Devil’s Advocate: Can We Achieve Health Equity without Examining Racism?

In this episode, host Mighty Fine talks about health equity and how it relates to injury and violence prevention with guests Pamela Imm, Wisconsin Department of Health Services, Ashley Lamar, JPS Health Network and Ina Robinson, Safe States Alliance. Mighty poses some challenging questions to the group to encourage a very full discussion on what's been learned on these topics and what some possible solutions may be to improve equity across our nation.

Transcript

Mighty Fine  0:00  
Hello everyone and welcome to the injury and violence prevention in depth podcast. My name is Mighty Fine and I'm the host of this Safe States Alliance production. In this space we'll engage in dialogue with IVP professionals on a variety of issues to help inform our listeners on the latest trends and hot topics. Today's episode is sponsored by Faeger Drinker, and they're an organization with exceptional legal and consulting capabilities and a commitment to service excellence. their clients are at the start in heart of everything they do so a big thank you to them for their support. Be sure to check out their website at Faegerdrinker.com to learn more about the services they offer, and that's Faegredrinker.com. I'm very excited about today's episode as we'll be talking about health equity as it relates to injury and violence prevention. We're really just engage in a candid conversation, discussing our work and uplifting how our lived experience may also shape our perspective in the work that we do. I definitely recognize that this is a huge topic and our intention is certainly not to touch on all of the intricacies of this matter. Instead, we want to add to the collective conversations that are happening around race and equity. And it's our hope that this episode will spur more thought, attention and eventually action. I'm really jazzed about the guests for today. We have three phenomenal folks joining us and I don't think I'm biased or anything I'm sure after the episode you'll be like yes, Mighty, they are phenomenal. So first up, we have an injury and violence prevention epidemiologist who works with the Wisconsin Department of Health Services, Pamela Imm. Adding to the fold is a trauma injury prevention specialist at a level one trauma center in Texas, and the chair of the Safe States anti-racism and health equity workgroup, Ashley Lamar. And rounding out the group is a program manager with Safe States Alliance, who leads a number of programmatic and evaluation initiatives, manages a variety of training and technical assistance programs for ivp professionals, and also as a facilitator of the Safe States, anti-racism and health equity work group. Ina Robinson. So ladies, I'm very excited, as I mentioned about the conversation that we're going to have today. So let's dive right on it. Pretty hefty topic, right? And certainly not something that we can cover in the short time that we have today. But we hope that this conversation will spur additional conversations and movement in the field, as we are really working to advance racial equity. And just to center us a little bit, I want to open up the conversation to see if any one of you would like to share with me or and the viewers, from your perspective, what is health equity? I know that's a really easy question, right? And how is it? Or why is it relevant to injury and violence prevention? Let's go for a free fall. Ina you're shaking your head for those who can't see here, but let's let's start with you.

Ina Robinson  2:48  
Absolutely, thanks Mighty. So for me, health equity is ensuring that an individual or community or population not only has access to the tools, resources and materials to achieve optimal health, and quality of life, but it also sort of removes the barriers to achieving optimal health. And this kind of ensures that the resources are allocated based on again, as I said previously, the specific needs of that individual community or population.

Mighty Fine  3:22  
Thank you, I think you really elevate a point that sometimes is missed is not just the absence of those adverse events, right. But it's also the inclusion of opportunities and support so that folks really can achieve equity. Ashley are Pam, any of your thoughts?

Ashley Lamar  3:39  
Yeah, I think Ina pretty much covered it, she did such a good job with how to explain health equity. The only thing that I would like to add is, just like Ina said, removing those barriers and giving people equal opportunity to grow and thrive in their own environments for whatever that looks like for that population. If they need more, give them more things like that.

Mighty Fine  4:07  
And, Pam, if you want to add there, or even if you can just lead us into the conversation of why is it relevant to injury and violence prevention, when we think of equity.

Pamela Imm  4:17  
Sure. No, I really appreciate what Ina and Ashley have said. And I think the other word that comes to mind when I think about it is it's an application of fairness. Right? And they definitely mentioned how, you know, that doesn't necessarily mean equal distribution of, say, effort or funding or programming or anything else, because equal distribution would just perpetuate the current reality which is unequal, which is not fair. Far across the board. Um, in terms of I was trying to think of examples specifically related to injury and I think it's specifically related to everything in our lives, right. So of course, it's also related to injury and violence. But thinking about particular situations, when you think of applying fairness, let's take creating safer neighborhoods, for example. So some neighborhoods may be less of fluent, to because of the way that homes are valued and the property taxes. And then therefore the infrastructure that goes into critical items for that neighborhood such as safe sidewalks, you know, they're not cracked and they're not broken, or sidewalks at all, if they're not existing. So then if we provide more funds for those neighborhoods in order to address those infrastructure issues, then we reduce fall and tripping injuries, we reduce motor vehicle-pedestrian injuries, because we build sidewalks where none existed before. So this all has wide ranging implications and impact, but certainly for injury and violence prevention as well.

