>> Good morning and welcome
to the 2017 CDC OMHHE Office
of Minority Health and Health
Equity in collaboration
with the National Center
for Bioethics and Research
and Healthcare at Tuskegee
University's third annual Public
Health Ethics Forum.
This year's focus is
on Women's Health.
And the theme is Optimal
Health for Her Whole Life.
My name is Shonia Zollicoffer,
and I will serve as the Mistress
of Ceremonies for today.
Today's forum is
also streaming live.
And for those attending
virtually,
please submit all questions
and comments to OWH@CDC.gov.
We will have that
slide back up for you.
Again, that email
is OWH@CDC.gov.
So, today we have a very,
very robust schedule.
So let us get started.
So allow me to introduce
to you our first speakers which are Drs. Liburd and Tucker.
So Dr. Leandris Liburd is
the Director of the Office
of Minority Health and Health Equity here at Centers
for Disease Control
and Prevention.
In this role,
Dr. Liburd oversees the work
of CDC's Office of
Women's Health, Diversity
and Inclusion Management
and Minority Health
and Health Equity.
She is a respected public health
leader, who has over the course
of her career championed
community health promotion,
chronic disease prevention,
community engagement,
eliminating health disparities,
and addressing the social
determinants of health.
She has worked in public
health at the local, state,
and federal levels,
and has held a variety
of leadership positions at CDC
since joining the
agency in 1987.
And our second speaker,
Dr. Patty Tucker is the
Director of CDC's Office of
Women's Health.
Dr. Tucker's career spans from
clinician for women and children
to consultant on evidence
and practice-based
strategies designed
to promote healthy lifestyles
and disease prevention
domestically
and internationally.
Dr. Tucker has worked with the
Center for Infectious Diseases in Zambia, Namibia Ministry
of Health and Social
Services National HIV Sentinel
Serosurveillance study
of pregnant women,
and in Sierra Leone to
assist in the Ebola outbreak.
So, to begin, Dr. Liburd.
[ Applause ]
>> Thank you Shonia and
good morning everyone.
Good morning to all of
the -- the early risers.
We really appreciate
your being here
at eight o'clock this morning.
I know for some it was a
sacrifice, but we wanted --
We were so excited about
today, we just wanted
to get started early and we know
that people will be leaving.
It's Friday.
They have flights and so forth,
but I want to add my welcome
to Shonia's welcome to this
year's Public Health Ethics
Forum that is dedicated
to the thoughtful
and ethical consideration
of a range of health issues
that affect women and
girls across the lifespan.
Women make up just over
half of the U.S. population,
and they are present
in every sector.
At home, they are organizing
communities, raising children
and grandchildren, leading
foundations, national
and global organizations
and universities,
and ensuring the implementation
of sound public health policy
and practice among other things.
This year's forum
will delve deeply
into selective public
health issues
that in some instances
disproportionately impact women.
And we will explore
how we can be better
at improving health
outcomes for women and girls
from preconception to old age.
Today, you will hear from
women and men, just a few,
who are nationally recognized
for their work as scholars,
as practitioners,
ethicists and researchers.
Our goal is to inspire lively
and focused conversations
about ethical issues we
need to be aware of in order
to deliver effective and
inclusive public health programs
that benefit women over the
course of their entire lives.
I want to take a minute of time
to thank all of our partners
and the planning committee.
I'd like to thank Dr. Reuben
Warren, Professor and Director
of the National Center
for Bioethics and Research
and Healthcare at Tuskegee
University for his commitment
to the ethical practice
of public health
and the relationship
that has been established
between our respective programs.
Many thanks also go to
Jo Valentine and the Division
of Sexually Transmitted Diseases
for bringing us all together
to expand the breadth of
the cooperative agreement
between Tuskegee
University and CDC.
I also want to offer
congratulations
on the 20th Anniversary of
the Presidential Apology
for the Tuskegee Syphilis Study
and also to congratulate --
[ Applause ]
And I also want to congratulate
the Division of STDs
on their Public Health
Ethics Internship Program.
I'd like to thank
Dr. Drue Barrett
and the Public Health
Ethics Office here at CDC
and Dr. Patty Tucker,Director of CDC's Office of Women's Health.
And I'd like to thank and ask
to stand this year's
planning committee,
Shonia Zollicoffer,
Gwen Baker --
[ Applause ]
-- Laura Ross, Gwen that's in
the back, Dr. Joan Harrell --
[ Applause ]
-- Benita Harris-McBride who is
off celebrating the graduation
of her son and Jenny Kinkaid.
Where is Jenny?
Thank you.
[ Applause ]
There are also many others in
the Office of Minority Health
and Health Equity in the
Global Communication Center
and colleagues near and far
who have made today's
forum possible.
And we extend our heartfelt
gratitude to each of you.
Susan B. Anthony who was
well-known suffragist
and abolitionist, once said,
"Wherever women gather together,
failure is impossible."
So we begin the forum knowing
that it is impossible
for us to fail.
Thank you so much for
being here for those of us
who are joining us virtually.
And I look forward to
the remainder of the day.
Thank you.
[ Applause ]
>> Good morning.
It gives me great
pleasure to extend
to you a very warm
welcome on behalf
of CDC's Office of
Women's Health.
We are glad to have you here
coming from near and far
to attend the 2017 Public
Health Ethics Forum.
Sunday, May 14th was Mother's
Day, and that's the first day
of the National Women's Health
Week, which is celebrated
through May 20th
through tomorrow.
Since 1999, the USC
Department of Health
and Human Services Office
of Women's Health has observed
National Women's Health Week.
During this time,
women are encouraged
to make their health a
priority and to take steps
to improve their health.
This year, during National
Women's Health Week,
CDC's Office of Women's Health
has coordinated the planning
and the implementation
of the Public Health
Ethics Forum Optimal Health
for Her While Life.
In promoting and protected --
It is promoting and protecting
from birth to older adulthood
the health of women and girls.
Optimal Health is as state of
a complete physical, mental,
spiritual and social well-being
and not just the absence
of disease or illness.
Optimal Health for
Her Whole Life begins
with comprehensive prenatal care
for women in all communities,
continual quality
health care for all ages,
promotion of individual
characteristics and behavior
or environmental conditions
that reduce the effects
of stressful life events,
financial literacy,
attaining higher levels of
education, economic security,
ending the cycle of violence,
preparing for retirement
and the list goes on.
Here in the CDC Office
of Women's Health,
our goal is support and protect
the health and safety of women
and girls by addressing
health issues
and identifying solutions.
We hope today's forum
is the beginning
of a stimulating dialogue and
opportunities to exchange ideas
and views and create across
multicultural collaborations.
And through this exchange,
ethical issues are identified,
and potential solutions or
actions are put into practice
for an impact on the
well-being of women
and girls across the nation.
In closing, I ask that may we --
I hope that we all gain
something of relevance
from this day and time
that we spend together
at the 2017 Public
Health Ethics Forum.
Thank you.
[ Applause ]
>> Thank you Dr. Liburd
and Dr. Tucker.
So moving right along, our next
speaker is Dr. Patricia Simone.
Dr. Simone is acting CDC
Principle Deputy Director.
Dr. Simone has served as
Principle Deputy Director
of the Center for Global Health
and the Director of the Division
of Public Health Systems
and Workforce Development.
There, she provided leadership
in building Ministries
of Health capacity
internationally
through the Field
Epidemiology Training Program
and the Sustainable
Management Development Program.
Dr. Simone is a retired captain
of the United States Public
Health Service Commission Corps.
Please join me in
welcoming Dr. Simone.
[ Applause ]
>> Good morning everyone.
>> Good morning.
>> I'd like to add my welcome to
all of you to this forum today.
I'm really happy to
be here in my role
as Acting Principle
Deputy Director.
I get the -- have the great
pleasure of getting work
with Dr. Liburd and her
team and learn a lot more
about the activities
of the office.
And it sort of brings
me back in early 2000s,
I worked in the National
Center for HIV
and STD Prevention before the
-- the hepatitis part was added.
And I got to work with
the Tuskegee Program
and the Minority
Health Programs there.
So, it's really great to
be joined with this types
of activities once again.
I want to thank the --
all of you for being here
and thank the -- the speakers
that have come before me.
So I have a few words for you
today about CDC and this work.
CDC has earned the
reputation of being one
of the most trusted
federal agencies.
And the way we're able to
maintain a public's trust is
by ensuring that we
engage in high quality,
scientifically sound and
ethical public health practice,
surveillance and research.
Public health ethics is the
process to clarify, prioritize
and justify possible course of
action of public health action.
This process must be
based on three things:
Ethical principles, the values
and beliefs of the stakeholders
and on scientific information.
While CDC excels at gathering
scientific information,
gathering is not enough.
We must act on this information
guided by the principles
of good public health practice.
Dr. Liburd talked to us
today a little bit already
about the work of the
Division of STD Prevention
and the Tuskegee University.
This collaboration is
really important one.
And in 2015, part of that
collaboration was starting these
ethics forum -- forum.
And these forums have
highlighted public health issues
related to African-American
health, Hispanic health data
and this year, women's
health across the lifespan.
These four are an important
way for us to come together
as partners to advance
health equity.
CDC is committed to working
with diverse populations
and creating opportunities
to better reach communities
that may be underserved
and whose voices often
don't have a chance to hear.
I'm also pleased to recognize
the CDC's Office of Women Health
in coordinating today's forum.
They are shining a light
on the public health issues
that in many instances
disproportionately impact women
and girls who make up more than
half of the nation's population.
We already have excellent
examples of this important work
and I'd like to mention two o
of those: First, heart disease.
Heart disease kills
one in five US women.
American -- It's the American
women's leading cause of death,
and yet is often thought
of as a man's disease.
CDC's Wise Woman
Program, not just --
aims not just to help
women understand their risk
of heart disease,
but provides services
to promote heart
healthy lifestyles.
It targets low income,
under-insured
and uninsured women,
age 40 to 64 years.
It provides heart disease and
stroke risk factors screenings
and services that
promote healthy behaviors.
And the currently consists
of 21 programs in 19 states
and two tribal organizations
and is administered
through CDC's Division of Heart
Disease and Stroke Prevention.
Another example is
gynecological cancer.
Each year 89,000 US
women are diagnosed
with gynecological cancer.
A teacher named Johanna
Silver-Gordon died in 2000
of ovarian cancer at age 58.
She had all the symptoms
but did not recognize them
for what they were.
The Gynecological Cancer
and Education Awareness
Act is named Johanna's Law
in her honor.
To support Johanna's Law,
the CDC in collaboration
with the HHS Office of Women's
Health developed the campaign
Inside Knowledge -- Get the
Facts about Gynecologic Cancer.
This educates women and
healthcare providers
about the signs,
symptoms, risk factors
and prevention strategies
related to cervical, ovarian,
uterine, vaginal
and vulvar cancers.
And it encourages women to
pay attention to their bodies
and know what is normal for them
so that they may recognize
any persistent symptoms
and seek appropriate
and timely care.
Programs like these are saving
the lives of our mother,
our daughters and our sisters.
We are hopeful that today's
Public Health Ethics Forum will
result in the greater awareness
of the ethical challenges
associated with promoting
and protecting women's
health, the formation
of new relationships among
persons attending the forum
and a greater knowledge
to inform all of our work
to improve the health
of women and girls.
On behalf of the Acting Director
of CDC, Dr. Anne Schuchat
and the senior leadership of
CDC, we want to thank Dr. Warren
and his colleagues the
National Center for Bioethics
and Research and Healthcare
at Tuskegee University,
all of our guest
speakers and facilitators
and subject matter experts,
the participating National
Centers Institutes and Offices
and all of you for taking time
away from your other commitments
to be part of this year's forum.
Thank you very much.
[ Applause ]
>> Thank you Dr. Simone.
So next, we have very
lively speaker for you.
I'm very excited to introduce,
Dr. Reuben Warren.
Dr. Warren is Professor and
Director the National Center
for Bioethics In
Research and Health Care
at Tuskegee University, as
well as the Adjunct Professor
of Public Health, Medicine
and Ethics & Director
of the Institute for
Faith-Health Leadership
at the Interdenominational
Theological Center here
in Atlanta, Georgia.
Prior to this, Dr. Warren
served as Associate Director
for Minority Health
here at the Centers
for Disease Control
and Prevention.
He also served as the Associate
Director for Urban Affairs,
as well as the Associate
Director
for Environmental Justice at
the Agency for Toxic Substances
and Disease Registry
here at CDC.
His extensive public health
experience at community, state,
local national and international
levels range from clinical
and research work at Lagos
University Teaching Hospital
in Lagos, Nigeria to heading the
Public Health Dentistry Program
at the Mississippi State
Department of Health.
Please join me in
welcoming Dr. Warren.
[ Applause ]
>> Good morning.
>> A couple of don't do's.
Don't stop by Starbucks
and get tea or coffee,
because you may spill it on
your coat, and you won't be able
to wear it when you
introduce our speaker.
I'm one of the few men that
has the opportunity to speak
with you today, and I
am so very, very pleased
and proud, one of the few men.
I'm on the planning
committee that worked
to make this day possible.
And our first meeting about when
we decided to do women's health,
I said very clearly,
"I will argue my point,
but y'all make the decision."
And in most instances,
I argued my point,
and they made the decision.
It was different than my point.
It helped me to learn
that I have a lens,
but that lens is limited.
So I want you to know,
your limited lens as well.
It may be around
race and ethnicity.
It may be around gender and sex.
It may be around income.
And as I've learned
being in Tuskegee,
it may be around
geographical locale.
I grew up in inner city
South Central Los Angeles,
urban America.
Tuskegee is not urban America.
I've learned a lot
from being in Tuskegee.
This forum is critically
important from my perspective
because it does a
couple of things.
It expands and continues an
authentic, ethical relationship
that has evolved into a true
and authentic partnership.
And there is difference, and I'm
intentional about using the word
"ethics" because that's the
basis of why we're here today.
And it simply means doing
not the right thing only,
not doing things right, as
science drives that agenda,
but doing those things
through the --
the lens of those who see
it differently than you.
And understand those who have
the most to lose have the most
to gain, and we ought
to listen carefully
to what they have to say.
This forum started in
2015 as you've heard
because we reflected on
100 years since the death
of Booker T. Washington, the
Founding Principal and President
of Tuskegee University,
then Tuskegee Institute.
Booker T. Washington had a lens
that was not an unusual lens.
It was one that looked at the
whole picture at all of us
and focused on those in
greatest need at that time.
And that sounds like
public health to me.
He found through the work
of some of his colleagues,
Monroe Work, a statistician
in particular that the health
of black people was terribly,
terribly different
than that of others.
And that difference
was bad, very bad.
He found that the causes --
the preventable causes of death
for African-Americans were
preventable, cost a lot of money
and cost a lot of lives.
So he established in
1915 Negro Health Week.
And what many didn't know,
and we reminded them in 2015
that that evolved into
Minority Health Month,
National Minority Health Month.
So when you think you're
starting something new, stop,
look back so that
you can look forward.
Negro Health Week is now
Minority Health Month.
Thank you BTW.
The lens -- the lens of
ethics has many spheres.
And as many of came through
looking at understanding
and trying to adhere
to bioethics, a very,
very important paradigm
evolved out of ethics,
evolved out of philosophy
some would say.
A little bit of argue
evolved out of theology.
But you know, we won't
argue that point.
Where are we today?
Public Health Ethics, a
different kind of lens,
one that we all think we know
about because we all think
we do the right thing.
But it is a basis for how we
should act in public health,
public health ethics,
here and now.
Not only the intention
to do good,
but doing good in and of itself.
Lowly, honoring and
respecting autonomy
but seriously engaging
community, not only in justice,
but in social justice.
And in my view, social justice
and public health
are one in the same.
Doing things right, the
importance of science.
Doing the right things,
the importance of ethics.
Doing the right thing for
all of us is the charge
of public health ethics.
So we're going to move on
today and understanding
that we all are vulnerable.
Every last one of us
has a vulnerability,
rather you know it or not.
But some of us are more
vulnerable than others.
I would argue those are those
susceptible populations.
Those who are most
vulnerable are those
who we should spend our greatest
resource and most attention to.
