outstanding member contributions to our college and profession, and remarks from our President-Elect, Dr. Tinette Castle-Wood. Be sure to create a profile and participate in the PM21 Networking Challenge, interacting with your colleagues, attending events and sessions, and earning points to be entered into a drawing to win a complimentary PM22 conference registration. We'll be starting conference events today with the State of the College with our CEO Donna Grande, ACPM President Stephanie Zaza, ACPM Treasurer Doni Shen, and ACPM Secretary Sandra Guerra. This will be followed by our KBS lecture featuring Dr. Aletha Maybank, the Chief Health Equity Officer and Senior Vice President of the American Medical Association. Dr. Maybank will also be featured in a plenary panel on building social justice and health equity on Tuesday afternoon. Remember to join us on social media and use hashtag PM2021. Concurrent sessions for today include a patient safety course, partnerships in public health, and managing stress and weight during COVID. And please join us this evening for the grand opening of our Partner Corner, the poster exhibits, and our virtual tour of the Smithsonian Museum of Natural History with our guide Dr. Steve Rockauer. We're so glad you're here and hope you enjoy PM21. Good afternoon, I'm Katrina Rhodes, chair of the American College of Preventive Medicine 2021 Annual Conference, here with Dr. Richard Bruno, our highly regarded vice chair. On behalf of ACPM leadership and planning conference committee, we have the honor to welcome you to PM21, Building Resilience, Preventing Pandemics, Health Inequity, and Climate Change. We are so excited to have you with us today and share with you some of the highlights of this year's conference and today's events. Now, while COVID precludes us from meeting in person, we're pleased to offer you an all-virtual conference. Our conference theme is Building Resilience, and sub-themes include climate change and human health, social justice and health equity, and COVID-19 pandemic preparedness. Our conference tracks, with sessions that run throughout the conference, include population health management and health technology, public health practice innovation and community medicine, research evidence and policy, clinical preventive medicine and lifestyle medicine, global health and environmental medicine, and the future of preventive medicine training and advocacy. Our oral concurrent sessions include updates from the U.S. Preventive Services Task Force, the Community Preventive Services Task Force, and the American Board of Preventive Medicine. Plenary sessions throughout the conference will highlight our conference theme and sub-themes, including Building Resilience during the COVID pandemic, Climate Resilience and Environmental Justice, Building Vaccine Confidence with Outreach Efforts and U.S. Regulatory Safety Practices, Social Justice and Health Equity, and Building Public Health Resilience, featuring health officials on the front lines and legislative efforts behind the scenes. Keynote speakers include Allison Cassidy from the EPA, Chelsea Clinton from the Clinton Foundation, Peter Marks from FDA's CBER, Amanda Cohn from the CDC and ACIP, Wayne Frederick from Howard University, Anand Parekh from the Bipartisan Policy Center, Ruben Warren from Tuskegee University, Ursula Bauer from the Office of Surgeon General, Wilma Wooten from the San Diego Health Department, and Clarence Lamb from the Maryland State Senate. The conference also includes scientific poster presentations on a variety of public health and preventive medicine topics and an opportunity to earn more than 25 CME hours to support your maintenance for certification and recertification. Our professional development events include a Young Career Lecture, an Advocacy Training Workshop, and there will also be networking opportunities during our Conversation Cafes, our Congressional Hill Visits, and social events including a virtual museum tour. Our conference will close with our annual ACPM Awards, recognizing outstanding member contributions to our college and profession, and remarks from our President-Elect, Dr. Tenette Russell-Wood. Be sure to create a profile and participate in the PM21 Networking Challenge, interacting with your colleagues, attending events and sessions, and earning points to be entered into a drawing to win a complimentary PM22 conference registration. We'll be starting conference events today with the State of the College with our CEO, Donna Grande, ACPM President Stephanie Zaza, ACPM Treasurer Doni Shen, and ACPM Secretary Sandra Guerra. This will be followed by our KBS Lecture featuring Dr. Aletha Maybank, the Chief Health Equity Officer and Senior Vice President of the American Medical Association. Dr. Maybank will also be featured in a plenary panel on building social justice and health equity on Tuesday afternoon. Remember to join us on social media and use hashtag PM2021. Concurrent sessions for today include a patient safety course, partnerships in public health, and managing stress and weight during COVID. And please join us this evening for the grand opening of our Partner Corner, the poster exhibits, and our virtual tour of the Smithsonian Museum of Natural History with our guide, Dr. Steve Rockauer. We're so glad you're here and hope you enjoy PM21. Good afternoon. I'm Katrina Rhodes, Chair of the American College of Preventive Medicine 2021 Annual Conference, here with Dr. Richard Bruno, our highly regarded Vice Chair. On behalf of ACPM leadership and planning conference committee, we have the honor to welcome you to PM21, building resilience, preventing pandemics, health inequity, and climate change. We are so excited to have you with us today and share with you some of the highlights of this year's conference and today's events. Now, while COVID precludes us from meeting in person, we're pleased to offer you an all virtual conference. Our conference theme is building resilience and sub themes include climate change and human health, social justice and health equity, and COVID-19 pandemic preparedness. Our conference tracks with sessions that run throughout the conference include population health management and health technology, public health practice innovation and community medicine, research, evidence, and policy, clinical preventive medicine and lifestyle medicine, global health and environmental medicine, and the future of preventive medicine training and advocacy. Our oral concurrent sessions include updates from the U.S. Preventive Services Task Force, the Community Preventive Services Task Force, and the American Board of Preventive Medicine. Plenary sessions throughout the conference will highlight our conference theme and sub themes, including building resilience during the COVID pandemic, climate resilience and environmental justice, building vaccine confidence with outreach efforts and U.S. regulatory safety practices, social justice and health equity, and building public health resilience, featuring health officials on the front lines and legislative efforts behind the scenes. Keynote speakers include Allison Cassidy from the EPA, Chelsea Clinton from the Clinton Foundation, Peter Marks from FDA's CBER, Amanda Cohn from the CDC and ACIP, Wayne Frederick from Howard University, Anand Parekh from the Bipartisan Policy Center, Reuben Warren from Tuskegee University, Ursula Bauer from the Office of Surgeon General, Wilma Wooten from the San Diego Health Department, and Clarence Lamb from the Maryland State Senate. The conference also includes scientific poster presentations on a variety of public health and preventive medicine topics and an opportunity to earn more than 25 CME hours to support your maintenance for certification and recertification. Our professional development events include a young career lecture, an advocacy training workshop, and there will also be networking opportunities during our conversation cafes, our congressional hill visits, and social events including a virtual museum tour. Our conference will close with our annual ACPM awards, recognizing outstanding member contributions to our college and profession, and remarks from our present elect, Dr. Tenette Castle-Wood. Be sure to create a profile and participate in the PM21 networking challenge, interacting with your colleagues, attending events and sessions, and earning points to be entered into a drawing to win a complimentary PM22 conference registration. Welcome back. For those of you just joining us, the KBS lecture is the final segment of our opening session. The KBS lecture is ACPM's highest honor, providing a forum for nationally recognized leaders to explore key issues and highlight innovations in health promotion and disease prevention. Past lecturers have included Drs. Jonas Salk, Elizabeth Barrett-Connor, David Satcher, and Ron Davis. The ACPM Board of Regents established the KBS lecture in 1979 to recognize the contributions of Dr. Catherine Sturgis in research, teaching, and service in the field of preventive medicine, for her courageous and effective fight against disease and disability, and for her wisdom and leadership in attaining preventive medicine goals. Dr. Sturgis was a pioneer in preventive medicine as the chair of preventive medicine at the Women's Medical College of Pennsylvania and as the first woman president of ACPM. This year's KBS lecturer, Dr. Aletha Maybank, has focused her career on the transformation of the medical profession itself to uncover, recognize, reconcile, and reform structural and other forms of racism to create a profession that understands, honors, and creates health equity. At this inevitable turning point in medicine and society, Dr. Maybank's work is demonstrating the kind of leadership and understanding of the relationship between public health, clinical medicine, and social structures that are the hallmarks of preventive medicine. Dr. Maybank joined the American Medical Association in 2019 as the Association's inaugural chief health equity officer, working to embed health equity in all of the work of the AMA and launching the AMA's Center for Health Equity. Just this past week, Dr. Maybank and her team released the first ever AMA strategic plan to embed racial justice and advance health equity. Dr. Maybank received her MD from Temple University School of Medicine and an MPH from Columbia University Mailman School of Public Health. She is board certified in pediatrics and general preventive medicine and public health, having attained her preventive medicine residency training at SUNY Stony Brook under the leadership of Dr. Dorothy Lane. In her distinguished career, Dr. Maybank