WEBVTT - COVID-19 Chapter 16: Disparities, Take 2 0:00:01.000 --> 0:00:03.800 Hi. My name is Corey O'Hara and I'm Country director 0:00:03.840 --> 0:00:07.160 for ID Nepal. We are an international nonprofit that creates 0:00:07.160 --> 0:00:10.680 livelihoods for the rural poor. Currently, Nepal is looking pretty 0:00:10.680 --> 0:00:13.600 good on the COVID nineteen front. People don't mind wearing 0:00:13.640 --> 0:00:16.880 masks here in the climate's mild, so people can socialize outside. 0:00:17.440 --> 0:00:19.479 Tests are only showing a few hundred new cases per 0:00:19.560 --> 0:00:22.079 day now. That's down from about five thousand a few 0:00:22.079 --> 0:00:25.000 months ago. And for comparison, the country has a population 0:00:25.120 --> 0:00:29.000 the size of California, and officially fewer than two thousand 0:00:29.000 --> 0:00:32.320 deaths have been linked to COVID here, But unofficially everyone 0:00:32.360 --> 0:00:35.320 knows our numbers are artificially low. We're pretty sure that 0:00:35.400 --> 0:00:38.040 due to social stigma, deaths in rural villages are being 0:00:38.040 --> 0:00:41.560 reported as heart attacks or something else. And testing rates 0:00:41.600 --> 0:00:44.360 are very low now as well, so it's also unclear 0:00:44.400 --> 0:00:47.440 what the current spread of the disease is nationally. We 0:00:47.520 --> 0:00:49.160 know that we're better off than most of the world 0:00:49.240 --> 0:00:51.560 as far as disease spread goes, though, which is lucky. 0:00:52.320 --> 0:00:54.480 The bigger problem here has been with our food supply. 0:00:55.400 --> 0:00:58.480 Most people in Nepal are subsistence farmers, with very little 0:00:58.600 --> 0:01:01.600 land who grow most of the cow they eat. About 0:01:01.640 --> 0:01:04.040 two thirds of the national population depends on this kind 0:01:04.040 --> 0:01:07.960 of small scale agriculture, and the national lockdowns we've faced, 0:01:08.000 --> 0:01:10.520 even more than the disease, have had a devastating impact 0:01:10.600 --> 0:01:14.080 on these rural communities. Our first case here was in 0:01:14.160 --> 0:01:17.760 January a student who returned from Muhan and after that 0:01:17.800 --> 0:01:20.119 we were all on high alert with restrictions on travel 0:01:20.120 --> 0:01:23.040 from China, then Europe, and on border crossings from India. 0:01:23.760 --> 0:01:25.520 Then when we saw our second case in March, the 0:01:25.640 --> 0:01:29.160 entire country lockdown. This was a severe restriction on all 0:01:29.200 --> 0:01:33.119 movement nationally. Police in many areas took their jobs very seriously. 0:01:33.720 --> 0:01:35.680 Here in the city, I saw people being beaten with 0:01:35.760 --> 0:01:38.040 canes and arrested for going to the market or being 0:01:38.080 --> 0:01:41.920 outside at the wrong time. All transportation in the country 0:01:42.000 --> 0:01:45.160 was stopped except with a medical permit. In some areas, 0:01:45.200 --> 0:01:48.320 police beat farmers for working in their own fields, and 0:01:48.480 --> 0:01:51.080 that kind of severe response was eventually reined in, but 0:01:51.240 --> 0:01:53.880 it was well covered in local press and many farmers 0:01:53.920 --> 0:01:58.560 around the country were understandably terrified because of it. Meanwhile, 0:01:58.920 --> 0:02:02.440 supply chains totally broke down in the first three months 0:02:02.440 --> 0:02:04.920 of lockdown. We saw produce rotting in some parts of 0:02:04.960 --> 0:02:07.320 the country where buyers were unable to come pick it 0:02:07.400 --> 0:02:10.360 up and farmers were unable to deliver it to markets. 0:02:11.120 --> 0:02:13.680 Many farm supply shops were forced to close or were 0:02:13.760 --> 0:02:16.840 unable to restock their shelves, so farmers didn't have access 0:02:16.840 --> 0:02:18.720 to the seeds and basic supplies they needed for the 0:02:18.720 --> 0:02:22.400 spring planting season. A lot of the corn or maize 0:02:22.440 --> 0:02:25.480 that went into the ground this spring was low quality 0:02:25.560 --> 0:02:28.280 seed left over on farms from a previous season, rather 0:02:28.320 --> 0:02:32.160 than more trustworthy, high yield varieties that farmers typically purchased 0:02:32.160 --> 0:02:35.480 to plant. For some crops that wouldn't matter much, but 0:02:35.560 --> 0:02:39.680 not corn, so we saw yields drop dramatically in those fields. 