Mighty Fine  6:00  
And I think this is a great segue into the next question, I want to ask you all, you know, I think I would be remiss if we talked about health equity, and we didn't talk about a component of that, which is really advancing racial equity. And some of the points you brought up, I think resonate well with me, because we're talking about neighborhoods, and we know neighborhoods and their resources are certainly not allocated according to need. And we know that there are structural barriers, structural racism, and a host of other challenges that make those a reality. So thinking about that, and just thinking about the time we're in right now, I would like to believe that in public health, we pull from social justice principles, right? So we've been doing health equity work and racial equity work before it was invoke. And it seems like now, though, more people are talking about race and racism. And just, I feel like the conversations are different than they were before. But as I've mentioned in other spaces, too, is I want to see the conversations morphed into actionable items and things happening and changes and paradigm shifts, and all those things, and not in an idyllic way, but in true reality. So with that, what do you think we have to do differently to truly advance racial equity, and we can talk specifically about injury. But Pam, you've made a great point. It's when we're talking about sort of these upstream things. It's in everything. So it's not just regulated solely to injury, but certainly there are certain components that are germane to us in the field. But I just would love to hear what you all have to think about. You know, it's a really easy question, what do we have to do differently to truly advance racial equity,

Ashley Lamar  7:37  
It's the elephant in the room, the thing that nobody wants to talk about. And I think at this point that we're in right now, the foundational information about racial equity is out there. These past two years that we've had, there's been an outpouring of information that is available, but there has to be people there to hear it and that are open minded enough to consider the possibility that just because this might not be their own personal reality, that it is a reality that is significant for a large part of our country. And I think once we pass this step of acknowledging and being able to talk about it, there needs to be policies that are put in place that support the mission of racial equity, that is going to be one, or probably the most complex step and potentially the most significant as well. And even further than that, having a system to enforce those policies will be really important as well, because ultimately, our goal is real change. We don't want legislation to pass and it accomplished nothing or worse, it becomes one of those weird laws that people cite as fun facts on social media,

Mighty Fine  8:44  
With no true enactment. Right? Because I think what you're speaking about Ashley is this idea that the sort of the the culture and the way we do business, so our policies, our practices, our thoughts, and our actions have to all be in in sync with one another right to see true advancement of racial equity. It's not just about a post on social media, no disrespect to folks posting, I think that's important, too, because it elevates visibility. But I agree there needs to be some true action. And when we think about policy, I think to your point, yes, federal policy, but, you know, small "p" policy within organizations, within local jurisdictions, within your states as well, because that's how we're going to see true change really happen. I know, Pam, any thoughts to sort of what Ashley just mentioned,

Ina Robinson  9:30  
We need allies that are solution oriented, to come alongside with us to move this work forward? Yeah. And then they have to be graceful enough, right, to yield to the communities with that lived experience. And with advancing racial equity. You know, we have to also consider and take into account the historical context and the the trauma, the lived trauma. experience by groups that have been marginalized for so long. And again, it's baked into our policy, right? The Constitution, the way that the United States of America has been structured, it has been baked into policy and enforced, like, catalyzed by the government to segregate and to keep these inequities in place. And even in moving towards sort of that policy change, to undo some of that stuff. It's an uphill battle, it doesn't happen overnight, right. But again we have to, policy is going to be key in undoing that. And of course, the the effects are lingering, right? They don't go away overnight, because here we are 400 years plus later, still dealing with the effects of slavery. And even longer than that, when you're when you're thinking about sort of the the societal impacts on sort of our indigenous communities and populations so well, and what they're experiencing. So that's what I have to add.

Mighty Fine  11:01  
Thanks. I like that. It's certainly a great addition, you're right, it's baked into the system. And it's really about us unearthing it and and shifting it and changing minds too. Because some people, someone elevated this -maybe Ashley said this earlier-- that this is a bad word for some people, or it's or they automatically think you say you talk about structural racism, and you equate it to someone being a racist. Sometimes people can't disassociate the two, it's like I can talk about the centering of whiteness, and how white supremacy is a social norm. I can talk about that and not look at someone who may have benefits from that, you know, what comes with white privilege and things like that, and not identify you as a racist, right? I can say that there are benefits from a system that some people have access to, and some people don't. But it's not a direct blow to you as a person. And I think to your point, actually, that's why sometimes these conversations are stymied, because it becomes so personal. And we think in order for us to really move forward, we have to acknowledge, yes, the personal hurt, and all those pieces, but really think about that it's beyond us. And it's about systems level change that we want to see. And how do we partner in order to make it happen? So with that, Pam, is there anything else you'd like to add to the convo?

Pamela Imm  12:24  
I think everybody summed this up so well. And your questions are so interesting, because it's made me more reflective than I thought it would. But um, yeah, it made me think and, Ashley, I think you mentioned this and Mighty I know, you brought it up to, you know, there was push in the past around racial equity. But you know, what happened with it, and it's still, you know, hasn't been fully addressed. And it's back in the spotlight again, would made me think about my start in public health back in the late 90s. And I thought it was a key concept back then. But when I think about it more, I think the focus was on naming it, and focusing on those downstream factors, the individual behaviors and outcomes, but not what we really need to do to address this is the upstream factors and the root causes and, and get at that. So I think maybe what we do differently, too, is just make sure that we create an environment of inclusion. Yeah. And that we consider like I'm thinking public health professionals, maybe agencies, specifically, racial equality in all the work we do, whether it starts with development, implementation of programs to also how do we communicate data, to policymakers, to the public, to researchers, and to the communities we say we're serving, that's key. So in order to, you know, create something positive and change and sustain it, we need to consider the impact and the appropriateness and the fairness. of all of this

