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Gavin: Hello, welcome to a special episode of The Lancet Voice, marking Black History Month in the USA. It's February 25th, 2021, and I'm Gavin Cleaver. We'll be hearing from three brilliant black women today about their research and experience, and we're starting off by talking to Professor Sherelle Barber, who's also featured in The Lancet this month in a profile piece, which you can read online, of course, at thelancet.
com. Cherelle, who works at Draxell University in Philadelphia, is a social epidemiologist whose research focuses on the intersection of place, race and health. We spoke about how neighbourhoods can determine outcomes, and what this means for racial equality. Professor Barber, thank you so much for joining me today.
Sharelle: Thank you so much for having me, Gavin.
Gavin: Tell us a little bit then about your background and what drew you to public health in the first place.
Sharelle: I'll start by saying I'm a daughter of the South. I've been born and raised in the Southern United States and always had an interest in health, actually medicine very specifically from a young age.
But as an undergraduate. student at Bennett College. I was fortunate enough to participate in a summer program at Harvard University, the summer program in quantitative sciences that literally opened my eyes to the world of public health. And what specifically struck me about that opportunity was that I was working with some researchers who were examining the role of discrimination on interleukin 6, which is a stress hormone.
And I had never thought about. Something like discrimination, which again, as a black American woman, knew about because of the history, but I didn't know you could study that. And I didn't know that you could study how these kind of very big contextual drivers influence the health, health of individuals.
And so that kind of struck me during that program. The other turning point during that program was I was assigned to read a paper called the Negro health. problem. And this was written in 1914, published in the American Journal of Public Health by a white physician who did work in Georgia. And he was talking about the health of blacks.
And and this was again, what less than 50 years after the slavery here in the United States, but what he. Said about the health of blacks was boiled down to individual behavior or their lack of discipline. And even went on to say that slavery had been good for black folks, . And that it actually kept them healthy.
And for me, I was livid, literally reading this as a, again, as a daughter of the south, as someone who is, born and raised in the south and I was just like. And this got published, how did, and he didn't know mention of slavery besides the fact that it was, oh yeah, they should still be enslaved because that was when they were healthiest and had discipline and had boundaries.
And I was just like, it just, it actually angered me, that this would be the perspective without taking into. consideration, historical context, without taking into consideration the poverty that enslaved individuals were left to face, we didn't get the 40 acres and a mule that was promised, of
Gavin: course, and it's astonishing how recent those publications are.
Sharelle: Exactly. And so I'm sitting there as a almost junior in college saying, this is absurd, but I'm also, that was written in 1914, but also still hearing in mainstream kind of conversations about health, the same arguments that the high rates of, certain chronic diseases among blacks, for example, particularly in the South are because they lack communication they don't engage in healthy behaviors and they don't engage in things like physical activity or their diets.
And so again, the blaming was still happening even, over, nearly a century later. So then I'm thinking to myself, what is it? What are, why are we missing this big context? Literally the enslavement of black folks in this country and what that means for all of the ways in which our society is structured that limits the potential for people for whole communities to be healthy.
And so that began my journey. And then finally, one, one last person I'll have to shout out is Dr. Sherman James. Because I also, in that same kind of in that same program. read his work on John Henryism which was talking about the active coping of blacks in particular in the United States in the face of kind of the oppression and the structural barriers that they face and how that might explain hypertension.
So I had these two juxtaposed. positions on health. One, totally void of history, totally void of structure, totally void of an understanding of health or health basically out of context. And then I had this Black epidemiologist who's a pioneer in social epidemiology, really speaking to these larger structural issues and the ways in which the Black American experience and us having to cope and work, work in the face of these things can lead to health.
And so that, that really began my journey.
Gavin: I think that leads nicely onto us talking about your work on structural racism in the community. And I was fascinated to read this in the buildup to our interview, thinking about how neighborhoods and inequality overlap. But why don't you tell us a little bit about your work in that area?
Sharelle: Yeah, absolutely. So again for me, neighborhoods or really racial residential segregation in the U S is one of the most visible manifestations of structural racism that we have. It literally is how racism gets. It's embedded in the brick and mortar and the social fabric of our cities. And it's every city, in the U S that has these legacies of racial residential segregation.