0:02:40.680 --> 0:02:43.320 Poor families depend on that crop for the summer months, 0:02:43.360 --> 0:02:46.079 all the way until October's rice harvest, and then the 0:02:46.200 --> 0:02:49.760 rice harvest should carry them through to the following spring. Instead, 0:02:49.800 --> 0:02:52.840 we saw terrible hunger problems spreading across the country over 0:02:52.880 --> 0:02:56.280 a period of several months. Just to compound these food 0:02:56.320 --> 0:02:58.960 supply problems, this year, we were invaded by the fall 0:02:59.080 --> 0:03:02.079 army worm horn pest from the Americas that caused extensive 0:03:02.160 --> 0:03:04.880 damage at exactly the point when farmers weren't able to 0:03:04.919 --> 0:03:08.360 buy supplies to manage it. At ide, we've been working 0:03:08.360 --> 0:03:11.120 with government and donors to coordinate the national response to 0:03:11.160 --> 0:03:15.040 the pest through integrated pest management approaches, which means low 0:03:15.040 --> 0:03:19.639 toxicity tools like pheromone traps and organic pesticides. Our surveys 0:03:19.720 --> 0:03:22.560 during the lockdown showed that our messages were getting out 0:03:22.600 --> 0:03:25.600 there about how to treat the pest appropriately, but because 0:03:25.600 --> 0:03:28.360 suppliers weren't open, farmers couldn't get the tools they needed 0:03:28.360 --> 0:03:32.040 to respond. Then in June, we saw another insect plague, 0:03:32.120 --> 0:03:34.480 the desert locust, which came to Nepal for the first 0:03:34.480 --> 0:03:37.560 time since nineteen sixty. It's been a tough year for 0:03:37.640 --> 0:03:41.920 Nepal's farmers. Our summer rice harvest was good, though, but 0:03:42.200 --> 0:03:45.040 we're still seeing the after effects of that first strict lockdown. 0:03:45.840 --> 0:03:48.280 Prices for all foods here rose by about twenty five 0:03:48.320 --> 0:03:51.400 percent during those months and they still haven't stabilized. We're 0:03:51.440 --> 0:03:53.760 all paying a lot more for food these days, and 0:03:53.880 --> 0:03:56.280 in rural communities that means people have less to eat 0:03:56.520 --> 0:04:00.840 and what they're eating is lower quality in cheap cereal grains. Meanwhile, 0:04:00.880 --> 0:04:03.640 households that depend on remittance is from family members working 0:04:03.680 --> 0:04:07.040 abroad lost their main source of income, and the one's 0:04:07.080 --> 0:04:10.600 hardest hit are landless renters and farm laborers who don't 0:04:10.640 --> 0:04:16.719 have land of their own. Nepal's situation isn't really that unusual. Globally, 0:04:17.400 --> 0:04:19.640 there are half a billion small farmers around the world 0:04:19.680 --> 0:04:21.640 who have all been facing these same kinds of issues 0:04:21.680 --> 0:04:24.320 in the past year. They typically feed or support about 0:04:24.320 --> 0:04:27.960 half the world's population, so this isn't a small problem. 0:04:28.760 --> 0:04:31.839 These kinds of small family farmers can sometimes be unusually 0:04:31.880 --> 0:04:34.160 resilient in a crisis because they've always had to depend 0:04:34.240 --> 0:04:38.080 on different coping strategies, But in an extended crisis like this, 0:04:38.240 --> 0:04:41.320 and in some areas like Nepal, a crisis after crisis 0:04:41.320 --> 0:04:44.440 after crisis. We've seen that supply chain breakdowns in the 0:04:44.480 --> 0:04:47.839 agriculture sector mean disruptions to the food supply months down 0:04:47.839 --> 0:04:51.000 the line. We've already seen what happens in the US 0:04:51.360 --> 0:04:55.000 when there are interruptions in the toilet paper supply. Now 0:04:55.200 --> 0:04:57.839 just imagine what that situation is like for small farmers 0:04:57.839 --> 0:05:00.400 globally who haven't been able to harvest an food to 0:05:00.440 --> 0:05:03.240 feed their families or to bring to market, do both 0:05:03.240 --> 0:05:05.919 to COVID nineteen and to the world's response to it. 0:05:07.960 --> 0:05:10.480 I am a hospital social