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Crossroads: Conversations about
Race, Gender & Disability

By Rasheera Dopson

Intersectionality: Race, Gender, & Disability

When you look at the things that contribute to health outcomes,  about 80% are determinants that are not clinical.

Dr. Stephanie Miles-Richardson, D.V.M, Ph.D. Tweet

When looking at health equity it is giving people what they need, when they need it in the amount they need it; so that they can achieve optimal health.

Dr. Stephanie Miles-Richardson Tweet

Rasheera Dopson (Introduction)

So in getting to our subject matter on this particular conversation, I have brought with me Dr. Stephanie Miles- Richardson who is the Associate Dean at the Morehouse School of Medicine Public Health program. So let’s get started and let’s dig into this conversation.

 

Transition-

 

Rasheera Dopson

So if you can take for a moment, just share some of your sentiments about this statement in this press release. Like what does that mean?

 

Dr. Stephanie Miles-Richardson (00:04):

Yea thank you for the question, I think frankly it means it’s about time. There is plenty of research that demonstrates the effects of Racism on chronic disease. So Racism is stress and stress affects the body response. So I think not only is there social unrest, but when you look at COVID 19 and how it’s disproportionately affected minorities and underserved communities, you have to look at a couple of things. One is this whole notion of social determinants of health. So there are lots of inputs that affect health. And one of those is stress and that stress of racism, is something you can’t get away from in a country that that’s built on slavery. And a lot of the messages remain. So, I am pleased that CDC had the courage to call it because it’s something we’ve known, it just needed needs to be stated in it. So that’s good.

 

Rasheera Dopson  (00:59):

Well, you actually lead into my next question.  As a current MPH student at MSM, our program has a specific lens in which we look through advancing health equity. Many other students, such as I, you guys have drilled into our brains, the concept of the social determinants of health, what that means. What does that look like in our current health system? Because it is a concept that some people are familiar with and then it’s a concept that still a lot of people aren’t familiar with. So, if you can break down even more, what exactly are social determinants of health?  Why do we as a public health community need to know about these things?

 

Dr. Stephanie Miles-Richardson (01:45):

So, when you look at the things that contribute to health outcomes,  about 80% are determinants that are not clinical. What that means is that when we think about health outcomes, you know, we often talk about access to healthcare that is so important; having a primary care physician that is so important, but when you peel back the layers, what you find is that the things that contribute to health outcomes have more to do with physical space, it has more to do with your environment. It has more to do with the work that you do. Whether you are in a position of authority or not and how that impacts your health. When we look at social determinants, we’re often looking at education and income or socioeconomic status, which is one and we look at because oftentimes your educational attainment directly impacts your employment status.

 

 (02:54):

When you look at employment, oftentimes you get into whether or not you have health insurance, most of that is through employers. And then, you know, if you take just those examples and think about COVID-19, you have folks who are more likely in-service industries that were essential, who are more likely exposed, who are a more likely minority, you know, and, and it kind of becomes a vicious cycle, but it leads to ill health. And so as public health practitioners and researchers and policymakers, we have to focus on those social aspects of health. And that means social policies, frankly. So, we have to, you know, not look completely at medical outcomes, and look at those social outcomes that lead to, ill-health.

 

Rasheera Dopson (03:45):

Well, that’s, so that’s so profound when you said you have to look at not just medical outcomes, but the social outcomes. And we all know, especially in the CDC, when they define racism, we tend to have a surface-level view of what racism is. We think it’s only if a person doesn’t allow you to go into a store because of the color of your skin, but how Dr. Camara Jones defines racism is more structural, systematic. So, in following her framework do you have examples of where we have seen structural racism in our public health system? Do you have specific instances?

 

Dr. Stephanie Miles-Richardson (04:35):

Yeah. You know, it’s interesting, you asked that question. I was talking with some students just yesterday and we talked about the three levels of racism that Dr. Jones so eloquently describes in her, her Gardener’s tale. So, you know, the personally mediated, right. That’s probably the most people see because that’s precious. So that’s somebody not liking you. So that one’s pretty clear. Internalized is something that you learn over time because systems prefer “other folks”, the structural or the institutionalized is, is the biggest challenge. Because in giving an example that I gave to the students:  I had a couple of students who are from the west coast and the majority are from the east coast and we are in a class together. Right? And so when the class starts at 8:00 AM, the west coast, students have to get up at three and four in the morning, right?

 

(05:42):

East coast students can get up at six, seven whatever time.  A structure would be if we have a situation where those students are looked at equally.  The students from the west coast are tired, so they’re not going to perform as well. But if we don’t account for that, what will happen is we will judge them just like we just the east coast. So we’re judging folks who don’t have sleep because of a system with those who do have sleep. And then the outcome might be the west coast students may have C’s and Ds in the east coast students may As. And over time we begin to prefer the east coast students. But in fact, through the time’s zone, there’s a structure in place that we have not accounted for.

 

(06:37):

When looking at health, equity it is giving people what they need, when they need it, in the amount they need it so that they can achieve optimal health. So in that same example, it might be that we make some accommodations for the west coast students so that they don’t have to lose sleep. And so that they can perform as the east coast students. A simple example, literally just had that conversation with my students yesterday. So yeah, structural, institutionalized racism, structural racism. That’s really the thing that we have to address to get everybody on a level playing field so that each has the option to attain optimal health.