And so what in cities, major cities like Philadelphia, where I live, but even in the South in Jackson, Mississippi, where I also have work is that because of policies, right? Not. Just by accident, but by design at the local, the state, the federal level, particularly policies such as redlining that took place in the 1930s, we have, we set the stage for a kind of segregation that has just persisted for decades and decades.
And that initial insult and disinvestment that redlining produced, basically making it so that banks would not loan for home mortgages in certain areas that were quote unquote redlined, mostly predominantly black American communities that set the stage for decades of disinvestment that has been, led to the conditions that we see today and on top, lay on top of.
of that the decades of disinvestment, so economic disinvestment, the ways in which neighborhoods these neighborhoods are targeted by police by extractive industries and polluting industries, right? Wait, so you have environmental racism and all of the other social conditions that kind of come with that.
It creates this perfect storm for poor health.
Gavin: It's interesting to think about the collective in that sense, isn't it? You're saying that it's nothing to do with individual decisions made within a neighborhood, but actually with the collective environment within the neighborhood.
Sharelle: Exactly. And what you have to, what you really begin to see is that individuals in certain communities have constrained.
Opportunities are constrained choice, right? And so even if engaging in behaviors it's a, it's more about the environment, right? And so if we understand that one neighborhoods matter for health, right? Because of all of the research that's been done in that area. But for black Americans in particular where they live, the neighborhoods they're live, live in are restricted because of these kinds of policies at the federal, state and local levels.
Then we understand that we have to address those structural issues if we're actually going to address and improve health in particularly black communities.
Gavin: Yeah, absolutely. Another thing that's really striking about your work is how you're you describe yourself as a scholar activist and you've got this role as a social epidemiologist as well as your activism.
So why has that kind of been important to you? How does being both help you in your work?
Sharelle: Absolutely. Because these issues that I study and again, this is, work I do in the context of the United States, but I also have some research in Brazil as well. And we can talk about that, but because they're structural in nature, that means they require structural solutions.
And often those solutions require push from the people and push from the collective, to really transform communities and it requires. It's linking up and aligning with, the community folks who are on the ground doing the work. And so it's important for me to align in that way.
I think I came to this also because some of my first work in community and public health were with local organizers and activists to black women from Eastern North Carolina. Who had been working in their community for years. And as a student in my master's program at UNC, had the opportunity to just watch and learn from them how they organize their communities, how they made their community aware of issues that were important and how they push local government, as well as other folks in power to do right by these communities.
And so I learned from organizers and activists and also come from a family of activists. And it's, just very central. I also think that in this moment my trajectory, so I finished my doctoral work at Harvard in 2014. That was right around the time that George Zimmerman was acquitted for the murder of Trayvon Martin.
But in the summer, I think it was the summer that I had finished, you had Mike Brown and Eric Garner being shot by police. And then the list goes on, right? And then we get to this year. Having a global pandemic that is wreaking havoc on Black communities, Indigenous communities, and poor communities having to bear witness to the vicious and violent murders of Breonna Taylor, George Floyd, and countless others.
I have no choice because of what I've seen to divide those two. And I try to use my scholarship. To quote, unquote, make the invisible visible so that can be then leveraged as a part of the action that's necessary to bring about change. Because what this pandemic has shown us, in so many ways is all these structural factors, racism economic exploitation all of these things are what has caused us to have so much death and suffering in our communities.
And those, and there's a fundamental need to change the systems and structures. And you only do that. through, bold social movements. And again, as a, as last thing I'll say is someone, who is in the field of public health, the public's health, it's almost a mandate in this moment that we use our, not only our scholarship, but our voices align with, those who want to bring about radical change.
And so I, I don't know how else to be, in this moment. And it's absolutely necessary if we're going to think about a world beyond this pandemic that is more just that is more equitable and allows every community to thrive because of what we've seen over just even over this past year.
