Good afternoon, and welcome back to PM21, American College of Preventive Medicine's 2021 Annual Conference. I'm delighted to be here as your conference chair and also as a moderator for this afternoon's interdisciplinary session on building social justice and health equity, understanding us surviving COVID-19 pandemic, and optimally thriving in our future. I am so pleased to have as a co-moderator, Dr. Chris Purnell, and speakers, Dr. Reuben Warren, Dr. Aletha Maybank, Dr. Ursula Bauer, and Dr. Abdul El-Sayed. For this afternoon's session, I will start the session by going over the topic, introducing speaker, Dr. Warren, who will give remarks and a Q&A, and we'll hand over the session to Dr. Purnell, who will continue as moderator, introducing speakers, Dr. Maybank, Dr. Bauer, and Dr. El-Sayed, and have their remarks followed by an engaging interactive panel Q&A and response. I would like to highlight some of the learning objectives and some of the goals of this session. As we build social justice and health equity, we're looking to understand the history of apartheid as a metaphor for ethical abuse and research in healthcare, and the role of bioethics in medicine, and understanding the importance of building trustworthiness before asking for trust. We're also looking to understand the historical perspective on diversity and inclusion in the medical profession and healthcare. This will build upon, I'd like to mention, Dr. Maybank's remarks that were provided on Sunday in the KBS lecture that were very insightful and would spark engagement throughout this discussion. We'll also look to describe the Surgeon General's report on community health and economic prosperity, understanding the role of businesses and society to strengthen community health, wealth, and well-being, while recognizing key business practices that thrive both community health and economic prosperity. We'll also seek to understand healthcare access, its challenges, solutions, and expansion efforts prior to, during the COVID era, and beyond. We have a high task, a high charge here, but we are with a more than well-qualified panel and presenters to accomplish this. We look forward to your Q&A involvement. We ask you to submit questions into the Q&A box, the tab located on your live session, and we will, for those questions, as we have first Q&A with Dr. Warren, and following an engaging panel Q&A discussion. Without further ado, I would like to introduce our first speaker, Dr. Ruben Warren. Okay. Good afternoon. I was waiting to see when I got on board. This is such an exciting opportunity. Building resilience, preventing pandemic, health inequities, and climate change. As we go through my brief remarks, keep in mind how you operationalize social justice and health equity. And we must be careful that those operational definitions don't take us too far what our goal is and ought to be. Forget my first slide. There we go. Social justice health equity. Building resilience. Preventing pandemic, health inequities, and climate change. Let us pause for a minute and read this kind of contradictory words. Medical apartheid. Let's start with what is apartheid? It is a former policy of segregation and political, social, and economic health, I might add, discrimination against the non-white majority in the Republic of South Africa. How does medical anything go with apartheid? And Harriet Washington did a wonderful job in trying to unpack that notion as she wrote in her wonderful book, Medical Apartheid, as you can see, the challenges that the African American has experienced over time. And I would contextualize that in kind of three or four different zones, if you will. And let's start 1619 and when the value, the devaluing of black bodies started with the middle passage and enslavement of African people. And it moved on to another horrendous phase in the history of this country. When talked about the disproportionate burden of one racial group over another. What was that? What was that? I'm not talking about segregation or Jim Crow or any of that. I'm talking about the United States Public Health Service syphilis study at Tuskegee. I would argue that was a prime example of medical apartheid. A prime example. Here we go. The United States Public Health Service syphilis study at Tuskegee, 1932 to 1972. And in that horrendous period, 40 years, African American men in Macon County, Alabama, were experiencing what I would call medical apartheid. Characterized by four notions withholding therapy, cultural insensitivity, deception and exploitation. Yes, the men were told they had bad blood, whatever that meant. They were told that they were being treated for bad blood, whatever that meant. So therapy was withheld. And as we fast forward to 2021, there's not a notion of withholding therapy, but it is a notion of hesitancy to receive some form of therapy. Cultural insensitivity. The men were not ignorant, as the literature sometimes suggests. They trusted the federal government. And the federal doctors knew where to go. They went to their places of faith. They went to the black church to get the men to engage in that horrendous so-called study. Deception, I'm using a kind word, the men were simply lied to. And of course they were exploited. Think about that as we continue to talk through challenges that we face in the 21st century. My comments have to be framed, must be framed around justice as fairness, which has a central value of community. Justice as fairness, which has a central place in the value of community. But what is justice? The scholar John Rawls writes each person possesses an invulnerability found in injustice that even the welfare of society as a whole cannot override. Therefore, in a just society, the rights secured by justice are not subject to political bargaining and the calculus of social interest. Are we in 1932, 1972, or 2021? Social justice. And we've heard the word over and over again, health equity, but what is that? Ideally everyone should have a fair opportunity to obtain their full health potential or more pragmatically that no one should be disadvantaged from achieving this full potential if it can be avoided. As I taught this course in my class every year, a student always points out, Doc, get rid of that if it can be avoided. They say it must be avoided. And I agree. It must be avoided. In the context of my comment, and we're going to be a little pragmatic, a little negative for a minute, but we want to be fair and set the context for what we're going to talk about throughout this afternoon. The context. Medical apartheid and United States Public Health Service syphilis study at Tuskegee must be viewed in the broader context of human subject research and health care delivery. Unfortunately, bioethics violations have been a continuous part of the biomedical research enterprise in the United States, and I would suggest abroad as well. Race and racism interrupt social scientific inquiry and equitable health care and continue to be of concern. For example, the father of gynecology, J. Marion Sims, MD, purchased enslaved black women to conduct obstetrical surgery without anesthesia because he supposedly believed that these women, these black women, could not feel pain. Other white physicians tested remedies for heat stroke by forcing black people to work long hours in the sun to determine if their remedies worked. In the North, cadavers were stolen from black cemeteries and used in medical school. I'm a dentist, and when I was in gross anatomy, I never thought about where the bodies came from. I was so interested, so engaged in understanding how gross anatomy functioned that I never crossed my mind who were these bodies, where did they come from? Bioethics violations are a broader way of characterizing, conceptualizing the broader range of injustices, or ethics violations over the years. And you can see there have been many. There have been many. And rather than read them all, I want to point out a very important point about the dates. If you look from A through E, or actually A through G, they all occurred within a time frame 1932-1972. The U.S. Public Health Service syphilis study at Tuskegee, we knew better, we just didn't do better. In my view, the most horrible, horrendous study of them all was the United States Public Health Service syphilis study at Tuskegee. When there's a problem, we create a remedy. We create a regulation, a rule, a guideline, or something that we're supposed to follow. But what I would argue is that why do we have to wait for a problem before we create a remedy, a solution to prevent the problem from occurring? Look at the list of remedies purportedly to resolve the problems, the violations in biomedical research and healthcare. The human subject research enterprise and healthcare delivery are all purportedly intended to improve human conditions through the acquisition of new knowledge and delivery of quality healthcare. Benevolence, the intention to do good, is the presupposition that undergirds human subjects research and healthcare. However, benevolence, as documented in the previously listed set of research studies, occurred all too often throughout the 19th and 20th century. And the results, we know the results, they weren't good. Though all of these previously listed studies document bioethics and public ethics violation, as I said earlier, the United States Public Health Service syphilis study is the most infamous biomedical study of them all. Let's shift the paradigm for a moment. Let's talk about what do we do good at a conference with colleagues as yourselves. We ought to talk about the good part as well as the challenges. Benevolence, the intention to do good, beneficence is what is actually doing good. There is a difference. As the