Session 2 | Racism as a Public Health Crisis: Personal Impact and Response

♪ Hello, I’m Dr. Linda Bradley, Founder and Chairwoman of Cleveland Clinic Celebrate Sisterhood This year, we have retooled our single live event to our first ever seven part virtual education series, Celebrate Sisterhood 2.0 This exciting change allows us to address more topics, hear from more experts and to reach you and your family in unique ways, using and embracing technology And you will be able to share and replay each edition So sit back, relax and enjoy You are not alone ♪ Hello everyone And welcome to this month’s edition of Celebrate Sisterhood 2.0 This is a community outreach and education program, that empowers multicultural women to embrace self-care and to strive for optimal health for themselves, their family and their communities This event is pre-recorded, but if you have any questions, about the information shared today, please email celebratesisterhood@ccf.org My guests today are Dr. Nazleen Bharmal, Medical Director of Community Partnerships at Cleveland Clinic, Dr. Charles Modlin, a Urologist and Founder and Director of the Minority Men’s Health Center at Cleveland Clinic, and Dr. Adam Myers, Chief of Population Health at Cleveland Clinic and Director of Cleveland Clinic Community Care Today’s topic is Racism as a Public Health Crisis: Personal Impact and Response Welcome everyone, and thanks for joining us Thank you Thank you Thank you There’s no place for racism in our world And Cleveland Clinic is committed to promoting racial equity and ending racism that results in health disparities Recently, we supported a Cleveland City Council resolution, declaring racism, a public health crisis This announcement has set the stage and fostered community wide efforts to tackle inequities that have led to poor health outcomes for African Americans in Cleveland Today, our esteemed panelists will address the stark issues of racism as an urgent public health crisis We are committed to partnering with others in the community to end long-standing structural racism that promotes economic, political, educational, judicial, employment, housing, food access, transportation, and health access disparities, that directly worsen health outcomes for African Americans We will learn how all of these factors, impact the life expectancy, quality of life and health outcomes So what’s our roadmap for today? Let’s look at defining, the emerging new definition of racism Let’s learn why racism is a public health crisis Describe Cleveland Clinic’s responses to Cleveland City Council’s resolution that racism is a public health hazard And we’re gonna outline outlined factors that will enable our road to recovery and solutions And finally, let’s discuss what are our individual and collective responses to improve this public health crisis You can’t solve a problem until you define it So let the first step be to define racism What’s the new emerging definition? Merriam-Webster, the (murmurs) dictionary, plans to update the definition of racism to show how racism isn’t just about discrimination or prejudice from one person to another, but also about how long-standing institutions, laws and regulations, buttress notions of supremacy and inferiority between races It will now include an explanation of systemic systemic oppression in its latest definition of racism At its core, racism is a system of structuring opportunity and assigning value based on the social interpretations

of how one looks, which is what we call race, that unfairly disadvantages, some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources So I’ve got a question that’s gonna come up in a statement So racism has deep roots It will take infinite energy to eradicate Recently, the Cleveland City Council declared racism, a public health crisis So I’m gonna ask each of you, what does this announcement mean to you, when you heard about it? We’ll start with Naz First of all, Linda, I just wanna say thank you for putting this program together, as well as reaching out to the community on such an important topic I think it means a couple of things to me First, like how do you think about a public health crisis, one that affects swaths of people and has a huge impact on communities, loss of life and economy So when we’re saying that racism is a public health crisis, it really means three things to me One is that we’re just, like naming it We’re naming that being black is bad for your health, and pervasive racism is the cause, not just at the individual level, but at the system level I see it secondly, it’s like a rallying cry It is a way that bring folks together You said it so well, not just only from the healthcare sector, but from all other sectors to really address this issue And then as a public health crisis, it’s telling us that it’s at the root of so many health inequities that we see, and we have about like three decades of public health research to support that So, and it doesn’t matter if you’re a poor or rich, educated or not educated, living in a good neighborhood or not a good neighborhood, at the end of the day, it is actually about the color of your skin And I’m really excited actually that the city has taken this on Thank you And I’ll ask you also Charles (murmurs) video here, what did the announcement mean to you? Again, the City Council declaring racism as a public health crisis, what does that mean to you? Yeah, I wanted to thank you also, Linda, for actually including me in this remarkable broad broadcast, because it’s very important that we’re talking about this subject matter You know, when I heard that the Cleveland City Council actually recognized racism as a public health crisis, I actually had several things, several motions actually, went through my mind First of all, I thought to myself, it’s about time You know, we’ve been, many of us in the healthcare profession, have been talking about what are the social determinants of health, and racism is actually a social determinant of health The thing I thought about the most, was the fact that this is being recognized not only in the City of Cleveland, the State of Ohio, but nationally It gives us an opportunity as healthcare providers, as public health professionals and a nation as a whole, to actually finally once and for all address this I mean, many individuals have felt uncomfortable, even mentioning the word, racism And when it comes to physicians acknowledging the impact that