Mighty Fine  14:12  
Absolutely you said a few things that really resonated with me is that the elevation of community so thinking about those folks who are most impacted, and if we're using a health equity lens, it's like, well, how are they involved? Right? Are we telling them what they should be doing? Or what their community should look like? Or are they engaged in those conversations. The other thing that you mentioned too, is like the collection of data. So we're constantly aware of what's happening so we can truly address it with from a science based perspective, but also using lived experience and practice informed approaches to really see the change happen. The other thing is sort of tangential to this conversation, it thinking about beyond the individual but structural. I was having a conversation. I can't remember where -- it's you know -- things just start blending together after. But we were talking about financial literacy. So I used to be a case manager, and we would have to do financial literacy with families who were making like pittance. So it was like, Is it really about teaching them how to do more with less? Or do we shift the system to fully support where folks can work and afford to live and afford to eat and clothe themselves? You know, so it's a mindset shift as well. I think that can be applied to this work, too. Whereas - yes, of course, we can talk about sort of individual acts of racism, right? There's that part of it. But for me, yes, that's a piece of the puzzle. But it's really about thinking about the full structure and the systems and the policies and practices that really need to change. If we want to see, if we really want to realize health equity. And if we say health equity is equity and opportunities for all, we really have to do some of that shift--shifting. Which leads me to my next question is, so I say to you, we talked about race, social determinants of health all the time, and I say, Ashley, Ina and Pam racism is a social determinant of health. What are you gonna tell me back?

Ina Robinson  16:16  
Okay, I think, I don't think-- I know. And you can, you can see it with your own eyes, that racism is definitely a risk factor. It is the risk factor that leads to sort of the poor in less than favorable health outcomes that we spend all of our careers exploring and analyzing in writing and talking about racism is often treated, I think, as a byproduct, or an unintended consequence when assessing health disparities. But again, we need to be forthright in making that clear connection between racism, trauma, in poor health outcomes when you're looking at, you know, minority groups and populations. Yeah, we just we have to be intentional about exploring the how and the why, behind what the data is actually telling us what the numbers is telling us. And looking at things through an anti-racism lens, but I'll put a pin there and let my colleagues chime in

Mighty Fine  17:14  
Yes--CTR, we certainly could have a several podcasts about that and all that's happening there for sure. But you bring up a good point, it's it's when we think about the disinvestment in the declaration of some of our communities. We know that's not by happenstance, right? It's the structural drivers that are making that happen. And then folks are moved out and they look--wait there are sidewalks, and there's a supermarket. And there's housing, and I wonder what's different here, right? So that's how we know that these things are intentional. And I don't mean to come off as flippant at all, but it's just, it's a personal observation, but the data can also reflect what we know to be true. And to your point, we have to be intentional about addressing that. Pam, Ashley? Thoughts?

Ashley Lamar  17:56  
Yeah, country, not just people of color would greatly benefit from there being a more even playing field. We're all in this together. And that's something that a lot of people don't think about or realize, you know, nobody wins when the family feuds, right,

Mighty Fine  18:11  
Right, right. Yeah, absolutely. Yeah. And if you think about it, there have been policies and practices really to divide. And you think even within communities of color, indigenous communities, there have been different. You know, I don't want to sound like a conspiracy theorist or cynic here. But they are often times where, as opposed to there being support for these communities who certainly have their unique experiences in America, but there are certainly some common experiences as well. But they're almost forced to sort of separate and say, No, you're different than them. And you're different than them, as opposed to what you're saying is really having this communal effort of all shades, colors, and anything in between to come together to recognize. Wow, you may not be directly impacted by the structural forces that we are all feeling the pinch in one way or another. So that's why it's a collective issue. And I feel like that's sometimes an uphill battle as well getting folks who may not have been on the receiving end of some of those aspects of the structural forces structural racism to truly understand how they fit into the full picture. Pam, your thoughts?

Pamela Imm  19:25  
Just triggered an analogy that you know, just as the pandemic is a collective action requires collective action for everyone and for everyone's health and well being and wonder in the world, so is everybody's collective action against racism? And it just yeah, I'm gonna tear up here. But yeah, everybody struck points that I had made myself when when you sent us the question that just racism is insidious and it's kind of that storm cloud hovering over all social determinants of health. It's like the ultimate social determinant of health. So yeah,

Mighty Fine  20:09  
Absolutely. And I feel I feel that with you that connection, because it's when you, I think others have felt that too, throughout this pandemic, and we start to talk about racism, you think about the historical ills, it really it just doesn't sit well with your spirit. If you're human, right? No judgments, anybody but maybe a little bit of judgment. It just when you think about these things that were done intentionally, I've often talked about this to reading 1491. And it's just the way that it was that indigenous folks were written about and black people you like, wow, you were so removed from your humaneness that you were able to write about people as if they were objects and not living and breathing and didn't deserve the same opportunities that you deserve. You know, so it's your right when you even now that I'm thinking about, it's like I'm getting goosebumps in my hairs are standing up, because you just can't. Sometimes you just can't comprehend it. And I don't even know if I want to be that type of person that understand that feels like I can treat people less than human. You know what, whatever that means. But yeah, I don't want to go into a whole diatribe here. 

Just, just to add to that, that piece, the humanistic piece, and I think when you get into the psychology behind the individuals and the systems put into place to cause the significant harms and ills experienced by by the groups that we've highlighted it, you have to psychologically disconnect, and convince yourself that the way that you're treating these people is okay, because they're not human, or they're less than human. That's just human psychology. Okay.