young folks say, don't get it twisted. Let me shift to, in my closing remarks, a framework that doesn't talk about the negative but purports the positive, that purports the positive. Optimal health, optimal health. Optimal health is your greatest state of aliveness, your greatest state of aliveness, the best you can be. John Shazell, MD, conceptualized an alternative to what he called a sick care system. Dr. Shazell is a charter member of the American Board of Family Medicine. He practiced primary care in Baltimore, Maryland for 32 years until he retired to pursue full-time a study to motivate and to teach principles and practices of optimal health. In his book, The Pyramids of Power, Ancient African-Centered Approach to Optimal Health first published in 1932 and republished several times as late as 2020, Dr. Shazell conceptualized optimal health and left it to us to translate optimal health into doable, measurable activities. Dr. Shazell was my mentor and he transitioned in 2004. I committed to translate optimal health into what we do in our everyday practices. the best possible emotional, intellectual, physical, spiritual, and socio-economic aliveness that we can achieve. Giselle went a little further and tried to operationalize what those different entities was. He called optimal intellectual health being aware of all thoughts and choosing to actualize those thoughts that we believe will move us toward our greatest potential and doing our highest good. Optimal emotional health, courageously managing the emotions, joy, peace of mind, and harmony within ourselves as we relate to our environment and nature, as we relate to the experiences in ways that allow us to maximize our well-being. Optimal physical health, assuring that your anatomical and physiological components are operating in the best possible ways. We achieve optimal physical health through optimal rest, optimal nutrition, optimal exercise. Let me conclude. Optimal spiritual health and optimal socio-economic health, the ability to live every human being in the best way possible. And last, stabilizing your social and economic situations. I'm having a problem moving my slides. Ah, the paradigm where I work, bioethics, health disparities, public health ethics, and health equity. In the middle is the Bioethics Center where I spend my time. Let me thank you for your time. And hopefully, ah, two of my heroes, David Satcher, the former US Surgeon General, simply said, we must know enough, care enough, do enough to make a change. And my shero, Dr. Maya Angelou, who simply said, history, despite its wretching pains, cannot be unlived, but if faced with courage, it need not be lived again. Let me thank you and show you the Sankofa bird, looking back to move forward. And I appreciate the time you're spending to listen to me. Thank you. Thank you so much, Dr. Warren, for those inspiring remarks and what an appropriate ending, Sankofa bird, looking back to move forward. I want to, again, introduce you as Dr. Reuben C. Warren, Professor of Bioethics and Director of the National Center for Bioethics in Research and Healthcare, Tuskegee University. I'd like to start off our Q&A with a question. What are some of the lessons learned from previous ethics abuse that can apply to the coronavirus pandemic? The most important one is the notion of trust and trustworthiness. We often ask people to trust us. The health delivery system, the research enterprise ask community to trust us. And I would argue that trust must be preceded by trustworthiness. Prove yourself trustworthy by your engagement, by your interactions, and therefore I would argue trust would follow. Prove yourself trustworthiness, trustworthy. Now, if we talk about the coronavirus pandemic, we started off with information that was not trustworthy information. And now we find ourselves being asked to trust the system that in fact had violated our trust. Prove yourself trustworthy and trust will follow. Well said, straight to the point, right? Prove yourself trustworthy and the trust will follow. Okay, let us move on to the next question here. Please continue to enter questions, audience, in the Q&A. And we will look to also ask those to our presenter. The next question is, we have worked so, rather, we have so much work to do in the U.S. How can we ensure equity in U.S.-sponsored research studies in low-income countries? I think start at home and it will manifest itself abroad. It seems to me that the world is looking at the United States and not judging us by what we say, but by what we do. And there's much work to do. And I spend much of my time focusing on the health of African-Americans. And you well know that excess deaths continue to explode in the African-American population. In 1985, there was 60,000 excess deaths. And excess deaths are simply the preventable, avoidable deaths experienced by the African-American population if you use a non-Hispanic white population as a baseline. And in 1985, there was 60,000 excess deaths. In 2002, that study was replicated and the excess deaths had gone from 60,000 to 83,000. We're going in the wrong way. Prove yourself trustworthy and trust will follow. Okay. We have a commenting folks. Let me present another question from the audience. Some paraphrasing Dr. Thomas Sowell, that we have corrected these legitimate injustices of the past and that by echoing and amplifying resolved or remedied injustices, this only serves to perpetuate grievances so that the demagogues can continue their proliferable mongering. Is this a fair argument or not? How do we, again, reconcile our past, deal with our present COVID pandemic, and how do we collectively move forward and optimally thrive in our futures? We've heard the term, the phrase, trust the science. And I'm suggesting let's trust the epidemiology. And the epidemiology says that everybody has improved, but the gap has broadened. So we've got an excess death notion. So when NIH improves the knowledge base, CDC is challenged to translate that into action and health improvement. So when you say we've improved, yes, we have, but comparatively speaking, the excess death gaps is widening. So until there's no difference, until you cannot base health disparities on race or ethnicity, then we have not gone far enough. It is unethical to be able to base your health on your race or ethnicity or your income or your geographical location. Let's remove those false barriers. Those are risk factors that can and must be removed. Again, well said. Dr. Warren, as we transition over to the second panel, you've provided quite a perspective on historical injustices and mistrust and where we are now with the pandemic and how to move forward. Are there any final remarks you would provide for our upcoming panelists? They include colleagues with medical societies, colleagues providing a surgeon general's report, colleagues dealing with healthcare access and expansion. How can we complement and summarize your remarks and carry it over so we can have engaging panel and response and combine that and interact it with their remarks? Look at the Sankofa bird. Looking back, don't deny looking back to move forward. Our current circumstance are equally as challenged, particularly with the coronavirus pandemic. Yes, we bring some chronic diseases forward, but our work conditions, our living conditions, getting to work, having to go to work is a current challenge that can be resolved so the past will not obstruct the future. We must not either or, but both and. Let's look back, but we must move forward. Not either or, but both and. Absolutely. Well said. Well concluded. Thank you again, Dr. Warren. Dr. Purnell, at this time, I would like to hand things over to you to start the next part of our session. Thank you, Dr. Rhodes. What a brilliant discussion so far by Dr. Warren and we thank him for his valuable contributions to this discussion. We wanna continue to advance the ball, so to say, and invite to the discussion table three brilliant vision artists, as I would like to call them. I will be sharing this platform with Dr. Aletha Maybank, MZMPH, who serves as the Chief Health Equity Officer and Senior Vice President for the American Medical Association, with Dr. Ursula Bauer, MZMPH, who is a Senior Advisor in Chronic Disease Epidemiologists working in the Office of the Surgeon General, and Dr. Abdul El-Sayed, MDDPhil, so Doctor of Philosophy, who is a Physician Epidemiologist, former City Health Commissioner, and Progressive Activist. And I'm Dr. Chris Purnell, the Chief Health Equity Officer at University Hospital in York, New Jersey. To start us off, Dr. Maybank. Thanks, Dr. Purnell, and thanks, Dr. Rhodes, for inviting me to be a part of this panel. And thanks to ACPM, again, for a KBS lecture. And this is really a little bit of some duplication from that. So if you saw the lecture that day, you're gonna get a reinforcement, per se, but really just focusing on kind of strategies of what physician associations and societies can do for the folks who don't know. American Medical Association has 270,000 members and has been around since 1847, definitely has its footprint in setting up aspects of our healthcare system and institutions and structures that did not advance or promote racial justice. And I have been here now for two years as a kind of report out from the House of Delegates with the need for AMA to be more explicit on the work that they're going to do, and intentional as well as accountable for the work that they're going to do as it related to equity and advancing equity over time. And so this report has been two years in the making. We just released our strategic plan to embed racial justice and advance equity. And so before I start, I think always critical to provide a land and