launched the Office of Minority Health in the Suffolk County Department of Health Services, where she served as its founding director. She later joined the New York City Health Department first as the assistant commissioner of the Brooklyn District Public Health Office, where her bureau did precedent-setting work in community-driven neighborhood planning. Following this, she served as the deputy commissioner and launched a new center for health equity within the New York City Department of Health and Mental Hygiene. For the center's work in transforming the culture and practice of the department, it received international recognition from both CDC and WHO. Dr. Maybank also teaches medical and public health students on topics related to health inequities, public health leadership and management, physician advocacy, and community organizing and health. She is a co-founder of We Are Doc McStuffins, a movement created by African-American women physicians inspired by the Disney character Doc McStuffins. I am incredibly honored to introduce one of Preventive Medicine's own, Dr. Maybank, as the 2021 KBS lecturer. Her work in dismantling systemic oppression and inequality and taking a hard look at racism within the medical profession to remake it into something better is incredibly important to the future of health care. Without further delay, it is my great pleasure to give the floor to Dr. Aletha Maybank. Welcome. Thank you. Thank you, and good afternoon, everyone. It's such an honor. And thank you, Dr. Zavza, for selecting me for the KBS lecture this year. It's just so warming. It's really a tremendous honor. I want to thank also Dr. Katrina Rhodes, who I know is serving as chair, who's been a colleague and a friend, especially this time, this last year, during some rough times that we've had. And just her support has been tremendous. And I really want to also thank Dr. Adana Grande, who is CEO of ACPM. Adana, it's been fantastic and really tremendously rewarding to re-engage with ACPM in very deliberate and meaningful ways over this last year. And I really look forward to doing more directly with ACPM. As was mentioned, I'm also trained in pediatrics. And some folks know my story that I didn't have a desire right away when I finished pediatrics to really practice medicine. I felt the culture was very ethnocentric. And I didn't really favor getting told oftentimes that I shouldn't be paying attention to all these conditions that are impacting my patients' lives and where they worked and what they had access to. And if I'm trying to help families be healthy and lose weight, I was told oftentimes, well, that's the social worker's business, not necessarily my business as a physician. And so I had to figure out for two years after I finished residency for peds. And I worked in a NICU to kind of buy time and figure out what I wanted to do. And after a second year, someone approached me and said, you know, they have this slot that's open over at SUNY Stony Brook in a preventive medicine program. And it's also connected to public health. Now, I didn't know too much about preventive medicine yet at that time, but I definitely knew public health from going to Hopkins for undergrad. And my major was natural sciences public health. So I thought this was great. You know, I get a residency, they're going to cover, you know, my MPH at Columbia. This is awesome. And I would say that for me, it was really one of the best decisions of my career that I ever made. And the flexibility that the program offered and allowed for me to grow and figure out, you know, who I was going to be and how I was going to show up as a physician was tremendous. And then more specifically, I had an amazing program director, Dr. Dorothy Lane, who many of you know, Dory as Dory, I can't call her Dory though. She says I can, but I can't. She will be Dr. Lane forever. And that's what she'll be. But she really supported the growth of all of us and all of her residents and she and her faculty and the team that was there, they allowed us this space and really with such patience to move through and to learn what preventive medicine was really about in many different places and spaces. And so it was during my second year of preventive medicine in which I got this amazing opportunity by Dr. Brian Harper, another ACPM graduate. And he was commissioner in the New York, sorry, at the Suffolk County Department of Health. And during my second year, you know, he wanted to start this office of minority health. I'm still a resident, you know, and so how am I going to do both? And in talking to Dr. Lane, you know, Dr. Lane said, well, we're going to figure it out. And you're going to be able to take up this opportunity and finish residency at the same time. It was going to be difficult, but she allowed that to happen and I'll never forget it. I will always remember because it is the reason why I'm able to sit here to this day. And I just want to say in the space of doing racial justice, it's that kind of belief and type of door opening that many physicians and young physicians and residents need and especially physicians of color, that type of faith and belief. And just, it's not just, you know, a demonstration of just justice, but also really of love from my perspective and love for one's profession itself. And we just, we need more of that as we do. And as we work to fight this fight of racial inequity and racial injustice in our country. So I just want to really thank everyone for the opportunity to speak with you today and thank Dr. Lane also for your belief in opening doors. So I'm going to move into the lecture and the conversation and it's perfect timing. As was mentioned, our strategic plan was released last week. So this is great. I think this is the first specialty that I'm really presenting the plan to. And kind of, you know, some of the roots behind the plan I think are important to know because as we have gotten lots of great attention and support while doing the plan and now the release of the plan, as you can imagine, there's tremendous amount of pushback as well. Just considering who we are as a nation and who America is, you know, not everyone is in belief of this. And within our profession, you know, it's the United States of America. And so, great, it works. So we'll talk, you know, somewhat about understanding, to get just a basic understanding of structural and systemic racism, identify some of the actions that I think we can take as organized medicine, and then just learn other specific ways of how to deconstruct and work with patients. I think our colleagues even more importantly, sometimes as well as communities that we are serving. So I'll start off, you know, always with the land and labor acknowledgement. This is in the opening of the strategic plan. And this is very new for folks within the medical profession, more common probably in public health and in different parts of the country, but really important that we acknowledge all who have been living off of stolen lands of the indigenous people. And then also acknowledging the labor of those who were forced to this land of African descent and have suffered, you know, for many generations. But we wanna make sure that we always celebrate really the strength and resilience of indigenous people and descendants of Africa and all that they've shown and given to this country and worldwide. And I fully recognize that I'm here speaking with you today because of the shoulders that I stand on and all the work that has been done from those who before me. So during this time of COVID, you know, there's a lot that happened very quickly and very rapidly. Many things where folks didn't think were even possible prior to COVID. And one example, you know, is around telehealth and telemedicine and COVID came around and all of a sudden, now we do it and we figured it out. And we figured out how to put it into our systems and we're working on how to strengthen it. And I would say the same thing is happening for racism. You know, racism was considered really a, not a, I say sometimes like a bad word. You know, it was a word that just wasn't used. It's people are very uncomfortable with it. And I'm sure there's still people very uncomfortable with it today, but COVID along with the public murder of George Floyd, I think really shifted this nation in many ways. And we started to see now a time in which we started to see, you know, folks declare racism being a public health threat and a public health issue. And the American Medical Association, which many folks I know did not think that AMA would have come out, you know, during the summer with a pledge, the board of trustees to say that the AMA was gonna actively work to dismantle racist and discriminatory policies and practices across all of healthcare. And this was further reinforced in the fall when actual resolutions were passed and adopted, led by the medical student section, who many of us know, you know, they have the analysis and they're really driving a lot of the social justice work and racial justice work at the healthcare system level. But we passed policies to name and act on racism as a public health threat, to rid our healthcare system of racial essentialism and to recognize race as a social, not a biological construct, and to support the elimination of race as a proxy for ancestry, genetics and biology and med ed research and clinical practice. These are pretty bold policies. I think for healthcare overall, pretty needed for healthcare overall as well. And so these policies have really provided an open door for us, especially at the Center for Health Equity and the American Medical Association to really push forward and to use language very explicitly and very directly on where we're trying to go. And so there's been plenty of folks, as I've already mentioned. So there are healthcare institutions and organized medicine starting to name racism as a public health threat. The American Public Health Association has a mapping system on their website. I think there are about 194 now, entities across the country, governmental entities across the country that have declared racism as a public health threat. We know on March 1st, many of you know, the National Institutes of Health announced an initiative to address the impacts of structural racism in biomedical research. And on April 8th, this last year, the CDC for the first time declared racism as a public health threat. So we're at this moment to really, we're at this moment actually where we've gotten to the point where we're naming racism. There have been folks, and when I worked under the leadership of Dr. Mary Bassett, she would, this was