worker in Oregon, which has 0:05:10.520 --> 0:05:13.360 been relatively less hard hit than other areas of the 0:05:13.360 --> 0:05:17.159 country and world. It's still been an incredibly difficult and 0:05:17.240 --> 0:05:21.320 confusing year, even more so for our hardworking bedside staff, 0:05:21.360 --> 0:05:26.279 like the nurses, respiratory therapists CNAs. As a social worker, 0:05:26.279 --> 0:05:29.120 I can see every aspect of my patient's lives has 0:05:29.160 --> 0:05:34.479 been changed by the pandemic. Most commonly, people feel alone, disconnected, 0:05:34.600 --> 0:05:40.400 and unstable. Any pre existing problems like depression, housing instability, 0:05:40.520 --> 0:05:46.279 domestic violence, addiction, COVID makes these problems devastating and sometimes deadly. 0:05:47.560 --> 0:05:51.200 The hardest situations for me to watch involve family, maybe 0:05:51.200 --> 0:05:53.280 because I haven't been able to see my family and 0:05:53.320 --> 0:05:56.720 friends for so long. One of my patients in the 0:05:56.960 --> 0:06:01.279 ICU and his wife, who are forty somethings, able bodied, 0:06:01.320 --> 0:06:05.599 working professionals in their child, all had COVID. While dad 0:06:05.640 --> 0:06:08.880 was in the ICU, Mom died of respiratory failure at 0:06:08.920 --> 0:06:11.640 home in front of her kid, who then had to 0:06:11.640 --> 0:06:15.160 spend two lonely weeks quarantining at a family member's house 0:06:15.240 --> 0:06:20.320 without seeing anyone. Another older gentleman was admitted with COVID 0:06:20.440 --> 0:06:22.679 only a day or two after two of his adult 0:06:22.800 --> 0:06:27.000 children had died of COVID. He spoke only a Mayan dialect, 0:06:27.040 --> 0:06:29.480 which we did not have access to in our language. 0:06:29.520 --> 0:06:35.800 Bank his family said goodbye over a video call. These stories, sadly, 0:06:36.080 --> 0:06:41.599 are common. COVID has disrupted our grieving process in horrifying ways. 0:06:42.320 --> 0:06:45.839 People die alone with strangers in full protective gear who 0:06:45.839 --> 0:06:50.120 don't speak their language. We are isolated, unable to hold 0:06:50.160 --> 0:06:53.800 each other or gather together. It's been a really hard 0:06:53.880 --> 0:06:58.080 year and in some ways a lost year. I am 0:06:58.120 --> 0:07:01.760 so angry and sad how our country has handled COVID. 0:07:02.800 --> 0:07:05.240 I have moments of hope, like when I got my 0:07:05.320 --> 0:07:08.840 vaccine dosays, but I also fear things are going to 0:07:08.880 --> 0:07:10.600 get a lot worse before they get better. 0:07:12.800 --> 0:07:14.920 Hi Erin and Aaron, my name is Amanda, and I'm 0:07:14.960 --> 0:07:18.600 a microbiologist with a passion for epidemiology and infectious disease. 0:07:19.240 --> 0:07:21.160 My sister, Megan and I wanted to reach out and 0:07:21.200 --> 0:07:23.320 tell our dad's story because we feel it's a COVID 0:07:23.320 --> 0:07:26.440 story that needs to be told. Our father had immigrated 0:07:26.440 --> 0:07:28.360 from Mexico when he was a little boy and had 0:07:28.360 --> 0:07:30.760 made his life in the US. As he got older, 0:07:30.800 --> 0:07:32.960 he was spending more and more of his time traveling 0:07:33.000 --> 0:07:36.120 back to Mexico. On many occasions, he would fly back 0:07:36.120 --> 0:07:38.280 to the US when he was unwell from not taking 0:07:38.320 --> 0:07:41.680 care of himself or treating his various ailments or illnesses, 0:07:41.920 --> 0:07:44.720 and my family would work diligently to get him healthy again, 0:07:44.800 --> 0:07:48.800 only to see him fly back to Mexico. Most recently, 0:07:49.000 --> 0:07:51.160 he had left an assisted care facility a few months 0:07:51.200 --> 0:07:53.400 into the pandemic to fly back to Mexico to be 0:07:53.480 --> 0:07:56.320 with his girlfriend, in spite of being asked not to 0:07:56.680 --> 0:07:59.760 because of the pandemic because it was dangerous for somebody 0:07:59.760 --> 0:08:04.160 his age with his illnesses to be traveling. We'd not 0:08:04.280 --> 0:08:06.600 heard from him for many months, and then the day 0:08:06.600 --> 0:08:10.200 after Thanksgiving things changed. His girlfriend had reached out to 0:08:10.320 --> 0:08:13.000 us to see if we'd heard from him. She said 0:08:13.040 --> 0:08:15.160 that he was trying to make his way to the 0:08:15.200 --> 0:08:18.440 airport when he had gotten confused and started driving in circles. 