vimeo.com/.../352279231

Hello everyone, I hope you're doing well.

It was really great to meet you at the
first residential.

My name is Paola Rojas, we met, and did
a session together.

I am part of the faculty in the masters
program.

I am a community organizer and a midwife,
and I work around issues of

health inequality, particularly around
maternal health and other issues

here in Austin.

Um, I wanted us to reconnect,
um, and kind of go back to what we

talked about in the first residential.

We gave you an assignment that included
watching a four minute video

called "the unequal opportunity race."

The point of that was to kind of refresh
your memory of some of the issues

we talked about in the session, where we
looked at roots of health disparities in

the United States, and we talked a little
bit about the uneven kind of playing field

that people are living in today, based on
centuries and centuries of different

experiences for different population
groups of different public policies that

affected people's abilities to have
access to resources and power and decision

making um, over hundreds and hundreds
of years, and that we're living in that

legacy today.

So part of what we're doing here
is looking at this overall kind of knot

of inertia, um, that keeps us from
transforming the, our current healthcare

system, right? That's something that
we're doing together in the masters,

and, part of what helps us untangle
the knot is to be able to pull out, what

are the different strands, and what -
where do they come from?

So that we can start to dismantle this
systemic inertia that is now kind of

cemented into the way the healthcare
system works, and also kind of cemented

into communities in terms of what kind of
health we even can aspire to, right?

So one of the strands of that knot
is looking at kind of inequality and how

inequality operates in many different
ways, um, in society, in the United States

in particular is what we're going to
be looking at.

And, how it impacts the healthcare system,
but also how it impacts us outside of the

healthcare system as people, and that
therefore also has an impact when we

interface with the healthcare system.

So we're going to be looking at
kind of different concepts and going

a little bit deeper than we started
talking about at the residential.

Part of what I want us to look at together
today is how disparities function kind of

along different systems, and
at different levels.

Um, and also, to start to build our
capacity to create equity, competent

organizations, as we talked about
in the residential.

One of the elements of that is having
shared concepts, definitions,

and terminology.

And so we're going to do a little bit
of that together today, as well.

Overall, what we want to get to
by the end of the masters is for each

of you to really have the tools to
create um, an equity competent

organization or healthcare system,
or to transform your healthcare

system to be equity competent
and having all of the different elements

to be able to be operationalized.

So we're going to do some of that
today, together.

If you remember, in our session together
in residential one, we talked about

what is particular about the
United States?

And we looked at the current health
outcomes, discussed some of that.

We kind of took a walk through U.S.
history, um to refresh our memory

and maybe cover some of the things
that we didn't all learn about in school.

We also talked about the difference
between equity and equality,

um, which is something we need to
keep that difference clear as we

move through the masters together.

And we began to look at what is
needed to be an equity competent

organization or health system.

So, what are the results of these
centuries of public policies that we

walk through in the timeline?

What are the results?

Um, in terms of how we're living
life today?

One way of looking at it is kind
of thinking about the social arrangement

that we live in, and the analogy of a
monopoly game.

Where some groups of people have
been playing the game many many rounds,

have gone, you know, you go around the
board and you collect two hundred

every time you pass go.

You buy properties then you build on
those properties, houses and hotels,

etc. and you accumulate wealth over
time, as well as ways to avoid

going to jail, and then other communities
are just getting on the board, after

some have been going around and around,
multiple rounds.

There's - that's kind of the current
arrangement that we're living in.

That means that we've all inherited these
social positions that we live in,

versus each of us, you know, producing
them individually.

So, if we understand that to be the
case, um, that the centuries of history

and the policies that developed this
country are part of the inertia,

it's kind of the status quo that's
been cooked into the way our society

works, how does that link to health?

I'm sure you're all very familiar with
the concept of social determinants

of health, and you use it regularly
in your work.

I wanted you to just be thinking
more specifically of what are the

different determinants of health,
um, in terms of social conditions,

and the reality we live in day-to-day,
and even thinking about how the

behaviors, which is part of our social
determinants, our individual behaviors

are also mediated by our social
conditions.

And we're going to get more into that
in the next course.

So as a result we have these health
disparities.

Which adversely affect groups of
people, who have systematically

experienced greater obstacles to
health based on,

it could be their race, racial or
ethnic group, their religion,

their socioeconomic status,
their gender, their age, their

mental health, their cognitive,
sensory, or physical disability,

their sexual orientation or
gender identity.

Their geographic location
or other characteristic that

they might have that is historically
linked to practices of exclusion

or discrimination.

Right?

So in the United States, we have many
documented examples of health and

health disparities by race, by ethnicity,
by gender, by literacy level,

by socioeconomic status, that's become
very clear by geographic location, we're

learning more and more about that,
and being able to research

and document it.

By disability status, as well as
sexual orientation and gender identity.

I'm sure you know many examples of
health disparities.

Um, but they exist in cardiovascular
disease, and diabetes, and cancer,

and HIV and AIDS, and infant mortality,
and maternal mortality,

and oral health, mental health, and in
healthcare quality and access.

So there are health disparities in
the U.S., and they operate in different

ways, and we're going to talk
about each one separately.

One is we have health disparities
in access.

So what does that look like?

One example is that OB/GYN's here
in Austin, I know for a fact,

because sometimes I call on behalf
of women that I work with,

to eliminate the language barrier,
since I speak English.

I call to find out if they have
appointments available,

and um, I'm told over the phone,
you know, our office does not

take medicaid, or our office
does not take MAP, which is

the medical assistance program,
something we have here locally,

or, we do take medicaid, but
only a certain number, and right

now, our medicaid panel is full,
so maybe try back in six months.