Know your vulnerability
and look around
and you'll find somebody else
with a different vulnerability.
Help them and in fact,
they will help you.
We're in this together
whether we like it or not.
So when you win, I win.
And quite frankly,
when you lose, I lose.
We're in this together.
This forum particularly looks
at women and their whole life,
girls in their whole life.
And every time I listen to my
granddaughter, I learn something
about women in their whole life.
This is an exciting day and I'm
so very, very pleased to be here
and to see that you're here.
Thank you for being here,
and we will have a good day.
Thank you.
[ Applause ]
I would like to introduce, no,
present a friend and colleague.
Because if you know anything
about women's health,
no matter how little
you might know,
to introduce our keynote
speaker this morning to you,
would be an insult to you
and more importantly to her.
So I want you to take a moment
this morning and listen.
I've been in school for a
long time, long, long time.
I'm a slow learner, so I
stayed there a long time.
And I didn't learn
much about listening.
I learned a lot about
talking, not listening.
So I want you to listen this
morning, because in 1970,
early 70s, while in Boston,
I was talking, teaching
and talking.
And somebody told me to listen.
As I did, I heard the name,
Vivian Pinn, this physician
at Tufts, that was finely
motivating,
inspiring, and guiding students,
mostly medical students,
mostly black students,
but others in Boston.
And you know in Boston, if you
think you have something going,
you take it to Boston.
So I listened, heard
the name Vivian Pinn
and how wonderfully she
was doing with students.
And when I joined CDC in
the, like, late 80s/90s,
I met some of those students
were here running CDC
because they listened.
And Boston I listened and
heard the name, Vivian Pinn.
Years later, and I wandered
around Harvard University,
and I heard the name again,
Vivian Pinn because
I was listening.
I went there to talk
but I had to listen,
and heard the name Vivian
Pinn chairing the Department
of Pathology, chairing the
Department of Pathology,
Board Certified Pathologist.
I was listening and
heard wonderful things
about leadership in it
around Howard University
School of Medicine.
I was listening.
I want you to listen
this morning.
And then I, as you heard, I
worked a while here at CDC and,
we were trying to work with
all the federal agencies
and all the -- everybody else
who thought they had
something to contribute.
And I heard the word
about the need
for office of Women's Health.
Heard it first here
at CDC and my response
because I was working minority
health say, when women's health
and minority health
is different,
so don't ask me to do it.
I -- I don't know how to do it.
So I asked not to do it,
and then it became an
Office of Women's Health.
And then as I listening
going through the agencies,
I heard about an
office or research
on women's health at NIH.
I said, "Now who
would have the courage
and the nerve to do that?"
And as I listened, I
heard the name again.
You know what name that was?
Vivian Pinn.
So, everywhere I went and
listened on strategies
to improve the health of
those most vulnerable,
the susceptible and I listened.
I heard the name Vivian Pinn.
So when I decided to go down in
the country, Tuskegee, I said,
no, I won't hear that name.
But then I say well I'm going to
introduce Dr. Pinn to Tuskegee,
and I was embarrassed.
Well she said, well, if I come,
I need to stop by the graveyard
to give my respects to some of
my kinfolk not in the country,
the name again, Vivian Pinn.
So I want you to be real
intentional this morning
about listening, not
talking, but listening.
And I'm sure you'll hear
something you haven't heard
before and much that
you have heard before
if you listen to
Dr. Vivian Pinn.
Let's welcome her to the stage.
[ Applause ]
>> Thank you, alright.
When I -- she invited me
to come into government,
thinking about giving up a
tenured full professorship
and a department chair in
Academic Medicine to go
to government, I said, "No
thank you Dr. Healey because I
like to say what I think
and I don't think I'll last
in government that way."
I literally, literally
said that to her.
And her response was
she does -- she did too.
Why don't I come and try it?
So in fact, that was
how I started NIH.
So, I'm pleased to be here
and pleased to be able
to with what time I haven't
lost already screwing
up this presentation.
But, to be able to
talk about the topic
which is Optimal Health
for Her Whole Life,
which to me is really
referring to lifespan issues.
And I often think when we
talk about women's health,
the label we gave, and over
the years, really thought --
we really misnamed this because
we really should've called it
The Health of Girls and
Women to really reflect
that lifespan issue instead
of just women's health.
But that's alright, we'll
make up for that as we talk
about the continuum of health.
And this is very timely
because it is National Women's
Health Week.
So from the standpoint
of I know the perspective
of the bioethics Center, and for
those of you in the room looking
in the terminology and
relative to ethics, justice
and inclusivity that National
Women's Health Week is a
wonderful time right on topic
to look at the issues related
to women's health or the
health of girls and women.
Now, I can say and I'm
sure there are many
in this room who've
been involved
in women's health
for many years.
And Marsha, I'm going to
call on you in a minute.
But I'll get to you
in a little bit.
That's doctor -- that's not
doctor, but Marsha Henderson
who is the Director of the
Office of Women's Health
at the Food and Drug
Administration, before that,
held many positions and has been
with that office for many years
and has really been a
wonderful colleague.
I probably now don't
get her in trouble
since I've been retired
for six years.
So, she's on her own
and she can behave
without me steering her on,
but has been a great champion.
If you don't know
Marsha, stand up Marsha
so they will know who you are.
[ Applause ]
But many in this
room I know have --
and we're well aware that how
we define and what we think
about women's health, how
women's health or the health
of girls and women really has
changed since the late 1980s
and especially since about 1990.
And that came about
because of advocacy combined
with scientific legislative
public policy
and human rights considerations.
And it really is important to
reflect on that because it shows
that when you have concerns,
that actually it was
grassroots efforts that led
to eventually a change in
public law for this country.
And so we can bring about change
if one is dedicated enough
to what we are trying or
one is concerned about.
So what was the historical view?
We talk a lot about
the traditional view
of women's health.
And actually I -- because I
didn't want to have 1500 slides,
didn't put them in,
but there are textbooks
and there are many documents
from the 80s and 90s.
And I go back and look.
I finished medical
school, I hate to say it,
but I finished medical
school in the 60s.
And looking at the textbooks
that we used at that time,
and women's health was
defined really in terms
of reproductive health.
Women's well-being was defined
in terms of her sexuality.
Women's health was
really considered
to be the reproductive system
during the reproductive years.
If you ask what was
men's health,
it was the total body
system everything from head
to toe, all of the systems.
You ask, what was
women's health?
They send you to OB/GYN
because it had to do
with reproductive
health with pregnancy.
Almost nothing related to
women's health after menopause.
It was as though once
you hit menopause,
reproductive years are over,
you just sat in a rocking chair
on the front porch and
you rocked and that was it
until you passed away,
as opposed to looking
at healthy aging, etcetera.
So, doctor -- I think Marianne
-- many people have claimed it,
but as I look back, I think
it was Marianne Legato,
who first gave the
label, The Bikini View
of Women's Health to that idea.
Well, we've made some changes,
and one of the first things
that we had to do at NIH when
we began to study women's health
and to really look at it from
the standpoint of research,
which very important is two
things: One, to recognize
that women are not the same as
men because this whole concept
of attention to women's health,
really came about because
of the concern to
whether not standards
of medical practice were being
based on information that came
from the study of women or where
the studies of health issues
in men aside from
reproductive issues done in men,
were being applied to women
as though women were
just little men.
And obviously that's given
rise to the whole field of sex
and gender-based medicine
and policy if you will --
but also recognizing that
women's health didn't begin
at puberty and end at menopause,
but that it really
encompasses the entire lifespan.
And so we had two things to do
-- One, to bring up the concept
of comparing women
with men and secondly,
to look at the expanded concepts
of women's health and not just
from birth to grave, which is
what some like to refer to.
But as we talked about
sex and gender differences
and obviously based upon many
things I had been involved in
and the fact that I was
heading this office,
we could not just look at
women in terms of the fact
that women are not
just like men.
But the fact also that not
all women are the same,
that there are differences
between different populations
of women, and it may not
have been popular in 1991,
but one of the first things
our office did was to declare
that as we look at
women's health,
there would be two aspects:
One, to look for differences
between males and females
and secondly to look
for those factors
that contribute
to differences among
different populations of women
or different populations of
men, which to me is a way to --
to explain why there
are health inequalities,
why there are health
disparities.
And looking at those factors
across the lifespan if you will,
not just in terms of health
status, but health outcomes.
How do we respond differently
in response it interventions
and responses to the
environment in which we live,
which we were born,
in which we grow up?
How do we respond
different to treatments?
And that really --
this slide really kind
of summarizes the essence
of what I really worked for
and how I constructed programs
during the 20 plus years I was
at the Office of Research
and Women's Health at NIH.
If you didn't know, Dr. Warren
didn't tell you, I'm supposed
to retire in two
months as of six years,
and you would not know
it from my schedule.
But anyway, I am
supposed to retire
and I have flunked retirement,
but that's another story.
But looking at health
disparities
and health inequalities, and
I must say that CDC has a lot
of wonderful information
really coming out of the Office
of Minority Health and the
-- the other and the other
and other parts of CDC with good
literature and good explanation
about health disparities
and health inequalities,
which I often quote
when I'm speaking
about health disparities.
But we all know what
health disparities are.
But I -- I had this -- this --
this slide that I often use,
but I added the section, Gender
Equity is a Social Determinant
of Health, because as we
talk about those determined,
those factors that --
that contribute to health
and that contribute
to health disparities,
I just -- On, what was it?
Wednesday, two days ago, I
can't keep up with the NIH,
where they have a
lectureship for women's health.
And it was interesting
because one
of the speakers made
a big point of looking
at social determinants
of health and emphasizing
that gender equity --
gender equity is a social
determinant of health.
And I think I've
been implying that,
but I like the way
she emphasizes,
so I added that to my slide to
make that point because we know
that the Center for Bioethics
is focused on and wants us
to consider social justice
and -- and -- and --
and social justice,
and to me, that --
that brings that forward.
And as we look at what's
happening in terms of looking
at different populations
of women,
we know that there
are differences
in health status/health
outcomes, access to care,
and that term which
we need to now reframe
in the current sociopolitical
environment, really differences
in that if we're going
to make a difference
and overcome these differences,
we need to know what
we need to overcome.
Anecdotes don't work.
To me, that is the
value of research
that we have the evidence
so that we know what we need
to tackle, what are leading to?
What is resulting in
these health disparities
at different points
of the lives of women
and different populations
of women.
So, when I went to
NIH and many asked,
"Why did you leave Academic
Medicine to go to NIH
and become a federocrat,
if you will?"
It was because having been
out there like with Dr. Warren
and many venues we've been
in, knowing we were trying
to make a difference in what
was happening for health
of our people and our
communities, as well as people
in general, knowing that
anecdotes were not working,
that we really need to have the
information based on the fact
that there now is
going to be an office
that would be focusing
specifically on getting the data
and -- and what we have
as the evidence-based
system of medicine.
And in order to change
standards of health practice,
in order to change
what is taught
in health profession schools
in order to change what women
and their families are told
about preserving their health,
we don't need stories
that are carried over.
We need evidence.
We need information.
So research is important,
and having that information
from research, then having those
-- that information incorporated
into healthcare, as well as into
public policy can then help us
to change and require
some changes and standards
of healthcare delivery, as well
as know what to inform women
and men and their families
about what they can do
to preserve their own health.
So, I mention this and I'm not
giving a lecture on inclusion,
but it's important because
this is what came about.
And actually, I have to give
a lot of credit to Dr. Warren
because the center at Tuskegee
has really focused so much
over the years and continues to
on the importance of inclusion
and clinical research of
women and minorities in --
in generating results and
actually has had several number
of symposia dealing on --
dealing on the issues of
inclusion, and I think --
Well, even, I know
that you're working on a project
on that now, but I wanted
to just emphasize this.
If you think about it, actually
the actual change came about out
of the Women's Health Movement,
because it was the
Women's Health Movement
that actually went
to Congress and said,
NIH is not including
women in clinical studies.
We need to make sure they're
going to do that, and a policy
for the inclusion of
women was developed.
But then there was
some who said,
well what about minorities,
which was the terminology
used then.
And so, then the NIH guide said,
well let's add the
word "urging."
So after inclusion, then --
then -- then there was a --
Language was added that said
we encouraged the inclusion
of minorities in clinical
research at the NIH.
And then the general
accounting office at the request
of Congress, looked
to see whether NIH was following
these guidelines, and were women
and minorities being included.
Focus was primarily on women,
but it also looked at whether
or not women were
being included,
and it was actually
NHLBI, the National Heart,
Lung and Blood Institute that
seemed to be doing the best
at that time in 1990 in
ensuring that women --
that members of minority
communities were being studied.
But when that report came out
saying NIH was not doing it,
it was a press conference held
on NIH's campus to lambast NIH
for not making sure
that women were included
in clinical studies that led
to the then Director/Acting
Director of NIH
to announce we're
setting up an office
to make sure this happens.
And that was what the
genesis was for the Office
of Research on Women's Health.
It really was established
to respond to concerns
about the inclusion of women.
You can't separate
women and minorities.
And although there was an office
of minority health programs
at that time, you can't separate
and have two different
sets of data.
So actually we ended up doing --
looking at most of the
issues related to --
to inclusion of both
women and minorities.
And as I think you should know
in 1993 what had been public
policy became a matter
of public law, and as far as
I know, we're the only country
in the world that has a
public law that requires
in federally funded
research that women
and minorities be included
in clinical studies.
So that is sort of the
genesis of what came about.
And actually in presenting
this, when the law was passed,
it really just strengthened
the policies NIH had.
This was in the NIH
Revitalization Act.
FDA has since had
language directing it
to -- to look at reporting.
Remember FDA does
not fund research.
It is regulatory body so
it doesn't fund research.
At NIH, we could say,
you won't get the funds
to do your research if you
don't meet our policies
and requirements, while FDA has
to evaluate research
that's done independently
and has brought to it.
So it's a little bit different.
But we were so proud
that we were able to show
that we were beginning
to include women
and minorities in
clinical studies.
And then I begin to get letters
from members of Congress,
mostly male members saying, "NIH
is discriminating against men
because all data
is looking at women
and minorities in
clinical studies."
So, I learned that when
I talked about this,
I had to automatically
just cover myself by saying
that we assume, and
the basic assumption is
that men are being included
in clinical studies,
and the purpose of our efforts
are to make sure also that women
and members of minority
groups are also included
in these policies, the purpose
being really to get back
to the concept of ethics
and justice to make sure
that results of research
are applicable
to all segments of
the population.
Remember prior to this effort
to move into inclusion in one
of the major areas that
we've all had to deal with is
that for years, women
were not included.
And one of the reasons
-- one of many reasons,
but the major reason
used to justify that was
that women were vulnerable.
It was going to hurt them to be
and then there were
going to be problems.
And the same with the
reference to the --
the PHS Study at Tuskegee
that maybe we shouldn't
have African-Americans
in clinical studies because
we should be protecting them.
We -- we should not be
using prisoners because --
Five minutes and I'm through?
Oh wow. Well, maybe I
should just stop now.
Let me see here.
In any case, let me
see what I can do
because I'm just
getting into this.
But it -- it's a matter
of looking at inclusion.
It is a matter of
ethics and justice.
Alright, seven minutes.
I'll see what I can do.
And so, we look at and
think about these principles
of justice inequity that they
really need to be considered
in the multiplicity of
factors that contribute to
or prevent good health and
wellness in girls and women
across the life continuum.
And being able to not just
have access to healthcare,
which is what we've been
referring to and always referred
to that we get the results to
research, we know what state
of the art or art of healthcare
is, and we want to make sure
that women and minorities have
access to that healthcare.
But in the current political
environment, we're learning
that we can no longer just
talk about access to healthcare
because we're learning that that
word can be used differently.
Having access and actually
being able to take advantage
of that access is a new way of
looking at that terminology.
So we all are going to
have to think differently
at how we express that.
And so, out of this, I've now
moved into a new terminology,
and I think this is going
probably be at the basis of most
of my talks about
health and healthcare now
that we really have to think
about the sociopolitical
aspects.