race actually has in portends with respect to healthcare outcomes, you know, up until now, a lot of physicians have not even recognized, the fact that healthcare disparities even exist, or recognize the impact that health care disparities, have on predominantly minority populations So it gives me a sense of hope that finally we’re getting past the point of being afraid or fearful of actually talking about racism is contributing to health outcomes And actually now that we can recognize this, we can actually implement programs to actually combat racism, combat the social determinants of health so that we can see and realize improve health outcomes for these minority populations So Dr. Meyers, I’d also like to ask you, what did the announcement mean to you as Chief of FACHE? Well, thank you so much, I appreciate it It’s a many variety of different things One, I was grateful that the City Council, specifically Blaine Griffin and Basheer Jones, felt compelled to do this and that they were successful in getting this resolution passed So that was a real landmark Part of me thought it’s about damn time,

actually was part of what I thought of, just being totally candid with you And you wanted to smile and be entertained, there you go And that’s what I thought, frankly, but I’m grateful that it’s happening, I’m grateful that it’s a now thing I also thought that this is an opportunity for us to differentiate between what we’ve already described The fact that racism is an individual reality, between two people or one person with biases and other groups of people, specifically black people, and that’s one traditional definition of racism But I liked specifically that this called out the other component, the structural components of our society The very fabric of our society that we as white people have oftentimes held as the safety net for us, and the structure that has allowed us to do well, has actually been the very same structural component that instead of being a safety net, it’s been a web or net that other people, people of color couldn’t pierce through, and that’s been that way for hundreds of years As Dr. Bharmal said, “We’ve known the results of that for decades “on the public health side,” we’ve been able to intuit it much longer than that, but we’ve had clear and present data to reflect that reality I’m just grateful that we’re looking at it now in a way that is comprehensive And it’s, you know, I’m sad in a way that it took another crisis like COVID, to really show us once again, the reality that every single time a pandemic, a public health crisis swings through It has a significantly disproportionate impact on people of color, but grateful, relieved that we’re talking about it and happy to be part of the process Excellent And I think in keeping with this question and your comment, I’m gonna swing back to Naz What is systemic racism and why is it a public health crisis? And I want each of my panelists to think about it and I’ll call on Adam after this So why is it, and what is it, and why is it a problem? Well, sure I loved your definition in the beginning of structural racism It’s like the policies, the practices, the cultural representation, sort of like all the norms in various places that reinforce our disparities or inequities among people And it’s not like something that it’s like a few institutions or a few group of people choose to do, it is pervasive It is, as I said before, it’s throughout so many things to the point where we don’t even realize it until it’s brought to our attention We have a lot of data I think Dr. Modlin will do a nice job, sort of summarizing about some of the health disparities that we know exist just very briefly in primary care, like African Americans are twice as likely to have diabetes than whites, same thing for high blood pressure, same thing for obesity, same thing for chronic kidney disease, you can sort of go down the list In addition to health, we also see differences in education So it’s not just about educational attainment, but who’s getting suspended at school, who’s not, and who’s often being targeted? We see the same things in employment It’s not just about jobs, but who’s in the leadership positions? And then where do we see disproportionate representation? In jails, in homeless shelters It’s often a disproportionate burden of African Americans And I think that’s sort of this recognition, all of these things are interconnected And at the end of the day, what does that lead to? We’ve had for years, a difference in life expectancy, both at the infant level and at the adult level, between African Americans and other groups And that has been shown again and again So that’s how I think of structural racism until we see a closing, a true closing of those gaps We’re not gonna be truly addressing these issues Thank you so much You know, Charles, let me ask you, what evidence as a physician, you’re a urologist, kidney transplant physician, what evidence have you seen just in your practice for systemic racism, affecting health outcomes? If you can just briefly speak on that You know, I’ll just give you one example It’s a difficult process actually, to go through what we call a pre-transplant evaluation That’s an intense evaluation where you have to have a series of medical evaluations,

had scans, x-rays to determine the feasibility of a particular patient to receive a transplant of an organ for transplant, as supposed to staying on dialysis There have actually been several studies that have demonstrated African Americans are less likely to be even, initially even referred for a transplant evaluation to be even told about that the fact that they would have an option to receive a kidney transplant, as supposed to remaining on dialysis We all know that the longer you stay on dialysis, your mortality rate goes up exponentially every year Not only are African Americans less likely referred to a transplant center for an evaluation, they’re less likely to actually complete their evaluation, less likely to be listed for a kidney transplant, wait two to four times as long to receive a kidney transplant, then after transplantation, have a 50% greater incidence of rejection One reason why many minorities are less likely to be approved and put on the waiting list has something to do unfortunately, and I’ve seen this, has something to do with the implicit biases that many healthcare providers, may place upon these patients They may not understand