common wherever she went, that we have to name it. We have to name it in order to do something about it. So now we're at the point where medicine is naming it. Public health has already started naming it. Medicine now is starting to name it. And now we're at the point of having to figure out, so now that we've named it, what do we do? What are the actions? What's the policy? What's the programmatic work? What's the research work? What's the culture change? How do we really put this into practice? How do we understand even how racism impacts the work that we're doing? And how do we teach that to residents and students? And how does all this work over time, understanding the political environment, how does it become sustainable? How is it sustainable? All of these are important questions and considerations as we move forward. But I do say that we have made this big step, and I think it's important that we acknowledge it, not just us as the AMA, but as medicine as a field. And so as a reminder, just so that there's just a little bit of level setting about definitions around racism. And this is a broader race definition really pulled from Dr. Kamara-Jones, that racism is a system of power and oppression that structures opportunities and assigns value based on race. And it unfairly disadvantages people of color and unfairly advantages whites. And she would further say it's that society of its full potential. And there are many levels, there are several levels, there are internalized, interpersonal, institutional, structural. And our strategic plan does take its time. As you will see in the beginning, if you get a chance to take a look at it, we really wanted to make sure that one, we provided kind of a vision of where we think we should be in terms of doing anti-racism work. In addition, being very clear that medicine, probably not as far as long as public health. And all of you are at that intersection of medicine and public health, understating that public health has probably been a little bit more aligned with social justice principles and values earlier than medicine. I'm not saying public health is perfect or optimal either. There's a lot of work in terms of public health, in terms of embedding anti-racism work. However, medicine came over to the healthcare space, I just realized the tremendous gap and that it was really important that we help bring people along. And so there's a primer in the strategic plan that really goes through concepts and definitions and language. So that by the time that folks really got to reading the strategy part of the document, we were hopefully had some level of, a little bit of some shared language and common language and some shared analysis about why we were going in the direction that we were going. And so that's why the document is also 80 something pages long, not typical for a strategic plan at all. But we knew that it was important to kind of provide this as an educational tool as well. And so there's plenty of evidence we have now that's been published around, the root cause of structural racism and its impacts on health and its production of health inequities in this country is the paper again by Dr. Bassett, pretty landmark paper. So for those who haven't read it, highly recommend, but that structural racism really shows up in all of our systems across the country, which really means that all of our systems have an impact on the health of people if they're rooted in us, are structured with racism. We know that it happens and it translates across generations. We know that early trauma and discrimination and racism at an early age, impacts our health at an older age. And a lot of the work around the adverse childhood experiences is really starting to elevate that. And I think there's gonna be more work in that space to pay attention to. And then we know the body of work that's really talking about the direct impacts on the body, excuse me. So clearly differences in resources and where people live, the stress that all of this causes on communities and bodies, the shaping of genes that happens and the increasing of stress hormones and cortisol that actually cause elevated levels of inflammation and ultimately cause harm on the body, all leading to inequities that we see in our data and in people and communities. These are two papers that were published, I guess about a little less than a month ago by myself, Dr. Rhea Boyd, Dr. Nancy Krieger, I'm sure many are familiar with, and Dr. Fernando DeMaio, who's on my team at the Center for Health Equity. And we had actually been thinking about doing these papers for a while. I will say the JAMA incident, which I'll come to a little later, definitely sparked some urgency around actually publishing them. But in the fall, we started to think about this we were working towards our own policies as the AMA and the anti-racism policies, wanting to be a little bit more critical and exact about what is happening with medical journals. And we know really for the most part that the healthcare industry has really avoided talking about racism. And our first sentence on one of the articles says, "'Ignorance is neither neutral nor behind, "'especially when it cloaks evidence of harm.'" And so, as I've mentioned already, the impacts of structural racism on health are pretty well established. And there's lots of credibility around this. And so we examined the top four medical journals in the world and really found that most of them really never published scientific articles that name racism as a poor driver of health. So over the last year, we definitely could see in 2020, you know, that the four articles, the four journals on the right, the medical journals, there was definitely a dramatic increase in the word racism in 2020. However, most of these were really commentaries and not really, and viewpoints, but not really empirical studies. And we know that that is a problem, you know, and really more than over the 200,000 articles that were published over the past 30 years in New England Journal of Medicine, Lancet, the journal JAMA, and BMJ, less than 1% actually included the word racism anywhere in the text. And among the few articles that did, upwards of 90% were predominantly, again, opinion pieces and not scientific investigations. And so, you know, we are a field that really maligns anecdotal evidence as like the least rigorous and most untrustworthy. And so what does that mean and what does that tell us for medicine? And what does it leave out? So we really said the name that there are four consequences for not really having these studies present within all of our medical journals really overall. The first is that non-publication of research conveys the message that racism and its impact on people's health are not important and are not topics that really warrant scientific study or publication, thereby really minimizing concerns about these harms among scientists and funding agencies and the broader public overall. The second consequence by not having this research, especially in a field where, you know, we do evidence-based clinical medicine, again, it fosters ignorance about these issues among health professionals who are trusted as sources of information. And then that transmits this ignorance to their patients with the clients and again, the broader public. The third issue is that this non-publication of evidence undercuts and limits important kinds of evidence needed for policymakers, health agencies, funders, lawyers, advocates, to complement their work on how to prevent racism and to figure out how to rectify the harms that are actually happening. And then lastly, and I'm sure there are other harms too, but these are the four we named. But lastly, not publishing this kind of work effectively really excludes scholars who study racism and health from high-impact journals, harming not only knowledge dissemination, but also really the potential career pathways of scholars, as we know, publishing in these journals means a lot for trajectory. And so I've been, you know, reflecting a lot more... There we go. Reflecting a lot more about, you know, what is our way forward in this environment? Whose work is this is one of the key questions. This actually, this has been brought up a lot around the COVID, this whole time of COVID-19 about the trustworthiness versus trust, you know, and really, you know, this is an issue of lack of trustworthiness on the part of institutions, but who's responsible, you know? And we do say, you know, that we all have a responsibility within the medical profession to be able to name racism, to find pathways to dismantle and do, to find pathways to reimagine and redesign, but the burden cannot be left upon those who are black and brown, those who are marginalized to do this work solely. And, you know, I even think about myself in doing this work, you know, it's not easy work. And at times it can be very lonely work. It's exhausting work. And we all need, honestly, in these spaces, even moving a little bit beyond allies. Allies to me is a bit of a, it can be a bit of a passive term where folks are kind of waiting to be told to kind of enter the space. And I truly need like accomplices and co-conspirators and all of us to kind of show up and do this work. And so it's, you know, I've been really reflecting on that piece. I've also been reflecting on about narratives and I'm gonna talk to you with you about some of the kind of technical parts of doing the work a little bit later in the talk. But we also have to look at kind of what is being said in our society, what's being said in culture, these dominant narratives that actually completely undermine our ability to advance equity beyond the technicalities of like diversity and who's there and who's not there. But what are the stories and narratives of people that really obscure power and responsibility and how do we do more to really, to dig into that and have an analysis around this. There was a great publication by NACCHO, Advancing Public Narrative for Health and Social Justice that came out, I would say about four years ago. Richard Hoffrichter, who is now retired from NACCHO, was really a part of leading this effort, but it's really a fantastic document, some fantastic work that I highly recommend people check it out. And then Kamara Jones expands on this idea of narrative and dominant narratives and she refers to them as, we have to see these seven value targets to really do anti-racism action. And for one of them is moving beyond just this focus on the individual and individualism, moving beyond the ahistorical stance, understanding that everything has a history behind it and it's rooted in history