 

Rasheera Dopson (07:32):

Wow, that’s such a brilliant, simple way of thinking, you know, laying out what structural racism is and what that can look like. To shift a little bit, you kind of hinted on this in the beginning about COVID, you know, black and brown communities were hit extremely hard. Is it a result of racism? And to even clarify more, there were so many narratives surrounding, you know, the virus such as it was called the “Chinese virus”, or it was the poor man’s disease. And it seems as if minority communities were kind of the culprit of all those narratives, black communities, immigrant communities. Is racism to blame for how COVID-19 hit black and brown communities, the way that it did?

 

Dr. Stephanie Miles-Richardson (08:27):

Yeah, I think, a couple of things, probably the best thing about COVID, if there is a good thing, is that it is highly contagious and it has no concern about your race, your political affiliation, none of that. So COVID is equal opportunity. And so that’s what made it so stark, because if it’s equal, how in the world, is it impacting some so much more than others? And when you look at that what you find is that things like some populations have to work more than others. There are some folks who because of their educational attainment or because of their economic situation who work from home, there are some folks who had to stay on the ground, even without the proper protection, right?  You’ve got similarly folks who, if they felt a little sniffle who could take off work, then insurance, and then you have others who, if they take off, they’re not eating right.

 

(09:39):

You have some who have their own private transportation, whereas others have to depend on public transportation, not protected.  And the list goes on and on. And then what you look at is over time, when you take away the ability to access when you add stress when you add economic situations that caused you to have to eat a poor diet, you are set up for chronic disease. And so those folks we talked about comorbidities, this just means multiple chronic diseases. One more likely to be adversely affected. So, when you put all that together, it was a perfect storm. And it highlighted the disparities in certain segments of the population. Why did we have to pay attention? Because it’s contagious? So this is not something people couldn’t look away from, because as much as those populations were engaging in life, the more we would all be affected. So, that’s why I said the best thing that came out of COVID is that is completely contagious. Yet it showed the fragile nature of how people are living differently, how people experience life differently. And then those are options and opportunities.

 

Rasheera Dopson (11:02):

Yeah. There’s, there’s no rebuttal to that because like you said, it’s highlighting the disparities that were already there. And so as public health practitioners moving into our next question, what can we do? And moving forward to ensure that vulnerable communities are more protected when the next public health crisis comes because there will be another one after this one. Hopefully, it’ll be years, years from now, but this is not going to be a single event. So, what can we prepare, make sure these communities are more protected?

 

Dr. Stephanie Miles-Richardson (11:41):

Yeah, I think it kind of goes back to principles of health equity. While everybody is awake, whereas the young folks like you are wake, I think this is the time to assure that resources, get to those communities who need them to bring everybody up to where they should be. Now, one of the things that we anticipate seeing out of this is going to be an increase in educational development. And so certainly, when schools were closed, it had to do with whether you had a laptop, whether you had Wi-Fi, whether you had access. And so there will need to be additional resources in communities that did not have that level of access.

 

(12:29):

We need to have a living wage. We need to have people in a position to be able to afford the things they need. In times like this, we have to do a better job in communication and showing that the people who ought to be communicating now, the communicators… this is a public health emergency. And so, I think one of the challenges was that the messengers were not in many instances early the public health officials who would look at all of these things who would look at the social issues, who would look at, you know, access to food and education, uh, access to even health care. So, I think the coordination, I think we’ve learned a lot about, what that ought to be, and, you know, maybe a bit painful learning that politics is not really the way to deal with a public health emergency it’s through public health interventions and talking about communication.

 

Rasheera Dopson (13:33):

It cannot be a political issue because it affects every human being.  I can definitely echo that same sentiment.  So, we talked about bias. We talked about structural racism, social determinants of health COVID, looking to the future now, especially for black and brown professionals who occupy these spaces, policy changes, addressing racism on a systemic level in general. What does that mean for the field of public health going forward, futuristic-looking?

 

Dr. Stephanie Miles-Richardson (14:14):

Yeah.  you know, that’s the question of the day… of this year. I happen to be on the council on education for public health that looks at this and literally looking at how we address diversity, equity, and inclusion in our coursework, in our training, how do we prepare as future practitioners to be sensitive to this? We have to sort of taking advantage of this, this emergency, you know, this COVID emergency, this social justice emergency has brought to light that we need to prepare people in public health, particularly to be able to address this. So I think that the first thing that has to happen is that educators have to take advantage of this time and have some uncomfortable conversations. If we are truly concerned about assuring conditions, where all people can be healthy, then we have to deal with all populations.

 

 (15:26):

And what that means is that those populations that are most vulnerable, those who are less than have to get more attention so that we can move everybody forward. So, I think what we’ll get out of this and where we have to go is to have a different level of engagement. I believe that public health is, I think we’re the ones who can lead that because you know, most people get into public health, really aren’t concerned about society. I think the part that we missed is that we have to see all aspects of society. And so, I’m optimistic, I think we’re going to be better in the future than we have been. You know, through this painful time.

 

Rasheera Dopson  (16:12):

Just like the old saying, “what doesn’t kill you makes you stronger.” This has been such an amazing conversation. I’m full. I’ve, even learned something new, even though I’ve heard you teach on this many times before but having a richer understanding, not only on my specific role as an emerging public health practitioner but the messages that we should be administering to our audience and people who are watching. So, thank you so much Dr. Miles-Richardson for taking the time today to sit and chat with me about such an important issue. And thank you for this audience for tuning in, I will be posting some hyperlinks in conjunction with this interview. Thank you for watching. Stay tuned and stay engaged for more conversations. Thank you.

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