0:08:18.800 --> 0:08:20.960 He was pulled over by the police and escorted back 0:08:21.000 --> 0:08:23.360 to the hotel. After explaining to the officers he didn't 0:08:23.400 --> 0:08:26.400 feel well and couldn't breathe, the police dropped him off 0:08:26.480 --> 0:08:29.000 and said that they would call an ambulance. He had 0:08:29.000 --> 0:08:31.600 called his girlfriend and said he was confused, couldn't breathe, 0:08:31.640 --> 0:08:34.480 and felt like he was drowning. That was the last 0:08:34.480 --> 0:08:37.600 time anyone had spoken to him. The hotel staff found 0:08:37.640 --> 0:08:40.520 him deceased in his bed the next day. While the 0:08:40.559 --> 0:08:42.559 outcome might have been the same, we're disappointed that the 0:08:42.600 --> 0:08:45.200 police didn't do more to get our dad help. Instead 0:08:45.200 --> 0:08:47.360 of driving him back to the hotel. Why didn't they 0:08:47.400 --> 0:08:49.160 drive him to a hospital to make sure that he 0:08:49.240 --> 0:08:52.880 was treated for whatever illness he was experiencing. We can't 0:08:52.880 --> 0:08:55.079 help but wonder if the police would have done more 0:08:55.120 --> 0:08:57.360 if he wasn't an older Hispanic man in the Southwest 0:08:57.480 --> 0:09:00.720 United States. Thank you for taking the time to hear 0:09:00.760 --> 0:09:04.160 our story. We hope that it shed some light on 0:09:04.200 --> 0:09:07.760 the discrimination that people of color experienced daily, both as 0:09:07.800 --> 0:09:10.440 part of this pandemic and the healthcare system in general. 0:09:10.840 --> 0:09:12.199 Thank you, and. 0:09:12.240 --> 0:09:14.719 Remember to wash your hands and wear your masks, you 0:09:14.800 --> 0:09:15.760 filthy animals. 0:09:59.760 --> 0:10:03.400 The Thank you so much for sharing your stories with us. 0:10:03.520 --> 0:10:06.600 To all of our first hand account providers, and thank 0:10:06.600 --> 0:10:08.800 you also to everyone who has written in to share 0:10:08.840 --> 0:10:11.520 your story with us. We really appreciate it and we 0:10:11.960 --> 0:10:13.960 are very grateful that you're willing to share your stories 0:10:14.000 --> 0:10:14.319 with us. 0:10:14.520 --> 0:10:15.600 Yeah, we really are. 0:10:16.800 --> 0:10:17.000 Hi. 0:10:17.320 --> 0:10:20.720 I'm erin Welsh and I'm erin alman Updek and. 0:10:20.559 --> 0:10:22.400 This is this podcast will kill you. 0:10:23.120 --> 0:10:30.719 Welcome to the sixteenth extallment mean sixteen episodes in our 0:10:30.760 --> 0:10:33.840 Anatomy of a Pandemic series covering COVID nineteen. 0:10:34.440 --> 0:10:37.840 That's a lot of episodes. We say this every episode, 0:10:38.000 --> 0:10:45.040 but well, we are very excited for this particular episode 0:10:45.440 --> 0:10:48.840 because we get to revisit a topic that we covered 0:10:48.880 --> 0:10:52.880 earlier in the Pandemic, but from a very different perspective. Yeah, 0:10:52.920 --> 0:10:56.240 so this week we are talking about disparities and what 0:10:56.360 --> 0:10:59.880 kind of disparities that we are seeing in COVID nineteen, 0:11:00.480 --> 0:11:05.240 particularly in the US, and we are super excited. But 0:11:06.240 --> 0:11:09.199 before we get ahead of ourselves, let's start with a quarantini. 0:11:09.559 --> 0:11:13.480 We should start with a quarantini. This week we're drinking 0:11:13.679 --> 0:11:17.439 Quarantini sixteen. Sixteen entire quarantines. 0:11:17.840 --> 0:11:21.199 That's a lot of quarantinies. It is a lot of recipes. 0:11:21.480 --> 0:11:24.680 It really is Aaron, You're a boss, are coming up 0:11:24.720 --> 0:11:28.319 with them all. So what is in the quarantine sixteen? 0:11:28.760 --> 0:11:34.120 The Quarantine sixteen is well it's rye whiskey, orange juice, 0:11:34.240 --> 0:11:37.640 lemon juice, and a bit of grianandine. Yeah, and we 0:11:37.720 --> 0:11:41.280 will post the full recipe for this Quarantini sixteen as 0:11:41.360 --> 0:11:44.640 well as our non alcoholic Placeberrita on our website this 0:11:44.720 --> 0:11:46.840 podcast will kill You dot com, as well as on 0:11:46.920 --> 0:11:48.400 all of our social media channels. 