that is right here in the present myth of meritocracy, the myth of a zero sum game, the limited future in orientation, the myth of American exceptionalism. And then I think the last one that, now we're naming racism and I've been reflecting on this for a couple of years that I'm not sure if naming racism is sufficient enough, but we have to be able to also name white supremacy as well as patriarchy. And that being just to break it down as far as the definition, the false notion of the hierarchy of human value based on skin color with white being on top, sorry, there's a little mistake there, with white being considered to be on top. And so, if we don't name that belief system, we're missing a lot. And I think now I am starting to see more of a movement. So this is from the American Journal of Ethics that really has done some exceptional work over years that doesn't necessarily get as much attention as the Journal of American Medical Association. But this Journal of Ethics is really, I think quite profound at times. But now we're starting to name more so, white supremacist policies, but also the impacts of colonialism as well. And the importance of us having to get to that space I think is critical too. Starting to understand privilege and how does privilege show up and how are we using our privilege to advance justice I think is really critical. And there's racial privilege, I think, and there's also even just physician privilege and physician supremacy that also exists that we have to acknowledge and how we talk about issues related to health and racial justice. In this photo is Peggy McIntosh, who I had the opportunity, this was not 1988. I would have been, I think in middle school or something like that, the picture. But I met her a few years ago at a WK Kellogg Conference and had the wonderful opportunity to sit and talk with her about my experience growing up in Harrisburg, Pennsylvania as one of the only black children and her work to really help systems and education systems better address white privilege and how to unpack that. And it was part of StoryCorps. So actually our conversation, if anybody's interested is in the National Library of Congress. But I'm reflecting a lot about how do we use our privilege in ways that are meaningful and do not continue to harm. Again, I mentioned before colonization and being able to name that I think is also gonna be an important evolution and we do do this in the strategic plan. Dr. Myra is over at UCSF. She's fantastic, but also pushing us to think about racial capitalism and the impacts of that as it relates to health inequities and being able to really name that the harm upon those who are racially marginalized really has direct roots from our system of capitalism within this country. And that it leads to long-term, again, generational trauma and inflammation over time. And then lastly, before I start to get more so in the specifics of the strategic plan, as many of you know, we had an incident now probably about two months ago where there was a tweet that said physicians weren't racist by JAMA and then a corresponding podcast by two white male physicians talking about structural racism who really didn't have expertise in structural racism and really naming that it didn't exist or we shouldn't be talking about it. We need to find other ways. And I think beyond just even talking about racism and the systems of racisms and the beliefs of white supremacy is really making sure we have conversations around power and how powerful agents, whether afforded power by their credentials or the positions within governance or assets or membership in dominant socially defined groups, we have to really talk about that oftentimes beyond just sexism, racism, heterosexism and talk about how there is the desire to seek to preserve their power by bolstering ideas favorably to their status by challenging, distorting or suppressing knowledge that questions the legitimacy of their power. And if we don't really root some of this work in hard conversations and who has to give up power, who's trying to hold on to power, we also lose the opportunity, I think to advance justice and equity work. And so our roles, you know, I've come to say are really naming and calling out white supremacy, racism and other ideologies and power, as I mentioned, making visible, not mere, just descriptive inequities and how these ideologies and systems operate to cause harm or concentrate power within our institutions. And then we have to also ask then, as I was alluding to before, is how do we inspire power held by a few to be and to do differently beyond their own self interests and own experiences and to really care? And this is, that's a hard question that I'm working through as I'm doing this work. You know, as the strategic plan, as I mentioned, it was released lots of support, but then what do I do with folks and how do I engage with folks that may not be as supportive of this work and of this plan because of their context of coming into the space. And so this is the beautiful cover and the beautiful design of our plan that was released. You know, and our mission, just to read the mission is that, you know, we envision a nation in which all people live in thriving communities where resources work well, systems are equitable and create no harm nor exacerbate existing harms, where everyone has the power, conditions, resources and opportunities to achieve optimal health and all physicians are equipped with the consciousness, the tools and resources to confront inequities and dismantle white supremacy, racism and other forms of exclusion and structured oppression, as well as embed racial justice and advance equity within and across all health systems. That's our mission that is listed at the very beginning of the document. And in order to do this work, you know, we again took the time to make sure that it was really rooted in theory and frameworks that are existing that, you know, I have learned over the years that my team has learned. We've consulted with many experts externally to help support in guiding this document and also internally at AMA and folks who have been really working, you know, to fight and push this work forward. And really again, thanks to Dr. Katrina Rhodes who was a part of the task force that actually put forward the resolution and the recommendation for there to be a center for health equity at the American Medical Association. And so our theories of change, we felt are writing the injustices of our past, challenging the dominant narratives, as I mentioned before, centering the voices and ideas of those most marginalized in any space, adopting an anti-racist and intersectional approach or race and approach, recognizing that oftentimes, you know, race, as I mentioned before, racism is the most difficult one for folks to talk about and discuss. It's been ignored. And so, you know, we're not excluding other forms of oppression, absolutely not, because that would not do us any justice, but we are making sure that we are naming and leading with racism and anti-racism work at the intersection. Also embracing public health frameworks of health and moving upstream and acting upstream. Again, as many of you know, I'm a public health person. I've worked in governmental public health for most of my career. This is new, you know, these last two years, and I fully believe in public health and all that it brings. And I also see the segregation between the two and how that's harmful and how that really undermines the advancement of equity as well. And then lastly, really implementing an inside outside strategy for organizational change and transformation, which I'll talk about a little bit more. So our five approaches, you know, are one, working to embed equity. And I'll talk about that in some detail and practice and our process actions, everything that an organization has. And that's really the organizational change for the internal work. Building alliances and sharing power via meaningful engagement. Ensuring equity and innovation for marginalized and minoritized people in communities. Pushing upstream to address all determinants of health and the root causes. And to foster pathways for truth, reconciliation, healing and transformation on our five strategic approaches that will provide kind of the guideposts on how we organize our work and move forward. But understanding that, you know, the document will be iterative to some level and we'll learn over time what needs to change and what needs to stay and what needs to be strengthened. So the first is embed. And a beautiful quote by Alice Walker is that we will be really misled if we think we can change society without changing ourselves. And so, you know, embed, again, I mentioned before, this is really about all that's happening within our organization. So AMA, right, 270,000 members. We have an 1100 management team, which is pretty sizable for a membership organization. And that management team, right, is responsible for executing on policies that are passed. And so it's really, really critical that the management team has this lens and they are able to kind of go through work and be able to challenge and see where inequities show up in their day-to-day decisions and within the context of their mental models and what they do and how they make decisions. Because that's what influences the external part of the work. I don't believe we can do equity outside of the organization with other people for not looking internal to our own institution. So that's a lot of, you know, building the capacity of our teams and staff, as well as membership as well. Looking specifically right now, we have already started across enterprise work groups on workforce equity and contracts and budgeting equity, as well as communications and publishing equity. We're making sure we're integrating a trauma-informed lens because a lot of, you know, when you start to do this work, conflict arises, there's no doubt. And you have the chance and potential to re-traumatize people when we didn't mean to. And so, you know, we will also be measuring this change over time. And so here's one of kind of the logic model, just thinking about the inside outside strategy. And on the left, you know, are sections, you know, within our organization that really typical for most institutions of workforce and, you know, communications, data, budgets and contracting. And again, saying that we have to really have specific focus on all of these and embedding racial and gender justice and other kinds of justice. And then we will look at our levers of change and our assets that we have in order to amplify and strengthen this work. And