Gavin: Just finally, then our conversation is taking place during Black History Month in the U. S. What does Black History Month mean to
Sharelle: you? One, I don't think it should be just a month. For me, Black History is. 365 days. And one thing that I'll say, it's a time of reflection for me. So I am able to be in the spaces that I am, have the education that I am because of the women and men who came before me.
I am here because of them and can't, and I'm and I'm not disconnected from that. So that's one thing. It's a time of deep reflection for me. Thinking about the shoulders that I stand on women from the South, like Fannie Lou Hamer, who fought for voting rights in the 1960s, or Ida B. Wells, who spoke out against lynching during her time or folks like Audre Lorde who used.
the power of the pen and poetry to speak to issues of racism and so many other isms in our society. Those strong, courageous black women who have really shaped and dare to speak truth to power, even in some of the most challenging times in our country. And so for me, it's a time of if they did it, then, how dare I not use my voice, my platform, whatever I've been given.
To speak truth and to try to make change and also recognizing that it's not just me, but it's a collective. And so I'm, Black History Month also reminds me of the ways in which it's always been collective power, not one individual, but a collective of individuals who've moved our society.
So it's a time to reflect on that. There's this idea that history also helps us think about how we move forward, right? And so if we think, if we can learn from our history. Both the past mistakes of, these systems and structures inside societies, but also learn from, again, how folks have been able to change the path or change these systems and structures.
We can take those lessons and actually move us towards a more just and equitable future. And so it's a time of reflecting on. And learning from and gleaning the wisdom, of those who came before us and again, how we forge a path forward, because again, we are in, we are at an inflection point in history, right?
With this pandemic, with all we've seen in terms of state sanctioned violence, not only in the United States, but around the world. And so this is, for those of us in my generation, this is our moment. And how do we reflect on what. past moments, past movements for racial and economic and social justice to really propel us into the just future that we all deserve.
Because if nothing else, this pandemic again has shown us that justice is actually a necessity for everybody. It's not just about those most directly impacted. Racism doesn't just influence the most marginalized racial groups, racism is bad for all of us. And so if we don't dismantle and disrupt these systems and structures, we're really doomed.
And yeah, so this month has been really reflective for me and how we take the lessons of the past and really move forward.
Gavin: I think that's a great place to end. It's been a really interesting speaking with you, really wonderful chat. Professor Sherelle Barber, thank you so much for speaking with me.
Sharelle: Thank you so much.
Gavin: Thanks to Sherelle there for speaking with us. Jessamy and I also spoke with Dr. Kimberley Jacob Ariola, who's currently at Emory University in Georgia. She's a public health professor whose work focuses on improving the health of marginalized populations and communities of color. Here, Kimberley talks about her career and how racism gets under the skin.
Kimberley: So I'm happy to start by talking a little bit about my background. I graduated in 1998 and came to Emory University to get a master's of public health and epidemiology. For me, that was a huge decision because I fell in love with public health while I was working on my doctorate. I had discovered this new field that was.
committed to understanding how racism gets under the skin, and that's what I wanted to figure out.
Jessamy: That's brilliant, and you've done some very interesting research, and I wondered whether you might take us through some of those fields.
Kimberley: Most of my work has focused on racial disparities in chronic kidney disease and end stage renal disease.
The underlying factor for all of my work is that there are these, we're trying to understand and intervene on these social factors that contribute to excess disease burden for African Americans. That's really the underlying theme. And kidney disease is exactly one of those factors where African Americans progress to end stage renal disease.
So that's stage five, chronic kidney disease at a rate that's three to four times that of white Americans. And there's increasing evidence that suggests that it's due to the social determinants. And my work is increasingly seeking to understand how race and racism as a social determinant gets under the skin and contributes to the faster progression to end stage renal disease for African Americans.
Jessamy: Can I ask, from that experience, what are your kind of bugbears, the things that kind of get you going about people talking about race and health that you think are under focused on areas?
Kimberley: One of the key concerns is, so I'll say the field of public health, we really, say 20 or 30 years ago, we're focused on individual level factors.
So we delivered individual level interventions to improve health. HIV prevention, while you teach women how to put a condom on their partner. And you have these interventions that include, People, teaching people how to put condoms on and to negotiate safe sex with their partners.