0:11:48.840 --> 0:11:52.800 Yes, other business items really quick. 0:11:52.679 --> 0:11:56.559 Erin the usual stuff. If you head to our website, 0:11:56.600 --> 0:11:59.960 you will find a link to our bookshop dot org 0:12:00.160 --> 0:12:02.360 affiliate account. You will find a link to our good 0:12:02.400 --> 0:12:04.880 riads list. You will find a link to merch to 0:12:05.160 --> 0:12:08.720 transcripts to alcohol free episodes, and a link where you 0:12:08.840 --> 0:12:12.120 can submit your first hand account for COVID nineteen for 0:12:12.400 --> 0:12:14.240 this Anatomy of a Pandemic series. 0:12:14.679 --> 0:12:17.520 Yeah, basically, we're just saying you should check out our website. 0:12:17.640 --> 0:12:20.400 There's a lot of stuff there, a lot of stuff there. 0:12:20.720 --> 0:12:21.360 Yeah. 0:12:21.440 --> 0:12:26.200 All right, So this episode, like Aaron said, we're very 0:12:26.240 --> 0:12:32.240 excited to be revisiting disparities. In our earlier episode on disparities, 0:12:32.280 --> 0:12:35.520 we had a really amazing conversation with doctor Jonathan Whittall 0:12:35.679 --> 0:12:40.480 from Doctors Without Borders about how vulnerable populations are disproportionately 0:12:40.520 --> 0:12:44.560 impacted by public health crises, and we discussed how these 0:12:44.600 --> 0:12:47.160 issues play out on a much more global scale. 0:12:47.840 --> 0:12:50.240 But in this episode, we're zooming in a bit to 0:12:50.280 --> 0:12:53.480 talk about racial disparities and healthcare in the US, and 0:12:53.640 --> 0:12:57.679 in particular, how the COVID nineteen pandemic has profoundly amplified 0:12:57.679 --> 0:13:01.600 these disparities. Where did these barities come from, what do 0:13:01.640 --> 0:13:04.400 they look like, especially in the context of COVID nineteen, 0:13:04.720 --> 0:13:07.880 how do we measure them? And importantly, what are we 0:13:08.000 --> 0:13:12.000 doing to reduce or eliminate these disparities to achieve actual 0:13:12.040 --> 0:13:13.720 health equity in this country. 0:13:14.200 --> 0:13:17.719 Yeah, that's a big one. To help us answer these 0:13:17.800 --> 0:13:23.960 questions and so many more, we are thrilled, like so 0:13:24.960 --> 0:13:26.040 fan girl excited. 0:13:26.240 --> 0:13:27.280 Oh my gosh. Yeah. 0:13:27.559 --> 0:13:28.079 Yeah. 0:13:28.120 --> 0:13:33.080 We got to chat with Harriet Washington, amazing writer, medical 0:13:33.160 --> 0:13:38.960 ethicist whose books Medical Apartheid, Deadly Monopolies, Infectious Madness, A 0:13:39.080 --> 0:13:42.760 Terrible Thing to Waste, and most recently Carte Blanche, The 0:13:42.920 --> 0:13:47.440 Erosion of Medical Consent have received wide critical acclaim. 0:13:48.080 --> 0:13:51.120 We recorded this interview on March tenth, and we were 0:13:51.120 --> 0:13:54.120 recording this on March twenty fifth, So just keep that 0:13:54.200 --> 0:13:57.600 in mind when we discuss any numbers and stuff like that, 0:13:58.920 --> 0:14:01.439 but you know what, let's just get to the interview. 0:14:01.760 --> 0:14:38.240 So we will let Harriet introduce herself right after this break. 0:14:39.400 --> 0:14:42.480 My name is Harriet Washington. I'm a writer and I 0:14:42.520 --> 0:14:47.760 focus on medical ethics research ethics. Typically, I've been doing 0:14:47.800 --> 0:14:51.000 a lot of work lately around informed consent and some 0:14:51.080 --> 0:14:53.960 of the hidden problems with it, such as it disappearing 0:14:53.960 --> 0:14:57.440 from the landscape without anyone really realizing it. But I 0:14:57.480 --> 0:15:02.360 also work on other things. I'm very concerned about conspiracy theories, 0:15:02.400 --> 0:15:06.680 and I've been to several international conferences presenting on some 0:15:06.760 --> 0:15:09.400 aspects of conspiracy theories that kind of elude us. We 0:15:09.440 --> 0:15:12.480 talk about them in order to dismiss people's fears, but 0:15:12.560 --> 0:15:17.320 sometimes these are real conspiracies, not just conspiracy theories, and 0:15:17.400 --> 0:15:21.560 sometimes the fears are actually, you know, rational, So that 0:15:21.640 --> 0:15:24.120 makes a situation harder. But we need to confront that, 0:15:24.800 --> 0:15:26.680 and those are some things I'm working on. I'm also 0:15:26.720 --> 0:15:31.120 interested in the use of art in medicine to promulgate 0:15:31.480 --> 0:15:38.600 political stances and frankly perpetuate lies. So that's a fascinating topic. 