Thanks for that. Yeah, that makes sense. So it makes it makes perfect sense, because I can't imagine another explanation for it. But what we are, we are seeing progress. So I don't I hope folks listening in recognize that we're elevating this because it's something that we need to talk about. But we're also putting it on the table. So again, getting back to this idea of this collective energy towards really making this happen. Even if you're entering the space feeling a little uncomfortable, I identify as a black man, I've been subjected to structural racism, personal racism, and I don't have all the answers, right? You just because I'm a black person living in America? Yes, I think I bring a lot of experience both lived experience, but also work experience to this space. But I would never sit here and say that we own this as, as a representative of the BIPOC community. I think, again, we have to think about this as a collective. And there's still learning that I'm doing, there's history that I'm learning about, you know, my people that I was never taught. And, you know, in, even in that it's informing my work or informing my work, but also making me feel even more. So were more inspired to do the work. And I don't want to say obligated, but I sort of feel like I'm obligated to do it, you know, I just feel like it's a calling for me personally not not telling others that they should be obligated as well. But but maybe. Nonetheless, as I was saying, this is something that I could talk about forever, especially with you all conversation has been great so far, and hopefully folks listening in are enjoying it as well, and giving them food for thought. And we've seen it APHA has actually a map of the cities who have or other jurisdictions across the US who have named racism as a public health issue or crisis, or something within that ballpark. So with them naming it as we talked about before, we want to move in this is no no dis to them, we want to move beyond sort of performative gestures and not saying that those are performative at all. But my question to you all is, what's the significance of that? of them naming it? What could that potentially lead to? And why is, uh, I don't know if this is a rhetorical question. But why is racism a public health issue? We've named it, now what? You know, so I gave you a few questions in there. So if I need to disentangle--don't let them let me know but happy to hear from you all,

For public health, regardless of what topic area you're in, whether it's injury and violence prevention, chronic disease prevention, maternal and child health. Public health is a beautiful conduit for a beautiful and natural conduit for addressing social change, addressing social injustice. And racism is is a matter of social injustice. It's a matter of civil liberties being abused. And so with with the way that our frameworks and approaches are structured, it's just a natural like I said, conduit for addressing that. Weaving that into sort of our traditional public health practices in terms of how we're designing programs, how we're implementing them, how we're engaging with communities and our stakeholders, how we're evaluating success and improving our processes along the way.

Yes, evaluate, that's just one piece. Evaluation. That's a big piece of it, too. No, that's a great point. I think that's something that's not often elevated either, is to your point, I know, what are we doing? And is it truly addressing the needs that it should? Right? If we're using this health equity frame with this racial equity frame? Are we really hitting that mark? And what does that mark look like? What you know, what are the metrics that we're using? And I think that's, you know, a beautiful point, that's something that we in public health do across the board, right? So we need to do it with that racial equity lens as well. And we can even think about sort of inside your organization's if you're saying we're doing health equity work. Well, what work are you doing internally? You know, how are we inwardly working to ensure that we're showing up in the best way possible? externally? Pam, your thoughts on? Yeah, your thoughts?

Pamela Imm  26:13  
Sure, sure. No, I agree with everything shared. And as somebody who sits within a state health department, I thought I could share some of the work that is happening in our state and, and things that are exciting and, and being created. So for the Wisconsin Department, we've got health equity offices and coalitions that are currently being formed and staffed. And this is for developing strategic plans, taking actions and also that important part, the evaluation, then measuring improvements, right. So the strategic planning will be worked on over the next how many how, however long it takes right to create and sustain, and will focus on developing programs and health inputs that lead to the more equitable health outcomes, and certainly will include voices of persons and populations that are negatively impacted. And then the other thing that certainly I've noticed in the last, I want to say more than just a year, a couple of years, our health department has included racial bias training for all employees as well. So I think we're working on it on a number of different levels. It's focused on personal responsibility as employees of public health, but also agency responsibility as well. So I like how all of this is coming together. And when I'm seeing and, of course, you know, it's at infant stages. So we'll see where this goes from here.

Mighty Fine  27:49  
Yeah, no, that's great to hear. Thanks for elevating that perspective. And you said a few things that sort of tickled some things in my brain, one of which is I think, by naming it and seeing organizations shift to have internal policies and programs to elevate this to the forefront of the work that they're doing is that I feel like more people are, you know, I've been trying not to use the word empower, but there's sort of like that power building and is that that that communal investment, whereas maybe a few years ago, if you saw microaggression taking place, or some injustice or some inequity folks are more likely to speak up. Now, at least in my experience, I don't have any data to support this. But in my experience, I feel like people are more aware. And they are recognizing things that are in justices that may be previously they just saw it at face value, but they didn't recognize the the the true sort of genesis of that interaction where someone was being mistreated or passed over because of their race or ethnicity. And I feel in my experience, I've seen that shifting more where people are speaking up to do some course correction and calling folks out. So again, that's at the individual level somewhere. But it also intersects with that system level. When systems level, we start thinking about promotion and opportunities within workspaces. Because we know that when you have a more diverse leadership, then the programs that you do are different, the communities you serve may be a little bit different. We know that there's a lot of benefit in having diversity in the broadest sense of the word. And so again, I just have been finding in my personal experiences, I've been seeing those shifts happen -- happen more, because people are more aware, and they're feeling a little bit more comfortable speaking up because of the tone of our nature, our nation right now. So I would be remiss if we had this conversation, and I didn't elevate I think one of the luminaries in this space, Dr. Camara Jones, who is a leading expert, right, yeah, round of applause for Dr. Jones. She's-- she's the bomb, so I'm gonna send this to her, make sure she listens to it. We're giving you your flowers now, right? That's been popular all over social media giving folks their flowers. So let's see, I'm still trying to be cool. Trying hard, I don't know if it's working. Nonetheless, she has these eight pillars of what she describes as barriers to achieving health equity. And there are a bunch of them, we could talk about them all in at length, but one of them I wanted to elevate is this myth of meritocracy. And that really stands out to me because it feeds into this idyllic notion and this ideology, that if you work hard, you will make it right. And we've already talked about sort of concentrated disadvantage, and how some of our communities, we think about social determinants of health, and we think about violence. And we just think about what's happening within those communities. And so it's not to paint the community with a broad brushstroke and say, Hey, if you come from impoverished beginnings, and you you know, this is definitely the your trajectory, but we know what the risks are. But we also know sort of what the protective factors are, and we want to elevate those, obviously. But let's talk about why is that myth problematic? What is it missing? When we say if you work hard, you can get it, it almost makes it seem as if the playing field is equal, we know that it's not so any thoughts