And as a field, we really evolved to a deeper understanding of the need to focus on social and environmental factors. So really the social determinants. So if a woman is in a relationship where she doesn't have the power to determine, what type of birth control will be used. The problem isn't that she can't put the condom on her partner.
It's that we're missing the larger context in which her relate, in which power dynamics exist in her relationship. And it's exciting that the field has really transitioned to a greater focus on social determinants of health relatedly. I've had a longstanding interest in racism and health.
And so 20 years ago, there was a greater focus on. individual level experiences of racism. And so I could report to you my experiences of racial discrimination, and then you would correlate those self reported data with my health outcomes. So all at the individual level, but as a field we've really transitioned to a greater focus on structural factors.
So structural racism. So what are indicators of structural racism that relate to health outcomes? And there's a lot of really exciting work that's looking at, say state level. Employment rates and voting participation and poverty rates as they relate to higher level health indicators. State level indicators of health or emergency department use.
And so it's exciting that as a field we've transitioned. But what's frustrating is when we as a field don't fully embrace the kinds of structural change that we can implement that's in our purview. So certainly we need universal access to healthcare for all. That would play a critical role in improving the health of African Americans.
So I work in transplant. So in transplant, if we sit back and say, hey, we need universal health care for all, there's nothing we can really do to address structural racism in the field of transplant until the U. S. gets its act together and gets, universal health care for all. That's not true.
That's not the case. It's not either or, it's both and. And so while we as a country are grappling with how to improve access to healthcare for all, there are things that we need to do within the field of transplantation to address the structural factors, not the individual level factors. This is not teaching, African American patients with end stage renal disease about live donor transplant as a treatment option.
This is about creating structural supports that help African American patients get referred and to complete the evaluation process.
Gavin: If we look on a more political side, in terms of legislation, what do you think has been some of the most like harmful or backwards thinking legislation over the last 10 years that's specifically impacted the health of black Americans?
Kimberley: The elephant in the room is COVID. In our country, there has been a hyper politicization. And that has directly harmed the health of African Americans and people of color in this country. In public health, we don't bleed blue or red, we bleed health. We are interested in eliminating health disparities and maximizing health equity.
And so that means there are things that we need to do as a country. There are decisions and policies. There's legislation that needs to be enacted that improves the health of people of color in this country, regardless of political affiliation. And clearly when it comes to thinking about COVID, there is a need.
For deeper investment in advocacy efforts related to mask wearing and, we need to get on the same page around the use of personal protective equipment and there needs to be more consistent messaging around vaccine uptake and testing. And depoliticization. Of covid and the legislation that surrounds that or lack thereof at multiple levels.
I'm talking at the federal, state and local levels. Right now is what would go far. So if you set COVID aside and, put that over here, honestly, the key factor is access to health care. And so access to health insurance is something that many of us take for granted. I talk quite a bit about privilege in my work.
And when people conduct research on racism in health, there's a desire to understand white privilege. But I also seek to draw attention to other forms of privilege like middle class privilege and heteronormative privilege. There's a lot of different type of privilege and all of us are a mix of both privileged and disadvantaged characteristics.
As an African American woman, clearly I experience oppression based on my race, but I enjoy privilege due to class and maybe my religion and a couple of other factors as well. We live in a highly racialized society, so all of that has to be contextualized. That being said, I have health insurance and so that opens doors for me and that offers privilege for me and so I have to be open about that and acknowledge that and think about the ways that we can as a society ensure that is something that's available to all people in this country.
Jessamy: You've said a couple of times that racism gets under the skin. What do you mean by that?
Kimberley: There's been a lot of work over the past, gosh, probably 20 or 30, maybe even 40 years to understand what that really means. And there is agreement that there are multiple pathways in which the experience of racism actually results in poorer health outcomes for African Americans.
So again, that's what drew me to the field of public health. This is a field that where we've documented that African Americans have relatively poor health compared to white Americans. We understand that race is a social construct. Being African American, and in the words of my close colleague, Kamara Jones, she says, race is a precise measure of the experience of racism.