0:15:39.280 --> 0:15:40.280 I keep busy. 0:15:41.520 --> 0:15:44.120 Well, thank you so much for joining us. We are 0:15:44.160 --> 0:15:47.680 so excited to chat with you today. So can you 0:15:47.880 --> 0:15:50.160 just start us off by telling us a bit about 0:15:50.200 --> 0:15:52.800 your new book that just came out and what inspired 0:15:52.800 --> 0:15:53.440 you to write it. 0:15:54.480 --> 0:15:58.560 Well, it's hard to think with inspiration is the right term. 0:15:58.680 --> 0:16:04.040 But the book is entitled carte Blanche and it focuses 0:16:04.080 --> 0:16:08.240 on how the erotional form consent informed consent is that 0:16:08.520 --> 0:16:14.320 very detailed and very informative mode of transmitting information to 0:16:14.320 --> 0:16:17.280 people who are thinking about engaging in metal research. Before 0:16:17.320 --> 0:16:18.840 you engage in the research, you ought to know what 0:16:18.880 --> 0:16:20.480 the risks are. You ought to know what the potential 0:16:20.520 --> 0:16:23.320 benefits might be. You ought to know that lifestyle effects. 0:16:23.320 --> 0:16:25.800 You know, we'll be able to unable to drive, we 0:16:26.000 --> 0:16:28.520 be very tired. You also need to know what your 0:16:28.520 --> 0:16:31.880 options are. Are there other medications that are not experimental 0:16:31.960 --> 0:16:34.600 but are tested, tried and true that you might prefer 0:16:34.680 --> 0:16:37.560 to take. Are there the non medical things that you 0:16:37.600 --> 0:16:41.400 could do for your condition, or do you have the 0:16:41.440 --> 0:16:43.600 option of not taking any treatment at all? All these 0:16:43.600 --> 0:16:45.200 things have to be spelled out to you in great 0:16:45.240 --> 0:16:49.120 detail according to American law, and that's largely because of 0:16:49.360 --> 0:16:52.760 abuses that we vowed would never happen again. Things likely 0:16:52.840 --> 0:16:55.240 here holocausts where people were murdered in the name of 0:16:55.320 --> 0:16:59.160 medicine pretending to do research, and the Nazi doctors actually 0:16:59.520 --> 0:17:03.360 focused on Jews, polls other people, but mostly Jews, and 0:17:03.960 --> 0:17:07.840 you know, they incurred harm force the mintarysearch sometimes killed 0:17:07.840 --> 0:17:11.200 them outright as part of studies. And then in this 0:17:11.240 --> 0:17:14.840 country we had prison research, the long history of abusing 0:17:14.880 --> 0:17:18.280 African Americans, and research arena that culminated in people's horror 0:17:18.320 --> 0:17:22.480 over Tuskegee. All these things made Americans and American doctors 0:17:22.880 --> 0:17:27.080 swear that they would never have this done in medicine again. 0:17:27.440 --> 0:17:30.040 And it's worth noting was American doctors and lawyers who 0:17:30.040 --> 0:17:33.200 went to Nuremberg, Germany to confront the Nazi architects of 0:17:33.240 --> 0:17:36.639 the Holocaust. So all these things culminated in what we 0:17:36.760 --> 0:17:39.560 hear every day one way or another that in this 0:17:39.640 --> 0:17:42.760 country no one can be forced into medical research without 0:17:42.760 --> 0:17:45.800 their consent. But that's actually wrong. As I detail in 0:17:45.840 --> 0:17:49.440 the book, many people have been escalating. We're talking about 0:17:49.440 --> 0:17:52.359 tens of thousands of people forced into medical research without 0:17:52.359 --> 0:17:53.000 their permission. 