Now, I am retired
from government,
but I still have a
government title,
and I'm in a government
building.
I'm not being political,
but if we want to think
about contributors
to healthcare,
we have to think
and health status.
We have to think about those
sociopolitical aspects.
And if you're familiar
with that report that came
out about differences
in health and -- and --
and mortality in different
counties across the US,
I just heard a presentation
on Wednesday looking at that
and that one of the
major contributors
to differences are
state policies.
And as we look at the
discussion now about --
about what's happening
in terms of healthcare
and perhaps a new
healthcare bill
and whether the states
will be controlling our
national standards.
We need to be concerned about
those sociopolitical aspects.
Alright, let me see what I
can do in three minutes even
with the southern
accent, Reuben,
let me see what I can get
through here very quickly.
We've always talked about
the many contributors
to differences in health status.
And I think women's health
was one of first areas
to go beyond just the biological
factors that contribute
to the women's health.
You cannot look at women's
health and think about women.
Perhaps this should've
been true for men,
but at least we did
this for women,
and hopefully the men's health
area learn from this too
that we can't just think of it
in terms of genes and biology
and environment, but
we need to think of all
of those other factors.
And we really begin looking at
social determinants of health.
This is not my diagram, but
it's a wonderful diagram that --
that I've adapted
and used from --
from that article by
Dahlgren and Whitehead.
But if you think about it,
we really started looking
at social determinants of health
before there was an office
of bio-behavior and
social science research,
before there was
emphasis on that.
And so when we look at factors
related to the health of women
and girls across the lifespan,
we do focus on and we have
to continue to focus
on, and especially
in today's environment
behavioral
and social are societal factors,
as well as looking at race
and culture, how women
relate to their bodies,
environmental exposures.
You know, not just looking
at endocrine disruptors
in the soil, but also
looking at things like --
like access to toxic waste that
-- that there may be in an area
or where one lives with
how far you are if you're
in a rural areas from having a
-- having access to a physician
or a nurse or a clinic, and
also looking at that access
to medical -- to
medical practice
or I should say healthcare
practice,
and of course looking
at life course.
We -- we've seen many different
variations or divisions of life
or the periods of life,
of course the life span.
And mostly, it boils
down to prenatal infancy
and childhood years
that have less years,
reproductive middle
years, pregnancy years,
menopausal transition years
and the elderly frail, elderly
and healthy aging years
to sort of separate those
who are healthy elderly and
those who are elderly but frail
because there's sort of a
difference there in terms of --
of looking at health
and health divisions.
But the important point is that
it's really a continuum of life.
It's not a -- it's not that
you jump from one to the next.
And you know it's like people
and you see references often
referring to women under 50
and over 50, we know that age 50
is arbitrary because it's used
to sort of suggest premenopausal
and postmenopausal,
assuming that age 50 is the
stand-in or the surrogate
for menopause, and yet we know
some women undergo menopause
at a much earlier age.
Some women undergo
menopause at a much later age.
So you can't assume
that once you're 51,
you're automatically fitting in
all the data related to women
at age 50 and over or under.
So we really need to think of
our life course as a continuum,
and that's what makes
the lifespan
or life course important.
And -- and actually,
when we think about it,
and with that in mind,
we really and one
of the most important
things to come
out of not just women's
health research,
but I think out of
science are those concepts
to help us recognize that there
are contributing factors not
just from birth to death,
but actually from pre-birth,
meaning the entry
uterine environment
that can affect our health as
we become adults and as we age.
And so we really need to think
about that comprehensive
continuum
from the entry uterine
environment.
I like this slide which came
out of our strategic plan
that we did that really is sort
of based on the Barker Theory
that is that if you look
at conditions or statuses,
even things like substance
abuse occurring in --
in adult years or later years,
that often it can be
tracked back to influences
in the pre -- in
the in utero time.
And so that Barker Theory,
we actually spent a lot
of time funding research in that
-- don't hear as much about it,
but it's beginning
to come about again.
But it really comes down
to the idea of looking
at the importance of
the in utero environment
for healthy babies and
for healthy adults really
with that spectrum, which is
why I have a great time not
understanding the objections
for providing maternal care,
but that's another issue,
but actually thinking
that if you provide, and
whether you're male or female
and you're helping to
support maternity care,
maternal healthcare that
you're actually looking
out for both men and
women in their later years
because of the effects a lack
of prenatal care can have
on the health of the fetus
and therefore the health
of who's going to
be the adult male
or adult female 30,
40, 50 years later.
That is important.
But -- And so we can look
at the health factors,
keeping in mind it's a
continuum for prenatal infancy
and childhood years really
looking, mostly focusing
on the implications of
the in utero environment
and prenatal exposures.
We don't see a lot of
sex differences and a lot
of differences other
than -- than -- than --
than low birth weight
babies and mortality
and maternal mortality
in those early years.
But getting into
adolescent years,
which is where bad behavior
seem to begin to form.
You have to worry about sexually
-- sexual maturity and -- and --
and what's happening
with -- with --
with STDs and handling
the sexuality,
looking at eating
disorders, obesity,
as it comes are the other
extreme eating disorders.
Yes, teens are beginning
to experience intimate
partner valance even
in the adolescent years.
We're seeing issues related to
drugs of choice, but I'll get
to that again in a few minutes,
but looking at the teenagers
with their parent's
prescriptions out of their --
their bathrooms for
substance abuse
because it's "a fun
thing to do."
But we know that seven out
of ten deaths for kids in --
in this age group are related
to unintentional deaths
like motor vehicle accidents,
homicide and suicide.
So these are things that need to
be considered in that age group
as we trans -- but then
also, how good are we
at delivering healthcare?
Do teenagers -- do adolescents,
do they go to the pediatrician?
Do they go to the gynecologist?
Do they go to the
general internist?
Do they go to the
family practitioner?
Or do they go to their friend
next door and ask, what do I do,
and go to their buddies
in the --
in the local gang or
local -- local group?
So we really need to give
more attention to healthcare,
health direction and health
information, because we do know
that ten -- teens can carry out
some wonderful ideas in work
and help improve the
health of their parents
when they're in on it.
And then looking at
reproductive in middle years,
we talk about going beyond
the reproductive system,
but there is so much
more we need to know
about the reproductive system,
so we can't forget that.
They're reproductive
health issues.
And again, it is important
to have healthy pregnancies,
full-term babies, and that
continues to be important,
in addition to fertility
issues, as well as --
as fertility issues and -- and
reproductive health and things
like fibroids and endometriosis.
But then really looking
at obesity,
and we know how obesity affects.
We look a healthy behaviors.
Intimate partner valance
really becomes an issue here.
Cardiovascular disease
and you've already --
So I'm not doing a list
of all the diseases,
because I'd spend all day
doing that, and you're familiar
with them, but just
pointing out so many issues
that are a major concern
during this particular part
of the lifespan continuum,
and course cancers
especially this age,
breast and cervical
and melanoma.
Now with the idea and it seems
that every place
I've been recently
and I've been too
many places recently,
but almost every
place I've been,
I was in Boston just a few days
ago, and then again this week
at several meetings, there
have been discussions
about overdose -- opioid abuse
and I know you have
discussion session coming up.
But you heard my
background is pathology,
so I recently had visited the
-- the DC morgue and the --
the medical -- the chief medical
exam, there's a great young man,
Roger Mitchell who is now
in charge of that office,
but he was telling
me about the increase
that they're seeing right in DC.
So I just looked, wanted
to see how that -- that --
that how the data there really
would look when put in terms
of national data, which
you'll be hearing about.
But it's interesting because you
can see that the major increase
in drug use and drug overdose
use is among age 50 to 59,
and so not in the teenage,
but the later years.
Actually and women constitute
only about 25 percent in DC
of those who die from
drug overdoses, but it --
it's interesting to see --
and it's --
it's nice to see that women went
down a little bit last year.
But look at the --
look at the variations
by race and ethnicity.
This is the kind of
data want to see.
And just look at --
look at blacks for example.
Now, the red line for 2017,
this year is only five months
on the way so
we don't have much data yet.
We hope it won't catch up,
but look at the difference
between 2014 and 2016
and the number of over --
opioid deaths, and of course
they're mainly opioids fentanyl,
etcetera and derivatives,
etcetera.
So while the --
while these fatal overdoses
are more common for males
than females, we still
have the issues of women
who about 25 percent are
women, but then beyond that,
when we lose the young
men or the older men,
the impact on the women of
the family in caregiving
and taking care of the
family and the impacts
of women are affected.
Menopausal transition
-- I -- I could --
If I could take off my
jacket and show you my back,
I could show you lots of
scars related to the fact
that I was the co-director of
the Women's Health Initiative
which you may or may not recall
was the study that looked at --
It's a broad study and CDC
was actually very involved
in the public -- in -- in the
public health studies of that.
But the major thing the Women's
Health Initiative is known
for was of the stopping of the
study early with recommendations
that menopausal hormone
therapy should not be used
for prevention of cardiovascular
disease or prevention
of other diseases and that there
were more risks than benefits.
And my back still itches from
the attacks I got from that.
Well, that was 2002,
and it's continued on.
I just want to show you
that for the menopause area,
the menopausal transition
to come --
the major concerns
continued to be
around the use of
hormone therapy.
And I want to show you that the
preventative services task force
just came out this
week with putting
out again recommendations
which essentially say what
in fact Marsha Henderson can
tell you is the FDA actually has
the -- gives the -- the FDA
has never approved the use
of hormone therapy in
menopause for the prevention
of chronic diseases, although
that's what most physicians used
it for and what most women
thought they were taking it for,
prevention of chronic diseases
and to keep them young and sexy,
which is what we were sold on --
sold through our traditional --
Don't let me get
started on that.
In any case, I want you to know
that this is again coming up.
This is just this week,
but actually what they're
recommending is something
that is actually Marsha and her
office are really responsible
for the education of
women about this topic.
So I just wanted
to show you that.
And then looking at elderly
and frail elderly years --
And I was watching the clock.
I started at five
minutes after would --
so I think I have
another five minutes.
Is that okay?
Alright.
>> Alright.
>> Thank you, because you really
called me up for five minutes
and it was 15 minutes,
but anyway.
Sorry, I'm watching.
But looking at the elderly
and frail elderly years,
that's when we get into
issues like osteoporosis,
as well as cancers,
again breast.
We know the greatest risk
for getting breast cancer is
being a woman and getting older.
And then looking at the
fact that the new data shows
that opioid and drug deaths
are increasing in older years.
But the major we can
summarize all that by saying
that when one gets older,
especially for women,
but it's true for men too,
but especially for women,
we live longer, but
we're more apt
to have complex chronic
diseases.
We don't have just
one condition.
We often have an interaction
of chronic diseases
and that can be a major
issue for healthcare.
So when we think
about interventions
for health disparities for women
of color or women in general
for midlife to beyond, we
want to lessen disparity.
We want to prolong life.
We want to preserve
mental acuity.
We want to prevent
functional, physical decline.
We want to be able to
get around, be mobile,
not have to go to a nursing
home become of incontinence
or not being able to -- to
have free mobility ourselves
and continued -- I
shouldn't say improved,
but continued good
quality of life.
And I just want to mention
briefly a major area,
and I know that -- that
it's interesting if you go
to your college reunion
or school reunions
and you see the differences, as
you age along that continuum,
I remember when I went and --
And where is Rochelle who's
also a Wellesley grad?
I remember many years ago I
went and everybody was talking
about menopause because the
class was getting to that stage
where everybody was
going through menopause.
And of course then I had
all the answers I thought
from the Women's
Health Initiative.
Then the next one, everybody
was talking about dementia
because so many people in
the class were affected
by taking care of parents
or relatives with dementia,
their in-laws or
their own parents.
And that was the discussion.
I don't know what it's
going to be when I go back
for my 55th reunion next
month, but I can imagine.
But anyway, but knowing that
dementia is a major problem.
And we do know Alzheimer's
is more common in women,
not just because we live longer,
but now it's been shown it
really is more common women even
-- even with or in
spite of living longer.
And so we look at
attention to --
to dementia in that not just
Alzheimer's but other forms
of dementia how important it is,
but it then raises another area
because important for women's
health actually looking
at what have some referred
to as the Sandwich Generation
for those who are midlife
who are taking care
of older parents, as well
as young, their grandkids.
But then also looking
at the fact
that for caregivers,
most are older.
One in ten of caregivers in this
country are 75 years or older,
and then we have the
women who are giving care
and the women who
are needing care.
And what I'm often preaching
and people ask how well I do.
I don't do so well myself, but I
hope all of you are doing better
at taking care of yourselves,
because we can't take
care of everyone else.
So now caregiving has gone from
just a sociocultural concept
to actually being the basis
of research, being the basis
of studies, being the
basis of the science.
What is the role of
stress in health?
How does stress and stress
coming from caregiving,
as well as other factors
affect the health of women?
Well, then to just sort
of bring this to a close,
I've looked at this sort of in
terms of lifespan, but then many
like to look at the
health of women in terms
of leading causes of death.
And these are obviously
from the CDC data.
But heart disease, cancer,
and you notice stroke used
to be three but now chronic
obstructive pulmonary disease
has moved up to three,
Alzheimer's is number four,
and look at diabetes
that comes down.
So those are for all women.
If we look at the
divisions on the basis of --
of racial and race
and ethnicity,
we can see some variations while
heart disease is the most common
for all women and for white
women and black women,
cancer is the leading cause
of death for Hispanic,
Native American/Asian
Pacific Islanders.
But you can still see that
these same conditions,
whether they're one two or
three, they're all important
in the health of women.
So we need to think
about prevention.
We need to think
about treatment.
We need to think about education
and which populations are
at higher risk, and what
are those contributors
to higher risk?
Because if you want to
eliminate disparities,
you've got to know what you're
tackling so that you can do --
be strategic in your planning
and that is important --
important in -- in going there.
And if we look at
different racial groups,
while we see the top ones,
these are the conditions
that if you look
at various groups
that you could really
summarize, and I'm not going
to go through all of those.
And then looking at threats
to help the age in caregiving,
wellness, staying active, mental
health which is so important
and looking at sexual
health, which we don't talk
about that much, but
how important that is,
not just for young girls,
not just for adolescents,
but also looking at
older populations.
And if some of you have
heard some of the stories
from nursing homes and those
that run nursing homes,
we know that these are issues,
but that's healthy living
supposedly for those
who are at that stage in age.
So we need to think about all
of these issues in addition
to drugs and alternative
medicine when we're thinking
about lifespan issues.
And then we bring in the
immigrant populations.
We now got more immigrant women,
and they bring sometimes
different,
not only different conditions
to be concerned about,
but different cultural values,
different family relationships
and how that affects their
ability to get healthcare
or to get healthcare
or to participate
for example in clinical studies.
And then looking at
other undertreated,
I'm calling them undertreated,
under-health service populations
like the poor or those who
are in inner city urban areas
or those who are in rural areas.
How do we then make sure
they're getting access
to health services
and not just access,
but actually being able
to benefit from that?
We've got to make efforts
to improve health communication
and health literacy.
We've got to examine better --
and I know many of you are doing
this, and you'll probably talk
about some effective ways to
disseminate health information
and better use some of
the new social networks
that can get this kind
of information out
and with the focus
on prevention.
So we know that preventive
behaviors can reduce the risk.
And I want to just
point out something
that really concerns
me quite a bit.
We know that from
research, and I've talked
about research actually
affecting practice patterns,
that the IOM had a
committee to look
at clinical preventive services
for women, using the latest
in research on what really can
make a difference in the health
of women through
preventive practices.
And out of that came as part
of the ACA recommendations
for preventive services
for women,
which were then based
upon research,
based upon the IOM report,
were then incorporated
into healthcare as
part of the ACA bill.
These were going to lose if
the ACA is done away with.
And my question is, what happens
when we think about the lack
of maternal healthcare?
What happens when we don't
have support for these kinds
of screening services?
And when we talk about -- talk
about access to healthcare,
it's available, but how
will it be available?
To me, this is a good example of
how research has moved forward.
We know about the risk
factors for heart disease.
One of the things I get
concerned about is that,
and that some of
them we can modify,
others are not getting
the message
out with heart disease being the
leading cause of death, from --
for most women, how
do we get women
to understand what they can
do to protect themselves?