And so the question is if race is a social construct and race is a your experience of being Black is a proxy for your experience of racism, then the question is, how do your experiences of racism result in poor health for African Americans? And so a lot of work has been conducted in this area because there's a lot of different pathways depending on the particular disease outcomes you're looking at.
So clearly there's work that explores mental health. And there's, there's studies that explore how individual experiences of racial discrimination relate to mental health among African Americans. There's also work that explores how individual experiences of racism relate to Physical health in the sense of self reported physical health to being.
My overall sense of health and well being. And studies have been somewhat inconsistent, but in general, there's evidence that the experience of racism is associated with poor mental and physical health for African Americans. But how? What's the mechanism? How does that work? How does racism get under the skin?
And there are a, again, a range of different pathways. There are people that have looked at stress as a mechanism. And one of my studies looks at race related stress as it relates to chronic kidney disease progression among African Americans. And there are physio, there's a large literature that looks at the body's stress response.
and how that relates to inflammatory pathways and poor cardiovascular outcomes. And so if you draw from that literature about stress in general and race related stress in particular, as it relates to risk factors for cardiovascular disease like high blood pressure, those same risk factors are risk factors for end stage renal disease.
And so you can start to extrapolate from that literature and get a sense of whether race related stress So stress is contributing to the higher rates of end stage renal disease for African Americans. So stress is one pathway. There are also, and then related to the stress pathway is inflammation.
And so there's increasing work that examines inflammatory pathways and the ways in which stress contributes to inflammation and that inflammation contributes to poor disease outcomes. And then there's also work around the behavioral aspects of stress and race. There are studies that suggest that reports of race, racial discrimination are associated with negative health behaviors like greater drinking behavior, eating unhealthy foods, lack of physical activity.
And so a behavioral pathway could be One of the pathways as well. There are studies that look at allostatic load. What the weathering hypothesis looks at cellular aging and the extent to which experiences of racism contribute to excessive cellular aging. And then with all of everything I've talked about is more at the individual level.
And so again, I'm going to take a step back. And focus on structural factors, right? And so that's when you look big picture and you say there are these neighbors, neighborhoods and communities that are characterized by higher levels of segregation. And lo and behold, more segregated communities have less access to community level resources, maybe social capital, maybe it's access to healthy foods, maybe it's safe environments for physical activity.
But there's something going on with neighborhood environments. And that those environments might be the pathway through which race is impacting the health of African Americans. And what's interesting about this broader structural focus is that it's not something that individual people can describe.
You have to measure these factors using indicators at the higher level of the social ecology. So you might use community level measures, state level measures, census tract level measures census block level measures. You use measures that are above and beyond the individual to understand phenomenon at those higher levels.
As a way to try to understand how the social environment might be the mechanism through which racism gets under the skin. What's exciting about this area of inquiry is that people with a range of different types of training approach this question differently and are all shedding light because they're getting at different angles.
Of this question, right? So if you're trained in the use of geographic methods, you might look at the spatial, geographic layout of an environment and how that contributes or how that serves as a link between race and health. If you're trained in social psychology, you might look at factors like social capital, the character, as at a community level and how that serves as a link between race and health, racism and health.
And so people come at this from a different lens. And the reality is that there's a lot of different ways, a lot of different mechanisms. Those were just a few.
Gavin: So just finally, then, obviously we're at the start of a new administration in the U. S. Are you hopeful for this administration? And if you had a kind of wish list of legislation for your area, what would be on it?
Kimberley: I'm very hopeful. I am eternally hopeful. So clearly our initial focus is on taming the COVID pandemic. We've got to enact legislation at multiple levels. Not just at the federal level, but enact legislation that helps to improve access to testing and vaccine, improve uptake, particularly among communities of color.
The early data are already showing disparities in vaccine uptake due to a range of factors. And so really trying to get a handle on the over representation of people of color being impacted by COVID is the start. But the reality is that we've got to move towards access to healthcare for all.
