of the relative quiet and introduce myself to those of you who I've not met. I'm Lauren Black, we have met. The Chief Equity and Engagement Officer here at Correctional Health Services. And I'm super excited. Have any of you had any anti-bias training before? Yeah, through DHS or previous? Anyone at DHS? Okay, so this is really exciting to me because it's the first time I think it's been brought into Correctional Health Services. So, and this is a gift to us through UCLA, the, oh, I know I'm gonna screw up the acronym and I will let Dr. Young-Mercado introduce it. But we are able to have this presentation because of their grant funding. And the fact that we were, please join us, come in. The fact that Dr. Henderson actually supported and brought this forth. So I really, I wanna take a moment and be appreciative to him and to all of you who are being here today. You do need to sign in to get credit. We really are hoping this is an ongoing dialogue. This is just one of many conversations that we need to have. And I'm super excited to introduce Dr. Young-Mercado. She was previously part of the county world, I think. And now she's at Morehouse. So she is here with us virtually today and hopefully in person later on. She is a president of the Black Women's Physicians and an assistant professor at Morehouse School of Medicine. And I am really excited to introduce you. And as you guys can see, she can see you and then she has a camera here. So if you do wanna address her, all we need to do is have you come up here so she can see you and hear you. And I'm excited to have this dialogue. So thank you so much. All right, so I believe that that's my cue to go ahead and get started. Well, welcome everyone. I just wanna say that I know how busy you are, how hard you're working. And I get that taking this time out of the day may seem like, why do I have to do this? But I'm thankful that you've been offered snacks. So maybe this is just a time for a little reprieve from the day-to-day work. Now we are gonna talk about a difficult topic today and I'm gonna go into some details. But first, I just wanna say that, let's make sure I'm bouncing the slides. Okay, so no disclosures. We're not making any money doing any of this. We are just presenting this to you. So no products, no reselling of anything. This is me. Can you guys all see the slides changing? No, the slides actually are not up. They're not up? Okay, hold on. Let me go back to Teams. Thank you for letting me know. No one else can see the slides too, right? Okay. So we have the presenter view right now. Okay, let me go ahead and I see. We present. It was just on and I was moving things around. One more. It's the next one. There are two presenter views. So I know what I'm gonna do is, and it's not gonna be in front of me. Okay, that's it. Give me just one second. Let me just do one thing. While she's doing one thing, let me give you a heads up that before you leave, I'll also need you to sign out or just do your initials really quickly. It's just one of the things UCLA requires and since they give us the credits for continuing ed, we will do whatever they want. Okay, how about now? Perfect. All right, great. So let me go on. I present view. They had it perfect and I just started playing with it. Okay. Now let me see. It's like an advanced. All right, so this was the title slide. Yep. No disclosures. This is me. All right, so one of the things that we wanna do today is actually have some community agreements and aspirations. What would make this a safe place and respectful place to actually learn? What we wanna do is listen actively, respectfully, speak from our own experience, stay curious. Don't be afraid to respectfully challenge one another by asking questions, but also clarify maybe some nonverbal communication. So if someone is quizzical or looks like they're taken aback by something. And then also understand that discomfort is sometimes an indication of growth. So notice any discomfort you might feel. And then we also want to validate the lived experiences of individuals who may be people of color. And sometimes what happens when people of color share their personal experiences with racism, they're dismissed or they're questioned. And so it's crucial to approach stories and experiences with respect and validation. So their experiences, our experiences are reflectful of real and impactful truths. And instead of becoming defensive, focus on listening with empathy and acknowledging the validity of those experiences. So this helps to create an environment where voices are respected and everyone's experiences are understood and integral to the conversation. So now what we wanna do, we're gonna just jump in really quickly with an activity. So I'm just gonna have you partner up with someone who's next to you. If you can't form a group of two, go ahead and form a group of three. Okay, you have your partner? All right, perfect. So I just want you to look at them and we're just gonna take 30 seconds to do this. You're gonna look them in the eye and just say, I affirm your truths. So one person says it and then the other person says it. Go ahead. I don't know if you've had a great internship. I've had a great time, personally. I hope that you too, today. I don't think we've had a good opportunity. I haven't looked at what you're doing. I'm looking for something that's a fragrance, maybe. Oh, okay. Okay, well, it's nice to see you again. I just called you for my- Thank you. Yeah, it's so good to see you again. Okay, great. Thank you, everyone. So