But also we don't want to
make a guilt trip for women
when they're thinking about
-- And just one last example
and then I promise you
I'm through, when we talk
about diabetes, and we know
that there's differences
in diabetes prevalence.
And we look at gestational
diabetes,
and we know that gestational
diabetes occurs most often
in women, especially from women
of color, and that we've learned
that what is important
talk about life continuum,
that women who have developed
gestational diabetes have a
greater chance of
developing Type Two diabetes.
After the pregnancy, you know
gestational diabetes usually
goes away and women are told
to get a sixth month checkup
and the diabetes has gone away
and they think they're fine.
But we've learned that actually
they're more apt to later on,
maybe years later
develop Type Two diabetes.
But more importantly,
the children
of these gestational diabetes
pregnancies are at greater risk
of future obesity and
Type Two diabetes.
And that means that
pediatricians need to know
that they are born of GBM
-- of -- of GDM pregnancies.
And that recommendation
needs to be carried forward.
To me, this is a great example
of showing the continuum
of conditions and how, you know,
this is the in utero environment
and how it can lead to adult
disease and conditions.
And that means we
need to make sure
that our healthcare
system accommodates that.
Well, you know about
all of these
and I just mentioned Precision
Medicine, which is sort
of basing -- and
everybody's doing it
because there's funding right
now for Precision Medicine.
So everybody's focusing
an institution
on developing Precision
Medicine initiative.
But it's based on the genetic
approach to the individual,
but I'm hoping in
that genetic approach
to the individual we don't
forget the importance of ethical
and social implications of this
new approach but also looking
at all of the other factors that
contribute to the development,
the manifestations
of genetic diseases,
but also the whole
health of the individual.
So, how do we proceed?
There's still a major
challenge to overcome some
of those political biases about
what constitutes women's health.
We need to continue
to get the message
out that while the reproductive
system is important,
women's health is more than
just abortion and contraception,
and I don't know how we get that
point across more than we have.
We keep trying, but we have
to recognize and make sure
that our leaders and
our funders understand
that women's health is more than
just contraception and abortion,
but reproductive
health is important --
that we look at some of
these contributors to health
and equities, that we need
to be informed and make sure
that women and their
families are informed.
And again, here I go with my
latest soapbox issue dealing
with the sociopolitical aspects
of healthcare policies
and practices.
If we are going to have
justice for all and --
and human rights preventing
women's rights are human rights,
that we really make -- need
to make sure that biased
and uninformed politics
don't affect what we do.
So, efforts need to continue
to provide advances that means
through research
and basic knowledge,
prevention strategies.
We need effective
information dissemination.
We need more effective cures
and interventions if we're going
to take care of these
diseases that affect us,
but always with whatever we do,
keeping in mind ethical
principles
and common sense approaches,
because it doesn't --
we can be held as
smart information,
but you got to have a good
dose of common sense with it
and how it's applied and what
we do with it if we're going
to bring about the
kind of health equity
that Dr. Warren always talks
about and takes us forward with.
And I know you're going
to pull me off the stage,
but this is my last slide.
Thank you very much.
[ Applause ]
>> This next session is
within the program is our
Plenary Panel discussion.
The title is Women's Health at
the Intersection of Context,
Inclusion, and Public Health Practice a dialogue.
So, the plenary discussion
includes women representing
racial and ethnic perspectives,
women who live in rural areas
and scholars of religion
and ethics.
They will grapple with
the larger question
of how can we ensure an ethical
practice of public health
across multiple dimensions
of women's lived experience?
So we're very excited to hear
the dialogue that's going
to take place today.
Moderating our dialogue
is Dr. Dazon Dixon Diallo.
She is a recognized visionary
and advocate in the struggle
for women's human rights
and reproductive justice,
and the fight against HIV/AIDS,
on behalf of communities
of women living in HIV--
living with HIV and those
at risk for HIV and STIs.
Dr. Diallo is Founder and
President of SisterLove, Inc,
established in 1989, the
first women's HIV/AIDS
and Reproductive
Justice Organization
in the southeastern
United States.
Dr. Diallo is a member
of the Board of Directors
at the National Women's
Health Network,
and she is a founding member of
the 30 for 30 Campaign for Women
in the National HIV
AIDS Strategy.
She serves on the Fulton
County HIV Advisory Board,
and is a co-chair for the Act
Now End AIDS national coalition.
Diallo was recently appointed
to the NIH,
National Institutes
of Health Office
on AIDS Research
Advisory Council.
She has received numerous
awards and recognitions
over the 32 years she has
been working in HIV/AIDS,
and women's health
and human rights.
Please, a round of applause.
[ Applause ]
>> Thank you.
Give me my hug.
>> For you, thank
you so much for that.
>> Thank you.
>> So SisterLove is
not an accidental name
for the organization.
I -- As we get started, I --
I just wanted to first say
thank you for this opportunity.
It is a privilege, and
I know, and I'm going
to say this very quickly as
she walks out of the door,
it's been my privilege to have
an opportunity to be in the room
and to hear Dr. Pinn address.
Because I believe that in
1983 when I was a student
at Spellman College, I became
the youngest, nonfamily member
of the founding of the National
Black Women's Health Project,
which is the first ever black
women's health conference held
in this country at
a national level
on black women's
health issues in 1983,
founded by Byllye Avery,
and Byllye had the foresight
even then to make sure
that Dr. Pinn was a part
of that really critical
and historical conversation.
I'm a proud member of the
National Women's Health Network.
So in a lot of ways, we
have relationships with just
about everybody who's on our
panel today and I'm excited
to hear their thoughts
and ideas on some
of these challenging issues
around the ethical practice
and public health and in women's
health across the lifespan.
I'm also really grateful
for the question
around community-based
participatory research
and community engagement
because that is something
that we struggle with a
daily basis as the fact
that we are also a part of the
Women's Inner Agency HIV Study
as the only community-based
organization directly contracted
into the study as
a research partner.
And I would be remiss to say
that just as a person who is
in her early 50s that I
am "perimentalpausal."
I am -- I am not confused
about what I just said,
and that I think that
mental-pause and --
and that I think that mental
pause is probably more
of an accurate description
of this experience,
and so I ask early
on forgiveness
if I get a little
few lapses as I go
through meeting our
new folks this morning.
So we're just going to
start out, and I'm going
to take my seat in a moment.
But this really is a
dialogue and discussion.
So it is sort of the same
way I run my radio show.
It's a kitchen table
conversation.
We just left the
kitchen table down there
on the -- on the floor.
And we're going to start with
folks giving us just a couple
of minutes about yourself
and maybe inside those couple
of minutes, a reflection or
two about what we've talked
about so far this morning
or what we're having
in our conversation.
So I'm going to start
immediately with my left just
to give you a sense
of who's in the room.
We have Professor
Dr. Rosetta Ross,
who is at Spellman College
and she'll tell you a little
bit more about herself.
And then we have -- Is that
Maria sitting right next -- Yes.
And then we have
Maria Lourdes Reyes who was with
the U.S. and Border Programs Project Concern International.
She's the Director of
that -- of those programs.
And then we have
Judy Monroe, President and CEO
of the CDC Foundation.
And at the end, we have
Kathy Yep,
Professor at Pitzer College
of the Claremont Colleges.
So, can we just start with
our first discussion question
and then role?
Alright. So, I'm going to just
start with our number one,
according to the
2017 Proclamation
for National Women's
Health Net --
Health Week, Cindy would love it
if I mistakenly said National
Women's Health Network,
women are more likely to
be the primary caregivers
for their families, caring
for their children, spouses,
partners, parents,
caregiving especially
when a family member falls ill,
and honestly sometimes our
employers, our coworkers,
our church members,
our friends --
I tell you my aunt who is a
retired Family Planning Nurse
ran five family planning clinics
for the Fulton County Department
of Health and Wellness --
been retired almost 20 years
and is still the nurse to
the family, the community,
the church, the neighborhood
and anybody else who happens
to learn that she's a
nurse and needs care.
In doing so, many women tend
to put their own health
needs on the backburner.
So what are some of
the primary challenges
that impact our ability to
address this behavioral tendency
and other factors that
negatively impact the health
of women and girls
across the United States?
So prioritizing our lives
begins our conversation.
And anyone who is
ready to jump in,
I guess we would
start right here
with Rosetta introducing
yourself.
And then we'll go
down the line and come
to the question in discussion.
>> So again, my name
is Rosetta Ross
and I teach Religious
Studies at Spellman College.
Prior to teaching at Spellman,
I did teach at seminaries.
My research focuses on religion
and women's social
justice activism
and particularly
do I focus on women
in the Civil Rights Movement --
African-American women in
the Civil Rights Movement.
Recently, I have been
working with African
and African diaspora women on
ways that religion interacts
with the quality of life of
women and girls across the --
the lifespan and there
are both positive
and negative factors
as you can imagine.
So we're going to introduce
ourselves and then respond.
>> Yes.
>> Okay.
>> Thank you.
My name is Maria Lourdes-Reyes,
and I am the Director
for the United States
and Border Programs
for Project Concern
International,
a nonprofit organization.
We are in 15 countries,
Asia, Americas
and then the -- the Africa.
So my work -- I am a pathologist
by training and practice,
and like Dr. Pinn, but
found myself truly looking
at the communities
that we serve.
I was past President for
the American Cancer Society
for the state of California,
and was very involved
in the cancer world.
I also worked with
the NIH, UC Irvine,
being the research
liaison for the communities
on Pacific Islander Cancer
Control in Guam, Samoa,
the United States, Tonga.
But I found myself moving onto
public health as a pathologist,
really looking at
the communities.
So prior to going back to a
Master's in Public Health, I --
I went through the business
school really understand what
does that mean?
Why -- why do we have
many programs and
yet people don't come?
And so really looking at
where are the communities?
What do we need to do
that really needs to be
from the bottom up and not
our usual top down approach?
So having moved onto public
health then, I found myself
at the beginning of life.
Can you imagine?
I'm a pathologist to really
looking at the end of life.
And then the program came about
where I became the Director
for a Healthy Start Program,
a pregnancy program for the --
for HRSA, and so the
beginning of life.
And I said, wow, okay, public
health is public health.
Medicine is medicine.
I can do this.
And so I really started with
that and moved from that program
to now a highest funded
level with HRSA looking
at mentoring other states in
Arizona, Texas, New Mexico,
California, really looking
at what are those
disparities in -- in pregnancy.
But then of course
I'm a pathologist,
so it's a life course
-- a lifespan.
And then have many programs now
with chronic disease prevention.
And just recently, working now
with the Alzheimer's
Association and Hospice.
So, I feel like I -- I -- I
feel like I have really looked
at the entire spectrum
of life, and --
and then all of the above.
And truly, my personal mission
statement which is what I want
to share is that I am
dedicated to the realization
of human potential
through servant leadership.
And so as a servant leader,
I am really at the bottom
serving the community.
And that is how I wanted to
live the rest of my life.
We're not talking about age,
because I think I'm the oldest
on this panel, but anyhow
as public servant leader.
So thank you.
>> Thank you.
>> So I'm Judy Monroe.
I love that mission
statement by the way.
So I started my career as
family physician with the intent
of practicing in an
underserved community
and had a National Service
Corps Commitment through HRSA
that took me to Appalachia
and practiced in --
in rural America, where
it really hit me hard,
the issues facing
women and rural women.
And from there, my husband
actually led me into academia.
We went to Indiana University.
I joined the faculty there.
From there, went to
St. Vincent Hospital,
part of Ascension Health to
direct the residency program
in Family Medicine, where
I thought that was --
would be what I would do
in my career and did a lot
of women's health through the
residency program and a lot
of teaching, but then was called
to be the State Health Officer
in Indiana, and that was
my journey in from Medicine
to Public Health and I became
a State Health Officer in 2005.
And after five years of
serving as State Health Officer
and loving public health,
then I was called here to CDC
and became Deputy Director
under Dr. Tom Frieden, and --
and reported to him
for six years.
And now I'm with the
-- And I established --
We established the
Office of State Tribal,
Local and Territorial Support
where I had an opportunity
to work with all the
health departments
and communities across
the nation.
And now I'm with
the CDC Foundation,
pleased to be in philanthropy.
>> Hi, good morning.
I want to thank the
offices of Women's Health
and Minority Health Equity
and the National Center
for Bioethics and Healthcare
for this interdisciplinary
conversation,
grassroots and grasstops.
I think it's really innovative
in that way and it's an honor
to be on the panel with you.
So I am Kathy Yep.
And my pronouns are
she, her, hers.
I'm a cisgender Professor
of Ethnic Studies,
and I'm based the
Southern California
in Claremont Colleges,
mostly an Associate Dean
of Faculty looking at
faculty development,
as well as diversity
equity and inclusion.
And think my offering
for today is thinking
about the framings
of a research.
So in pivoting away from
just exclusion to inclusion,
but to thinking about
the paradigmatic
and positionalities and
how do we ask questions,
who's in the room?
Who's not in the room?
I'm a fourth generation
Chinese-American.
My family is all
San Francisco Chinatown,
and the first generation
college student,
first generation faculty
and now administrator.
And I think in terms
of what I hope to bring
to this conversation
is ways that women
and under-resourced
populations have different forms
of knowledges that can
inform our decisions
on a policy level
and healthcare level.
>> Thank you.
I'm already fascinated,
how about you?
>> Yeah.
>> Yes.
>> So let's come back
to the question, right.
What are the primary challenges
that impact our ability
to address the specific
behavioral tendency
around women caring for so
many others before we care
for ourselves and some
of the other factors
that negatively impact
the health of women
and girls across this country?
Who wants to jump in with
what your first reaction
to that question was even when
you first got it in your email?
What did you go, humph?
>> So -- so -- go ahead.
>> Well, I'm -- I'm going
to jump in because this --
this question hit hard for me.
A year ago, Mother's
Day weekend, my husband
and I attended the wedding of
a really great friend of ours,
a pediatrician we'd
known through the years
that was practicing,
actively practicing pediatrics
in rural North Carolina.
We attended her son's wedding
and it was a wonderful
weekend, just fascinating.
Now this individual -- this
friend of ours always took care
of everybody before herself,
her patients, her family,
did a lot for her kids and her
answer to everything was always,
"But they're my kids," right.
A month from the
wedding, I got --
I went to the office
one Monday morning.
My husband called.
He'd gotten word that she'd
had a massive heart attack
and had died, and she
was in her mid-60s.
She -- This question hit hard
because this is an example --
My -- my friend and colleagues
death is an example of someone
that did care for everybody,
always put her own
health on the backburner.
We all fussed about her,
and we got after her.
I personally got after her
all the time about taking care
of her own hypertension
and issues.
But it also is an example
of it happens to all --
We're all vulnerable, and
I think Dr. Pinn said that.
This is a pediatrician.
She knew better, you know.
So she had the knowledge
and still put her own
health on the backburner.
So I think part of
it is we're fighting
in some ways evolution
-- It's evolutionary.
I mean the other is the -- We
-- we want the gene pool to --
to carry on and so I think
women over the, you know,
eons have always cared
for their families.
We know mothers who've always
put themselves, you know, or --
or putting women in general
whether they're moms or not
at putting the family first.
But then there's culture.
And culture eats strategy
for lunch as we know.
And -- and I think there's just
such strong cultural, you know.
This is what women do.
We were the caregivers and so
-- and that's the narrative.
I remember as a small child
at hearing the narrative
of my grandmother and my mother.
Quite frankly in my case, my
mother was like, well, you know,
it's a man's world
and my grandmother was saying
she shouldn't be playing
with microscopes
and chemistry sets.
She should plan to make toast
for her husband someday, right.
I mean, literally,
that was the narrative.
And as a very young child,
I didn't buy the story.
But why was that?
Why did I not buy the story,
but how many women
do buy the story --
>> Right.
>> -- right?
They buy the story all the time.
So I think there's those kinds
of issues, and then the other --
And Dr. Pinn hit on
this, health literacy.
We're up against that.
I saw that in rural
America when I practiced.
Women just -- I would
have women coming
in with end-stage breast cancer
and their complaint was earache.