labor acknowledgement. I think oftentimes, and AMA has representation from all of the racially marginalized physicians and physician groups, and we're continually reminded of the invisibility or how indigenous people have been made invisible over time. And I think it's really critical that we don't allow that to happen or continue to happen. I'm also really critical to recognize the forced labor and the forcing of folks to this country for the sake of capitalism. And so it's important that we celebrate the resilience and strength of all indigenous people and descendants of Africa, who have shown this country much and provided much reward, and it calls us to do better for the work that we do. And I think that's, and just to kind of name that, I think important to strategies of equity and advancing racial justice is ensuring that we are in centering the voices and ideas, the history, the experiences of those who have been most marginalized in this country and everything we do, and not in just kind of superficial ways, but how are we building it into our structures and our processes, I think is absolutely critical. And so this is the plan, it was released last week. And it's, as it says here in its mission, envisioning a place where all people live and thrive in communities and resources are working well and equitably, not producing any harm or exacerbating harm and ensuring in terms of an equity point of view that everyone has the power, the conditions, resources, and opportunities to achieve optimal health. And because physicians are our audience, ensuring that physicians are equipped with the consciousness and the tools and resources to confront these inequities, to dismantle white supremacy and racism and other forms of exclusion and structured oppression, as well as embed racial justice. And really this is also about, not only dismantling racism, but decolonizing and then also re-imagining, redesigning systems for the future that actually advance equity and justice. And so our strategic approaches that we landed with in the plan, and the plan is there and folks can get access to it. And just to say that, we really took time to make sure that we helped move, hopefully move the physician community along in terms of the language, the concepts that they're using around equity, especially the roots of it. My observation, especially from being in public health for so long and coming to healthcare is that there's just, there was a gap in being able to even say the words and name the words racism. I think this summer's public murder of George Floyd kind of propelled that conversation more so to the space of healthcare where people were now saying it. I'm not clear that everybody always knows what it means, but people are using the work and starting to investigate what it means for their own systems. But we took the time to really provide an equity primer to move people forward. And so these are our strategic approaches to embed equity in all of our practices and processes, to build alliances and share power, to ensure equity and innovation, to push upstream, to address all determinants of health and root causes and to foster pathways for truth, reconciliation, healing and transformation. And so we also thought it very important to help inform the rest of the medical community is that we have some theories of change that we think were very critical as one writing the injustices of our past as what was illuminated in the previous talk, making sure that we challenge our malignant rather and dominant narratives that totally undermine health equity. Again, centering the voices, as I mentioned earlier, adopting an anti-racist and intersectional approach to a race and approach, embracing public health frameworks of health and acting upstream and implementing an inside-outside strategy. And so that's really important for the embedding part. I don't feel we can do this work externally as institutions if we don't look internally and look at our own kind of house inside. Really, if our staff and our teams cannot even define equity, understand how it shows up in their day-to-day decisions, how it impacts the work that they do and then therefore impacts others, then we're not doing our work in meaningful ways. And so we are doing this internal process, really building the capacity of our staff and membership to understand and be able to operationalize anti-racism and other equity strategies, whether it's via training, and I'm very clear, training is not the end-all be-all. Education is really still important because we still need to build a shared analysis, but there has to be other opportunities around organizing for infrastructure, around the infrastructure for accountability and building in changes so that it influences culture overall. That's what becomes more sustainable over time. And making sure that there's integrated trauma-informed lens as we do this work, because we have the potential to traumatize as well as re-traumatize people and staff as we do this. And we have to assess clearly our change over time. I'm not gonna go in much depth because I wanna make sure I don't go too far over time, but this is our logic model. Really just, again, saying internally in an institution on the left-hand side, every institution really has these kind of buckets of work. There may be some nuances, but we're all doing work around workforce. We're all doing work around data and leadership. And I'm saying that if we don't have intentionality around each of these areas in our institutions, working to embed justice and social justice, again, we're not gonna be able to do or contribute to any work as it relates to improving outcomes overall, as well as becoming an anti-racist multicultural organization. And this is just a model we're using from Race Forward, one of the larger racial justice organizations in the country. Again, just normalizing conversations, organizing for accountability and operationalizing whether the data and the tools that we're using inside of our institution to do this work and to push culture and to push action and to change structures and processes. So building, this is about very clear healthcare overall, but AMA, a history of being more top-down. And how can we do better to build alliances and share power with several physician groups that have been marginalized and minoritized and again, centering those voices. And there's a lot of work in this. And I will just mention, I saw today that the AAMC, their Center for Health Justice, just released some principles on trustworthiness. And what does that look like? So if y'all have a chance to check that out, to check that out. I'm gonna kind of move through this, but this is just another way AMA is doing things differently. It's not so much about the programmatic work. The programmatic work is like, this is a downstream work. It's more about how we're working differently with the National Medical Association, the Association of Black Cardiologists. Knowing that AMA has financial resources in a much different way and different space in these institutions. However, valuing the expertise, the ideas, the experience, the people of the organizations, we're at the table in a different type of way. So there's no expectations for financial commitments in the way that we can do as AMA. And I'm very explicit about that because I think that's what we have to do in order to really recognize and share and shift power as we move forward and do work. So pushing upstream, many of you are public health preventive medicine. So you get this context. Healthcare really is still very much on the left-hand side and barely on the left-hand side still of addressing social needs. The idea of addressing social determinants and really what's happening at the neighborhood level and community level, and then pushing up to address kind of the structures through advocacy and policy. The work that we're trying to do is really get healthcare to better embrace all of this. And to strengthen physicians' knowledge on public health and structural and social drivers of health inequities, empower them to dismantle structural racism and intersecting systems of oppression and equipping them with the services and knowledges and tools. And so we have a lot of work that is building across that. We just launched a medical justice and advocacy fellowship. We will announce the fellows at some point in July. This is a partnership with the Satcher Health Leadership Institute at Morehouse, now led by Daniel Dahls, formerly the former Surgeon General to, again, equip more physicians with really, I think, the confidence, the courage to speak up, to speak truth of power, and to really advocate for meaningful ways within their own communities and within their own institutions. And this is another fellowship that we're in partnership with, with the American Academy of Pediatrics. And then recently, AMA, along with five other healthcare anchor institutions, it's the first time, really, that AMA has done something in their own backyard in terms of a real financial investment and commitment. And this is to invest funding to support upstream opportunities that are listed in the left-hand side. Again, I think a very important way for healthcare to start pushing, but also measuring the impact of these decisions over time. We all are very aware that many of our communities have lacked investment, definitely a cause and a result of structural racism. Ensuring is about ensuring equitable structures and opportunities and innovation. For me, when I first came to AMA, and I, again, coming from public health, innovation to me means bringing together people and ideas from different places in order to create a solution, and people who are very proximate to the problem