the fact that, some patients have difficulty with transportation, childcare, getting to their pre-transplant evaluations And when they miss appointments, for example, oftentimes their healthcare providers, may look down upon them and think that they’re not a suitable candidate to receive a kidney transplant saying that, “They may be non-compliant with follow up, “following the kidney transplant operation.” And also we look at the individual’s ability to access these very expensive post-transplant medications to prevent rejection And that actually influences an individual’s ability to receive a transplant, if it’s felt that they don’t have access to these anti-rejection medications, if they don’t have a family support system or adequate reliable transportation back and forth to the transplant center So, I mean, these are some examples in my practice that I’ve seen over the past 27 years being at Cleveland Clinic And this is not just something seen at Cleveland Clinic, this has seen nationally, there are several reports that actually corroborate this So there are many more examples, but that’s just one stark example that I’ve seen firsthand Thank you for helping us understand that And Dr. Meyer, this is such a big area of discussion in terms of systemic racism As a physician, tell me your experience And you also had shared with me, when we talked before getting the session going, before you were a physician, some things that you saw in your life before being an MD, if you can kinda help us frame that, your pre and post experience Yeah, before I went to the medical school, in fact, it was one of the inciting events for going to medical school I helped open and operate a shelter for homeless men in the most impoverished area of Louisiana And it was not an emergency shelter, it was a transitional shelter So it wasn’t a three nights and out kind of moment, it was men who were on the streets, had no other place to go and were interested in actually making a difference in the trajectory for their lives We had 25 private rooms and there were three of us, one staff, that’s it And we would meet with each one of these gentlemen and they would apply to come in With part of that process was learning from them and listening and seeing what got them to where they were, understanding their felt needs and what path they wanted to be on And I’ll just say, as we worked through that, it was worked in that place for a couple of years, we had phenomenal experiences We used to shoot a scene, what it was like for us to all go grocery shopping at the same time, going through the aisles, we tended to kind of clear the aisles a little bit with the six carts that we had rolling down, rolling down through the grocery store But anyhow, it was a lot of fun, very much eye opening About 95% of the men who were residents, they were African American, about 95% So very clearly, homelessness was disproportionately impactful But what I learned was interesting, there was one gentleman who was about 35 years old and he had been born in a Southern part of Louisiana in a house, a house that had no running water, a house that had no electricity He was not born in a hospital, therefore he did not have a birth certificate If he didn’t have a birth certificate, he had no social security number and he did not exist,

as far as the U.S. government was concerned He didn’t even exist So all of the equal rights and privileges that you and I take for granted, just were not available to this person And it was stunning to think about the barriers to getting there And the process was amazing to try to get him back into the status of being a citizen and to get a social security number, and establish so that he could begin to access things And you can’t seek employment if you don’t have a social security number, so all kinds of things, but we were able to get him taken care of, we were able to get him plugged in, but time after time, story after story, structural racism, as I began to understand it, really were the barriers, and all the things that the other panelists have described Prior to that experience, my understanding with racism was very limited and focused on the individual with the individuals, and boy was I wrong, So, and what I have seen over the years, as well as additional if time after time, study after study of disparate outcomes for people of color and people of minorities that as you trace them back, it’s linked to the fact that the wealth gap, you know, that African American families have one 10th of the wealth of the average white family, that for in the criminal justice center situation, the average sentence for an African American male is 20% longer than a white male for the exact same crime So it’s those sorts of structural and just embedded realities that make it, make people of color, have so much harder to climb to get to the point of being free from those burdens So just shows up all the time in every setting, whether it’s access to medications, transportation to get to appointments, you name it Excellent, excellent I think that’s important And we are opening Pandora’s box at this point And I think to make sure that we’re all on the same page, let’s crystallize what social determinants are I’m gonna ask you Naz, if you can tell us a little bit more specifically, or summarize as a physician, when we look at the social determinants, if you can just itemize what some of those things are And then we’ll move to how these social determinants and the factors affect what happens Yeah, the way I think about social determinants, it’s a lot of words, but it basically means, it’s like, where the places where people learn, work, live, and play And it’s kind of, it’s the way I sort of describe it, it’s really the conditions around one I agree with the panelists, that race is also a social determinant And the way I think about it is we know that, when you think about a population’s health, 80% of it is not from medical care Only 20% is from actual clinical care, all the rest of that stuff, your health behaviors, your physical environment, your social and economic policies All of those are social determinants of health And some examples are housing, transportation, food, race, and all of those things are considered factors to make one healthy And let me ask you Dr. Meyer, what’s health equity? So we look at social determinants of health, how do you look at health equity? That’s a term that we banter around a lot Let’s kinda weigh in on that Yeah, there’s an access component to it, but access doesn’t ensure equity Access to health is part of the issue And if people don’t have the means, the insurance covers, the transportation to get to receiving health care, and that certainly can impact their health and their health equity But it goes deeper than that, it goes back steps and steps and step The trauma that people have in their life, as far as the adverse childhood experiences sets people up to be less healthy The incessant components of personal trauma and personal aggressions, both micro and macro aggressions that people endure when they are of color, set a person up to be poor in health And so to really get to health equity, not health access equity, but true health equity, where people are on a level playing field from a health standpoint, we’ll take unraveling all of those social determinants