And they -- they
weren't even aware.
I mean it was just shocking.
And so the health literacy and
even knowing what, you know,
what was wrong with their
bodies was really power --
a powerful lesson for me when
I first got to the county.
And -- and then, you know,
I think for women too,
there's some self-esteem issues.
We have things like
depression that --
that is prevalent and they
interfere with their health,
and then trust of the medical
profession I would add as well.
So, I'll stop there.
>> Thank you.
>> I -- I -- You mentioned
a few things in there,
but I think as you'll find,
we have different perspectives
based on our backgrounds,
theology/religion, rural equity,
the ethicist among really the
two ethicists among the group,
and I was asked to really talk
about the Hispanic population
in many of my programs.
I am Filipina, but I
am 50 percent Hispanic,
grandparent from Spain.
But we have a lot
of programs dealing
with the Hispanic population.
So what I'm going
to share would be
about the Hispanic population.
And Dr. Pinn mentioned the
social political aspects
that is really besetting many
of their program participants.
At -- at the core of the primary
challenge for this whole thing
at the core of ethics
is that values
and beliefs of stakeholders.
That was mentioned
again and again.
And so you mentioned
culture, the beliefs.
That is the even not
just among Hispanics,
among all the ethnic groups
in the country, the value
and belief of the stakeholder I
think is the primary challenge.
But for the Hispanic population,
the culture, the barriers
of language and transportation,
we have many women
who are pregnant who don't
even speak the language
and right there and then
is a barrier to access.
But then the how, how do
we get them out of that --
the mental wellness, the
lack of mental wellness,
not only for women, for girls?
But I truly want to
emphasize also for men,
because we're not going to be
able to have a holistic reach
to our women and girls
if we're not going
to involve the father's or the
male partners in our efforts,
but truly addressing
that more comprehensive.
When I talk about Hispanics
along the border, we -- The --
the various issues, the
lack of health insurance,
the poverty level which is
at one of the highest rates
in the country comparatively,
depression,
42 percent of pregnant
women are --
have domestic violence
and are abused.
And then the Colonia's -- You
know I cannot even imagine.
We just had a global leadership
conference of all the countries
that PCI is in with the
country directors being
in Washington D.C., these past
two weeks, and they were saying,
"Well how do you look at the
mother and child in the world?"
And we -- and I say, "But take
a look at the mother and child
in the border areas
of our communities
in Arizona, Texas, New Mexico.
They live in stables
with a horse.
They don't have water.
They have to take their
truck, if they have a truck
and get water to bring home.
They still have an
outhouse, so I mean we do
in this country still have
similar areas with many
of the challenges that are
in developing countries.
And when you took -- talk
about the illegal immigration
or the immigration per se, we
won't even go to the politics
of illegal immigration
or immigration.
But when you think about
the undocumented population,
a third of them have a
child that is a US citizen.
So we need to really
think about the impact
on what Dr. Pinn said, political
-- social political aspects.
And I think at the very core
of what we're going to be doing
in the communities, that needs
to be at the core of that
and the value and belief
of the stakeholders.
>> Okay, well I actually
want to begin with something
that you mentioned as well
Judith, and that is the --
the perception that
women are caregivers.
I think that we still need
to talk about that a lot
and how it ends up making such
a difference in women's lives
and even the way our logic
around women giving care is
not consistent with the logic
that sometimes privileges men.
For example, one of the
things that I thought
about immediately was that
there is an emotional element,
but there is also a physical
element, because giving care
to some person means lifting
them, changing diapers,
making sure they have
proper nutrition, etcetera.
And there's a lot of heavy
labor, but that gets connected
with women, although we often
think about distinctions
between men and women around
the issue of physical strength.
But that is not taken
into consideration
when we talk about giving care.
One of the other
things that I thought
about immediately was the extent
to which religion plays a role,
and this is something
that I'm always talking
with students about.
Religion is interacting
with almost everything.
And it plays a role
in the way we think
about what women's
responsibilities are,
but even the notion of, and I'm
going to push back a little bit
on the idea of servant because
especially in Christianity,
there is a propagated the
idea of being a servant
and even a suffering servant
that gets attached more
to women I think than
men because of the idea
of service being
something that women do,
so there are theologies that are
often being preached and persons
on the ground sharing
those at well --
as well that interact
with the way we think
about women taking care of
themselves because the concept
of love also in Christianity.
But I think there are
ways that they're --
they're connected to this and
other religious traditions.
I know Christianity more.
But the concept of love
is also often thought
of as not attending
to the self, right,
giving to the other, right.
So agape is understood as in
some Theologians perspectives,
flowing everything out of
yourself to the other person
and that there's something
problematic in yourself
as a Christian if you are
attending to yourself.
So our religion is as well.
A couple of other things I
wanted to note were the ways
that religion interacts with
making it difficult for women
to build bridges
so that conceptions
about who is a woman,
especially in regard to queer
and transwomen and the
possibility of collaborating
across the spectrum of women
sometimes gets interrupted
in terms of women attending --
>> Yes.
>> -- to themselves because
of the inability to push
against theological perspectives
about who actually is a woman.
And then finally for black
women, I think the legacy
of having black people, black
bodies having been chattled,
it interacts with the
conception of servant and women
because servant is also
understood as person
of color is black person, and
I think that is in the psyche
of all of us actually and
something that we should talk
about as we're pushing
against this.
>> And -- and as we go to Kathy,
just as you were saying it,
because my whole life, my whole
world is talking about sex
and I love that,
is the connection
to the sexual identity, sexual
health, sexual well-being
and sexuality of women in
connection to servitude.
And that, whether it's through
the historic horrors of slavery
or even through the older
context of marriage,
why marriage existed, why
we're in it, why we're not,
what happens in terms of
those gender dynamics.
It's all still related to this
sense of service servitude
and prioritizing others --
So, and religion plays its
own role in all of that.
>> And if I can just
quickly add I think the --
that there is a deep
connection to what's --
who is sex traffic and the
idea of that being of service
to persons who are the Johns.
>> There you go.
>> Yeah.
>> And I think that --
>> Just for you Kathy,
that was --
>> Well I think riffing off
of that is this idea of --
of trafficking and the
social constructed of --
of servitude and sexuality is
there's a normalization of it.
And it becomes these categories
like culture or gender.
And then we use those categories
in a normalized way
in our research.
So I think, particularly
for Asian, Asian-American
and Southeast Asian women in
history, and I can't speak
for all of the population,
but I will offer what I know
from my understanding of
literature is, you know,
we have our histories of
being human trafficked,
whether it's comfort women --
Korean women with Japanese
soldiers, etcetera.
But often the research tends to
look at it in terms of culture,
Confuciusinism and shame.
And it doesn't go beyond that.
It doesn't push back
beyond that.
And we don't look at
historical traumas.
We don't look at
human trafficking.
So, I come to this
conversation doing a lot
of community-based research
[inaudible] action research
alongside immigrant
and refugee elders.
And, you know, the suicide rate
for Asian women over the age
of 65 is the highest of
all women of all races
for -- for that age group.
So a lot of the research might
say it's because of obedience
or because of shame
factor or under-utilization
of mental health services is
because of this flat
notion of culture.
But what I get to do is I
get to learn from immigrant
and refugee elder
women at the library
about what are the difference
social political dynamics
of their health?
I posted a prompt to some
of the immigrant women,
and they pushed back.
Like we don't want to talk about
what you want to talk about.
But -- So we ended up talking
about their biographies
and their stories, and
through the biographies
and the history timelines,
we learned about women
who had been trafficked,
women who had experiences
with domestic violence
in multiple countries,
split family labor
and emotional care.
We learned about occupational
safety health being seamstresses
or work in the laundry.
And through that process,
we learned about access
to healthcare because of --
because they're low wage.
So part of it is they
wrote their stories,
and then those stories were
the basis for grant writing.
So I'm kind of looking
back to thinking
through conceptually how we need
to have more complicated ideas
of culture, and then
also who tells us
about this complicated
ideas about culture.
And perhaps from the populations
we're trying to study can --
can have a seat at the table to
unpack through their stories.
>> I love that.
Sister Love, we actually have
a whole initiative called,
"Everyone Has a Story."
There's a whole video series,
and it really is about the power
of the lived experience
to inform the programs,
the service delivery, the
policy work, the advocacy work.
So thank you for that.
And you actually
started touching
on the next two questions all in
one Kathy, so I'm going to just
into that, because
we are going to move
to you all at about 10:15.
I'm just letting
y'all know that now.
That's my aim.
That's not my promise.
I mean, 11:15 -- I mean 11:15.
That's my aim, not my promise.
But -- So I'm actually going
to throw the two questions
out together because I think you
sort of already have provided
where the synergy is
in there a little bit.
One is what are some of
the most ethical approaches
or best practices in -- in --
in ethical approaches
for modifying some
of these patterns?
Behavior and other factors.
And -- and then how can women
across that lifespan
actually have a stronger voice
in decisions affecting
their health?
I think those two things
actually go well together
in that you started working
on that a little bit Kathy.
So if you want to come in
on some of that to continue
and then whoever else wants to
jump in, that would be great.
>> So there's two ways -- When
-- when I read this question,
I was excited about
it in two ways.
And one is to think
about the possibility
of democratizing
research processes
and community knowledges.
So we have Dorothy Smith and
Patricia Hill-Collins who talks
about situated knowledges.
And that's a valid
form of evidence
to have our data
informed decisions.
Again, I just get scolded by
these "aunties" at the library,
but it's such a good
practice as a researcher,
as an administrator,
as a teacher.
And, you know, they
have multiple ways
of sharing their understanding
of what our social determinants
of health and how
do we upend them,
through autobiographical
cookbooks.
We've done poetry
readings together
and in multiple languages.
So that's the one piece.
And the other piece is, you
know, I am in higher education
and I have the -- the
wonderful opportunity
of training researchers.
Most people who will
go onto Med School
or critical global health,
because I'm at LeBard School,
so it's more on the
Bachelor's side,
and I think that's
the big question
for me is really
pushing my students
to ask what do they not know?
And what do they need to know?
And what are their
positionalities that shape --
Maybe they universalize what
their situated knowledge is.
So I think that's a question
we have to ask ourselves
as we enter any community or
any room or any research project
or any grant proposal,
is what do I know?
What do I not know?
And how does that in fact
impact my sets of questions
and how does that impact in what
Dr. Warren said is my ability
to listen?
Because ideally from my
perspective and training,
as a researcher is someone
who can listen deeply
with humility and
with compassion.
>> Now, I'll pick up.
There is the listening piece
that, you know, in the practice
of medicine, a really
key lesson is you start
where the patient is at.
I mean that's the --
that's the starting point.
And that means you need to
listen, you need to find
out what their story
is and understand that.
And so I think and I love what
you do with your radio show
because I was going
to say on this --
I mean I think some
of the approaches are using
the media very creatively
and getting more voices out
there, that power of story is --
is so amazing in my own career,
because I'm a public
health practitioner.
I was a clinician that actually
reached to the media when I was
in Appalachia, because I
wanted to get these voices out
and be able to educate women.
The power of the media,
that's how we rate the --
reach the masses, right.
And today, both with
our social media,
I think there's more creative
ways that we can do that.
Obviously there's a dark side to
the social media and we've seen
that with bullying and so forth,
but we need to get the
positive I think in our films.
We should be influencing
more of Hollywood in some
of the films with our songs.
You know, when we look at --
at pop culture and so forth,
what -- what are the messages
that are getting
out that we can do?
I also -- I wanted to
touch on clinician bias,
because I think we do need to
recognize there's clinician bias
and -- and we need to
think about being --
being more forceful
in our education of --
of clinicians whether
it's physicians, nurses,
nurse practitioners
and pharmacists.
I mean you can go through
the list, because there's --
there's -- I saw that a lot of
the suspicion in role practice,
the bias that --
that individuals had to
the point sadly -- I --
I was actually told when I went
into Appalachia to practice
that I was the first physician
that had treated
them like humans.
And that was -- I got to
tell you that hit me hard.
But I -- but kind of bridging
into the second question
for the stronger voice, I'll
just kind of end with this.
You know, the -- When
we talk about ethics,
the tobacco industry has had
some pretty unethical practices
over the years.
And when I was health
officer in Indiana,
they came out with a
cigarette, the Camel Number Nine
that was focused on women,
particularly young women.
And they would have parties,
inviting young women to come
and to have -- and give
them free cigarettes along
with doing their
nails and their hair
and giving them a Martini
Number Nine and so forth.
This was all over the
news back in the --
back in the probably
about 2007 or so.
And so one of the things as a
reaction to that, and I --
I think fear is a
really -- That's a --
that's an emotion we've
got to be very cautious
with because it can be
very damaging, right.
But I think anger is
something you need to harness,
and harness it productively.
And so as a health officer
that had cared for young women
that had been addicted
to tobacco
and then saw the
consequences on --
on the birth and low
birthweight, I hit the ceiling
when I heard about this.
And so we started something
in very short order called,
Influence Women's
Health in Indiana.
And -- and what we
did is we started
by convening the most
powerful women in the state
to educate them about
what was happening.
And from there, we
rippled through every --
We had events throughout
every county
where women would come together
and they would tell
their stories,
and they would be
able to have dialogue.
And we -- we helped
facilitate that.
And it was one of the
most powerful things
that I look back on it.
Finally, and when I go back to
Indiana, even the First Lady,
the -- the governor's wife
always talks about what we did
and the legislator, so I think
you've got to involve the top
and -- and the bottom, right,
I mean, all across the spectrum
of women's voices, we need to
get angry and -- and mobilize.
>> And I actually will pick
up on involving the top
and the bottom and
make a connection
to situated knowledge.
When I thought about this
question, I use a lot of images
from the Civil Rights
Movement and I thought
of Fannie Lou Hamer testifying
before the Credentials Committee
of the Democratic Party in 1964.
She was a very unlikely person
to be doing that, but she did so
and was able to do so
because many people reached
into where she was in a variety
of ways and brought her voice
into the conversation.
So, the situated knowledge is
important, but there has to be
in terms of the ethics
of -- of attending to --
to our persons and overcoming
some of the patterns,
there has to be from the side
of persons who have power
and access and influence,
reaching in
and making possible getting
that situated knowledge.
And it is not only
about getting persons
from one place to another.
It also has to be about making
sure that people who are talking
with each other communicate
with one another and so issues
of hospitality are important,
even translation may be
important, and it may be
that people have to learn
each other's language.
But getting situated
knowledge, and there's a lot
of work involved in that.
And if I think of the
Department of Health
and Human Services
and its agencies.
For example, as the
entities to whom the question
of ethical approaches are --
is directed, then I would ask,
what are some ways
that personnel can be directed
toward getting situated
knowledge from the
most vulnerable persons
who are the least likely to
be a part of the conversations
because there's information
there that needs to be gotten
into the conversations, yeah.
>> Yes. Social media might be
changing that a little bit.
I just -- I know that even one
of my physicians has
their own Twitter handle
and their own hashtag.
And all you have to
do is make a couple
of the right comments,
and you get reaction.
>> Yeah, but --
>> Of course.
>> -- I -- I actually
think there are --
there are populations who
are not even interacting
at that point where there's
knowledge to be, but I --
I agree, it is changing -
>> Absolutely.
>> -- yes who's talking.
>> And -- and -- and -- and
as Maria comes in, I just --
I want to acknowledge
your own acknowledgement
of Sister Fannie Lou Hamer.
And that of course for
those who don't know,
that's where we also get the
standing moniker, "I'm sick
and tired of being sick and
tired," and I think that a lot
of -- In -- in addition
to her political activism,
a lot of her harnessed anger
also comes from the fact
that she's a survivor
of what we know
as a Mississippi Appendectomy,
which was forced sterilization
on so many poor black
women in Mississippi
and across the south
during that time.
All of these issues are --
I mean, to go from forced
sterilization to taking
over the DNC are connected,
but we don't have
those conversations
in public health
spaces, where policy
and implementation hit
the road in our lives.
And I think that she's a perfect
example of what the voice,
the questioning of the
ethics and the movement
around making change happen.
Yes.