and to the injustice overall. In healthcare, it's really more rooted about health tech, and it's really an exclusive environment led predominantly by white men, and excludes women, people of color, those who identify as LGBTQ, people with disabilities. And when I started at AMA, lots of folks reaching out, saying they had ideas, started products, but had no way in and couldn't figure out how to get in and access the system. So because innovation is such an important, I guess, value of AMA and healthcare, really felt that we needed to figure out what our footprint was going to be in this space. And so we are building this and working with advocates from across the country to help support us doing this in a meaningful way. And it really starts to get to kind of the roots of injustice within this country when we think about racial capitalism, as well as colonization. And so then foster is the last one. How do we foster pathways for truth, reconciliation, and healing? Fully believed, no set of commitments to anti-racists can really begin without an honest assessment of our institutions over history. This is some of them here, but there are plenty more that are listed within the strategic plan. And there are probably plenty more that we have not identified. And we still need to work through that. And so we need to unearth the narratives that have been made invisible over time, and then also quantify the effects, and that could be quantitatively as well as qualitatively, the effects of our policies and decisions, and what have been the costs of those, like a financial cost, but also kind of the social emotional health costs of these decisions that have been made. And then what do we do in order to repair them as well? And so this is movement that's really aligning, I think, with folks that really are on the front line of doing this equity work, and with the federal administration and some of the policies that have been coming, or the policies that have been coming forward. We did issue an apology, as many of you know, in 2008 to the National Medical Association, Ron Davis, that we have the power to right the wrongs of the past, but this was only, this apology was really only a very modest step forward, and it really only spoke to the exclusion of black physicians. And then more recently, our own CEO, Jim Madera, after reading a piece that was jointly written by NMA and the AMA, read the letter and realized the explicit role that Nathan Davis had, the father of AMA, in excluding women and black physicians, and removed the bust from public view, put it in the archives, as well as we removed the name of Nathan Davis. Now, we're clear these are small steps, but there are steps, and there's more that we need to do. But I think this is important work for all, really, all medical societies in this country, and all historically white institutions as well. We'll need to dig into the Flexeter Report and the impact of that, put forward to create rigor, but also really only allow the focus of medical school to be on basic and clinical science, away from the social context of health in our lives, and then also recommending for the five or seven black med schools to be closed down, which has tremendous impact even to this day, and then all women med schools as well. And as was mentioned earlier, J. Marion Sims, who was a former AMA president and was mentioned, he performed experiments, rather, on enslaved women without anesthesia, and even after knowing all of that, he became and was lauded and became president of the AMA. So thanks again to Harriet Washington, who really elevated that story for many of us, but that is work that we still need to reckon with as a reality that we still need to reckon with as the AMA. And this is the end of my talk, but just Ida B. Wells is somebody that I kind of call to a lot, and it's kind of in my spirit a lot, just in general with her activism, and just for me, also remembering the legacy that has been put forward for really all of us on this call, but especially myself, as we do this work, and the recognition that what gives me kind of the light forward is to know that I'm part of a legacy continuing on this work. Thank you. Thank you, Dr. Maybank, for that very comprehensive and insightful introduction to this panel. Next up, we're gonna have Dr. Ursula Bauer. Thank you. It's such an honor to be on this panel with such esteemed thinkers and advocates, and very much appreciate the ACPM invitation. I'll follow Dr. Mayberry's lead and acknowledge I'm on land here in Albany, New York, that was home to the Mohawk Nation and the nations of the Haudenosaunee, also known as the Iroquois Confederacy, and before that, home to the Mohican people. My remarks focus on a subset of this very big topic that the panel is addressing. I'll be talking about optimally thriving in our future together, and specifically how businesses contribute to community health and economic prosperity, thriving as a whole of society enterprise. So we'll bring in the public, private, and nonprofit sectors. I'll draw my remarks from community health and economic prosperity, engaging businesses as stewards and stakeholders, a report of the Surgeon General. I worked on this report for two and a half years, and it really changed my view of how we work in public health. The premise of the report is that Americans are not as healthy as we could be, and are not as healthy as people in other wealthy nations. On average, we have more illness, shorter lives, and we pay more for healthcare. This is called the U.S. health disadvantage, and it has implications for people, families, communities, businesses, and the economy. The report seeks to increase awareness among businesses of the U.S. health disadvantage, and to motivate businesses to engage with and invest in communities in order to strengthen the conditions that shape health, wealth, and wellbeing. The report argues that doing so is good for business and good for society. The target audience is business, but the report contains much useful information for public health professionals as well. I do commend the report to you, and call your attention also to the large number of companion materials, including a business digest version of the report, several summary documents, and a variety of fact sheets and videos. These are all available on the Surgeon General's webpage at hhs.gov forward slash Surgeon General. Americans tend to think of health as healthcare, but health happens in communities and is largely driven by conditions outside the healthcare system. In fact, we say 80 to 90% of health outcomes are the result of conditions in communities. In the report, we call these conditions vital because everyone needs them in order to have the opportunity to achieve their optimum health, as Dr. Warren said, their best health, wealth, and wellbeing. The U.S. health disadvantage, more illness, shorter lives, and higher healthcare costs, has its roots in poor conditions in neighborhoods and communities where the vital conditions are unmet. Racism and bias are an important contributing cause of unmet vital conditions and poor health outcomes. For example, residential housing segregation, unequal treatment in the criminal justice system, and lack of access to credit and capital have the effect of concentrating poverty, limiting access to quality education, and limiting employment and economic opportunities, all of which, of course, affect health additionally. Just as the U.S. health disadvantage sets the U.S. apart from other wealthy nations, so, too, do the contributors. So, for example, our policy and spending decisions, such as taxation, social welfare programs, and investment in education, our economic conditions, such as poverty and income inequality, social and environmental factors, like access to affordable housing and to recreation and parks, and our exposure to violence. We're different from other wealthy nations, our peer nations, in so many ways. Individual behaviors, like alcohol and drug misuse and use of seatbelts, and, of course, healthcare costs and lack of access. Although these may seem like issues that governments tackle, the fact is, in a democracy, all members of society can shape solutions together. And businesses often play an outsized role, due both to their influence on government, which can be positive or negative, and their role in the economy. So, what can business do? The report includes four sets of recommendations, 14 recommendations in all, and provides examples drawn from 40 businesses of specific practices businesses can implement to strengthen both business and society. Businesses are critical to solving the US health disadvantage and building a more equitable and sustainable future, and it's in their best interest to do so. That's a key takeaway. The report doesn't ask business to become philanthropies or to take on a government role, but it does ask them to solve business problems with society in mind. So, the first set of recommendations has to do with learning more about your stakeholders. Stakeholders are everyone, all the entities and people that the business depends on in order to be successful, such as its customers, its employees, its suppliers, investors, and communities. The report recommends actions to help businesses understand and meet the needs of their stakeholders so they can all thrive together. And I'll give you an example. The Hillenbrand Company established a dialogue with their community of Batesville, Indiana. This group of local business and civic leaders has become a think tank in the community, studying and solving the large issues that are facing the community, including diversity, workforce skills, and the development of a vibrant downtown. Second, businesses can