0:17:53.840 --> 0:17:58.600 Yeah, this kind of issue of eroding consent that you 0:17:58.840 --> 0:18:02.760 touch on in the book and how it disproportionately affects 0:18:02.760 --> 0:18:07.320 people of color, it's really just one dimension of health disparities, 0:18:07.359 --> 0:18:10.919 both here in the US and abroad. And we know 0:18:11.000 --> 0:18:15.360 that although health disparities have been around forever, it's only 0:18:15.400 --> 0:18:17.960 within the last few decades that that term itself was 0:18:18.000 --> 0:18:22.040 actually coined, and it's often only vaguely defined. Would you 0:18:22.080 --> 0:18:24.440 mind describing for us kind of what we mean when 0:18:24.480 --> 0:18:27.080 we talk about health disparities. 0:18:27.040 --> 0:18:30.119 Well, if you ask ten people to get ten different definitions. 0:18:30.560 --> 0:18:33.840 But I think the simplest and most useful definition is 0:18:33.880 --> 0:18:38.720 simply treating any group of people en mass differently than 0:18:38.760 --> 0:18:42.000 you treat other people. So if, for example, there are 0:18:42.040 --> 0:18:47.240 studies then showing that consistently and routinely African Americans are 0:18:47.320 --> 0:18:51.320 less likely to have their complaints of pain acknowledged and treated, 0:18:51.720 --> 0:18:54.600 then that's a very important health disparity. In fact, in 0:18:54.600 --> 0:18:59.159 twenty sixteen University of Virginia study showed that half of 0:18:59.280 --> 0:19:03.520 all medical student surveyed thought that African Americans didn't feel 0:19:03.560 --> 0:19:06.719 pain the way whites did, and a good number of 0:19:06.760 --> 0:19:09.960 practicing doctors think that too. That's a very clear example 0:19:10.000 --> 0:19:14.159 of health disparity that has wide ranging effects. Instead of 0:19:14.200 --> 0:19:17.440 having their pain addressed with appropriate medication or other treatment, 0:19:17.840 --> 0:19:21.840 African Americans are often dismissed as drug seeking and sent 0:19:21.920 --> 0:19:26.520 away without any medication, and stigmatizing notes in their medical charts. 0:19:26.840 --> 0:19:30.600 So that's a very dramatic example. But frankly, you'd be 0:19:30.680 --> 0:19:34.600 hard pressed to find any area of American medicine where 0:19:34.640 --> 0:19:36.480 you're not going to find disparities in the way that 0:19:36.520 --> 0:19:39.439 black and white people are treated. And that emanates from 0:19:39.920 --> 0:19:43.879 the nineteenth century, where you had this wave of very 0:19:43.960 --> 0:19:47.800 prominent doctors and scientists telling the country and telling the 0:19:47.880 --> 0:19:51.120 world who African Americans were. And one of the things 0:19:51.119 --> 0:19:54.040 they said about African Americans was that African Americans had 0:19:54.119 --> 0:19:57.840 very different bodies from white people. They suffered very different diseases, 0:19:58.000 --> 0:20:00.960 they'd immunities to certain diseases, they didn't feel pain the 0:20:00.960 --> 0:20:04.639 way whites did. These beliefs are not lodged in the past. 0:20:05.040 --> 0:20:09.200 These beliefs have surfaced today in these studies that consistently 0:20:09.240 --> 0:20:11.760 show that we don't creat African American pain. But I 0:20:11.880 --> 0:20:13.760 worry about the things that we're not studying. We're not 0:20:13.800 --> 0:20:17.440 following what other beliefs in the nineteenth century are still 0:20:17.480 --> 0:20:20.760 held by doctors, but we don't interrogate them. I see 0:20:20.840 --> 0:20:21.679 quite a few. 0:20:22.000 --> 0:20:27.720 Yeah, absolutely so. In these discussions of health disparities, Sometimes 0:20:27.760 --> 0:20:31.760 the conversation focuses solely on barriers to quality healthcare in 0:20:31.800 --> 0:20:36.200 the US, but in reality, those inequalities are only one 0:20:36.240 --> 0:20:38.440 part of the story. So can you talk a bit 0:20:38.480 --> 0:20:41.040 about how it's not just being able to go to 0:20:41.080 --> 0:20:43.919 a doctor or afford a doctor, but how things like 0:20:44.000 --> 0:20:48.520 access to education, chronic stress, and environmental racism interact with 0:20:48.680 --> 0:20:52.000 and compound each other when it comes to these health disparities. 0:20:52.480 --> 0:20:56.879 I frankly don't see any difference between environmental exposure and 0:20:56.960 --> 0:21:00.639 the more traditional barriers you mentioned. It's simply an barrier. 