>> And I'll follow through on
what you just said, the policy
and implementation connection
-- so, and then the voice.
But are we truly listening,
Dr. Warren's question?
Are we truly listening?
I mean, we -- we go off and say,
we're doing community-based
participatory research,
but are we truly
doing community-based
participatory research?
Is that voice really
at the table to --
to get that knowledge
that we really need to do?
I think we have come a long way
but we have so much more to do.
And I wish I could do --
do the Energizer Bunny to
where we're all already
in that energizer bunny,
and we lead to the end
of the sci-fi movies,
and I'm a movie buff.
But -- but talking
about fast forward --
I mean, we can't even be
doing things fast enough.
But when I looked
at this question,
I was really looking at, yes,
Dr. Pinn showed the
biomedical model,
but when I teach public health
and health policy and law,
I look at that socioecological
model.
At the center of that and
at the center of anything
that we do even in servant
leadership is that self --
that person at the
center of that.
But are we really looking
at all of those layers
and truly looking
at an approach?
Perhaps we need to when
we look at an approach,
look at every one of those
layers, the self, the community,
the organizations,
the environment,
and at the very core of that end
cycle is policy and government.
Are we really looking at the
policy and implementation
from the perspective
of the voice?
So when I take a
look at this in --
in addressing how do we get that
voice from the women and girls
and people, one of the
things that I would
like to really emphasize is
that we need to address first
and foremost I think
that mental wellness.
It is now this year, the lack
of is now the leading cause
of disability in the world.
And we put it aside.
We don't have enough funds
or resources allowing
for improving mental wellness.
But even then, at the very core
of the programs that I have,
I don't do any program, one
without the evaluation piece
and one with -- without
involving the people
at the table to tell me how do
I really want to reach them?
And then their voice
is at the table.
But looking at what are those --
What are the things that I can
do for people in the community
to help improve their lives.
And at the core of any
program I have is life skills
and mental wellness.
That is the initial piece
that I do before I even do
chronic disease prevention.
I look at teaching them how
to budget, how to communicate;
what is that financial
literacy like?
Where are they in
their education?
What do they need?
Is it a language?
Where are the -- Are
they in elementary?
Are they going to -- What --
what is that path like to get
to high school education?
Because we know that is attached
to better health outcomes.
And so giving them the
tools to get out of poverty,
teaching them how to save.
So those resiliency factors,
resiliency tools is what I'd
like to share and
really emphasize.
I was -- I was at
the World Congress
for Women's Mental Health in
Dublin just six weeks ago,
and even throughout the world
when we're looking at anything
that we're doing, we're doing
all these approaches either
on the treatment side, too late,
kind of sometime, but not enough
from the prevention side.
But even then, at the very core
is to really help people have
that tool and factor as to
being resilient, otherwise,
they're going to continue
in this very bad cycle
of falling back and falling
back and not truly emerging
as the power and the
voice that we need.
And until they get
that self-esteem back,
that little bit of I am saving,
I have this tool, I can go back
to school, we're still not
going to hear their voices.
And even as much as we try
to listen, we're not going
to hear it because
it's still going to be
that whisper that's even beyond
our -- our decibel hearing.
>> So, I -- We're going to move
to the next question and it --
But it's -- I want to segue it
with continuing the conversation
on women and stronger voices.
And so I have this next place
of not only understanding the
whole issue around resilience
and the resilient factor, but
as someone who works with women
who are survivors of violence,
gender-based violence,
other mental health issues,
particularly dealing with HIV
and sexual relationships and
risk patterns and all of that is
that what moves me and
fascinates me the most
about this work is the women who
not only survive and -- and --
and our living the resilience,
but then move from resilience
to revolution where they
actually become a part
of the movement for change,
whether they're going to school
to become nurses or
public health practitioners
or advocates or activists in the
community on behalf of others
with the same or similar
stories and issues.
So, you know, in January, there
were hundreds and hundreds
and hundreds of thousands of
men and people who love women
and people who love us, who
all showed up in Washington
for whatever their issues were.
And it was a myriad of issues
that some was around anger,
some was around fear, but people
who had never found their voices
before, found their voices,
even if for a day or for, you
know, another hashtag or a pink,
you know, knitted cap.
So the -- the question would be
that in terms of the decisions
that are made about women's
individual health, what are some
of the other ways that you
are engaging those voices,
not only on behalf
of their own lives,
but communities of
women's health?
What are some of the other ways
that we're finding
women find their voices?
>> I'll -- I'll start.
Thank you.
I think one of the
things that --
that I like with HRSA and
CDC, the Maternal Child Health
and the CDC, the racial --
the ethnic approaches
to community health,
the Reach Program to
eliminate the disparities.
One of the mandates --
It's a mandate to actually
have an infrastructure
in the community would --
called Community Action Network
and Collective Impact.
And the mandate is that
the membership needs
to at least 25 percent of
the membership in any network
or any group meeting
that we have has to be
from the community
and participants.
I think short of being mandated,
we really must do it, but again,
that implication of a
mandate, you have to do it,
because it's a benchmark.
You're being provided monies
that are very hard-earned
dollars that you really need
to perform in these benchmarks.
And sometimes, that's the only
way we're going to have --
we're going to make the
changes is to make the mandates.
Because we can talk all we want
about community-based
participatory approaches,
but unless we mandate that the
voices need to be at the table
who are community members, who
are participants, then we're --
we're not going to get
that much ahead of us.
So to me, I -- We use that in
the programs that we have is
that we follow the mandate with
at least -- be nice if that --
if it goes -- the
percentages go more than that.
At least 25 percent of
the membership needs to be
from the participants themselves
and from the community
themselves.
And I think that's when
their voice is at the table.
>> So starting to talk about
how we're changing our current
practices basically.
Yeah, go ahead Rosetta
and then we'll do Kathy.
>> Okay, one of the
things that I've --
I've been working on recently is
actually not only with the US,
but a gathering of women in
religions, plural, African
and African diasporan women.
And although the event --
the consultation begin in the
academy, it is a consultation
of practitioners and scholars.
So, the voices of
women in religions,
interacting with them, not
only from the perspective
of what we do in scholarship,
but also hearing their voices.
And the context of religion
or religions is an important
context to hear women's voices
across the social strata.
And I think in addition to what
we are doing or what I'm doing
in my own practice, I think it's
an important place to consider
because the ritualizing that
occurs in religious traditions,
the words that people
hear and the things
that they do become a part
of how they think the world.
So health agencies
seeking places to interact
with the ritualizing person's
lives I think is also an
important possibility for
expanding their voices
because I know that what
people hear in churches,
I hear them repeating and
if it's something different,
they repeat it and it becomes a
part of their way of thinking.
And I think that that can
be done in regard to health
and caring for the self as well.
>> Absolutely, Kathy.
>> And I appreciate you talking
about the way things are echoed
and resonated in
different spaces.
And -- and hearing from
this panel, I was thinking
about it's more than just
info and content delivery.
It's also about that process
of transformation, right.
And I think you example
of resiliency is,
is it's an assets-based
approach, right.
So how do we -- how do we
draw upon and water the seeds
of leadership in
different individuals?
And that takes time.
And that takes a committed --
a commitment to a relationship,
and we were talking about
the earlier at the break.
And -- and I think that doesn't
always fit in a grant cycle.
That doesn't always
fit in a semester.
And so I think that's that
element of humility with that.
So an example would be I was in
a discussion group with again,
the aunties of the library.
And, you know, I had one
prompt that was -- what --
what do people need to know
about you that they don't know?
And they spent about
30 minutes on what does
that warden need mean?
Is it need like food?
Is it need like shelter?
Is it need like access
to -- to resources?
And then I kind of got to the
turn to needing that meaning
in your humanization,
what do people need
to understand about you?
And one of the -- Two of the
"youngerish" elder women said,
"I don't get paid for what I do.
So I don't know if I
have a voice in my home."
And the elder woman said, "No,
you were worth something,"
and this was all in English and
then mixed with Chinese too.
But they said, "You were worth
something," and they kept
on repeating that over and over.
And that was -- ended up being
the theme of their anthology.
And I think that was that
shift from info delivery
to transformation, and
then the opportunity
to take a leadership role,
and then now over time,
we can set up the
infrastructure to deepen that,
taking that phrase, "You
are worth something,"
and then adding onto that.
I think that's that piece of it.
It's not just adding voices and
not just provide information,
but sets basis for
transformation leadership.
>> So, Judy I'm going to --
because I know you're going to
respond to that, but I'm going
to go ahead and throw this next
question in so we can grapple
with it for three
or four minutes.
And -- and that is, you know,
it's a perfect place to come
and land with the CDC
Foundation is as we're talking
about these current practices
and these really granular
stories of what it really looks
like in the implementation
space,
in addition to how we're
expanding, what are some
of those resources needed
to build the capacity
for addressing some of
these ethical issues
that impact practice --
public health practice,
research or even policies?
So some -- some worst things
about the current landscape
and then what are some
of the resources to
actually implement some
of these innovations.
>> Yeah, so -- so
that last question,
the only thing I did want
to highlight the clergy
and the public health practice,
we used the churches a lot
in Indiana to magnify the
message that we were trying
to get across because it really
makes a big, big difference.
And then I think
standardization too.
Accreditation is an area
that health departments
now have accreditation
and there's opportunity in that
because that gets modified,
and you'll -- refined are we
learning the right things?
But when we think
about resources,
so money, money, money.
Now that I've been at the
foundation, I get that a lot.
But it-- You know,
its people, processes
and technology are what we need
and that does take resources.
But we can be creative
about our resources too.
You know, I -- I
wanted to mention this.
I've loved the story now of
how in rural communities,
they're using like an
uber-like transportation,
but they're doing it
with community members
because they get the technology.
It's like -- So sometimes
it's not actually additional
resources or -- or minimal
resources can be done
if we leverage the
community at large.
And then you give people even
more involvement and purpose
and might help with some
of these other issues,
those that might
not be involved.
But I think that expertise is
one of the things that's needed,
when we talk about resources,
expertise at the right time
at the right place
as -- is important.
I think case examples, I think
people need again stories
and I love case-based examples
to help bring things together,
communication as we all know.
And then -- and all
of this, we're talking
about the analytical tools.
And the -- and the
analytical tools that are there
for the practitioners.
We got the -- the translation
from research to practice.
Where the rubber meets the road
is so critical if we're going
to really make a difference
and have the implementation.
So I think we need more tools
in -- in regards to that.
>> Anyone else?
>> I had -- I have
something to add.
>> Go right ahead Maria.
>> Sorry.
>> Yeah. So I'm going
to go basic
on this question
about resources.
Since time about
25/30 years ago,
we looked at now what's called
an evidence-based promotora
model, which is the
community health worker model.
>> Right.
>> That does not really expand
it into all the ethnic groups.
And there's 20 million, no, 20
different names for community
of workers, patient
navigate his family,
navigators, whatever it is.
I think at the core
of resources,
I want to just really
emphasize the need
for actually standardizing the
community health worker model
and I'm one of those
proponents of --
of certification
with the states.
Not many states have looked
at that, and the reason I say
that is because it goes
back to reimbursement
and actually how
do the people feel
about the work that they do?
I'm not discounting the
community health worker work,
that volunteer that goes
and helps their family,
the faith-based, but I
still am not an economist,
but I'm very much into
economic development,
those resiliency tools,
give them something
that makes them feel
worthwhile or that worth
that Kathy you talked
about in the aunties
of the library with the aunties.
But, so community health worker
model is actually being used now
in many communities.
I attended the communities
Joined in Action Conference
in San Antonio three months ago.
And many models in the
cities and counties look
at multi-sectoral approaches,
the libraries, the police,
the -- the academic,
the nonprofits,
the people at the table so
that multi-sectoral approach
but at the core of that service
delivery is the community
health worker.
And I think that needs to reach
in all the different ethnic
groups even if we looked
at the evidence based initially
on the Hispanic population,
the evidence is there now
that it is a valuable tool
for improving lives
through having someone
from the community help
provide that -- bridge that gap.
So I really want to emphasize
that because it's not enough
that in 2016, only 48,000
community health workers were
employed in all 50 states.
That's not enough, because we
need to reach those communities,
and it's at the core
of that service.
>> Thank you.
I'm going to -- If you --
We're going to come back
at the very end for folks
that have some closing comments,
but I want to really appreciate
the thoughtful responses
and really critical
issues put on the floor.
And I would echo the issue
around the community
health workers
which is a worldwide
issue in terms of respect
and inclusion of that field.
But I also want to throw in that
most community health workers
come through community-based
organizations,
which is another
part, another layer.
I'd be remiss if I
didn't support my sector
that is a whole other layer
where there's so much potential
and so much opportunity
for capacity building
and system strengthening
that we get left
out from the research
world all the way
to the implementation sciences
and so I just want to make sure
that -- that community
question writ large deserves
and should be getting a lot more
of the investments financially,
as well as infrastructurally
as possible.
So, with a round of
applause, thank the panel
for our conversation thus far.
[ Applause ]
So we're -- Parting
thoughts and --
and it can be in response
if you like, but let's --
let's move through
parting thoughts --
>> Okay.
>> -- one or three sentences
or something like that.
>> It's --
>> I promise to keep us on time
and now I'm a little bit over.
So --
>> -- kind of in response,
I wanted to not directly
answer the question,
but to lift up again the idea
of changing consciousness
and ritualizing what people do.
So I think the interactions
with religious traditions
and religious communities
is important at any level.
The creeds and confessions
that are written and repeated
that sometimes get crafted at
the local level and sometimes
at denominational
or organizational level
is another way to interact
with what people
are thinking just
as the curriculum is
developed, those creeds go out
and are spread and -- and -- and
that is one thing that I wanted
to lift up as a possibility.
The other thing I wanted to
affirm was relationship building
and how important that is
and to underscore
building relationships
with what may be unlikely
communities and context.
And when I think about
African-American women
and communities, I think the
Black Lives Matter movement may
be an untapped resource
in regard to --
Well, I don't know in regard
to healthcare emphasis
for black women in particular.
Because the Black Lives Matter
movement is very intentional
about looking at all of black
life and being inclusive.
>> Interruption -- Did everybody
see what Black Lives Matter did
for Mother's Day weekend?
Was everybody up on that?
>> No.
>> Raised money over the last
month to bail out black mothers
from jail all over this country,
hundreds, if not thousands
of women at the local level,
local organizations
raised the funds
through the national
messaging of Black Lives Matter
and they literally went and paid
the bonds and bails of women --
mothers, sitting
in jails for fines
for which they shouldn't
be sitting in jail except
for the fact they
couldn't afford the bond.
So if you gave money, there
were women who were home
on Mother's Day because of you.
So thank you for that.
Sorry about that.
That's how they can textualze
it and become relevant.
That's how they become relevant.
>> Well my parting words is I
would like to thank everyone,
CDC, Tuskegee and each
and every one of you
for having the opportunity for
me to be part of this panel.
But deeply, I want to thank
each and every one of you
for the work that you do.
And I guess I want to give you
a call to action to dig deeper,
dig deeper, dig wider
in your commitment
to the work that you do.
And I'm just going to quote
a male, George Bernard Shaw.
And I -- I feel this and I truly
think about this: "The true joy
in life is being
used for a purposed,
recognized by yourself
as a mighty one."
So it comes from us --
>> Thank you.
>> -- and we give,
but it comes from us.
>> Yes.
>> Thank you.
>> So -- so I'll just end again.
Thank you -- Great to
be part of the panel.
I -- I leave you with a thought
or a question of what part
of the problem do you own?
And then what action
can you take?
>> Yes.
>> That is so hard to
follow, this panel.
It's an honor to be part
of this conversation.
Maybe we should do a radio
show together or something.
>> Thursdays at 6PM Eastern
time, 89.3 FM and on the web.
We stream live.
>> So it's -- The
parting words are to think
about cultural context
in more complex ways.
I think situated knowledge is
in the context of power dynamics
and the relationality of that.
And then lastly is, you
know, well not lastly,
but it's the unconscious bias.
What do we carry in our
situated knowledges?
Situation knowledge isn't
just about marginalized
under resource population.
It's about those in
dominant positions of power.