and all of those layers to help people heal to the point where there can be true health equity, not just health access Excellent And Dr. Modlin, if I might ask you at this point, what is the Cleveland Clinic Enterprise doing to address some of the social determinants of health and also some of the things that you’re doing? I know that you’re on the board of governor, and I’m gonna ask this question because to each of our panelists, because each of you are coming from a different spectrum within the clinic enterprise So for you as a physician, being on the board, even telling us about some of the projects you’re involved with, that would be helpful So, yeah, I mean, I appreciate the question There are a number of things that are being done at Cleveland Clinic And behind the scenes, not everybody is actually aware of what is being done You know, Dr. Bharmal, Dr. Myers, are doing a remarkable job leading the Department of Community Relations and our population health initiatives Back in 2003, we actually started our Minority Men’s Health Fair And I always, first of all, let everybody know that it’s a Minority Men’s Health Fair, but it’s open to everybody regardless of race or ethnicity The reason we target minority men, our initial target disease was prostate cancer You know, African American men develop and die from prostate cancer twice as often as white men So we wanted to alleviate that healthcare disparity experienced by men of color That’s one example of an activity that’s ongoing every year or annual Minority Men’s Health Fair And again, it’s an opportunity for men, all men to come in to undergo a opportunity for free preventative health screenings for early detection of disease, health education, health examinations In order to be successful, we first had to become part of the community and develop a trusting relationship with the community So people would feel comfortable coming in to the healthcare setting You know, there’s some things that have happened in the past, the Tuskegee syphilis experiment that have actually interfered with individuals trust with health care organizations and seeking care in these formalized healthcare institutions Not only did we start our Minority Men’s Health Fair 2003, 2004, we started our Minority Men’s Health Center, which is a year round program opportunity within the Glickman Urological and Kidney Institute, Department of Urology, where men of color, we partner with primary care, our medical directors, Dr. Gordon (murmurs) where we see patients, I call it a friendly portal of access So these individuals can come into Cleveland Clinic, get a urologic and a medical assessment If they need to be referred to other specialists within the organization, we do that We actually encourage that every man, every person actually established care with a primary care provider We, as urologist are here to augment that care Since then, we’ve also established number of other programs throughout the enterprise We established in last April, a Neurologic Minority Stroke Center within our Neurological Institute We’re developing a program and we just started a couple of weeks ago, our Multicultural Kidney and Hypertension Center of Excellence And we’re developing programs in our Digestive Disease Institute, our Cardiovascular Institute, we have a Dermatology Multicultural Skin and Hair Center All of these institutes represent different areas of medicine around organ system and disease states And in every specialty of medicine, we have seen a higher incidence of healthcare disparities, chronic diseases, poor outcomes, especially in minority populations And that’s why we’re establishing these specialty health equity centers throughout the enterprise I call the overall initiative, the Multicultural Health Center of Excellence, because really it’s our responsibility, Cleveland Clinic being the leading healthcare organization in the world, I think we can represent our best practice in terms of showing other healthcare institutions, what can be done if we put our collective minds and medical expertise into solving these healthcare disparities It’s not only about improving access, it’s also, we’ve talked about eliminating social determinants of health, but it’s also about improving clinical care and clinical aspects of cultural competency, reducing implicit biases, but also encouraging minorities to participate in research that is so necessary to advance the science and medicine There are examples in medicine where we’ve discovered medications that are more efficacious, more effective in minority populations in terms of saving lives There’s a medication called BiDil, used to treat congestive heart failure, that’s very effective in African-Americans, has less effect in Caucasian Americans So we need to do more research, encourage more minorities to participate in research so we can discover more effective therapeutics I read an article recently, there was a, actually 2008,