hopefully over time, one, being able to change culture at the organizational level and our programs, our research and policies, and that equity is embedded in those, that we're able to contribute to a greater understanding of health and equity and racial injustice, to the field of health equity, that we actually do address structural and social drivers of health and health inequities, and that we're also confronting the root causes such as racism and white supremacy and ableism in our health system. And so then all of this leading to driving, improving health outcomes and closing the gaps, being very clear that AMA alone, we know we cannot do that alone, that that's a lot of folks work, that's the entire country's work, but that's what we're working towards contributing to. And then becoming an anti-racist multicultural organization overall. And we'll have to evaluate that over time and learn over time and adjust. We're using this, I'm just showing this quickly. This is from Race Forward, which is the largest racial justice organization, one of them in the country. And this is their model of normalized, organized, operationalized. It's a national standard. They have worked with hundreds of governmental entities across the country, public health institutions, but also other institutions and cities to implement this particular framework. We used it when I was at the New York City Department of Health, worked very closely with them. So the normalized is that area of where you have to create spaces to ensure that you're getting to a point of having a shared analysis, having conversations, that's one of our big barriers, being able to do that. And that's where a lot of the training parts come into play. And so, and as folks know, training alone will never be sufficient enough to become an anti-racist organization or an individual, but it is an important part to have that type of training. It's beyond just implicit bias training. I tend not to use implicit, I tend to use bias if we're gonna go that route, but we also need other types of trainings as it relates to gender oppression and anti-racism. And then the second part is organized at the institutional level. This is really critical really to identify champions across the organization, but also to kind of move the work in a very structured way and to offer accountability amongst staff and teams and have an infrastructure to help do so. And so we've started to build that out with having, we have a health equity work group that is made up of representation from every single business unit and they meet on a monthly basis. Each business unit has their own equity action team to kind of implement the same model, very specific to their own expertise. And I mentioned earlier the cross enterprise work groups. All of them are very, very critical at this point in time. And then operationalize is the third thing, what are the tools? What's the data that people need to have in front of them to make these decisions and to do things differently, to ask questions. How is racism showing up here? How am I ensuring I'm not denying care, et cetera? And then we added one of the biggest learning lessons that I learned when I was at New York City Department of Health, again, is that you have to be very intentional about setting up systems of trauma-informed and healing supports, or else people will feel extremely burdened, extremely exhausted, unsupported in doing this work, somewhat isolated, and again, potentially re-traumatized. We have to have a lot of spaces of where we're just talking about, how's this going for you? What did somebody say that may have felt like it was triggering them and how do you deal with that and how do you process that? How do you have conversations around racism with your teams? All these are important parts of the training, or the work rather. The other piece, just really quickly, this is for our internal part and our internal visualizing and for our teams and staff. We did add equity as a value to AMA's values, and this one is really focused on centering the voices of those most marginalized within our institution to make sure that we are asking them what is happening and how things are going with them, and that will drive our accountability in doing this work. So build alliances and sharing power with historically marginalized and minoritized physicians and other stakeholders. So this, again, is also primarily about centering. And we're inclusive of international medical graduates as well, because oftentimes they're marginalized as well and as part of our community. But this is where we're kind of working in coalition together with other groups such as, and we're in partnership with NMA and NHMA, the National Medical Association, the National Hispanic Medical Association, the Native American physicians and the Asian physicians to do some collective work and some collective advocacy and to build power and ideas. This is just one example, and this is more of a programmatic downstream example, but it does provide, I think, a demonstration of how we at AMA are working and pushing to do things differently. We have a collaborative, it's called Release the Pressure, really focused on hypertension outcomes and improving them specifically within the black community and really building upon the MAP program that's a partnership between the American Heart Association and AMA to help support physicians and physician practices to better and more accurately measure blood pressure. But then there's like this P part in MAP of how do we engage people and patients in this work as well. And so felt it was important to really partner with National Medical Association and Association of Black Cardiologists. And we actually have an outside entity that is managing the coalition so that we are stepping back from it as AMA. Now we're providing our support and resources financially to help support this coalition, but we know that history has kind of taken away investment equitably from National Medical Association and other groups. They still have though the expertise clearly, the connections, the relationships, the ideas that are very important to move this work forward. So it's a new way of working for the AMA, but we are gonna do more of this type of opportunity as we move forward. So pushing upstream, which I think is probably meaningful for most people within this presentation or within the audience and really to address the root causes. So really we wanna strengthen physician's knowledge of public health and structural and social drivers of health inequities, empower physicians in health, mental, structural racism and intersecting systems of oppression to equip physicians and health systems to improve services, technology partnerships and payment models that advance public health and health equity. This is, you all have a sense of what moving upstream is, sorry, excuse me, means and is. And most of healthcare is on the left here, really focusing more on social needs, less on social determinants, even though that's the language that's used. How do we get people to actually think more about, and systems to really operate more so at the social determinants of health and the structural determinants of health space? And to feel that they have a place. I hear oftentimes, well, it's not really healthcare's role to be working in the neighborhoods or it's not healthcare's role to really focus on the structures and the laws and all of that. But many of us know that that's not really true. And we need to find a way to help support the systems doing that. We did just recently launch the Medical Justice and Advocacy Fellowship. I'm gonna take one sip of water really quick, sorry. The Medical Justice and Advocacy Fellowship, we received lots of applications. We'll make announcements in July. We were choosing 10 fellows from across the country to learn more about, what does it mean to address upstream issues? What does it mean to really confront racial justice? And also to better understand the political determinants of health. So this is a partnership with the Morehouse School of Medicine and the Satcher Health Leadership Institute, who is led now at this time by Daniel Dawes. And so we look forward to amplifying that. And then also another one that we just launched, or in partnership with rather, I should say, is with the American Academy of Pediatrics, the Women's Wellness Equity and Leadership Program. And so we are one of the 10 organizations that in which five of our AMA members are part of an equity and leadership program. We think these are absolutely critical to push our physicians upstream. And then we also, for the first time as AMA, are investing within our neighborhood of West Side of Chicago, in the partnership called West Side United, which is community driven, community led, and six other healthcare anchor admission institutes are also a part of this, as well as the government, the city of Chicago, and the public health department. And so we are collectively investing and doing social impact investing in the areas that are on the left hand side of the screen. And we have a huge measurement process that's happening right now to see what change can happen over time and what will happen over time. Because this infrastructure was in place before COVID, they were able to actually rapidly organize the city of Chicago and the mayor's office called upon West Side United to launch racial equity rapid response teams. So it's really, I think, a powerful opportunity to really highlight the usefulness of this type of collaborative work. To me, it builds infrastructure and it's also a form of emergency preparedness that oftentimes folks don't realize that, excuse me, is the opportunity with doing collective action work in this way. And then ensure equitable opportunities and innovation. This really came about, you know, when I first started, I was receiving a lot of reach out from minoritized and marginalized physicians and other just entrepreneurs of color, as well as women, those who identify as LGBTQ, who said they had ideas. They had started, you know, some product development, but they never, they were having a difficult time accessing whether it was capital or just doors that were gonna allow them to push forward their idea. And so also understanding that healthcare space, this idea around innovation, you know, in public health, innovation to me is more about like bringing different voices and minds and ideas together to think through things differently and to see things differently. I think that's part of it, but in healthcare, it's really very tech driven. It's a very exclusive space, predominantly white men get