Ina Robinson  31:15  
It's to go to that old adage of what just pull yourself up by your bootstraps? And then always say, Well, what if I don't have a pair of boots to wear, therefore, I don't have any straps to pull up? The  myth of meritocracy is is definitely problematic, because it just does not enough consider all of these hidden, yet not so hidden unspoken, yet spoken. barriers that that folks are experiencing along their journey.

Mighty Fine  31:43  
Absolutely, totally agree. And then it allows the, the, the myth is allowed to continue, because it puts up almost like a smokescreen, right, it's like well, or they have shining examples like oh, such and such data, if they did it, then you certainly can do it. So it's making it seems that again, if all of our experiences are the same, and it's not taken into consideration, as you've mentioned, all those different factors that contribute to someone's limited opportunity and potential to to for self actualization really, right?

Ina Robinson  32:14  
Absolutely. And, and, you know, just getting a little personal here as a black woman, and even as a, as a little black girl, I was always taught, you're going to have to work twice as hard to get half as much. And I and I, you know, and I have to say, for my own lived experience, and some facets of my life, that has been very true.

Mighty Fine  32:35  
And that continues to be true. And that's what we want to change. Right? You know, we want it to be absolutely based on my merit, and not being discounted immediately because of how our present, you know, certainly when we want to shift that. Ashley, Pam, thoughts on this myth of meritocracy?

Ashley Lamar  32:54  
Yeah to go with the working twice as hard to get half as much is this idea that, you know, it's not about what you know, it's about who you know, because we can all think about our personal lives, or I'm not going to generalize to everyone. But for me, I can think of people who got to the positions that they were not because they worked super hard, not because they showed up every day before they were supposed to clock in and stay late, but because they had people that position them in spaces, that would help them get to where they want it to be faster, or people that got into spaces that they never thought they wanted to be in but they were placed there, because it was their, you know, legacy or their birthright or, you know, a family thing that they had to continue with. And so for people that are waking up every day working from the time they wake up to the time they lay down their heads, and and keep hitting the ceiling and wondering, you know, when am I going to get my break, that's what it's about. It's about someone seeing you and giving you that break, whether that's you know, when you're in school, having a teacher that looks at you and realizes and recognizes that you might need a little bit extra help and gives you that help. And so when when they keep growing and they keep going through these life experiences when they keep trying to elevate that gap is only widening more because they're not given the tools they're not being put in spaces to succeed.

Mighty Fine  34:28  
Absolutely. Yeah, for sure. I there was a Twitter thread and thankfully I had some wonderful teachers that really poured into me and folks were just chiming in on all the things that teachers told them that they couldn't be and some of the things that I read I was just astonished that someone in that position a position of power really right and authority was telling these children what they could not be based on their race or ethnicity or gender sometimes and it just, it blew my mind. So you're right. I think if, if you don't even have buffers to counter that and think about how much time we spend in school, that certainly can be a challenge as well. Pam, your thoughts? 

Pamela Imm  35:11  
Yeah, if I can indulge for a second, I was gonna share in childhood memories. So your questions, as I said, were bringing up so much reflection for me. So I started thinking about my own childhood, because my childhood didn't support the myth of meritocracy, even though I did grow up white privileged. But instead, I was told, specifically by my parents that, you know, life isn't fair, and it's not equitable. But even though I wasn't taught the myth of meritocracy, the problem with me hearing that, and my interpretation of it as a child was that I would just accept unfairness as fate, and saw myself as having no agency in changing the outcome. So I think if we, we recognize that meritocracy is a myth, we also need to accept responsibility to act as agents of change, whether we prosper from fertile soil or struggle in under nourished soil. You know, we all have to act as agents work, we're a collective society. And I hope this you know, I don't take this on a whole political rant but but um, that's it, that's some of the thoughts that were like spinning through my head,