an article about a certain medication that was available to treat multiple sclerosis And out of about 800 and some patients in the study, only 13 African Americans were enrolled in the study, but African Americans represented about 20 to 30% of those individuals who were suffering from that disease And so that just underscores that we do need to have a greater focus, concentration and effort in terms of conducting healthcare disparities research At Cleveland Clinic, actually, another thing that I would like to announce that maybe everybody’s not aware of, we were actually building a biorepository building, a biobank building, which is going to focus our clinical and basic science efforts to addressing and performing research into elimination of healthcare disparities It’s being built in the Fairfax Community, the black community on Cedar Avenue And really that is remarkable example of the leadership of Cleveland Clinic supporting our efforts to address these healthcare disparities Excellent All of you certainly have grit and you all have resilience and helping to make our City of Cleveland better And I think our participants today and our viewers will see this As we’re living in the era of COVID, Naz, I hope you guys don’t mind me calling you your first names we are friends, but all physicians But Naz, what are we seeing with COVID-19 and health disparities? Yeah, so COVID-19 is like blowing open our disparities, especially among, racial ethnic health disparities I would say, you’re hearing this thing double, that’s the same thing with COVID-19 African Americans are twice as likely to die from COVID-19, than other groups in general, and that that had persists We also see increased rates just to be complete for the Latinas population, for Asian Americans and as well as native Americans So wanted to just put that out there, that we are seeing a disproportionate effect on communities of color And, you know, I think it’s been an interesting journey because it has helped transform some of the work even in our clinic So we’ve had a community health strategy where we’ve outreached to both patients, as well as community members, to understand their sort of needs around COVID, both in terms of like health behaviors, the social distancing, the wearing the mask, don’t touch your face, like I’m about to do, as well as understanding other things that they might be (murmurs) social isolation, or understanding if they have any social determinants of health, food needs or safety needs And it’s been an interesting process because I think through that, we have learned that, there’s this greater increasing recognition, not just about social determinants, but as our panels have said, “Action on it.” And we have a community health strategy at the enterprise level that it’s now gonna be focused on populations that are clearly disproportionately impacted by things like that So racial and ethnic minorities, or those with limited English proficiency, or older adults with a lot of pre-existing conditions or those who live, who are economically disadvantaged or live in concentrations of poverty So making sure that we are really impacting the neediest so we can really lift up health equity And the only final thing I’ll sort of say about COVID, is that there are sort of, it’s really been driven, these sort of racial ethnic disparities by a couple of things Like, yes, the preexisting conditions that we talked about before You have diabetes, if you have high blood pressure, some of those high risk conditions, you are more likely to die And we know for example, that in general, African Americans are more disproportionately affected, but also in general, African Americans are dealing with a lot of social determinants of health They are either the neighborhood conditions that they live in, make social distancing, can be difficult They might live in multi-generational homes They might be frontline workers We know that there’s a disproportionate essential workers that have to be there and contact, food service, custodial, as well as transportation workers And we know that accessing health care, as some of the panels have talked about, there’s a stigma There’s still a stigma that exists, and it can be difficult about who to trust, when you’re feeling unwell and where you can get your information from So I think those are all the things that we’re seeing with COVID In a way it’s been helpful in terms of really helping people understand what racial ethnic disparities exist Thank you for your comments And Adam, do you think that COVID-19 is helping

to fight racism directly or indirectly? Yeah I wanna take one quick step back and then only answer that question Sure And racial social determinants, an example I like to give of how social determinants really work well or work, is if you think about lead poisoning for children, that affects in a very disproportionate fashion communities of poverty, where they’ve had houses, where the paint has been painted over and painted over and painted over and never been stripped, never been fully sealed, never been mitigated, there’s dust of paint on the floor So those children in those communities, are disproportionately affected So there’s a clear health outcome from that, that people who are children who are exposed to lead, get lead poisoning, and it has potentially longterm neurological results and developmental results So this is essentially a housing problem that is demonstrated by a health outcome, that’s sort of the definition in my mind of a social determinant of health It’s a housing issue that has manifest in a health crisis So that’s just sort of an example for what social determinants of health really sort of means But COVID, is it a cure or a solution in racism? No, it is not In fact it is devastating to many communities as we’ve described, but in the event, in the possible event and the hoped for event that we can take this moment, this moment where we’re recognizing this and turn it into a movement where we’re acting upon it, then it can be a catalyst for change I don’t wanna give too much credit to COVID because it’s a nasty beast of an infection, but at the same time I will take the crisis And we have an opportunity here to use it as a catalyst, and I think in that way, it’s a good thing Excellent Nazleen, I’d like to ask you, what is our bridge to recovery? If you can just think about that (laughing) Thank you, Linda There’s more question (laughing) And for the next eight hours And I’ll hand it over to my team colleagues (laughing) You know, there’s a number of bridges I think first and foremost, I really wanna acknowledge Cleveland Clinic efforts as well as being a collaborative partner with others to really address, being part of the solution to address racism as a public health crisis and wanting to lean in on it So just first and foremost, I think what we talked about in the beginning, naming it, naming it, and having people come together as a rallying cry So I think that is a one bridge I think another bridge is recognizing the work that we sort of need to do