0:21:01.640 --> 0:21:04.800 The fact is that, you know, the African Americans, Native 0:21:04.840 --> 0:21:08.040 Americans and Hispanic Americans are much more likely to be 0:21:08.160 --> 0:21:12.000 forced to live in areas that a butt toxic s 0:21:12.040 --> 0:21:19.280 viewing industrial parks, bust depots, are old housing that is 0:21:19.400 --> 0:21:23.320 rife with interior lead pain. These exposures are strictly racial. 0:21:23.359 --> 0:21:25.760 In fact, they had been characterized for a very long 0:21:25.800 --> 0:21:29.400 time as socioeconomic, and people often spoke about vulnerable people 0:21:29.480 --> 0:21:32.960 being low income people. And although poverty is a risk factor, 0:21:33.320 --> 0:21:36.719 it's a risk factor that is dwarfed by racism. Studies 0:21:36.760 --> 0:21:40.520 have shown consistently that your race is what dictates whether 0:21:40.560 --> 0:21:43.800 you're exposed to environmental autoxins or not. In fact, one 0:21:43.880 --> 0:21:47.000 study showed that African Americans with an average income of 0:21:47.040 --> 0:21:50.399 like sixty thousand dollars a year are more exposed to 0:21:50.480 --> 0:21:54.439 environmental toxicity than very poor whites who only have an 0:21:54.440 --> 0:21:57.440 income of say ten thousand dollars a year very poor. 0:21:57.880 --> 0:22:01.400 So it's not poverty, it's race. And these barriers are 0:22:01.960 --> 0:22:05.280 of many varieties, but they're racial barriers, and that's what's 0:22:05.320 --> 0:22:08.520 really important to me. They can be categorized in many ways, 0:22:08.560 --> 0:22:12.119 but if you're focusing on the victims and focusing on 0:22:12.240 --> 0:22:15.359 improving their health, then the most important character relation to 0:22:15.440 --> 0:22:18.320 me is how prevalent they are and what effect they 0:22:18.320 --> 0:22:22.280 have on people's health. Environmental racism has an extremely profound 0:22:22.480 --> 0:22:26.240 effect on people's health, and yet it's not often enough 0:22:26.680 --> 0:22:32.200 included in initiatives to resolve health issues and address health disparities. 0:22:32.480 --> 0:22:35.840 I wrote an article for Nature last year showing that 0:22:35.960 --> 0:22:41.640 environmental racism is a key indicator of stability to coronavirus nineteen. 0:22:42.280 --> 0:22:45.000 In fact, the risk factors caused by in regular racism 0:22:45.400 --> 0:22:47.720 are the same risk factors that make one susceptible to 0:22:47.760 --> 0:22:53.960 coronavirus nineteen. So these are all all barriers to better 0:22:54.000 --> 0:22:56.439 health for people of color. But of course we have 0:22:56.520 --> 0:22:59.760 to realize that we will indict some of the barriers 0:22:59.800 --> 0:23:03.840 as if they arose of their own. These barriers arose 0:23:03.880 --> 0:23:06.840 for a reason, and that means that in some sense, 0:23:06.880 --> 0:23:11.320 these barriers were all created by people. It's racist policies 0:23:11.440 --> 0:23:14.600 that sometimes date from the nineteen fifties and sixties that 0:23:14.680 --> 0:23:17.920 dictate how African Americans are trapped in areas where there's 0:23:17.920 --> 0:23:21.520 a lot of environmental toxicity. So we have to remember 0:23:21.600 --> 0:23:26.520 that these are human decisions, human actions, and existing policies 0:23:26.560 --> 0:23:30.000 and laws that need to be changed. It's not just 0:23:30.040 --> 0:23:32.760 a matter of HM this seems to be standing between 0:23:32.800 --> 0:23:35.439 African American and good health. We have to take a 0:23:35.440 --> 0:23:36.400 more holistic view. 0:23:38.000 --> 0:23:42.159 Absolutely. What are some of the ways that we actually 0:23:42.280 --> 0:23:44.560 kind of measure these health disparities. 0:23:45.720 --> 0:23:50.160 They're measured in so many ways. Sometimes people look at 0:23:50.200 --> 0:23:53.160 the years of life lost, the years of health loss, 0:23:54.080 --> 0:23:58.480 and depending on what question you're trying to answer, there 0:23:58.520 --> 0:24:00.760 are variety of ways who can do it, and some 0:24:00.800 --> 0:24:05.720 measurements are better for certain estimations. But what's really important 0:24:05.800 --> 0:24:07.840 is the fact that no matter what measure you use, 0:24:08.359 --> 0:24:10.560