And if we're serious about addressing health inequities, this has to be on the table. It just has to be. It can't be ignored. We have to be intentional about studying and intervening on the social determinants of health. I understand that it's hard and I understand that it's scary because you're telling someone in a specific field, say in transplant, that part of the reason We experience profound and persistent racial disparities in access to transplant are because of long standing health inequities that have existed for hundreds of years.
And I understand you can't change that history. I understand that. I understand that you can't change the inequities in the education system. In this country, so the fact that your patient came to you today, that let's say on in general, your black patients have lower educational attainment than your white patients, so you can't change the educational system in the US.
I understand that I get it, but we can think about supports and implement structural changes to accommodate for those inherent differences in those inherent inequities. Access to information. So we've got to get to a place where we all think in our space about what we can do to address inequities in health instead of wishing and hoping that someone else will just go out there and fix, say universal access to health care.
Gavin: It's been fascinating to talk to you, Kimberly, and thank you so much for speaking with us on The Lancet Voice.
Fantastic to hear from Kimberly there. Finally then, I spoke with Professor Janice Blanchard, who's the Chief of Health Policy at George Washington University in Washington, DC, and she's a professor of emergency medicine. Janice has been writing high profile opinion pieces over the last year for CNN about her experience as a frontline physician.
And to highlight the need for Medicaid expansion, she spoke with me about a vaccine hesitancy in the black community and her hopes for the future. So Professor Blanchard, you've been writing quite a lot over in the US about the kind of racial disparity in covid vaccine uptake rates. Generally the outline.
What are some of the reasons for this?
Janice: There are a lot of different reasons. We've had racial disparities, throughout this pandemic first and having more people of color who actually had severe COVID and now with the vaccine, sadly, we haven't had as good of an uptake. Some of it is rooted in mistrust.
There's a long history of mistrust. of the medical community. You probably have heard a lot about Tuskegee, but Tuskegee is the, one of the biggest examples that we hear about. In the earlier part of the 20th century, the U. S. Public Health Service actually studied the natural history of syphilis in black men in Tuskegee, Alabama.
And they actually studied 399 men who had syphilis, and then they had about 200 controls, so about 600 men total. And even when penicillin came out, which is a very easy treatment for syphilis, they actually still studied the men to look at the natural history of syphilis. As a result, many men died from it.
They infected their families. They infected their children. The study ended in 1972, but since then there's been a long history of mistrust. There have been a lot of other examples of mistrust, even dating back to slavery, when they would test experiments in different things on slaves. And some of those scientists that did that are still honored today in many medical schools.
So some of the, some of this is based on mistrust, but other parts are, based on access. So in some communities it's harder to access. Vaccines. So that's also been a really big barrier. We've also seen low rates of uptake in healthcare workers. Some of the, not necessarily in the physicians, but in some of the support healthcare workers.
So we've even seen these low rates of uptake in healthcare workers.
Gavin: What are some of the reasons you think for the low uptake in healthcare workers?
Janice: When you think about home health workers, for example, so if you look at the pandemic, health care workers of color were actually much less likely to have personal protective equipment about 21 more times likely.
to get the disease. This was actually published in Lancet Public Health back last year. So we haven't really focused on home health care workers or health care workers. Some of the support health care workers throughout this pandemic anyway. So now suddenly we're turning our attention to them for the vaccine and it's Almost like we're trying to make this really big jump to have people trust us when we really haven't done a good job at all during this pandemic.
Home health care workers in particular have been really hit hard. Even before they don't have access to great insurance. We also have to remember that this population tends to be also, people of color tends to be more likely people of color tend to be more likely immigrants in the U. S.
So the same things that apply to the general population of people of color, it's also going to apply to them.
Gavin: You're still active working in emergency medicine. What have been some of your observations over the last 12 months?
Janice: Initially when I was working and we had our peak back in April and May, and I have to say, it was scary for me as an emergency medicine initially, and then just completely disheartening.
I would go to work and then people would just, we'd have so many sick cases, so many of them would die, and so many of them were black and brown. Just all the sickest patients. When I first started, I remember one of the first patients I saw was a woman who wasn't that much older than me. And she came in, she was talking and asking for her phone.