to lead it and get to have power in that space. And so because innovation was such an important value and it's an accelerator at the AMA, I thought it was really critical that we are somehow connected and embedded in this space in the AMA. And to help support AMA's embedding of racial justice into our own innovation efforts. And to help then equip, hopefully the healthcare sector better to advance equity and justice. And so to help us do that, I apologize. To help us do that, we have an external equity and innovation advisory group of some wonderful folks across the country and leaders at the intersection of equity innovation. Again, knowing we cannot do this on our own, but we need the input of others to help drive us, really create this particular strategy and build it out. So this one is pretty much still in its infancy. And then lastly, foster. This is the one I think for me, the first one and this one, the first strategy of embedding and this one are kind of the most meaningful. There are no set of commitments to anti-racism that really should begin without an honest assessment of our institution's own history and present practices. And some actually already, some physicians have started to do this. The document takes a few pages to list out some of the things that we've known and we work closely with our archives department to find some of those harms and realities that are listed. Though I'm sure there are more that we need to really better assess and document, but we did spend a good amount of time to kind of highlight that in our document. And so this particular approach is really one, again, about the narratives and making sure that we're amplifying narratives that often are not heard, not seen. Of historically marginalized physicians and patients, quantifying the effects of AMA's policies and process decisions that excluded and quantify both qualitatively and quantitatively are gonna be really important. And then figuring out then what do we need to do to repair and cultivate a healing journey for these harms that have been committed. And this is kind of, this is the movement right now, at least under this particular administration, federal administration. And we see much more conversation around what does even reparations look like and all of that. And we named that in the document as kind of when we're thinking about repairing the harms. But I think we have to really be very strategic and be inclusive of this particular approach and really thinking through and figure out what are we going to do? We did our apology. Ron Davis was mentioned earlier in 2008, in which he even mentioned in this, we have the powers AMA to right the wrongs, but this was only our first step toward healing and reconciliation. This was the apology for only the exclusion of black physicians, but not for all the other harms that have been done. And then most recently, our own CEO, Jim Madera, after reading a joint piece by NMA and AMA in the early 200, early 2000s rather, after he really realized that Nathan Davis, the father of AMA was really very directly responsible for the exclusion of black physicians, actually kind of ordered for the bust of Nathan Davis to be removed from the AMA headquarters from a visible place and placed into the archives for an educational purpose. And then also the board also voted to remove Nathan Davis's name from the award that was given. And we actually removed all names from awards at the AMA now. And it's not the largest thing, but it is a step. And then we have to work on what are we gonna do related to Flexner Report and the Flexner Report that we commissioned with support of the Carnegie Foundation years ago in 1910, and the harm that that has caused still to this day. And the lack of, we know black and brown physicians that it still exists in our medical community. And then there's our own CEO, in our medical community. And then there's our president of J Marion Sims, who performed procedures on enslaved women in the mid 1800s, vaginal procedures without anesthesia, well-documented by him. And he became president actually of AMA after all of that, he was lauded by AMA. And so what do we do with that past? What did we do with that history? A lot of this was really elevated to medical community's attention, thanks to Harriet Washington's book, A Medical Apartheid. So a lot for us to think about, a lot for us to do in this work. And as again, I kind of mentioned just now, went over more of the technical pieces of the work, but we have to remember, and I especially have become keen to this over the last couple of months because of the JAMA incident, and now the strategic plan. And I hear so much intellectualizing harm that I think is really harmful. And we have to remember that these are hearts and spirits and souls, and this is causing great violence upon bodies. I love this quote by Coates. And I just challenge us all that as we're looking at the data and the data is critical, the data is important, we all know that. But to remember that there are people and families and dreams and desires and desires for not just freedom and liberation, but the desire for joy. As I was told the other day that, Aletha, you're in this fight and you're a part of this legacy, not just for justice, but for joy as well. And your ancestors wanted you to have joy and to be able to experience life to its fullest. So I thank you all for your time and for listening in. I thank you all for this award. It's extremely meaningful to me and as well as the team and the AMA. And I look forward to partnering with ACPM more in the future. Thank you. Aletha, thank you so much. That was incredible. I wish we were in person so that you could hear from our members directly and hear their reactions. I think you're gonna be on the beginning of a really big voyage with this new report, with your strategic plan. Congratulations on getting that out. There's so much in what you just gave us to unpack. But the last thing you mentioned was wanting to partner more with ACPM and one question that is getting a lot of airplay on our Q&A system is exactly in that space. Could you just mention and describe a little bit the recent CDC grant that was awarded to ACPM and AMA to work together on this very issue? What will that look like? I know it just happened, but what are you envisioning for us working together, our two organizations in this space using that incredible grant? It's a very large amount of money. So tell us a little bit about it and what you would like to see happen with that. What will look like success for you with that? Yeah, sure. Thank you. So first, again, thank you to Donna Grande, who I called up two days before I think it was due. And I said, Donna, we need another path. We need another pathway to figure out how to do this. And right away, Donna was awesome. And she's like, we're gonna figure this out. So I just really thank again, ACPM for this. And the opportunity is for, it brings several opportunities. So the pieces of it is that, it's a program and an opportunity for us to better identify, support, fund and evaluate folks and BIPOC physician-led collaborative opportunities that are happening as it relates to COVID response. So whether it's for vaccination or for testing, but things that of which they're in community, like what I mentioned earlier, like about Westside United and to evaluate them because CDC says, just we don't have enough evaluation around them. But we're very clear BIPOC physician-led groups most likely also need support. So it will provide some funding to help them, one, better collect the data as it relates to being able to evaluate this opportunity. But we will provide technical support and assistance to help do that. But this is an opportunity also to bring, I think, again, what I mentioned earlier, healthcare and public health together. So we'll probably identify some folks who are directly connected to their public health systems within their localities and some who are not and learn to see what are the strategies to do that and the best ways to do that. And then the great part, I think, the partnership with ACPM is the engagement of preventive medicine residents in these localities to help support the work of this particular grant, but working with the physician practices themselves. And it's not just small physician practices that might be part of it, but it could also be a physician that's practicing within the context of a hospital as well. But the preventive medicine residents will be there to provide assistance. And I think this will be a great kind of just practicum opportunity and really hands-on opportunity to learn kind of the barriers and the ways to move the work forward at a very local level. And also what does advancing equity work really look like? Oftentimes we can be kind of disconnected from that. So that's the gist of this opportunity and we're very excited about it. I think it will be again, after all of this is done, there will be an opportunity to be able to publish some of these results and be able to share some strategies and some best practices that are happening across the country. And then I think also a guide to help support pushing people forward to make those connections better and stronger between public health and physicians at a local community. Thank you. We're really obviously very excited about this too. And the opportunity to begin to learn how to implement some of the strategies that you've listed out in the plan. It is particularly externally focused, right? So not within our own organization. And I wanna ask about that. We have done a little bit, we're a very small organization. So AMA has 1100 administrative employees and we have eight or 10. So it's a different order of magnitude. Help us understand a little bit, when you talk about medical specialty organizations having to do this work internally to figure out what is the history? What are the truths? And then figuring out how do we reconcile those? How do you recommend, are there programs or documents that can help an organization that is very small like ACPM do some of this internal work? And how do we go about doing that given the limitations of our own resources? Yes, I mean, it's a great question. And I think Donna was around the table with me and Mark from AAP as well. And we talked about, I think now that the strategic plan is released, we'll be able to do this better now. How do we support the federation within the AMA in very specific ways and consistent ways? One, kind of we're doing an assessment of where different physician specialties are at in terms of just advancing equity. We're collecting that data now, quantitatively