Mighty Fine  36:33  
I can certainly appreciate that. Because as you all are talking and made me think about sort of, there's a, I think it's an ad campaign, if I can see her, I can be her, if I can see him, I can be him something around that. So just this idea of what is all possible. And it made me think about a colleague of mine who was working with some youth, and I can't remember the city, but this it broke my heart, they were like 16, and 17. And they were designing their t shirts for their funeral. So you know, you've seen the T shirts that I find it mostly when younger folks die, and they have the T shirts to RIP t shirts, I guess, is the best way to capture that. And the fact that they were 16 and 17, designing their t shirts, because they already had in their mind that their life was gonna end prematurely. Right? So it's just all those pieces sort of fit together for me where there's this idea that if I can't do that, you know, because I don't have these bootstraps. And I know this is my fate. And, you know, we that's a shift that we have to make happen. Because there's, we shouldn't live in a world where you're 16 planning your funeral, right? That's just that that just doesn't sit well with my my soul at all. Yeah, and it mean to get somber, but you know that that's just sort of where the conversation led me. But I think it's good for folks to hear, hear that experience, although it's not mine. But we know that our young folks are facing that daily. So thinking about all of that we've talked about and recognizing that, again, we wanted to elevate it get folks to think about what's happening, add to the collective conversations that are currently going on within our organizations, our families, our friend groups. In public health, where are some places that people listening in can start if they truly want to work towards a world where we have equal opportunities and taking a bit further, what's our role in injury, violence prevention, or just public health more broadly, any any thoughts there

Ina Robinson  38:39  
Sometimes starting the conversation is is the hardest part or, and then you have to leave space and give grace for for the the learning to happen, and for people to get comfortable having those conversations, especially, you know, for those of us who don't have a certain lived experience, depending on what the topic of discussion is, at that particular point in time. Public Health. Injury violence prevention, but but public health, oftentimes were the convener, right? We bring people together, and we can reach across the aisle and form some non traditional, you know, partnerships and connections that can make our work in this area in addressing racial equity or health equity, a little bit more comprehensive, a little bit more robust. Because the value and having the multiple perspectives actually get to see things in ways that you may not have originally thought of them on your own.

Mighty Fine  39:42  
I think it would be great to give folks some resources to tap into for sure. Ashley? Pam, any of your sort of thoughts around where where do we go from here? Some folks already started right. So how do we continue this work with intention and conviction? Really?

Ashley Lamar  39:57  
Yeah, just to echo kind of what Ina said is to be open to learning, and not even just being open to learning, but understanding that you should probably question everything. No thinking about where your information is coming from who your information is coming from, you know, there's so much out there that's there's so much that's available that it can be overwhelming. So my, my first step that personally that that I took myself was just to start with reading, and just like Ina, I have a whole list of books, but I'm sure ours will cross I'm gonna to let Ina take that one. Um, you know, I started taking in so much information that it kind of had a two fold effect. On one hand, I was super excited about all the things that I was learning that I never learned in school, and it validated my existence. And obviously, as a, as a black woman, you know, I have my own personal lived experiences. And seeing that other people were experiencing the kind of coming of ages that I was it, the conversations with the parents that I had, those things all helped me. And I think that it would honestly be really beneficial for people to share their experiences, because a lot of people in different parts of the countries don't encounter people of color to the extent that they would need to, in order to day to day, understand what our experiences are. And so by putting that information out there and putting our own experiences out there and caveat that to say, do the education that you have to put in your own time, and your own effort into educating yourself is also important. But I also think that sharing our experiences is a good step, step as well. And I mean, books, podcasts, movies, interviews, all of that, I was just taking a taking in a mass amount of media and I learned so many things, and it kind of opened my eyes. And you know, that's kind of where you start. I know, it's like, popping open a fire hydrant and trying to drink from it. Because all of the information that we have, right. Everything that's been going on and even know not just going from here to the future, but going all the way back historically as well is super important. Because like they say if you don't you know understand history, if you don't know history, then we're doomed to repeat it. And we're we want to move forward. We don't want to repeat the mistakes and the injustices of the past, because we want to move towards progress.

Mighty Fine  42:48  
Right, a little saying, Cofa, I know where I'm going, because I know where I've been right. So to your point, we don't want to revisit that in any way, shape or form. So totally, totally there with you, for sure. Pam, your thoughts?

Pamela Imm  43:05  
Yeah, um, I guess one of the things I was thinking of a place to start, besides of all the great suggestions about educating yourself and learning more and more, I guess the other maybe the starting point for a lot of people in the work world or not in the work world, just in your social circles is to acknowledge that all of this is difficult to discuss. And it takes patience and self reflection, which can be difficult, and humility. And so find your center, find your starting point, and then reach out for assistance to colleagues and those who may have different lived experiences than you and make sure that you're listening instead of just telling or, you know, waiting for your turn to talk, I guess. So, and I would suggest, you know, participating in in workgroups, which focus on addressing these issues, such as the Safe States one that Ina and Ashley chair, they've been doing this amazing job, and I just feel safe, participating in this workgroup and learning so much from my colleagues and everybody who's, who's participating. So I think it's a great opportunity for others to participate in as well. And then you mentioned, you know, what's our role in IVP? And is make addressing the inequities a part of my daily consideration in my work. So think about it, what am I doing, and how could I do it differently or better? You know, as an epidemiologist in injury and dealing with surveillance data, which often reveals disparities, whether by sex, race, or another classification, I'm trying to take the time and we all know how hard that doesn't public health take the time to caution data users and say, do not put absolute faith in these data? They don't reveal all that's going on. So the data collected are often based on biases of those collecting it

Mighty Fine  45:14  
Right? Like today, what they're collecting what questions were asking? Yeah, absolutely. Yes,

Pamela Imm  45:20  
Yes. So can we consider So first of all, we should consider correcting that. But that takes time. So perhaps we change the questions, we ask or gather more information on social determinants, etc. But in the meantime, I try to provide context and narrative around the data that we do have, so that it's not misused, or, you know, used for, frankly, evil purposes. So so even those, those are small steps, and it's just a start. But hopefully, it will be more influential over time, and we'll get there.