And within two weeks, she had died. It got so hard and depressing that, I stopped following cases just because I didn't think they'd have a good outcome. Things have gotten better in terms of we see, still see a lot of COVID cases. Patients aren't as sick. But they still are predominantly people of color that I'm seeing that come to the hospital.
And that really is reflective of what we're seeing across the country, and it sounds like also in the UK you're seeing something very similar.
Gavin: Yeah, very much. Thinking about kind of frontline healthcare workers, you've been working on a study to evaluate the mental health in frontline healthcare workers.
Tell us a little bit about that study, how it came about and what you're seeing so far.
Janice: So I'll say that I've started writing a lot during COVID. It was my outlet as a frontline emergency medicine worker. It was really stressful. And I just saw what was going on around me, people working in these stressful environments without much of an outlet.
And that's actually when I started writing op eds just to help relieve that stress. I had never really written. Op eds before. This was my outlet for me. So then I actually decided to apply for a grant through the Emergency Medicine Foundation to look at stressors and workplace, the workplace environment, and how this leads to stress and mental health outcomes, and particularly depression, anxiety, and burnout in emergency medicine physicians.
And so what I'm doing is I'm looking at providers across the country at 10 different states that we've all had different rates of COVID and different peaks at different times of the of the year. And I'm interviewing them and also doing a survey of them. I've actually completed the data collection.
Gavin: Sounds excellent. Look forward to seeing that. So some of your op eds that you were talking about then focused on Yeah. government communications during during the pandemic and their kind of lack of inclusivity. Tell us a little bit about that. How could they be more inclusive?
Janice: COVID affected a really vulnerable population and the government hasn't always been that great period for these populations. So this, it just highlighted what we already knew, right? That there are really big disparities in health in terms of access to testing, in terms of. enforcing social isolation guidelines.
If you look at the people who get COVID, it's essential, essential workers, people who live in really close quarters, who live in multi generational housing. This stems back to really big government policies. Things like minimal wage, things like affordable housing, things like wealth distribution.
People of color in our country are less likely to have a home ownership because of This historical issue with redlining where they couldn't get homes and now, you're seeing the effects of this. You're seeing overcrowding in homes. It really goes back in terms of government policy and the more immediate term, just really.
Supporting the social distancing guidelines, supporting testing centers supporting PPE for essential workers would have been really important. And now that we have the vaccine, making sure that the vaccine is distributed equitably to these populations is really important.
Gavin: So what are some of your hopes for the U.
S. post COVID? Broad question, I know, when we can look past this pandemic. What do you hope to see in government policy and kind of, neighborhood organization, that sort of thing?
Janice: I think for the vaccine, we need to have a community based effort. Some of the issues of vaccine distribution are in older people.
People don't have internet. So we need to have this community effort to really come together and make sure all populations get the vaccine. So someone older who doesn't have the internet. So part of it is, I hope we have more community. work together. Even though right now we have social distancing, we can still use our community to ensure that we have equitable vaccine distribution.
We can tell our friends, particularly if you're a person of color and you have a family member or friend who doesn't trust the vaccine, they're going to trust someone they know they will trust you. So that's the first thing. I hope that we have equitable vaccine distribution, but I also hope that we can use this to learn how to make a better America, right?
We need to look at how we can make things more equitable, how we can make health care more equitable. One thing I didn't mention is some of the cases of COVID were highest in states that didn't have Medicaid expansion. So people don't even have access. Access to insurance. So we need to look, use this as a lens to see what America, what we can do better in terms of improving housing access, helping people to live a good life so they don't have to work even during a pandemic and risk their lives, and really looking out for the most vulnerable individuals in the country.
Gavin: Janice Cher, thank you so much for speaking with me today and speaking with The Lancet.
Janice: Thank you. Thanks so much.
Gavin: You've been listening to a special episode of The Lancet Voice to Mark Black History Month in the USA. If you're interested in hearing more, we had a special episode to mark Black History Month in the UK in October last year.
You can hear that and subscribe to The Lancet Voice by just searching for The Lancet Voice. It should be on any platform, really, that you choose. Thanks so much for listening to this special episode. We'll be back in two more weeks to continue the conversation.