foster a culture of stewardship. Stewardship refers to managing one's impact on society in a positive way. Businesses can become better stewards through their policies, their investments, advocacy, hiring, and procurement, all the ways that businesses conduct their operations. And here's an example. Some businesses like Greyston Bakery and Belden LLC go out of their way to hire individuals who may be passed over by others due to, say, lack of education or a history of incarceration or substance misuse. When these individuals are hired instead of being passed over, they often prove highly effective. They're productive, dedicated, and loyal employees. That's good for business and jobs and incomes, especially family-sustaining incomes, are good for people and communities. Third, businesses can join partnerships. Collaboration is key to business success in improving community health and increasing equitable prosperity for all. Here's an example. Morgan Stanley, an investment and financial services company partnered with Local Initiative Support Corporation, a national CDFI, along with the Kresge Foundation, and created the $200 million Healthy Futures Fund. The fund finances community health centers and affordable housing in underserved areas. These affordable housing, health centers, job training, these are the building blocks of health. Finally, using data and measuring progress are critical. The report offers ways to help businesses get started, identifying what matters most in community health, creating their interventions together with others, and measuring their progress to achieve success. Another example, Starbucks collaborated with Opportunity Finance Network to spur job creation in struggling communities following the Great Recession. It carefully tracked and reported loans made and jobs created or retained, and thus were able to document the impact of their investment on the communities they serve. Businesses are used to tracking business metrics and public health is used to tracking health outcomes. Businesses can take a similar approach to their community engagement and their philanthropy. And likewise, public health can learn to recognize business, community, and economic measures as indicators of community health. Metrics like labor force participation, showing up for work on time, even carbon emissions. These are health indicators as well as business and economic indicators. And speaking of measurement and tracking health indicators that are meaningful to the community, I'll end with this quote from Robert Kennedy. We all know the aphorism, what gets measured gets done. Well, the things we choose to measure and the measures we rely on to see if we're on the right track are not necessarily the things that matter most to our health, wealth, and wellbeing. Of course, we want a robust economy, but we also need those qualities that make life worth living. The quality of our children's education, for example, our courage and our compassion. The Surgeon General's report invokes the idea of a wellbeing economy and encourages businesses and all the rest of us to measure performance using meaningful indicators of community health and wellbeing. Thank you. Thank you very much, Dr. Bauer, for that additional informative and thought-provoking presentation. Next to the discussion table is Dr. Abdul El-Sayed. Thank you so much. I'm grateful to be with you all today and grateful to have the opportunity to share with a number of thinkers and leaders whom I deeply respect. I wanna actually go back to the early 2000s when former Surgeon General David Satcher did a very simple study. He asked a very simple question. How many black lives would we save every year if we were able to reduce the black mortality rate so that it was the same as the white mortality rate? And he found that we would save 85,000 lives a year. Now, the only way to accurately attribute the causes of death for those 85,000 excess lives that we lose every year is to attribute them to systemic racism. Now, I wanna fast forward from that point in the early 2000s to what we witnessed last summer when a police officer knelt his knee on the neck of a man for nine minutes and 29 seconds and murdered that man in the middle of the street on a hot day in the summer in Minneapolis. And talking about the murder of George Floyd. And if we wanna understand systemic racism and the way it takes lives, that was the tip of a very large iceberg because it has a lot to do with who we think of as part of the public. And the argument I wanna make today is that we have for a very long time excluded black folks from the concept of the public that we have in this country. the concept that animates so many of the public goods that too many folks get to take for granted and too many others don't get access to in the same way. Because that officer, he was charged with protecting the public safety. And not only did he fail to appreciate that George Floyd was a member of that public that he was supposed to keep safe, rather, he assumed that George Floyd was a part of that which he was supposed to keep the public safe from. And that reminds us that black folks have not been included in the public in public safety for a very long time. But it's not just public safety. That's a tip of the iceberg. It's also public education. We continue to fund the public education through local property taxes. And we know that property taxes are a function of property investment. And we know that the federal government has invested in certain properties and not invested in certain other properties. So in the 1940s, under the Federal Housing Administration, under the New Deal, black folks were not allowed to get low interest or zero interest loans to buy homes. They weren't allowed to buy homes at all in certain neighborhoods. And so they're redlined in certain communities where the government was not investing in those properties. Over time, those investments accrue. They compound. And we continue to fund school districts based on the consequences of the compounding of those investments. That is systemic racism in public education. So black folks aren't included in the public in public education in the same way either. Think about public utilities. I live 50 miles away from Flint, Michigan. And I can tell you that black folks haven't been included in the same way in public utilities when the state of Michigan robbed people of their local choice in terms of self-determination, upended their local government, took control, made a decision to change their water source, and poisoned 9,000 children, 100,000 people in the city of Flint, excluded from the public in public utilities as well. Think about public service and the fact that we don't nearly have representation for black Americans in the same way that we do for white Americans, let alone white men in our Congress. Think about the public in public service. And today, our goal is to talk about public health, to bring us back to this conversation about public health. And I want to talk a little bit about the ways that we have systematically excluded black people from the public in public health for a very long time. I can tell you statistics, right? Three times as likely to die in childbirth if you're a black mother. Two times as likely to die if you're the infant that that black mother birthed. I can tell you statistics about gun homicide. I can tell you statistics about cardiac mortality, about diabetes. But I want to go a little bit deeper. I want you to remember two numbers, 60% and 3.7 times, okay? 60% and 3.7 times. The two problems I want us to diagnose that systematically exclude black people from the public in public health are that our healthcare system, healthcare, the medical side of health, it systematically sucks all of the oxygen out of the room. And so that leaves us disinvesting in the places where people live, learn, work, pray, and play. The second point, though, is that even in the healthcare system, the health of black people, black bodies are systematically devalued. That's where I get to these two numbers, 60% and 3.7 times as much. In our medicalized healthcare system, health insurance is your ticket in. But private health insurance stratifies our system. There is the platinum plan. There's the gold plan. There's the silver plan. And then there's Medicaid, right? And we know that high income people who are insured through an employer or have access to private health insurance, that they have those platinum, those gold plans. And lower income people who are not employed in a traditional way, they may work jobs that don't come with benefits, or they work in gigs, or they're unemployed, that these folks are systematically more likely to be insured on plans that they get on the exchanges, the so-called silver plans, or on Medicaid, if they're lucky enough to live in a state that's expanded that. And the numbers here that I told you about, 60% and 3.7 times as much, 60% of black children, 60% are insured via Medicaid. And we know that 60% of white children are insured privately, okay? Now here's where 3.7 times comes in. If you are insured privately, the average reimbursement for your care is 3.7 times as much as the reimbursement for Medicaid. So I want you to do the math there. If 60% of black babies, children, are insured on Medicaid, that reimburses at 27% as much as private insurance, compared to 60% of white folks on private insurance, then the healthcare system systematically devalues black bodies for the medical side of healthcare. So we've been having a conversation in our country about coverage, assuming that coverage itself is the problem, as if coverage meant the same thing when you're talking about different people. And I just want to disabuse us