Mighty Fine  45:55  
Yeah, that's a great point. And for those of you who are listening, and if you didn't listen to our episode on data, go back and check it out. Because some of the points that you elevated Pam, were brought up there as well. And they've got they went into greater detail. But I totally agree, I think that's a piece of the puzzle where public health is instrumental, we have to be intentional about that. And, and to your point as well, how are the data being used? And what story is it telling? And when we don't know, say, you don't know, you know, it's okay, that is perfectly fine to say we don't know. But here's how we plan on finding it out, and we need your help, you know, whomever the aid needs to come from, but being very intentional and forthright about that, I think that's a place where we can grow a little as well. Well, as I said earlier, this has been a wonderful conversation. And I certainly can keep you all on for hours. But I know you have other things that you need to be doing, with your time, all the fantastic work that you each are doing and contributing really to work in public health, but also to advancing racial equity. So virtual round of applause to you all for that. I wish I had the sound byte to play the applause right now. Yeah, so thank you all for that. I know you mentioned that there are some resources that you wanted to share. So in addition to that, as you're sharing those resources, to you to Pam to Ashley, if there's anything else you'd like to share any call to action, anything you want to tell your colleagues, shout out your mama, I don't know. But honestly, if you um, if there's anything you want to elevate, as we close out, please feel free to do so. So I now start with you.

Ina Robinson  47:40  
Anyway, I'm going to share

Mighty Fine  47:41  
anyway. Anyway, yeah.

Ina Robinson  47:44  
First Book is the Color of Law by Richard Rothstein. I hope I'm saying that right. But that sort of gets into the forgotten history of how our government segregated America so that's a great read for like the public health law and policy junkies, The Sum of Us what racism costs everyone and how we can prosper together that one is by Heather McGee. And that sort of taps into some of those determinants of of health equity that Dr. Jones gets into just in terms of unpacking that zero sum game as a good read and then Caste by Isabel Wilkerson that's usually a good place to start and then for, you know, for for our new not to single anybody out for like our new allies or old, a good place to start, as well as is with White Fragility by Robyn D'Angelo, just to kind of, you know, unpack some things and kind of start to wrap your, your brain around some of these these concepts around like racism and equity. In terms of closing thoughts, you know, I just want to say this has definitely been a season of, of new awakening, I think, for our country, with between the pandemic and with the events around George Floyd and Breanna Taylor and so many, many, many, many, many others that have succumbed to the to the hands of law enforcement. And we've reached a critical tipping point in our country, and so not that equity or racism or fights for civil rights or against poverty is not anything new. But we definitely have to be advantageous in terms of how we leverage our work and move our work forward. In this moment, we have to focus our energy, our sustainable movements of change. And that includes policy as well. Yeah, absolutely.

Mighty Fine  49:36  
I love that. It's, it's not about the moment it's about the movement, right and moving and continuously moving forward, and also picking up where some folks left off and taking what we can from that and learning from all of the sort of the luminaries and our racial equity work or just racial addressing racial injustice in this country. And I think that there's still work to be done. But there are certainly pieces of the work that has been done that we can pull from. For sure. Then just wanted to also note, Heather McGee will be one of the keynote speakers for the APHA annual meeting. So folks will have a chance to check her out there. I'm sure she'll be talking about that book, which I just started and it's really good. So great suggestion. Ashley, Pam, your closing thoughts or remarks?

Ashley Lamar  50:28  
Yeah, firstly, I'm also now reading The Sum of Us and it is phenomenal. It's sitting on my bedside table and I just pick it up every night before I go to bed and read it hashtag

Mighty Fine  50:40  
book club, right? Anybody

Ashley Lamar  50:45  
can read Honestly, I just the tone, the language, the the situation's explained in it are so good and easily readable. It's it's not one of those exhausting reads. It's very, very good. Not to make this a personal commercial for this book.

Mighty Fine  51:05  
Not at all, no, no way are we affiliated but it but it is a good book.

Ashley Lamar  51:10  
But it is very good. As far as closing thoughts, I first of all, just want to thank Mighty for, for holding this conversation. And second of all, I just want to kind of end on a high note, I am really encouraged with the way things are going right now with the conversations that are that are going on just how I have seen a shift in my own personal life of people that surround me. You know, I I see a lot of people moving out of that kind of defeatist mentality of that, like this is, this is what I was born into. So I have to stay kind of in this lane. I love that people are now realizing that they can get out of that lane. And they don't feel so heavy about all the things that they're experiencing, because they know there's a system kind of stacked up against them. And that there are so many other people out there to support them that are trying to elevate. There's just been this outpouring of love and faith and support right now for people in the people of color community. And it's just really encouraging to see, I again, I'm just going to, to emphasize the importance of educating yourself. Nobody knows it all. I don't know it all. I know, nobody knows it all. And I still have questions. So I know other people still have questions. And it's okay to be new in this it's okay to not even know where to start. Because sometimes you just have to pick a place that there's no perfect way to start or no, no perfect place to start. Just pick a place. Any place. And that's that's honestly how how you sometimes have to handle an issue as big as this is just starting. And that's that's oftentimes the hardest part right is to start that goes with anything exercising. So guilty. Starting is sometimes the hardest part.