and soon qualitatively. And from there, we'll be able to kind of have a better plan on how to engage with specialties and federations as the Center for Health Equity. In the meantime, I would recommend definitely the work of Race Forward and looking at, they have a racial equity toolkit that is online. Look at the government alliance for racial equity. Even though it's government, it very much applies to institutions. And it just gives strategies that you can start with of what you have capacity to do. It is well understood that not everybody is gonna be able to hire a full-time chief health equity officer. That's just not realistic. There are things that you can do. I think even there's, so we've done lots of training so far with the Racial Equity Institute. They have a two-day training and our board has all taken it. And I think about now 40% of our staff at AMA have all taken that two-day racial equity training. Again, that's just a start. That's not the end all be all, but I think it's a good start. And there are other institutions out there and organizations that do training as well. There's the People's Institute. There's the Equity at the Center. There are a lot of good organizations. What we're looking to do is pull some of that information together to help support the physician specialties and in a way that's kind of tiered. So if you have high capacity and high level resources and financial resources, consider doing these things. If you have medium fees, if not the kind of the minimal, then consider doing these things. We know that that support is gonna be needed and so we're looking to do that as well. Thank you. You mentioned that Preventive Medicine- Oh, I'm sorry. Can I, one more thing I thought of. So also just in terms of education, we have our Prioritizing Equity Series that is on. And I think it's, we've gotten a lot of great feedback from it where med schools have even picked it up and certain residency programs. And so for the last year, we've had some really great guests to just, again, this is about more kind of normalizing, building a shared analysis part of doing this work. And that's just a good place to start just reading, watching. There are lots of lectures and people talking now about racial justice and what to do. So I just say to kind of soak it up. And then soon we'll also be launching at AMA, the education, the Health Equity Education Center. That's gonna be launched within about a month or so. And then we're also gonna release a communications and narrative guide to also be helpful. Wonderful. You're sort of playing right into the questions that are coming up. And so I'm gonna kind of combine a couple here. You mentioned that Preventive Medicine audiences are very comfortable with the idea of talking about going upstream. And we always talk about how do we build this in earlier and earlier and earlier into our medical training? We have some very interestingly phrased questions that I just wanna read to you. And then feel free to kind of combine and talk about all of these issues, however you see fit. The first one was, what might a new medical school admissions policy look like to combat meritocracy and supremacy among physicians? So that was one way that this sort of idea how do we go further upstream just in our own training programs? Another was, what are graduate medical education and medical school opportunities? How are they building in training and educational aspects on addressing health equity within their own programs? And how is equity work communicated with healthcare students to raise awareness of the strategic work within their own organization? So talk about medical students in particular, since we're talking about physicians at AMA and ACPM, our physician-based organizations. How do we start really early with this, with selecting our students, with helping them learn and grow in this environment, helping them do this kind of work within their own schools? Yes, so thank you. That's a big one. And it is an area of focus of pushing upstream. And so folks may or may not know, AMA has a medical education business unit in arm. And part of this work, so if I start from kind of our approaches of even looking at the past, and I think part of this definitely has to be to look at kind of the impact of Flexner, because not only did the impact, one of the negative consequences was shutting down five of the seven black schools and all of the three women physician schools, it also really shifted medical education to really focus on the basic and clinical science, pushing out the social context of medicine, the needed social context of medicine. And that was pretty, I think that was pretty intentional at that time. And so we have to name an honor and recognize that too, in our role in doing that. And then the medical education team has been working with med schools over the last couple of years through the accelerating change initiative. It's with a cohort of schools across the country to help inform direction of what we should be doing as AMA, but also to help provide support and funding for them to help implement opportunities that push them upstream. So one of the opportunities was starting health system science as a kind of third pillar beyond the basic and clinical science. And so health system science really focuses on kind of the delivery aspects of the healthcare system and making sure that students know that. And now we're kind of working towards, so what's, you know, do we expand health system science to make sure it's definitely inclusive of public health, as well as kind of structural competencies. And we're doing a lot of work on that, right? We're working on a book with Jonathan Metzl and a few others, an educational book. Or is that another science that we're adding, you know, another pillar of science. But that's some of the work that we're working to drive. And the schools that we're engaging with are also driving us, you know, really to focus more on structural racism. And so I think that that's an exciting thing at the school level anyways. For a while, you know, they have been starting to figure out what are the curriculums, what are the competencies that need to be put forward to do this work within their school. And so this last year also, I am on a committee with the AAMC. So we've been working more partnership with AAMC around this to create competencies and standards for diversity, equity, and inclusion in med school, as well as for residency and as well as for attending physicians, but really focused on the med students. So this has gone through, it's, I think it's been over a year now. It's gone through a lot of iteration, but that should be released soon to help provide some guidance for a collective guidance for where schools should go, where they should start and where to go. The challenges I think to that is, so we provide like the standards and competencies, but what tools do they use? Like what's out there? And then oftentimes many faculties still are not trained on these concepts. So what's the training program for faculty also to be able to be responsive to this particular time where oftentimes, honestly, the students are the ones really driving this and they really have the analysis but they want the freedom really in the space to be able to wanna learn these concepts around racial justice and power, and also to figure out how do they operationalize it in practice and not to meet the resistance that's there. And so I think a lot of the work also is gonna have to happen at the faculty level and being able to support students in that way. Wonderful, thank you. I don't exactly know how to ask this next question. It's really complicated. A lot of the questions that are coming in are about the very essence of what we're talking about here which has having these very difficult conversations. And so in some cases, the questions are, how do I have this conversation? How do I have better conversations with my patients? Or how do I have a conversation with the community or my organization? Sometimes it's between colleagues. We hear this all the time. We need to have better conversations. What to you are the sort of things we need to do as individuals to be able to walk into these difficult, fearsome conversations that can generate quite a lot of anxiety? How do you do it? How do you recommend I do that, for example? Could you and I sit down and teach me how to walk into a conversation that's difficult and can cause this sort of sense of discomfort? Yeah. Well, I think, so first I'll start just with myself. I would say my greatest probably growth of time was probably under Dr. Bassett and having a leader that really, again, gave space in terms of my lens. When I say growth, building my lens around all of this work. And I think that that's an important part is giving people grace and space that they don't have to know everything. You don't have to know everything, but you're willing to step into the conversation and be humble and to be okay if somebody tells you you were wrong or that was offensive or that hurt me and move forward and not take it personally. I think that's an important just kind of grounding context because I think part of the anxiety and a lot of the anxiety is that people are afraid they're gonna say something wrong or they're gonna do something wrong. And as an educator kind of in this space, it's just always important for me to remember and to say, it's okay. And we're all learning and we're all learning through this as a time. I have made my mistakes, plenty of them. And you move forward, but you're humble in it. So that's number one. Number two, I've learned the most by probably reading as well. There's so much out there now in a way that there just hasn't been. And there are plenty of sites. You go to the Racial Equity Institute site and there are plenty of books that are listed. I put some of the resources in here. I think the important thing is starting to build your own personal analysis and understanding. If you wanna read Kendi's book on how to be an anti-racist, fine, start there. There's so many books that are kind of can provide a foundation. And so I would suggest pulling together a library for either your institutions or your organizations that just start to pull these resources together. And it's not just books, films. There's a film, one of the really good films I think is Race, The Power of Illusion. It's a little over 10 years old now. It was on PBS. It's a three-part series. And we actually stream it for our staff at AMA so that they can watch it at work. But it really talks about the evolution of race. And there are a lot of really great ones that