of that notion right now. Coverage is not all created equal. And the goal itself is not coverage. Because in fact, if you're a health insurer, of course your goal is coverage, because that means more people on your product. That's not actually what we're after. We're after consistent access. Because the knock-on effects of the fact that black people are systematically more likely to be insured on Medicaid, that we've segregated black people in particular communities, is that primary care physicians don't locate in those predominantly black communities. Those hospitals don't command the same reimbursements for taking care of black patients. And so even if you may have Medicaid-based insurance, it doesn't necessarily mean that you have access. I think about the city of Detroit where I was health director. And in Detroit, we know that you can literally draw a map of the city of Detroit based on where primary care doctors are, because they don't locate inside the city. And the tragic irony of the motor city is that only 40% of Detroiters have regular access to a car. And so access to a primary care clinician who will take your Medicaid insurance is very low. And so you don't really have that thing. And on top of that, because the hospitals in those communities are trying to make ends meet on 27% as much reimbursement on average for the care that they provide, they tend to be under-resourced as well. They tend to get bought up by for-profit providers who are trying to nickel and dime the system, who don't provide the same level of care as the richer, better-reimbursed hospitals do. So that's the one problem. But then think about the logic of our system in the first place. Health insurance is for-profit. Hospital care, clinical care is for-profit. If you don't have money to spend in the system, if you don't bring the same reimbursement into the system, you're not going to get care. But our entire health care system has been dominated by medical care because it makes people money. And when we ask these questions about why we don't invest in the places where people live, learn, work, pray, and play, it's because you can't make money doing those things. And so we don't do them in our country. And who tends to be hurt the most? Well, Black folks. And here's the bigger issue. And I'm speaking directly to the public health community now. We've perpetrated a very violent term to talk about the differences in access. We have this term called healthy lifestyles, as if being unhealthy is just a lifestyle choice. And we neglect the fact that we disinvest in the basic social services, the basic clean air, the basic clean water, the basic access to good food, the basic walkability of predominantly Black communities. It's not about healthy lifestyles. And we have to disabuse ourselves of that notion as well. And so where am I going here? I think we have a responsibility to step out of the system that we have. And rather than talk about incremental fixes to a system that is structurally broken, if we're serious about putting Black folks into the public of public health, we've got to be rethinking the system as it stands on its basic foundational moors. We should not be tiering access to the health care system as it stands. No matter who you are, where you grew up, the color of your skin, you should have access, the same access, to the health care system. It should reimburse for your care the same way. Because you know what? All of us value our bodies the same way. And we need to stop thinking about the profit motive as some sort of holy grail. Instead, there need to be real investments in the places where people live, learn, work, and pray and play if we're serious about taking on health disparities. And so I hope that coming out of this today, we take into account a lot of the things we can do in the system. And don't get me wrong, getting more people health coverage and investing in more culturally appropriate care are good things. But let's not pretend like they're going to solve the whole problem. Because there are structural flaws, structural costs that are systematically born by people of color, by oppressed people across our country of the way we do business in health care. Thank you. Awesome. Awesome. I just want to start by thanking all of our panelists, Drs. Maybank, Bauer, and El-Sayed for your very vigorous dialogue around the issues. And we have quite a few questions that are already percolating in our Q&A box. And so what I'm going to try to do is weave some of these questions together where they are related and look for dominant themes. And I may address a question to one of you specifically, but please, if there are others who feel you have something to add to the discourse and the dialogue, please, please go ahead and do that. So let's start with Dr. Maybank and the work that you, the seminal work that you're describing at the AMA. And I think a lot of us would want to know in as much practical terms as possible, what does it mean to truly center diversity and inclusion within medical societies? And I'm going to relate that to an audience question. There's an audience question around a popular movement. And I would say this has been happening for years. I saw it when I was in college of groups wanting to affiliate with others that they self-identify with. So it's becoming popular in college campuses to have safe spaces for people of color. Is this reverse segregation? Is it unhealthy? Are we on our way to imposing reverse apartheid? And why are safe spaces for groups, for people of color always questioned as reverse segregation or reverse apartheid? That's a lot there, but let's start to unpack that. Dr. Maybank. Yeah. I mean, okay. Let's see how to break this down. I think what Dr. El-Sayed really elevates, which I think is critical to this work of advancing equity and justice is challenging, again, narratives and dominant narratives and malignant narratives that don't advance equity. Right? And I think that the biggest part of doing this work that I've learned, I'm well aware of some of the technical aspects of how to do this work. And I went through some of them in the slide. But the reality is, is if we don't get to the narratives and disrupting those, we don't get to value targets, as Dr. Jones says, value targets of individualism and how we prioritize that in this country instead of collectivism, American exceptionalism, the myth of meritocracy, white supremacy, the myth of white supremacy, as Dr. El-Sayed said, we don't get to move very far. But because, from my perspective, folks have been excluded, they have a right to be able to convene and to become collective in the ways that are critically important for one's own sense of humanity and collective humanity, in response to the trauma that many folks in communities have experienced for generations. And so I don't, I'm not sure what is meant by the movement. But people have always worked in collective opportunities around collective identities, right? People have done it for centuries. And so there's no reason why other folks should be able to have the opportunity to do so as well. And I think it's important that we have the opportunities to be collective with one another for that safety that has been elevated, but just the ability to be able to have some sense of pride and resilience, if that's the right word, but at least some sense of pride to be able to move forward. And some remembrance from one another, and this has happened to me more recently in the work that I'm doing within the context of the institution, that to remember this is a fight not just for liberation and freedom, but the right that we deserve to have joy. And so, you know, we have the right to come collectively in order to experience that, and to fight and to thrive for that. And I keep that as the lens of why I'm doing the work and why we need to be doing that work. Clearly all the other opportunities that were mentioned from the previous talk. In terms of for the organizations and the medical societies and physician organizations, you know, that we put forward the strategic plan to hopefully provide some level of a roadmap. Again, understanding that this is only like a small part of the step, and really understanding there are contradictions and conflicts in a lot of it. But I have to meet right now where I can meet the organization and the institution, and I think it's important to understand that movement work has historically always been internal and external to an institution. So the push for extreme accountability on the outside by those who are usually most marginalized historically and experienced in injustice is actually critical to any movement, because we're using the ones who started. In addition to recognizing all the folks who are internal to the institutions who are also trying to push and fight for justice as well. And so I think it's critical for us as physicians that if we're really interested in, again, movements, there's inside outside strategy to do this work forward to better understand how our system really does operate and really either undermines equity or advances equity. Excellent. Is there anyone else would like to add to that before we move to our next question? There was so much there. This is such a rich opportunity to discuss. Okay, so just segueing briefly to some of the themes that you touched on, Dr. Bauer, and if we consider what we have been living in the midst of something that I call a collision of two pandemics, there are multiple pandemics, I believe that are happening, but a collision of systemic racism, the pandemic of systemic racism and the collision of the pandemic of coronavirus, which have become a foundation for demands, which have become a foundation for different