Mighty Fine  53:17  
It's no, it's true, but to your point, and I don't know this research, but I've heard it before, like 21 days to form a habit or whatever I don't know. So don't quote me on that. But to your point, Ashley, it's really about starting it or even with the gym, Ina know you and you're getting it in with your with your work. But it's once you start it, it becomes so natural to you Don't even think about it anymore. It just becomes second nature. So to your point you started. So you're going to start thinking about things from an equity lens and assessing it. So I agree, you get started and then you move it forward. The other thing that I mentioned that several times that resonated with me as well is grace. I think grace is critically important to be introduced into this space and especially when you don't know where to start you don't know what to say you're nervous about what you want to say you don't want to say the wrong things. And so I say ask the question, right? I'm from that school of thought I know we've felt in some spaces we've gotten to a place where where I don't want to face sensitive but we're like trying to think of a nicer way to say that. hypersensitive Uh, yeah, there we go. Yeah, okay, well, that's nicer, critical. co signing it, then we're gonna go with it, but to the point where we've gotten to this place where we're so like, afraid of saying the wrong things, because it's sort of this canceled culture like Oh, you're quick to be labeled something based on natural misunderstanding of something with no other intention behind it. But this is what I there are words that I grew up learning that I didn't know that they were racial epithets until I was told right? But they were part of things that I would say, and I didn't know, like the historical underpinnings of that. So when I learned differently, guess what? I did differently, you know, so we have to have that grace to allow people to make mistakes. And, and, and help them along their journey. We all have to help each other along. Right. That's essentially what I'm saying. So, before I go down another rabbit hole pair, you want to close this out with any of your closing remarks?

Pamela Imm  55:27  
Sure, I don't mind your rabbit holes. Okay. Um, no, I had a couple of thoughts. But I guess the first one I really wanted to draw attention to was Ashley's closing comments right there, again, create that safe space. And I just think that is so critical to, to moving forward and sustaining and supporting change to is people need to feel safe and for making mistakes and possibly being called out and and critiqued. But if it's also a supportive environment, you know, it's a learning experience, not a punishment experience. Um, the other thing I wanted to say more specifically with public health, is that important for all of the health equity work and movement is public health's coordination and collaboration with multisectorial partners. So we really need to work across agencies to influence health by addressing housing, economics, corrections, law enforcement, education, etc, all the upstream factors, again, that influenced the downstream health outcomes. I just want to make sure we don't go back to the 90s or, you know, perhaps before then I didn't start until the late 90s. I'm aging myself, but um, you know, where we focus on those health outcomes and individual behaviors. And because that's not really where this discussion lies. And then I just wanted to end by saying, I just feel so honored to be part of this discussion and part of this amazing group of colleagues. That is, it's just thank you so much.

Mighty Fine  57:10  
Yeah, well, thank you for showing up in the way you did, and sharing as you shared, you know, absolutely a shout out to Safe States Alliance, and who's the host of IVP INdepth. And really, I think showing their commitment to this worked by creating the space for us to have this conversation on this platform. So kudos to Safe States for that. And again, I can't thank you all enough for showing up and engaging me in engaging with me in this conversation. I hope the folks listening in have some pieces to take away. And when you see us virtually at the conference, you know if you want to have another conversation about it, we are I'm volunteering you all, by the way, we are more than welcome to, to talk through this with you all. But as the as has been mentioned, throughout this conversation, no singular person has all the answers. But collectively, we can come up with solutions, ask the questions. And even when we don't have the answers to me, asking the questions stimulates the mind to think about what the possible solutions can be. And when you deal with other people, it makes it even more meaningful to me I always say in a vet, tell my interns and folks who are looking for career advice when they're coming out of school, they're like, what do you know, with some sick? What do you have? What suggestion do you have for me? And I always tell them if, if what you're thinking about and you're the only person that's going to get you there, you're thinking too small, right? That's limiting you because there's just something I appreciate maybe it's my bias about the collectiveness of the work that we're doing, and maybe that's why I'm in public health. But I recognize that the issues are, they may seem insurmountable, right as an individual, but if we think about them and engage with one another collectively, then it's like, okay, Ashley can bring this to the table, Ina can bring this to the table, Pam can bring this, Christa can bring this, Mighty can bring this like, no, now we actually have a plan, you know, we can move it forward. So I don't say that to be like you topic in any way, shape or form. I truly believe that there is a lot of benefit in our collective understanding and in moving together in unison, even as diverse as we are indigent visually, the that diversity adds to the power of the collective. So I'm gonna zip my mouth up now. And conclude this episode of the podcast, again, virtual round of applause to you all, and by.

Ina Robinson  59:43  
Thanks, Mighty. Thank you.

Mighty Fine  59:45  
All right, thank you. Thank you to everyone for listening to IVP in depth. It is certainly my hope that this conversation was enlightening and thought provoking and just as fulfilling as we had intended it to be if you enjoyed it Be sure to if you haven't already done so. Subscribe to and listen to us on Apple podcast, Spotify and Google podcasts. You can also follow Safe States on Twitter at Safe States and LinkedIn. And don't forget to check out our website at www that Safe states.org for more injury and violence prevention tools and resources that I'm certain you will find useful. Again, I'd like to thank our sponsor Faker drinker for supporting Safe States and helping us to bring you programs such as this, this is your host mighty fine signing off and until next time, be sure to stay safe and injury free.

Transcribed by https://otter.ai