in our time today, this workshop, this session, and I do want to acknowledge that this, we hope is a first in a series of sessions. And today we want to focus on gaining a common language for understanding bias, whether it's personal, individual, or systemic. And in future sessions, we will be focusing explicitly on challenges and solutions that we can implement. So today is more of a resetting, reframing, and developing that common language. So we are going to talk about the critical role that you can play in combating health and racial disparities, particularly within your setting. First, we're going to start off by discussing bias and stereotypes, and the impact that it has on patients. We're going to understand the components of the impact of systemic racism. And this is the portion that we will likely get to at a future date, but identifying the strategies to implement equitable health assessments in the correctional health setting. And so I just want to say, stay tuned for that. You will hear information on more specific on day-to-day operations and how we can improve things at a future workshop. Okay, we're all good? Great. So let's start off with what is implicit bias? Some of you guys might've heard back in the early 2000s, there was a paper that was published that really looked at implicit biases. And because we've likely heard this information before, I'm going to move through this relatively quickly. So there are attitudes and stereotypes that affect our understanding, actions, and decisions. And sometimes it can be in an unconscious manner. It's errors in cognition. It can be involuntary, where we don't necessarily have awareness that we are acting in a bias. And we defer from explicit biases. Explicit biases are things that we would expect to see as that's apparent racism, or that's apparent homophobia, or that's apparent sexism. And those are things when people make explicit comments to individuals based on some of those protected characteristics. And then implicit biases may not necessarily be accessible only through introspection and looking and understanding. And so therefore, we have to have models and ways to acknowledge or look at whether we have specific biases. And so in defining biases, we can use the SEEDS model. So some biases, again, they are looking at things that are similar to us. We prefer things. So people like me are better than others. Expedience, if it feels right, it must be true. Experience, my perceptions are accurate. Distance, closer is better than distant. And then safety, bad is stronger than good. So, Dr. Anwargado, I think that we're not moving through the slides, so we're still on our time today. Oh, okay, here we are. Thank you. So that's implicit bias, that one, and then this is the SEEDS model. And so the question is, sometimes when we're faced with biases or the term biases, we may have a hard time accepting this. So why is it hard for us to accept that we have biases? It could be that we have bias blind spots. So we are all quick to detect and criticize bias thinking in someone else. You know, their thinking and decision-making, but we believe that ourselves, that we are far less susceptible to the same biases. The other thing is that there's a reward circuitry and pain matrix in our brain, and we really don't want to do things that make us feel bad. We would rather do things that make us feel good. So if we say that we have bias, that might make us feel bad or feel ashamed. However, that's one of the things that we'll be addressing today, is that it's not necessarily to feel biased or just to feel ashamed or to feel wrong, it's to acknowledge what it is and then move forward from there. So again, what are some strategies to accept that we have biases? So we've got to educate ourselves. We have to become familiar with the research and the real world consequences of bias. There's an article, the Neuroleadership Institute SEADS article, I referenced the SEADS model earlier, and that's something that I will provide to Lauren and also to Mamta to present to you guys. And then you can also watch the AAMC Unconscious Bias module. Additionally, you can take the Implicit Association Test. Has anyone ever taken this test before? If you have, raise your hand. Okay, I see a couple hands go up. So this is a basically a test that's been given to millions of folks. It's run by Harvard. And I actually took this test when I was a medical student. And so now we actually have a lot of data based on the research that they've done. This type of test helps you to look at your individual bias in your own personal setting. You don't have to send your scores to them, but it is something that's sort of like a check and balance. So ones that folks have done in the past are particularly the race bias. I believe there's also one on color. And then you can see that there are other biases or other implicit bias tests that are available. But this is the one on race. So what we're looking at right now, this is a distribution of the summaries, again, of that 3 million scores. And this is between 2002 and 2015. So in that test, that race bias test, so in that test, that race implicit association test, they wanted to see whether folks had a strong automatic preference for European-American compared to African-American. And they found that it was a high percentage at 24%, or if they had a moderate automatic preference for European-American compared to African-American. And that was 27%. So we're almost at, you know, we're just over 50% of all of these folks, these 