone that this is the kick off to the 21st annual summer program presented by the Center for Public Health Practice at the Ohio State University, College of Public Health.

The ongoing summer program is available to be viewed and participated in at your convenience. If you have not registered yet, please do so at 2020 Summer Program at the College of Public Health. Again, thank you all and enjoy the rest of your day.
>> Thank you.
>> Thank you.


>> Thank you.