The quick plug is I had
suggested some readings,
and they're on the CDC
website and they're examples
of the things that were -- we
have been talking about here.
And there are -- My colleagues
have suggested readings as well.
The last thing I'd
say is, you know,
to your great question -- mental wellness and
mental illnesses drawing from
Tenojan [Assumed Spelling]
who is known as a theologian,
but also his work
during the Vietnam War
in Vietnam was really public
health and social work.
And we must heal ourselves
in order to heal others.
So to center that balance and I
think that's part of our task,
our call and our hope for
everyone is that we have peace
in ourselves, that we
have peace in others.
>> Wow. And I just want
to thank this panel.
Please give them a
round of applause.
Thank you for your
comments and questions.
And I also -- I just want to
acknowledge and be grateful.
Intersectionality is a word
that we have been working
with in the Women's
Reproductive Justice Movement
for two decades.
And we want to acknowledge
that intersectionality is
term that's coined and defined
by none other than
Professor Kimberly Crenshaw,
world renowned human
rights attorney.
And I just want to
acknowledge and thank the CDC,
because intersectionality
has arrived
at the Centers for
Disease Control.
Thank you.
[ Applause ]
>> So without further ado, we're
going to ask Dr. Liburd to come
and introduce our
closing plenary speaker.
>> So what a full and powerful
and rich day that we've had.
I'm just excited
about everything
that I've heard today.
I was tapping my foot through
all of the presentations
and I want to thank
everybody who is still here,
hanging in here to get us
through the rest of
our journey today.
And I am very, very
pleased and honored
to introduce our closing keynote
speaker, Dr. Melanie Nadeau.
Melanie is an enrolled citizen
of the Turtle Mountain Band
of Chippewa in Belcourt,
North Dakota,
so she traveled all the way
from North Dakota
to be with us today.
She graduated from both the
Turtle Mountain Community High
School and the Turtle
Mountain Community College.
She received her undergraduate
degree in Psychology
from the University of
North Dakota and a Master's
in Public Health in
Community Health Education
with a concentration
in health disparities
from the University
of Minnesota.
She recently completed
her PhD in Epidemiology
in the Social Behavioral Track
Program at the University
of Minnesota School
of Public Health.
She is a community-engaged
scholar and has worked 13 years
on various research projects
within the American
Indian community.
There's a lot more that I
can say about Dr. Nadeau,
but I want to end by
saying that she has a wealth
of experience working in
community health education
and research and is dedicated
to improving the health
and well-being of
Native communities.
She has been married for 24
years and has one daughter.
And in her free time, I
don't when that is, right,
she enjoys attending
cultural events
and hosting cook-outs
with her family.
So please join me in
welcoming Dr. Nadeau.
[ Applause ]
>> Thank you so much.
And thank you for having me.
I'm so excited to be here.
It's been just great listening
to everybody's thoughts.
And before I get started, let's
see how do I bring this up here?
Can I just escape
out of this here?
Okay.
Okay. So before I get started,
I just kind of want to reflect
on the -- the summaries
that were given
and just share some
of my thoughts.
Health literacy seems
to be a big issue,
you know in talking just from
my community perspective.
I try to relay to individuals
that are working in community,
that come into community
and that want
to translate information back to
the community, which is a step
that unfortunately gets
skipped a lot of times,
and that's probably the
most important step.
But when you're looking
at health literacy
across the nation, you're
going to see a second
or third grade level of
health literacy on average.
So depending on what
community you're working in,
it could be a little higher
or a little lower than that.
And so it's really
important that we're mindful
of when we're translating
these resources
who we're trying to target.
Also, you know just thinking
about cultural adaptation,
cultural adaptation of --
of current best practices,
current interventions, current
resources, you know, it's --
it's -- We don't
really necessarily need
to recreate the wheel here.
I mean, if we bring these
resources community,
a lot of times, you know,
people sit down and --
and put their own spin
on it, and you'll end
up with a great product.
So I think that there's --
there's a lot of opportunity
in that -- that realm.
Another thing is that
with digital storytelling,
that's something that's,
like, hot on my --
in my arena right now.
I think that, you know,
when you're working
with community members and
having them share their stories,
people relate to people
that are like them.
So when you're having
someone share or you're trying
to change what's currently
going on in the community,
having people that -- that the
target audience can relate to,
it's very important.
And digital story is --
Storytelling is a very powerful
way to do that, and at the close
of today, I'll share
briefly a --
a little digital story
with you that I did
on why I pursued public health.
Community engagement -- I
mean, all of these things.
I think we're all on
the same page here.
You know these community
engagement --
I think we all understand
the importance of that.
The -- But with the --
the messaging, the
social media messaging,
I think that it's
also equally important
to calendar the bad
messages that are out there,
to take the time to actually
counter those publicly,
because somebody said
when I was in school,
working on my Master's way
back then that the impact
of a bad message, it can take,
like, ten years just to remove
that impact of that
bad messaging.
So and how much of our efforts
are actually going towards
"rebuttling" these things that are out there that are true.
And I think too, you
know, American --
especially with American
Indian data,
the data is really
weak right now.
There's just really
poor data out there
for American Indians, you know.
They're -- You cant say there's
really good data out there.
It's pretty bad actually.
And so, you know, but
you use what you can.
And -- But I think that
when we're presenting things
that we really need
to stop and --
and share with our audience the
strengths and the limitations
of that data that we're sharing
so that you can say, hey,
this is really crappy data, but,
you know, I want you to be able
to make an informed
decision on whether
or not you want to
use this data.
And I -- I -- I don't
see that happening a lot,
and I think that, you
know, as educators,
we need to take the time to
share that with the community.
And the other thing
that I didn't hear
mentioned here today,
but I think is a huge issue
from my community perspective
is financial literacy.
You know, I'm a -- I'm first
generation college student.
I still don't know
how to handle money.
I come from a poor family,
you know, so -- And how --
how does that impact
one's health?
How does that impact
one's financial ability?
How does that impact one's
ability to stay in school?
And, you know, I know
I'm not the only one.
And so, you know, I think that
when we're talking about health
and improving the health of
our communities that, you know,
I think something could come
from increasing the
financial literacy
of our -- our communities.
Talking about community-based
participatory research, I'm --
I'm a trained community-based
participatory researcher.
I've done a couple of
projects in that arena.
I think it's also
important to --
We talk about it
about as a approach,
you know, or an approach.
It's not an approach.
There's a lot of approaches
to community-based
participatory research.
There's so many people
put their own spin on it.
There's different ways of doing
it, and so it really depends
on which -- whose approach
you're following or whose --
whose literature that you're --
that you're using to drive
your community-based approach
if you will.
But at the end of
the day, it should be
in community informed
approach, right.
And the other thing is
that there's also a
reality-based approach,
and that's -- that is something
that was created
by John Poupart.
He's from the American Indian
Community and you know,
really focuses on the voice
and storytelling of community.
So that's another
approach to be mindful of.
And then, you know,
the importance
of engaging our communities
and the evaluation and the --
the creation of our
assessment tools.
So, you know, everybody wants
to take this tool and say, hey,
it's already been created.
It's -- it's -- its'
evidence-based.
I don't have to do anything.
I just got to go give
it to my community.
Wrong. That's not a
good approach to do.
And I'll just offer
up a simple example.
When looking at -- I worked on
a tobacco project for a number
of years, and when looking
at knowledge, you know,
our knowledge question or
saying, you know bringing
in these cultural speakers
around tobacco and saying, okay,
now you know everything
about tobacco
from a cultural perspective.
You know the -- the
positives and the healing
of the medicine of tobacco.
Now are you going to turn around
and share this with
your community?
And we got the same
answers, "No,
I'm not going to pre and post."
Well, was that a
knowledge issue?
No. It was a cultural issue
because those people weren't
the people that were recognized
in the community as the ones
that should be sharing
that information.
So you have to be, you know,
mindful of those things
so it's not necessarily a
question that's going to get
at the answer that
you're looking for.
And then the opioid epidemic --
I recently attended a Harm
Reduction Summit, and, you know,
it's an epidemic
all over the place,
on our tribal lands as well.
And, you know, one of the things
that I think that we really need
to get an understanding on just
from a personal perspective
is the policy differences
and the intervention
differences and what we can do
as individuals, as -- You know,
because clinical people can,
you know, help someone that's
had an overdose, you know,
but I can't, well at least
in the state of North Dakota,
but I can in the
state of Minnesota.
So, like, understanding the
differences, you know, what --
what are your -- what
are you limitations?
What are you able to do?
Depending on state to
state, learning from state
to state differences,
but also looking at state
to tribal differences and, like,
how does that impact the work
that we're doing
at a policy level?
And then to reflect
on the students,
one of the student poster's
breast cancer, you know,
risk factors, I actually did --
That's what I just did
my dissertation on.
And, you know, as a
community engaged scholar,
I picked something
in my community.
I did a case control
study in my community.
It was over 400 people.
In my sample, I reviewed,
you know, medical records,
radiology records
all the way back.
My first -- my first
patient and my thing was --
sample was born in 1901.
But at the end of the
day, what did I find out?
I did this case control
study as a graduate student.
That's, like, unheard of.
It's kind of crazy, you know,
like what are you doing?
But I learned a lot working
with an Indian Health Service.
I learned a lot about, you
know, how I could use data.
And I had a community-driven
project, and at the end
of the day, I found out
that this breast cancer risk
calculator that is available
on the National Cancer Institute
site that providers used
to inform their patients
of their risk
of breast cancer isn't
relevant in my community
because the risks --
those aren't the risk
factors in my community.
So I think that, you know,
just not always assuming
that those risk factors
are the same in the --
in the communities
that you're --
that you're working in and that
things can change depending
on where you're at.
So that's kind of my reflection
on all of your reflections.
So, I'll go ahead
and get started.
Today, I'm just going
to talk to you briefly.
I'm going to try
to make it quick
about research considerations
and tribal communities,
sovereignty ethics
and data sharing.
And, you know, I always
start out by talking
about where I'm from,
who my parents are.
These are my parents.
My mom is Shirley BlackEyes
Belgard.
My dad's Raphael Jack Nadeau.
Seems like on the
Indian country there,
you always end up
with a nickname.
Somebody -- Everybody goes
by their -- a different name.
They're both from the
Turtle Mountain Band
of Chippewa Indians.
It's one of many tribes
in the United States.
As of January 2012, there's
actually 567 federally
recognized tribes.
And there -- In 2010, there
were 324 federally recognized
American-Indian reservations.
So we're talking about a lot
of different people here.
And the -- the thing that,
you know, we need to stop
and realize is that all these
people are very different
in culture language.
And like I try to tell people,
American Indians represent
the smallest population
in the United States.
We're about two percent
right now,
but we represent the biggest
diversity on this continent.
Here's a picture of my dad.
And this is actually my
favorite picture of my dad.
Here's he's sitting in
front of a relocation sign.
And relocation was and
effort by the government
to get natives off of the --
of their reservation out
into mainstream society
and to basically incorporate
them into mainstream society.
So, because of relocation
efforts, there's a lot of people
that ended up being
urban natives,
urban Indian population.
And there's different numbers
depending on where you're
at geographically,
but about half of --
about half of natives
on average are --
are in the urban community.
And my -- my dad, you know,
he went out on this
relocation program, and I mean,
he was just, you
know, just barely --
He just got out of the Army.
He went -- he went and
served in the Army.
Then when he got home, he
realized there was this program,
so he went down to the
bureau of Indian Affairs.
And he went out to California,
and I'm like, wow, you know.
He was 21-years-old.
He got a one-way ticket
to California all the
way from North Dakota.
He didn't know where
he was going,
didn't know what he
was going to, you know,
what was at the other end.
But, I mean, talk about
brave, what a brave individual
to do something like that.
And but, you know, there
was nothing, you know --
I was like, dad,
why did you do that?
He's like, because
there was nothing.
There was nothing, you know.
I didn't have anything at home.
I didn't have anything
to go home to."
You know, so we're talking about
poverty, education, you know,
employment, no jobs, no -- no --
We didn't have our
tribal college back
in that day, you know.
My -- my dad said they
lived way out in the bush.
You know, they didn't
have running water.
They didn't have electricity.
They went to town, and
you know, they were lucky
if they had a car
that ran, you know.
So -- so definitely dealing with
some demographic challenges.
And my parents, you
know, I never really got
to see them together
because they divorced
when I was 2-years-old and
my -- my mother and my --
my siblings and I --
Well I actually stayed at
my dad's unit I was seven.
But unfortunately, he end
up having a heart attack
and also we had to go
back to the reservation
and he, he, had diabetes.
And this is his mid-30s.
He was a -- you know,
he was in his mid-30s.
And so, we had to go
back to the reservation
so he could have access
to Indian Health Service.
And so that changed everything.
So, this is the first
time that I was, like,
exposed to that level of
poverty on the community level.
You know I come from the
city, and then all of sudden,
I'm sitting there on the reds,
you know, on the reservation,
you know, so it's
kind of shocking.
So, you know, here's some,
you know, numbers for you.
The one's little
dated, buy I'm you know,
sure they're still
pretty much the same.
It's that coronary heart
disease, well northern plains --
This specific to
the northern plains.
We're more likely to
report being diagnosed
with coronary heart disease
and have a heart attack.
And then the American
Indian/Alaskan Native adults are
also twice as likely as whites
to be diagnosed with diabetes
and women were 2.3
times more likely
than non-Hispanic whites
to die of diabetes.
So, a lot of disparities there.
And we have -- This is
our Indian Health Service,
and we do have a
beautiful facility.
But we, you know, we do have
challenges when we're talking
about intervention and services
and what's available
in the community.
And the, you know, the --
the dollars that are
allocated per individual
for any in-health
service are really low.
They're lower than what's
advocated for federal prisoners.
So, you know, you're basically
going to get better healthcare
if you go to prison
than if you go to IHS.
And it's not because
people are doing a bad job.
It's just that they're working
under a very stressed,
underfunded system.
So what does that do
to addressing issues?
So here's a picture of me when
I was in the third grade and,
you know, they say that
this is the age, you know,
that kids really start
thinking about what they want
to be when they grow up.
And I knew, like,
when I was a kid.
I'm like want to help my people.
I want to make a difference.
Like, I want to do
something about this,
because I could see
what was going on.
And, you know, I grew
up with all this stuff,
so I have a very personal
connection to what's, you know,
what -- It's more than just
a statistic, put it that way.
And you know, here's
some numbers for you,
American Indians/Alaskan Natives
die at a higher rate, you know,
from chronic liver disease,
unintentional injuries, assault,
homicide, intentional
self-harm, suicide,
chronic lower respiratory
diseases.
We're also dealing
with social challenges,
violence trauma and loss.
So looking at injuries,
accidents,
suicide, homicide firearms.
Then, eventually, I'd go onto
graduate from high school
and I was a first
generation high school and --
You know, it's a little odd to
put that in your bio, you know,
that graduated from the Turtle
Mountain Community High School,
right.
But I'm really proud of
the fact that I graduated
from a tribal college and
I'm really proud of the fact
that I graduated from
a tribal high school.
And I think that that's
a -- actually for me,
it ended up being a good thing.
It kept me grounded
to -- to my community.
And so as a -- as a first
generation college student,
I had a lot of things that --
that I'd end up having to face,
and you know, just talking
about educational disparities,
the graduation rate, you know,
American Indians you're
looking at 82 percent whites.
You're looking at 94 percent,
so there's a huge
educational disparity,
be K through 12 for graduating.
And then during my -- my school
years, I started a family.
During my undergraduate school
years, I started a family.
And, you know, unfortunately
one of the things
and I'm not the only one,
but, you know, with the --
with students that come from
communities that are impacted
by a lot of stress
socially, you'd --
you have to deal with that.
Like, there's a lot of death.
I've been going to funerals
since I can remember, you know,
and it's the life that I live.
In fact, my brother-in-law
passed away last week.
You know, so it's just like then
two days later, I'm graduating.
You know what I mean?
So it's like this -- It's
just like you're always --
you're always operating
in crisis mode, you know.
It's -- It almost
becomes second nature.
But, this was the one
that impacted me the most.
My mother, she passed
away from cancer.