narratives to be leveraged and uplifted and amplified as assets. And so we see more corporations, we see businesses talking about social justice or racial justice. And there's a comment too in the chat box about whether or not we are minimizing or invoking bias into the notion of justice by terming it social and or racial or health. But we have these businesses embarking upon an edict or an imperative to improve the physical and mental health of their employees, families and communities more broadly. Do you see this as a tipping point moment? Is there wind in our cells? And if so, how in your particular role are you trying to leverage that momentum? Yeah, thank you. Thank you for that question. You know, certainly businesses are trying to position themselves as attractive to consumers, as attractive to employees. Consumers and employees increasingly care about values. They care about the purpose of the place they work or the place where they shop. They care about government, governance, the environment, sustainability. So businesses, you know, are paying attention to this and they're trying to use the moment to figure out how they can act and how they can show their values and show their purpose. And, you know, a number are trying to take bold action. I mean, we just heard a description of what the American Medical Association, it's a non-profit, but businesses are certainly taking similar action. The trick, though, is to make sure that this isn't just a passing fad, right? To make sure that the actions are meaningful and are sustained. As I said in my talk, businesses are recognizing that it's in their own best interest to treat people fairly, to be stronger advocates for a just society, to make sure that our economy works for everyone. And people are increasingly recognizing that businesses need to step up and be part of the solution. So I am optimistic that we're in a moment where, you know, we could take off, we could see a lot of change. Hopefully it doesn't all just kind of ride the wave and disappear. But I do see a lot of action around conscious capitalism, creating shared value, and really looking at hiring practices, at a range of investments that can really help ensure a prosperous economy for everyone. Thank you. One of the questions I inserted there that's also coming from the audience, and I'll position it back to you, Dr. Bauer, because I think it's related to what you said, but please, others, feel free to weigh in. Critics have argued prefacing justice with social or racial, or even environmental, diminishes actual justice by removing the idea of impartiality. Despite our great intentions, do we risk removing the blindfold of justice and imposing bias? And if we are, will the end result just be a perpetuation of injustice? So is there a risk for businesses to say that they have specific imperatives or mandates around health justice, racial justice, or even environmental justice? You know, I mean, we use language in helpful ways and in pernicious ways and in misleading ways. So I think there's always an imperative to define our terms and explain what we mean, to boil our thoughts down to a very basic level so that we can communicate clearly. You know, I think the fact is, as a society, justice hasn't been equally delivered. We don't have blinders on with our American justice. Justice hasn't been equitably, equally delivered. I mean, look at our criminal justice system, right? It's fraught with injustice, with bias, with mistreatment, with maltreatment, with unequal treatment. I started my talk with a land acknowledgment. Our nation is built on stolen land and stolen labor. So how do we have a conversation about justice in that context? So there's a whole range. Justice is a fraught and large topic. And if we need to talk about social justice in one context, criminal justice in another, racial justice in another, there's plenty to talk about in all of those components. Thank you. I just want to do a check with our other panelists before moving, if anyone wanted to weigh in, because especially Dr. El-Sayed, you spoke about the power of language and the power of language around healthy lifestyles and what is the role of language, not even literacy further, but language in setting the table for narrative and setting the table for power discussions? Yeah, I really appreciate that question and that point. I think language is a way that sets narratives by default. And narratives that tell us about why something's happening are really powerful because, of course, they point to a particular set of solutions. And probably more importantly, they point to a particular set of people who are responsible for solving them. And narratives that place the blame, whether explicitly or implicitly, which is probably even worse, for the disparities that we witness on the people who are victimized by them, rather than taking into account the structures that created them, themselves are part of the problem. And we have to understand that, right? Because one of the ways that narrative gets set is that context gets ignored. And that norms get carried forward, right? And we sort of have to appreciate that the bias for whatever is normal is really quite powerful, even if normal itself is really quite abnormal. Our normal around health and healthcare in the United States is really quite broken. And you compare that to any other norm relative to countries that have anywhere near our per capita income, you'll see that our normal is not normal. And yet it's the only quote-unquote normal that any of us have ever actually known. And so we take it as just the status quo. And so deviating from the status quo, moving from the status quo, even if the status quo is itself violent, is part of the challenge. And so we have to be able to dissect the language that is justifying and excusing the status quo, even as that status quo is robbing people of basic resources. And so, yes, we have to be, I think, thoughtful about language, and we have to define our terms. But also, I think we have to be pushing back on what is the narrative that we've all imbibed for a very long time, and do so in ways that are consistent, kind, but recognize that there are people who are implicitly spoken for and spoken against in every way that we use our words. And so we have to use our words thoughtfully. Thank you. I wanna read two questions. They're quite long, but they're related. And I'll open it to the panelists abroad and to weigh in on it as best you can. And so one of the more popular questions is around the AMA having opposed universal healthcare system reforms in the past, such as Medicare for All, which would be a major way to eliminate health inequities and build a more just health system. Has AMA changed their policy around Medicare for All? And related to that, there was someone questioning, I wonder if Dr. El-Sayed, author of Medicare for All, and a member of the American Citizens Guide, can respond to the recent statement from AMA. We remain opposed to Medicare for All and policies that reduce patient choice and competition, and are built on flawed financing policies, said James Madour, AMA CEO. And so we have quite a few in the audience who are also AMA members. And this is a topic of discussion that is frequently volleyed back and forth. And so I'll open it to the panel for you all to weigh more broadly on health system delivery reform, health insurance reform, however you feel comfortable responding. Yeah, I mean, I can start, and then Dr. El-Sayed can give his thing, you know. So AMA doesn't oppose universal healthcare. They do oppose Medicare for All. That's just a language thing and a semantics thing to some level. So as was already said, the AMA does still oppose, the House of Delegates have still voted in that way. They didn't vote this year because of COVID, but the year before it was the closest vote to not oppose. And the AMA is evolving in terms of who is there and who's making up the House of Delegates, how resolutions are being put forward, you know. And we got, you know, when I think about the anti-racism policies to rid our healthcare system of racial essentialism and to rid race as a proxy for biology, genetics, et cetera. You know, excuse me, I look at the progress of that and how that would not have happened before, but really also acknowledging the students and the young physicians who are more aligned with social justice principles and realities, you know, and they see health and the society in different ways because they've grown up in a time where they've seen explicit advocacy, they've seen injustice and they've seen injustice. I'm talking about also predominantly white students who have seen injustice in a way they haven't before because of the advent of phone cameras and all of that. And so I feel that they have been able to become collective and have a voice and find a voice to push at many institutions across this country, but AMA being one of them. You know, that's as much as, you know, I can say, I am a health equity and justice person, very, very clear about what undermines health equity in terms of coverage. But right now I'm representing the AMA. So I'm limited in what I can say in terms of my response that I would give fully, but I'm sure Dr. El-Sayed can provide, you know, a context of which I probably am very similar and aligned with as personally Aletha Maybank. Understood and appreciated. Dr. El-Sayed? Yeah, sure. First, I wanna preface that I am a big fan of Dr. Maybank's work. I'm really grateful for the work that she's doing to I think bring the AMA forward from some very, very problematic positions that they've had. And so what I'm about to say is in no way a reflection of my respect for her and the work that she's doing. I'm a physician. My