internally So we’re caregivers and we know that we all have biases and prejudices and really sort of understanding that this moment as was so well stated by Dr. Meyers, also allows us to do some internal reflection And where we stand just as being physicians, we are in places of privilege, we are in positions of privilege and regardless of what race, ethnicity, gender we are And so recognizing what that means, I think, and we can advocate, but it would also be great if we could bring others with us who might not have that voice to be able to do that with us So I think those are some of the beginning bridges, not definitely not extensive And I think the more that physicians or clinicians sort of get involved, we’re just trusted voices in the community, and we should own that And we should help to use that, sort of platform to advocate for issues that we are seeing in our patients and we are experiencing ourselves Excellent And I wanted to ask Charles, thank you so much, Naz Charles, I know you’re busy with doing so many different things Tell us a little bit, about the Governors and Minority COVID-19 Strike Force, just a few words about that if you don’t mind So I wanted to real quick address your question about, what is the board of governors doing to mitigate, the impact of racism and in terms of health outcomes? So the board of governors is actually under the leadership of our CEO, Dr. Mihaljevic and our Chief of Staff, Dr. Wiedemann, has taken this very seriously in terms of promoting diversification of the healthcare workforce, especially the physician minority staff Only about 4% of U.S. physicians are African American And the reason that is of importance and consequence is that

we know African American physicians, are predominantly the ones who actually go out into the communities and engage minority populations, improve their health literacy and health education, encourage individuals to adopt healthier lifestyles, get preventative health screenings You would never actually recognize yourself, Linda, but you actually are the first ever black surgeon at Cleveland Clinic in the history of Cleveland Clinic And I called you, I really admire your leadership with that respect I’m actually the first African American urologist, the first African American kidney transplant surgeon in the history of Cleveland Clinic So we wanna get past a lot of these first, we know that it’s very important in the eyes of the community, that in many respects, not everybody, but many individuals feel more comfortable being seen by a physician that resembles them, that looks like them that maybe have maybe come from the same background that they come from And so, and we know that diversity inclusion leads to improved health outcomes of our patients So I know one thing that Cleveland Clinic is doing under the leadership of Le Joyce Naylor, the Executive Director of the Diversity and Inclusion office We’re having a listening towards called Lift Every Voice where it gives an opportunity, not only for physicians, but all Cleveland Clinic, 70,000 caregivers, to give feedback to the leadership in terms of what the caregivers are feeling, during this COVID crisis, during the racial tensions that have developed So that’s what the board of governor is doing, and we’re taking it very seriously I know you were also a member of the board of governors You were actually the first African American member of the board of governors also So you’ve been leading the way here I’m actually proud to be on Governor Mike DeWine’s Ohio Minority COVID Strike Force, which he formulated back in March because he realized the disproportionate burden that COVID was having on African American populations Not only African Americans acquiring COVID, but having more severe disease, dying more readily from the COVID virus So he developed this minority Strike force, it’s comprised of individuals across the state of Ohio We come together and we’re formulating recommendations through the governor in terms of what actions should be taken We’re not developing a document just for the sake of developing a document, that’s going to sit on somebody’s bookcase or bookshelf These are action-oriented recommendations that we feel need to be implemented so that we can actually not only mitigate, against the devastating effects of COVID in the minority populations, but get to the underlying causes for these higher rates of COVID and COVID mortalities which relate to the pre-existing medical conditions, the healthcare disparity So Governor DeWine actually in a press conference said that, “These are gonna be sustainable goals “It doesn’t end in terms of, “when the COVID pandemic is over.” These guidelines are our objective recommendations that we know will be effective in terms of improving health outcomes, and mitigating the social determinants of health for the long haul So I’m a proud member of that, I’ve been working with Dr. Bharmal, so we can actually increase additional testing locations in Northeast Ohio I know Dr. Myers is intimately involved with the identification of testing locations So we need to promote better education, better access to COVID testing And we have to devise better strategies to communicate, the importance of all this Thank you so much, a lot, a lot of information I’m gonna turn this next question to Adam, Dr. Myers So what are our short term, our six months goals, our 12 month goals, our two year goals as an enterprise? You’re leading, all of you are leading this effort, but give us a hint What do you think is gonna happen? First, the quickest things that we can do and then moving forward And there’s a couple of different things There’s an internal focus on what’s happening inside the areas under our direct control What do I mean by that? What are our hiring practices? What are policies around how we prepare people for advancement and promote people? What are our policies about how people stay on board in a good standing as an employee? What are our pay structures? So there’s that internal focus component that’s getting attention right now But then there’s also the external focus that I think is gonna be really, really important What we started with is seeking to understand, which is really important That’s seeking to understand is encouraging each one of us to look inward and figure out where we are in this process