I took care of her until
the day she passed.
And this at the point
when my life took a --
a totally different direction.
I was like, do I really
want to be a doctor,
you know, a medical doctor?
And this is what -- this is
where I change my mind and ended
up going into public health.
So, you know, some
stats for you.
Death rate for malignant cancers
for American Indian/Alaskan
Native persons,
it's 338 per 100,000 compared
to 220 -- 223.4 for whites.
Here's our college.
So, I was very fortunate when
I moved back to the reservation
to regain financial stability
after my mom passed that --
that I had a tribal
college here to attend.
And this is actually where I
discovered my first mentor.
I ended up taking
a Genetics class
with Dr. Lyle Best.
And he graduated at --
I mean not graduated.
He retired as a clinician,
medical doctor in my community
at the Indian Health Service,
and he was actually the
medical director at one point.
And he's not native
but he's is --
he was very vested
in our community
and he actually got a -- a
grant to conduct a genetics
in preeclampsia study with
the women in our community.
And it was really good because
it wasn't community-based
participatory research because
the community did not pick the
topic, you know.
So now, at, like, the center
that I run, we're moving
to the point to where we're
trying to work with tribes
to create -- to create agendas
-- health -- you know, what --
what do they want to address?
So research agendas and so that
you can match the researcher
with the research agenda so that
it's more meaningful partnership
instead of the researcher
coming in and say, " Hey I want
to do this," and it doesn't
make sense to the community.
So -- But, aside from the
community not picking the topic,
a lot of the components
of his project had
community-based participatory
research characteristics.
And just to name a few is
building infrastructure
at the college so that we
could do genetic research,
working with elders
in the community,
translating information
at multiple levels
of the community.
So he did a lot of
things like that.
So -- And here's some statistics
that I wanted to share.
And, you know, one of things,
like if you look at, you know,
our community graduation rates
compared to national rates,
we're not doing as well, right.
But the when you break it down,
and this is specific
to my community.
It'd be totally different
for another native community.
But for my community
what we're seeing is
that our men are
not doing very well.
Like, so when you start
breaking those statistics out,
you know, our men are sicker.
Our men are, you
know, not graduating
at the -- the higher rate.
And so when we talk about
wellness of women and children,
you know, I -- We need our men.
We need our men to be well.
We need our men to be
brought to the table.
And I hear that a lot in the
community, you know, with the --
with the community efforts
that we work visiting
with the tribes.
So, but the Tribal College is
where I started my
research journey.
And the first thing I heard is,
we've been researched to death.
And I'm sure everyone's
heard that one before.
And some of the, you
know, concerns are
that the results aren't
interpreted in a language
or formats that --
that are appropriate
and we talked about that.
You know, coming
in the community,
there's a lot of work.
I sit on the Turtle
Mountain Band
at Chippewa Indian's Research
Review Board, and in that role,
you know, people will come
and propose research to us.
And, it's like have you talked
to anybody in the community?
Have you -- have you
brought letters of support,
like you have a great idea,
but is it -- is it feasible?
Oh, we didn't do that.
Well, okay.
Somebody goes over to Mental
Health and Mental Health, oh,
no, we don't -- we
can't, you know,
we're working in crisis mode.
We barely have any -- enough
staff to see our patients.
Let's do a project on the side.
So and that doesn't
always happen,
but it's just being mindful of,
you know, what's currently going
on in the community
history demographics,
the history of research in a
particular community, cultural,
traditional versus
nontraditional, the etiquette,
you know, just encouraging
the community involvement,
be prepared for possible
community consent.
With our board, we
actually review everything,
so even if it's not
research, we review it.
We review everything coming
into the community because it --
We're -- You know, we're at
a point to where and maybe
that won't always be so, but
we're at a point to where it's
like how do you sit there
and make an informed
decision whether
or not something's research or
not if you didn't review it?
And then just raising that
awareness about what's going on,
hiring, you know, people from
the community to actually
to do the work, respecting
community protocols.
And you know just -- just really
-- just taking a minute to say,
you know, community
considerations are not always
the same as individual academic
research considerations.
They're -- they're different.
So one example I could give
is up in Alaska, there --
there were so many
communities that were selected.
It was randomized clinical
trial from my understanding.
I really don't know
the work that well,
just so, forgive me for that.
But, so they -- they selected so
many American Indian communities
to get the TB vaccine that they
were testing, and they selected
so many to not get it.
And my community
was a control group.
Well, I ran into
a lady in Alaska.
She was a descendant from
someone from her community
and that -- they were
-- they were actually --
they actually got
the -- the vaccine.
So -- But what --
what went wrong there?
Well what went wrong is the
vaccine was very successful,
but then it wasn't turned around
and administered community wide.
So then the community
was pissed off.
See, so did the researchers
do anything wrong
from their standpoint?
No, not necessarily
because they were operating
from an individual academic
perspective, you know.
But the -- From a community
perspective, that was wrong.
So, you know just -- just
taking the time to --
to realize that those things
don't always align and the
when you're working on a
community level that --
that doesn't, you know,
that those -- those --
those are things that need to
be taken into consideration.
Also, you know, just really
taking the time to say,
did we get it right
with publications,
presentations, results.
Everything that I do goes
through my community before
I publicly talk about it.
So, it's just a good -- it's
just a good way to be anyway.
And then, you know, just
talking about from the --
my standpoint as a student,
as doctoral student, you know,
my classmates had
to get an approval
from the Institutional
Review Board
at the University of Minnesota.
Well, since I was working with
my tribe, I had to get approval
from the University of Minnesota
Institutional Review Board.
I had to get an approval
from the Aberdeen Area Indian
Health Service Institutional
Review Board, which could've
determined that I would've had
to get a national
one, but they said
that I didn't have
to, so that was good.
I didn't have to
get that extra one.
I had to get approval from
the Turtle Mountain Band
at Chippewa Research
Review Board.
I had to get a resolution
passed with my tribe,
and I had to get a Letter of
Accommodation from the CEO
of the Indian Health Service.
So, it's kind of different
when you're working
at that level, but it's good.
It's good.
I think it's -- it's important
to have those levels
of approval as well.
And you know, just understanding
that it's important
to build these meaningful
relationships,
being culturally competent.
And this is, l like -- This
goes for, like, American Indian
to American Indian even,
like, you know, I --
I might be competent
with my own people,
but that doesn't
mean I'm competent
with the tribe down south.
So, if I'm working in that
community, I have, you know --
If I want to work in a good way,
then I want to attend anything
that I'm welcomed to, you
know, so that I can get
to understand the --
the ceremonies, the
community activities,
the service activities, the
volunteer opportunities,
everyday activities
that are occurring
in that community as well.
And, you know, just really
trusting the community
in that they know what they need
and they know how to get it done
and they know what it takes to
make their communities healthy.
So, when producing projects,
it takes a lot of time --
I mean products for American
Indian Tribal audiences,
it takes a lot of time.
And I'll use one example.
There's organization
that approached my center
and they said, we
want to make sure
that our materials are
culturally competent.
I'm like, okay.
And so they brought them in,
and my team, we do everything
on a team-based approach.
And so we -- we make
decisions as a consensus
because that's a traditional
way of doing that in our region
and so we don't move forward on
anything unless we all agree.
And so when reviewing these
materials we were, you know,
kind of laughing because it
was not one of those pictures
of those individuals on these
materials, like, looked --
They weren't from out area.
They were, like, from different
tribes, you know what I mean?
And it's like no,
no, no, no, no, no.
So then they went back
to the drawing board,
and they came back again,
and I think the second
rendition was worse
than the first one, you know.
So I was like, oh my gosh.
So anyway, so now they're
going to have a campaign
to do some pictures from people
from our communities to include
in their cancer resources.
So it's like, yes, that's
the way it should be.
So, incorporating
the local knowledge
and traditional knowledge
is very important.
And I'm not sure how
I'm doing on time here.
But anybody have -- idea
how much time I have left?
Five minutes?
Okay. So, yeah just take --
taking the time to
do things right.
And then we talked
about community-based
participatory research.
So, you know, just talking --
And I touched on some
of these things already.
Research in American
Indian community is so --
A lot of, you know,
from my community,
our board's only been, you
know, in existence for a couple
of years now, you know.
So we're learning a lot through
the process of having our board
and just making sure that --
that we're regulating the
projects that are coming in,
reviewing everything, using
a checklist to make sure
that the -- the -- that
everything's in compliance,
passed and resolutions
with the tribe,
that our team possesses the
professional qualifications
that required, you know.
And we do that because we --
we -- we -- we videoconference,
so we're able to meet.
So it's not like people
have to be in community.
You know, so just taking
advantage of technology in order
to make these things
happen especially
in rural communities is --
is a very good way to go.
Tribal possession of the
data is very important
to prevent misuse.
And I haven't come across where
they said, no you can't use it.
It's just mainly just being
a good, you know, being --
just informing -- informing the
community what you're doing.
And you actually end up getting
some really good advice on --
on how to move forward, so
it works out pretty good.
So, yeah, and, you know,
just from American Indian
community perspective,
just making sure that you
know who the researcher is,
what research they have
done, why do they want
to do research in
your community?
You know, we have
people approaching us
from all the way
across the country.
Why? Why do you want
to do research?
It might be a very good reason.
But why are you want -- Why do
you want to come all the way
over here and do
research right here?
And does that -- and does
your reason, you know,
make sense for our community?
And is it going to
benefit our community?
So and a lot of these
are reciprocal in nature,
but you know, just -- just --
just being informed basically
of the research and making sure
that the researcher's reporting
back and reporting to community,
not only reporting back,
reporting out to community
and translating that
information at multiple levels
so that it's actually
useful to the community.
And they can take that
information and use it
in reports, use it in grant
writing, etcetera or use it
for social, you know,
to change social norms.
And then, you know, asking them,
do you want to be identified
in this publication?
Some tribes don't want to be.
Some tribes say, yeah, of
course we want to be recognized
for the -- the work that we
contribute too so, you know,
that's another consideration.
So -- so in conclusion, the
best way for American Indians
to ensure that they're
not harmed by and benefit
to the greatest extent
from the research is
to be involved throughout,
and I'd say this is
true for any community.
And this is a picture
of our elder's group.
They actually overseen our
project at the Tribal College
and it was really
-- really good.
And, you know, I
think nothing that --
Probably stayed home
with me the most is
that once they were done, they
went into lab, they learned how
to pipet and do genetic
analysis.
They listened to our
spiel, all that good stuff.
But then they turn around
and they said, okay,
we want you to talk
to us about cancer.
We want you to talk
to us about diabetes.
We want you to talk to --
we want you to explain to us
what fragile X syndrome means.
So, you know, and
realizing that the work
that you do is not
only about you.
You become a resource to those
individuals in the community
and that you're expected
to step up and fill
that role even though it might
not even have anything to do
with the work that you're doing.
And then I'm just
going to finish
by playing this little
video for you that I --
that I created on why I
chose public healthcare.
[ Tribal Singing ]
Here's a picture of
me in the third grade.
At this age, I started thinking
about what I wanted
to be when I grew up.
This is a picture of my Uncle
Benny, dad, mom and Uncle James.
My Uncle Benny died from
an unintentional injury,
my mom from cancer and my
dad lives with diabetes.
Both of my grandparents
passed away from cancer.
My Uncle Beatty and his
daughter, Ivy, were shot
and killed by the same bullet.
My Uncle Edward passed
away from cancer.
Eventually, I would
go onto college
as a first generation
college student.
Experiencing all of
this loss motivated me
to pursue a health career.
My Uncle Bernard passed away
from an aneurysm, my cousin,
Bernard Junior passed
away from cancer.
My stepfather passed away
from an unknown cause.
My Uncle Francis
died of asphyxiation.
Right before I graduated
with my Master's degree
in Public Health, my father
had a toe/partial foot
and a below the knee
amputation due to his diabetes.
I'm happy to report that
it's been four years
since his amputation.
His first prosthetic leg says
a lot about his personality.
It has lightning bolts on it.
The fall of 2010, I entered into
the PhD and Epidemiology Program
in Social Behavioral Health.
[ Tribal Singing ]
Well thank you.
[ Applause ]
>> So let's give Shauna
a round of applause.
[ Applause ]
Yeah, we -- I just want
to say in conclusion
of a wonderful day, we
started out at the beginning
of this year to pull
together this forum,
and I couldn't be more pleased
with how the day has turned out.
We have been challenged
on many fronts
over the last several months,
but we came in this morning
with smiles on our faces,
because we saw all of you here.
And so I just want to thank you.
I want to thank all of our
speakers, our facilitators,
everybody who participated
in today's program.
And I hope that you will carry
what you heard today both
with you and your heart
and in your minds.
And consider it seeds planted
that we are looking to water
and then to see a great harvest,
so thank you for being here.
[ Applause ]
>> The thanks go far and
wide from my context,
but start with Dr.
Liburd and Dr. Tucker.
I think you need to know
that coming together
of these two issues in --
in times such as
these was phenomenal.
And they made a commitment
to make it happen
and it's happened.
So I want to publicly
thank both of them.
[ Applause ]
And the partnership and I'm
intentional about talking
about the difference between
relationship and partnership.
The partnership that
we're enjoying and growing
with the Centers for Disease
Control and Prevention is --
it's a work in progress that
requires attention every day.
And Jo Valentine gives
it attention every day,
and I want to thank her as well.
[ Applause ]
And then you've heard the -- the
cliche the media is the message,
and there's -- there's
been one message --
message bearer for the
National Center for Bioethics
and Research and
Healthcare, because so much
of what you hear is not true.
So much of what you
see is not true.
So much of what you've
heard is just wrong.
And I wanted to thank Dr.
Joan Harrell for assuring
that the message that
you're hearing about,
these events is true, is
correct and is consistent.
Dr. Harrell, thank
you so very much.
[ Applause ]
And I'm not going to take
any more time thanking folk.
I just want to thank y'all.
But the issue for me is about
women not mother, grandmother,
wife, daughter, granddaughter,
aunt, uncle, not uncle.
I got caught up.
But it's -- it's not about
the social role of women.
You know, I -- I -- I
don't know the right words,
so I won't use it.
I know the right word.
I won't use it, but
maternal child health.
I've been working in
public health for many years
and I've shuddered when I
hear maternal and child health
as if women are connected
to mothers only.
And we were intentional
about listening
as I started off talking
this morning, and --
and this forum was
about women and girls,
not their social role,
just to be a woman
and to be girl is
what this forum was
about for her whole life.
So I wanted to thank
you all for listening
and hearing I hope about women.
And the office, let me
get the office right,
Public Health Ethics at
CDC is really important.
It's a courageous step to say
that Public Health Ethics
is different than Bioethics.
It's important paradigm shift
that's still in progress
and I think the, both leadership
in that office is really --
Drue Barret, [inaudible] have done an outstanding job
in making a distinct difference
not good or bad, but different.
And as public health ethics
grows, you'll learn more
and more about that difference
and appreciate it I hope.
So I want to thank you two
particularly for your courage
to bring this new
paradigm into fruition.
[ Applause ]
And last and most
importantly from my context
and a historical context, I want
to thank Booker T. Washington
for his courage and
wisdom and vision to say
that we all ain't the same.
And -- and that's okay.
But we're all equally as
important, and that's okay.
And his courage to
say something then
that many times we don't have
the courage to say now is
that we need to target those
who are in greatest need
with all of our resources.
He's done that and -- and
you see the results of that.
And again, minority
health month started
with Booker T. Washington.
And I want to thank you all
for having the courage to say
that loud and clear for
those who didn't know.
And now they don't even have
to say they didn't know.
All they can say now is
Minority Health Month started
with Booker T. Washington
Negro Health Week.
So as we close, and
lastly you know,
what we said two years ago.
This is an annual event.
And unfortunately we have so
many vulnerable populations,
so we don't have a problem
with figuring out who to target
because a vulnerable
populations continue to grow.
So I look forward to the day
when we won't have to talk
about public health ethics
and target populations,
because ethical issues will
be applicable to everybody.
And they won't be equal.
They'll be equitable and I hope
now you know the difference.
Thank you so much and we'll see
you this time or soon next year.