are coming out. But films like that, I think documentaries are helpful. And then there are also things that are related at the intersection of kind of narrative and art projects that I think are also other ways to kind of start to build an analysis that you may not have had before. So that's the second thing. So it's kind of learning, doing your own work. And I would say, at the AMA, what has given me the greatest space in doing this is Jim Madera, who's the CEO, doing his own work. He was one of the greatest defenders of this document and really explaining why certain things needed to stay in and not come out. And because he's been doing his own work, him taking down the statue of Nathan Davis, that was his own work. And that creates space for me and ease for all those around him. And so I think as leaders and physicians, doing your own work is really critical. And then three, we need help, so we can't do it all on our own. And again, this is where I think we start to kind of engage with training opportunities that I mentioned. And again, there are places and spaces that have resources listed. We do have some of them in the document, but we'll make sure we get more of those and we have a resource center. But going through the Racial Equity Institute training, and my whole point of saying all of those things, that it's like practice as in with anything else. The more you do it, the more comfortable you get doing it. And so, I remember being at New York City Department of Health, and Dr. Bassett is saying racism and people, and we couldn't say racism before Dr. Bassett came. Which means if you're not using it a lot, potentially you don't fully understand it. And then so she comes on board, she says, we're gonna name racism. We're saying racism all day long, and then I'm able to say racism, and I'm able to build my analysis, and it just becomes comfortable. I don't have really much level of anxiety around saying racism, white supremacy, or any of those terms. And it's not because I feel like I shouldn't, but it's because of the practice of it, but it's also understanding that what I'm saying is rooted in evidence. And that's what I think is our greatest opportunity as a science community, is that this isn't just pie in the sky that we're saying this, but the evidence demonstrates it. The evidence shows it, that racism has an impact on the health of communities. And if we can go back to those things and go back to the data parts of it, that can sometimes help the conversation and moving the conversation forward. But there are some people that this is a conversation that just is not gonna move forward. It's just, it's not, it's gonna be a hard conversation. They are just not ready for it. And you have to know that, and know when that's happening, and then sometimes know when to just back off of that moment and that opportunity, because then that just becomes kind of a, it just becomes exhaustive and not potentially productive as well. Two of the questions that came in are sort of the next level up from this, right? So we talk about sort of our own work, how to have conversations one-on-one, maybe within our work organizations. A couple of folks have asked questions related to sort of getting past the noise of what's happening in the media, the noise of the headlines on critical race theory and woke culture and different ways of almost demeaning the conversation from the get-go, the use of terminology that then gets weaponized. The question is really, how do we then sort of get past all that noise to insert ourselves or insert a more evidence-based, maybe rational language into the public narrative? Yeah, I think, well, we're hoping that this document does exactly that. You know, you just, you do it, you know? And I think the commitment to equity is understanding there are perceived risks, there are real risks potentially, you know? And in naming racism and these concepts, again, I think it's fully understanding that this is all rooted and our work is rooted in evidence and to always come back to that. It's rooted in theories and frameworks of experts, who have been doing this work for a while and to always come back to that as we start to move forward and to get through some of that noise. You know, this is front and center for me right now with the strategic plan, you know, over the last, this last weekend, you know, we are hearing from members and as I said, this has made Fox News and several others are now talking about AMA's plan and socialist plan and, you know, naming critical race theory and the problem of that. And, you know, and we have people who say they don't wanna be associated with AMA anymore, you know? And so how do you get through that? And so, you know, even, you know, Jim Madera and Dr. Madera said, at least we focus on the strategic approaches. We move forward with the document. And I know Dr. Harmon, who's the current president, is very committed to going the course, you know, and saying, our evidence shows us this, my experience shows me this, you know, that this, that racism exists and we have to find a way out and move forward. And so it takes, it's gonna take courage. It's gonna take people who really care. And I think it's the courage part, it's the will part and the courage part that we don't often talk about that's really needed. We have many ways of how we work through problems as physicians and public health communities and healthcare communities. And this really shouldn't be treated any differently. And we follow that same kind of methodology, but we need to have courage when we start to feel anxious or threatened to push forward because we know that this is what is right and what's just. Thank you. You mentioned a phrase right at the very beginning of your talk and you said, we need to move past being allies to being accomplices. You need accomplices and co-conspirators. What's one thing somebody who thinks, I feel like I'm an ally, how do I move to being, what's the next step to move to being a co-conspirator? Yeah, and so, and don't get too caught up in my language. They're in the sense of- I love it. I know, and I said it, but allies are important and they are. I just, what it is, allies are to understand their power and how they can use their power. But what I've noticed when that term is used, it just becomes, there's something that's very passive and people's reaction to it is passive. And I hear conversations, well, I'm gonna wait till they tell me to come in and on. That's not how it's to be. We all are part of the system. When you look at the definition of racism, to me, all of us are named in that system of racism. And so, we all have an opportunity. Some of us are definitely more burdened and harmed, clearly, by that system of racism. And that's where the recognition of one's own power and privilege and how they're gonna use it and how they're gonna step up in this system is really important. And I just need folks who are gonna show up and do the work with me, along with me. I look at some of my colleagues at the American Medical Association. I'll highlight our general counsel, complete accomplice in a positive way. I don't have to say to the general counsel, you should consider this. He's already doing the work. His presentations are powerful. He's already working with NAACP or different organizations, thinking about really unique ideas of how we can use AMA's power and litigation power to make sure that we're not just talking about of how we can use AMA's power and litigation power to advance social justice. And that's just helpful. It's comforting as a person doing this work to know that other people are showing up in very equal ways in terms of the actions and activity of the work. I'm just gonna say this for myself, this conversation has been incredibly inspiring to help me understand my role as president. I mean, I've three days left as president of ACPM, but I am a fellow of the college and I will stay involved in the work of the college. And I do think that this is an incredible opportunity. It feels like a huge inflection point, both for our profession and for society at large. So this has been incredibly inspiring, Aletha. And I hope that we have many residents and medical students registered for the conference and on the conference web platform today. And I'm excited for them to have heard this so early in their careers, so that this becomes part of the norm of our training and how we think about our profession. So thank you very much for this inspiring presentation and session and your willingness to answer a lot of questions. We're gonna have a lot more questions. I think that this is something that we're gonna have to begin exploring in ways as a professional society and we're committed to doing that. So I'll just mention, I mentioned this in the earlier part of the opening session that we'll be inaugurating a lectureship in health equity and racial justice named for Dan Blumenthal, a past president of ACPM who passed away last year and who was a co-conspirator in this work for a very long time at Morehouse and who is somebody that had this topic on his mind all the time and made it part of what ACPM is today. I also, we did get a question from the audience about getting the resource list of the papers and the StoryCorps session that you mentioned. So I'll work with you and your team, Aletha, to get that and make that available if it's okay like maybe a reference list, some of these training programs so that we can make that available to our members as well. A last closing comment from you, if you like, from your heart about our meeting going forward and our work together as two big organizations that can make a difference, please. Yeah, thank you. Well, I'll just say, we're all still learning in all this. There's no particular road map. We're looking to try to create the roadmap for this for years to come. But I say that to say is as you all are doing your work and you're learning and growing, I fully anticipate to help support, but also to learn as well. And so what becomes success for you and what you all think is success will help inform us at the AMA and myself personally. And just to remember, again, this work is ultimately about valuing the humanity of each other and one another and really believing that we all are born equal and that health is our right. Thank you so much. Congratulations as our latest KBS lecture. And thank you again for a lovely presentation and an inspiring one. Have a great day. Thank you. I really appreciate it. You're welcome.

American College of Preventive Medicine

2021 Annual Conference

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systemic inequities