And part of the Lift Your Voice process that I’ve been very fortunate to participate in, is a listening process It’s an opportunity for me and lots of other people to get together and hear the voices of people, of what does it mean to be a minority person, a black person in the United States? I can never understand, fully understand and grasp what it means to be black I can’t do that It’s not possible, but I can listen to people who do, I can listen to people who experience it day in and day out I can listen to people who walk into a restaurant and get side glances I can listen to people that are at a public swimming pool and get glimpses where people wonder whether they belong there I can listen to people that are debating, as an African American male, do I put a mask on for COVID to protect me, but does that make me more suspect in public? Because I’m a black man, I’m wearing a mask I can’t fully understand that as an individual, but if I listen and seek to understand then we can do that So that’s step one for the clinic And we are gathering a group, beyond the Lift Your Voices, there is a group coming together that we’ll have executive sponsorship, that we’ll have members broadly from all levels of the clinic to share those voices, to bring the material and messages that have been heard in Lift Your Voice, to bring concise actions, possibilities together, vet them, and then advanced them into a formed policy So do I know when all that will encompass, over the next six months, two years, 12 years, 100 years? No, I don’t But what I do know is that as a process, it is underway, we are taking it seriously It will involve lots of listening, lots of people smarter than I am, coming together, coming up with solutions And the important thing is I know that are also involved commitment on the part of the clinic to both partner internally, to mitigate biases in the way we treat, biases in access to healthcare, biases from the standpoint of implicit, biases surrounding hiring practices, et cetera, promotion and diversity at all levels of the organization But we’ll also develop very specific strategies to collaborate with others externally to what can we do to help pierce holes in that fabric of our society that had been an upward barrier so that people who have been held back can prosper So it sounds like Adam, that we need allies Oh my gosh And what type of allies do we need? You and I talked about the issue of being color blind Let’s kinda merge these two questions I know it’s a lot, but if you could just summarize what that means to you, how do we work together, what type of allies? And tell us more about that Yeah, the whole concept of being color blind is, in my mind, it’s a farce For one it’s not possible I don’t think it’s possible for another human being to look at another human being and not notice their color, their skin color and for what their ethnic background might be, plus even if it were possible, it’s not desirable And what do I mean by that? It’s the goal, the final outcome of this is to not move from not seeing it, but to move to seeing it, embracing and be inclusive of race When we deny the reality of a person’s color, we’re denying an aspect of who they are And we’re also, and more importantly, I think this is one of the driving forces behind it When we say we’re color blind, we are then denying that any conversation about racism with me as a person is irrelevant because I’m color blind It doesn’t, it’s not a big deal for me You know, when Dr. King said that, “He imagined a world in which he would be not color-judged “by the color of his skin, “by the content of his character.” He was not saying, please don’t view me as a black man He was saying, “Don’t judge me and my value because I am black.” He absolutely wanted to be regarded as a black man, wanted to be understood as a black man, but just don’t judge me based on my skin and my skin color alone That’s something that most white people, have never experienced So the process of being color blind is a farce Even if we could do it, it wouldn’t be desirable And you know, in order to be good allies, we have to be honest with ourselves We have to be honest about this process and about the fact that this is real

It starts when it admission that it is real and a willingness to move past the fact that it’s uncomfortable to think about the implication of all these things and a willingness to recognize your privilege, to educate yourself about it, to check in with black colleagues and minority colleagues and invite them to safely up, to understand that not doing so and being silent is being complicit in the process And then seek wherever you can within your individual scope of influence to hire, promote, and support black professionals as you move forward So those are some of the things that we can do as allies And that’s some of my very specific opinion, about the whole concept of color blindness Thank you so much And I certainly celebrate your thoughts about the need to have allies And recently there was a visual mentor model that was developed by Dr. Andrew Abraham at the University of Michigan that described how individuals can become anti-racist And I like the visual because it helps us to move from a zone of fear, to a learning zone, to a zone of growth So I’d like you just to look for a moment at the sobering question that this visual detects Becoming an anti-racist in terms of the first zone, the fear zone, it says, “When you’re in the fear zone “that you strive to be comfortable, “that you only talk to people that look like you, “that you, I deny racism as a problem,” but as you move and evolve and move to the learning zone, what happens? You began to listen to others who think and look differently than yourself You might seek out questions that actually make you uncomfortable You educate yourself about race and also about structural racism and finally the growth zone, the most powerful zone that we should all aim for As that you begin feeling uncomfortable with being, and hearing racial statements, that you can sit with being having discomfort, that you can speak up and that you can address these issues So again, the allies that are listening, as we all move forward, we can become anti-racist and move our society forward I’d like to just ask as we think about learning, are there any resources that each of you could suggest to learn more to how we can support the efforts to become anti-racist? And just a small 30 seconds or so, if you could comment With resources, books that you’ve read, things that you’ve