wife is a physician. Neither of us are members of the AMA and the AMA does not speak for the, I would say the majority of American physicians. There was a time when the AMA did, but you know, you look at poll after poll of physicians today, they're recognizing that the circumstances in which they work have changed. There was a time when doctors were organized as a unit through the AMA because they were business owners. And as business owners, they were focused on what was good for the bottom line. The consolidation in our healthcare system that in part was brought about by policies that the AMA supported has led to a circumstance where physicians are no longer business owners. They're more likely to be employees. The median physician no longer works for a physician owned practice. And the median physician supports Medicare for all. I'm also gonna differ on the fact that I think there is a big difference between single payer healthcare and universal coverage. And I think the semantic difference is important because we can be for universal coverage, but if it means that one group of people's bodies are valued at 3.7 times as much as other people's bodies, that I don't know how universal that actually is when we're baking in the inequities that we see. The reason single payer matters is because it actually creates equity at the point of coverage. And I think that that really is critical. The other point I'll make is that the AMA has been on the wrong side of these issues for a very long time, whether it was Truman's proposed national health insurance program, whether it was California's approach to universal healthcare way back in the 40s, even before Truman proposed it in the 40s. The term socialized medicine was in part paid for by the AMA whether it was Medicare itself when the AMA opposed Medicare because, and even worse use the argument that Medicare would forcibly desegregate Southern hospitals to justify the opposition against Medicare, or it was the ACA until finally a number of conciliations were made that were made in the best interest of the folks who are members of the AMA who tend to be specialists. They opposed the ACA at that point, right? And so all of this is to say that there's a reason that if you are a physician in the United States of America and you believe in a more equitable healthcare system and you enjoy Super Mario Brothers, no, and you believe in a system that does value all bodies equally, that you don't, you're not necessarily a member of the AMA and you tend to oppose their position. I do have a belief that the AMA is going to have to change. And that's because physicians are changing because young people are sick and tired of graduating into a healthcare system that does not benefit their patients, that forces them to turn away people who are insured on Medicaid or are not insured at all, even though they are sick and deserve our care. And so my hope is that we'll get to a point, May is right on this, but until then, I do think that physicians of good conscience have to stand up and say, AMA doesn't speak for me, right? And we have a responsibility to honor the highest ideals of our profession, which are that we care for folks and first do no harm. And I would argue that doing harm includes opposing access to healthcare for millions of people who are disproportionately black and brown. Thank you to both of you. So we're coming up to the close for this session. I wish we had more time. The conversation and the dialogue is definitely worthy and relevant of it. I'm gonna ask each of you to provide some concluding remarks about a minute in length, but to set you up, I wanna read one final question because I believe the end of that question can be insightful in how you close out. So the question reads, as our system continues to refuse to negotiate with the poorest communities over wages and resulting loss of health and quality of life, we continue to use and perpetuate a system that survives on the marginalization of the disempowered instead of expanding an abusive system to cover more people what could be done to make the system itself less abusive? And however you would like to take that to offer your concluding remarks. Thank you. We can start with Dr. Bauer since the other two spoke recently. Thanks so much. And I'll piggyback on the last question because I think it's such a reminder that we don't have a healthcare system in this country. We have a healthcare industry and that industry is made up of lots and lots of businesses and businesses, whether they're hospitals or making brownies, they have to be first and foremost looking at the profit motive. And that's a major problem with our healthcare system. It's gonna be a major problem in our country in terms of achieving universal coverage and health for all. But as I said, businesses are stepping up and this is a moment of change for business. So I remain optimistic that we will see seismic change in the AMA, in the healthcare system, healthcare industry, and in the private sector across the board. Dr. Mabee? Yeah, I'll go next. I don't even remember what the length of the question was, but what I'll say is, in speaking about change and I'm gonna speak specifically about the AMA, is just, I think many folks don't realize how it's structured and how it works. It's not a single voice that makes decisions on the policies, right? It's the members and the members are, it's like, it's honestly the United States of America being represented as part of the House of Delegates. And so in order to create change within the AMA, that means there has to be people in the AMA, who are willing and more leaning towards progressive values and equity and justice in the ways that, I know that my values are aligned with for sure. But if folks are resistant to that, that AMA doesn't change per se. But I will say again, the med students, thankfully, have been pushing the health equity and the equity agenda overall. Like we've done a lot on equity in the last couple of years and justice beyond just what happens in the healthcare system. A lot in part in leadership of the resolutions that have been put forward and actually passed and voted past by the House of Delegates. But I just wanted to be very clear about that it's not a single voice. And so AMA changes like other quotes, democratic institutions by people becoming AMA members and pushing it to change. And AMA still does have power. That is what I see every single day in the work that I do. So I just wanted, how we create change is also understanding how, I think we all understand this, how the systems and really work to its nuance sometimes so that we can understand where we need to step in to create that change and to push. Thank you. Dr. El-Sayed. Yep, and I appreciate that reminder that we have to put our shoulders into the work. And I appreciate Dr. Maybank putting her shoulders into the work and grateful for that. And I wrote a book called Medicare for All. And I have some opinions about how I think we ought to fix the system. I'd encourage folks to look at and very deeply look at health reform packages. But ultimately my sense is that until we are able to take the profit motive out of the center of our healthcare system, and unless we are able to make sure that at the point of entry, everyone's body is valued the same way, we're gonna continue to have these disparities because we are not going to invest in getting people access to healthcare unless of course they have money to bring to the table under the current system. And we are not going to take on the public health challenges that people face in the communities in which they live until we are willing to unlock all of the money that is sequestered in the healthcare system for profit. So that is sort of, those are the two coins of the realm that I think really matter. And the last point I'll say is this, all of us have to decide that we are going to be a part of the solution. I think sometimes in our lines of work, we assume that we cannot be political. And I would argue that if this moment's taught us anything is that we have to be political. And the choice to believe in science, to believe in equity, those are political choices. They have to do with how we allocate scarce resources in our society. And so long as we allocate them inequitably, then it will be a political choice for us to change the way that they are allocated. And so my hope is that you will find a way to get involved, whether it's through a body like the AMA, or it's through making sure to get involved in a town council or to run for office, or just to make sure that you're organizing people around your issues, the issues that you care about. I hope that you will. And that really is the work. So I really appreciate this opportunity to share some thoughts and share a space with some incredibly powerful voices for health equity and leading minds, and looking forward to the future together. And on behalf of the ACPM and this conference in particular and my co-moderator, Dr. Rhodes, I just want to extend a heartfelt thank you and gratitude for all of you, just as an admirer and an observer of today's conversation and to salute the work that's being done in the three various realms that you're operating in. I'll leave folks with three words that I think we should all continue to reflect on and intentionally act around. Justice, narrative, and power. Next up, you'll see networking opportunities. So stay tuned for the rest of the conference. Thank you.

panel discussion

health equity

social justice

businesses

healthcare system

collaboration

stakeholders

community investment

Hillenbrand Company

inclusive hiring practices

social determinants of health

systemic racism

inequality

medical societies