That is a disparity in access.

Uh, another one that's clear here
in Austin is in terms of pediatric

dentistry. Um, there are many places
that only take private insurance,

and um, you know I've tried to get
people's kids in, I've tried to get

my own kids in, in the past, when
my kids had medicaid, and I couldn't,

and that has created a whole market
for pediatric dentistry that caters

to people on medicaid or MAP,
and those places,

often, are overcrowded, have uh
dentists who are over worked with

less resources, less time, and overall,
less um, -

more difficult conditions for everyone
involved.

So that kind of connects between
access and quality.

So, the disparities in quality of care,
we have across the board.

I can give one example, is, when
I was pregnant for the first time,

uh, fifteen, over fifteen years ago,
and the first half of my pregnancy,

I had private insurance, um
and I went to see a group of

nurse midwives, um, each appointment
lasted about thirty minutes,

where I got to talk about everything,
and I felt really supported.

I worked at a non-profit organization,
where we temporarily laid ourselves

off, and you know, as we were in a
budget crunch, which wasn't the

first time we had done it. And I
transferred to medicaid halfway

through my pregnancy. Didn't think
it was going to be a big deal, because

the same health system also took medicaid,
so I wasn't worried at all.

And it turned out that now, I had to
go to a different clinic on a different

day, where - the waiting room was much
more crowded, I had to wait a lot longer

to get in, and once I got in, my
appointment was five minutes long.

Really fast, really stressed out providers
who were trying to just get through,

get everyone through.

And um, though I still had access, there
was a clear difference in quality of care.

So that's another form of health
disparity, and then there's outcomes.

We have disparities and outcomes
which we're all aware of, um, there's

now been a lot of media attention
around maternal mortality and

maternal morbidity, where the data
is outrageous, and we're as a country,

having to wrestle with what this means.

Um, but usually, the disparities and
outcomes are linked to other -

to the disparities in quality and access
of care as well.

So now we're just going to talk
about some definitions,

so we can be clear about what we
mean when we use these words,

and not use them interchangeably,
so,

health inequality.

What does that mean?

It's the difference in health status,
or in the distribution of health

determinants between different groups
of people, whole population groups.

Uh, have health inequality.

Health disparity is something
we talked about already, which is

a particular type of health difference,
um, that is linked with socioeconomic

uh, or environmental disadvantage.

So it's uh, a disproportionality that
affects one group

around a particular type of health
outcome.

Healthcare disparity, which is different
from health disparity,

healthcare disparity relates to the
differences in the quality of

healthcare that are not due to access
related factor, or appropriateness of care

but these are the differences that come
from the role of bias, discrimination,

and stereotyping, from the
healthcare system.

So that would be the provider-patient
relationship,

or from the whole institution or
health system as a whole.

So, these - there's both health
disparities, and there's healthcare

disparities that are operating
simultaneously.

All of this is part of the knot
that we have to untangle.

Um, and finally on a more positive
note,

uh, what is health equity?

Health equity is the attainment of the
highest level of health for all people.

Um, in order for us to achieve health
equity, we have to value everyone

equally, with focused, well resourced,
and ongoing societal efforts to address

avoidable inequalities, both historical
and contemporary injustices.

And the elimination of health and
healthcare disparities.

So, it's a lofty goal, um, to reach
health equity,

and it isn't just eliminating health
disparities and healthcare disparities,

but it's - because of the link, the
inextricable link between social

conditions, social inequality, and
health, in order for us to reach

health equity, it's going to
require a larger kind of social

efforts, to transform social
conditions, and social determinants

that we live in, in combination
with healthcare system transformation.

So how do we remember to always
bring the equity lens in this work

that we're doing together in the master's?

Um, part of what we'll be doing throughout
all the courses is,

kind of developing a clear perspective
on what it means to be a fully -

to fully be an equity competent
organization, or healthcare system,

whatever it is that you're working on,
uh, tangibly,

and to help you develop an equity
tool, to use in your project or

organization, in order to make sure
that you're always wearing the equity

lenses.

Why it has to be so intentional is
because there have been so many well

intentioned attempts at healthcare
transformation, and at eliminating

health disparities, that have not
worked.

Tons of money has been put into
this, and we haven't moved the

needle as much as we would
have hoped, by now.

So it's clear that the way the
system works,

um, it perpetuates health
inequality, and so it's going

to take a lot of intentional
efforts at every level,

both at the larger social
policy level, as well as

within our healthcare systems,
in order for us to transform the

system.

But how I want to leave us is
on the note that this is absolutely

possible.

Just as we did not create the
current social conditions

and the current social determinants
of health that we all live in

in this country. It's a result of
centuries of very intentional

policies and practices that then
got kind of cooked into the

way things are.

Once we realize these logics and
how they function and where they

come from, we can, absolutely
transform them, and develop

new logics of how we work
within systems, and parallel to that,

as individuals, we can recognize
our own unconscious biases that

we all carry, and start to unlearn
the socialization that we have all

been taught, whether we're in
the dominant group, or not,

in any of these categories
that we'll talk about,

and we'll be talking about that
later, in one of the future courses.

But, all of these elements are
absolutely possible, and

this knot of inertia is something
that we absolutely can transform,

and using the equity lens and an
equity tool is one of the strands

that's going to help untangle this
knot that we are kind of

still tugging on.

But that we could look at in
a completely different way.

Thank you for your time,
take care

Bye-Bye.