looked at, podcasts, one or two things, or I don’t know Naz I love “Race Matters” by Cornel West I read that a long time ago, I still think many of those things are true If you’re looking for health data, the Center for Disease Control, the websites, I think it’s a lot of information, but a lot of great information And if you’re looking to implement things at the organizational level, there’s like sort of racial equity lens through ProInspire that you can download online and that’s available too And finally, if you wanna talk to your kids about racism, CNN did a really nice town hall about how to talk to kids about racism, and especially what was going on with the protests and continue to happen So I think all of those things are great resources Charles You know, so there are a number of things One of the best sources that actually has inspired me and educated me is the website, the Healthy People 2000, website can go back to Healthy People 2000, 2010, 2020, 2030 pretty soon Also, a local author, Mr. George Fraser I read a couple of his books, “Success Runs In Our Race” and “Race For Success,” those books are very important in terms of inspiring our youth, our young African Americans, to be proud of who they are, promote their self-esteem, let them know that they can actually achieve whatever they set themselves out to achieve You were talking about how we need to, Linda, how we need to collaborate with others and work with others across our racial boundaries I went back and remembered I wrote an article in when I was at Northwestern in the College, back in 1992, called “Self-imposed Segregation Leads to Misunderstanding Among Races.” So this means that I’ve been working on this and thinking about this for decades, you know, 40 years And I’m proud to see now that the nation is focused

and talking about racism, its impact on health outcomes Again, so I’m very hopeful Thank you To a lot of these racist Thank you And also Dr. Meyer, any resources that you might have? Yeah, a couple There’s a book by Frances Kendall called “Understanding White Privilege,” “Creating Pathways to Authentic Relationships Across Race,” another one called “White Fragility,” which is a new book, that’s really fabulous It’s by Dr. Robin DiAngelo, and that one’s about why are white people so uncomfortable talking about race? Where does that come from? It’s about that whole discomfort and moving past it component There’s another resource that I go to for “How To Have Conversations,” period If you’ve got a crucial skills.com, it’s the crucial conversations people, they, you can subscribe to an email service that sends out little snippets several times a week of different scenarios And they’ve been particularly good lately, about trying to find shared meaning around topics and conversations of racism And then the final thing I’ll mention is, there’s an author named Clifton Taulbert He grew up in Southern Mississippi, is in a sharecropper’s cabin He’s personal of mine He was formative in my early years of working with the homeless and in different situations Any book by Clifton Taulbert will blow your mind and broaden your horizons about the realities of this in our world Excellent And if I can even add my two favorite, I have many, and I think we should also start a book club, but that’s for another discussion, but my two favorite are the “Color of Law” and also “In The Warmth of Other Suns.” So I think we could start a book club within the greater Cleveland Community, and we’ll talk about that later, we all have so many ideas But to each of you, I just wanna personally thank you for a robust conversation that will be transformative for our enterprise and our greater community We assert that racism is a public health crisis You all have noted that the effects of racism, cumulates over lifetime, Inaction, indifference, and institutional racism, has deleteriously affected generations of black and brown people And as we move forward, we must get this right You have reminded us that silence is not an option And if we tackle this, if we tackle this like we tackle cancer, COVID-19 or AIDS, we will find a cure There is a bridge to recovery There won’t be a vaccine to halt racism, rather, we must all be advocates for change by speaking up, speaking out and educating our friends, our families and our community Policy changes, greater investment in public health, robust community and government partners, and stakeholders must all stand with us And before we end our session, I’d like to just take a moment and share with you an important message that relates to the conversation we had today As doctors We know African Americans are more likely To acquire and die from complications of the COVID-19 virus Why? Because people of color suffer from higher rates of chronic medical conditions Like diabetes and obesity High blood pressure Heart and kidney disease And asthma All of these lower our immune system and the ability to fight off viruses Being an essential worker And even using public transportation Increase the risk of getting COVID-19 But we can better protect ourselves and others from the virus Washing your hands Not touch your face Wearing a mask in public Social distancing Eating better, exercising, getting more sleep And visiting a primary care provider for health checks Will all make a difference If you have questions, call the number on the screen And visit our website Let’s work together to save lives And be (murmurs) Thank you to all of our viewers for joining us for this program We hope that you have enjoyed today’s session Please share this with your family and friends on social media too A copy of this session will be available on our website, clevelandclinic.org/celebratesisterhood Just as a reminder, this event was pre-recorded If you have any questions, about the information shared today, please email at celebratesisterhood@ccf.org

Also, mark your calendars and inform your friends of our next virtual session, that will be on Thursday, August 27th Our Cleveland Clinic experts will be Dr. Lyla Blake-Gumbs and Rev. Amy Green The topic will be Staying Well During the Pandemic And Why Self Compassion Is Not Self Indulgence Visit clevelandclinic.org/celebratesisterhood to register Remember, we are all in this together and here to help you If you need an appointment with Cleveland Clinic provider, please call 866.320.4573 or visit clevelandclinic.org/appts Please stay healthy and stay safe and wear your mask ♪