3 million folks had a strong or moderate preference for European over African-American. And then those same individuals, now we break this up by demographics. So by gender, was it male or female who had more bias? And here, this shows that those who identified as male, and understand that, and I understand that this does not have all the gender categories, and I'm acknowledging that, but those who identified at male at that time, it was, you know, over 3.35 had more of a bias. So over 0.35 to 0.65, they have a moderate bias. So this is male. And then we look at age, who are the folks, who are the individuals age-wise? And so we see that folks who were 65 and older, look at that, they go past the spectrum. Can you guys see my pointer? Yes, sir. I don't know. No? Okay, here. Okay, how about now? Yes. Okay, so you can see here that it is also in the moderate bias range, but much higher than the other age groups. Then we look at, you know, what is their level of education? And we see here that those with MD or those with MBA, they are also in the moderate bias range. And then we look at political identification of all of those 3 million people who took the test. So where would they likely fall? So we see here that those who are strongly conservative, moderately conservative, or even slightly conservative, demonstrated more bias than those who were neutral, slightly liberal, moderately liberal, or strongly liberal. And then finally, they look specifically at those who identified with a certain racial or ethnic group. This is actually just racial groups. So we see here that East Asian, and this is not clearly defined on this portion, but that there is a slightly higher, they're slightly higher than others with a moderate bias. Here, for those who identified as Black or African American, they were on the negative spectrum of this. And then those who identified as white or Caucasian, they were closer to the line as far as being in the moderate bias area. So one question that people often ask is, well, if it's an implicit bias, if I don't know, what can I do? And again, that's where we go back to doing things like this, having sessions where we actually talk about it so that we are aware. And then also recognizing that there are tools and strategies available for us. And again, we won't be getting to all of them today, but we will be just going in a little bit more detail. So when we look at biases and we look at healthcare, we have to understand that biases, whether implicit or explicit, have a direct effect on the health, particularly of marginalized populations. And so what can we do? So Harvard released this report in 2003 titled Research Reveals Path to Effective Anti-Racist Change in American Healthcare. Now, what they found is that we actually have to go beyond just measuring health disparities. We actually have to do more. So we need buy-in and sustained engagement from leadership. That's one. We need to use explicit language to define systemic racism. That's what we're going to do today. So we've got these two parts. We've got buy-in, and then we're going to do this part today. We need clearly defined metrics. That's in the future. Effective organizational infrastructure. That's something that may also be in the works. And then internal capacity and professional development. So we are also doing the professional development piece today. Now what I'm going to do is we're going to transition to a clinical case. And as we are going through this case, I'll be asking questions. So feel free to, yesterday we used the chat, but today feel free to go ahead and come up and speak, or you could just speak out as well because I can hear in the room. All right, so is anyone close? Would anyone like to read this first portion? We are not on the slide yet. Almost there. There we go. Can someone help her out? Anyone feel a desire to read? Bethany Bailey is a 23-year-old woman who presents to the emergency department with severe acute pain in her lower back and leg, which she described as excruciating. She reports that the pain began abruptly and has progressively worsened over the past 24 hours. She also reports that the pain is more intense than previous episodes and states that she feels pressure in her chest and feels out of breath. No, please begin at 9-9-0. Can I keep going? Sure, thank you. Her past medical history includes sickle cell disease, diagnosis in childhood. She has chronic pain that's based on regular opioid therapy, and she has no history of recent hospitalization. Her medications include hydroxyurea, bacterial melanin therapy, oxycodone, 15-milligrams, ibuprofen, and salicylaldehyde remedy for pain, which includes folic acid, 1-milligrams. All right, you're welcome to keep reading, but do we have another volunteer? Oh, come on, someone wants to relieve their colleague. Yeah, thank you. We have a volunteer. All right. Social history, education, BA from USC, Occupational Administrative Assistant, substance use, denies recreational drug use, support system, lives alone, extensive local family support. Vital signs, blood pressure is 108 over 69. It's a little decreased for her. Her heart rate is 112. She has tachycardic. Respiratory rate is 28, and it's increasingly labored. She has a fever of 100.4 degrees Fahrenheit, saturating at 90% on room air. Physical exam, general appearance, she is distressed, appearing in severe pain, cardiovascular, irregular rhythm, no murmurs, rubs, or gallops. Lungs are clear to occultation bilaterally, tachypneic, musculoskeletal tenderness in the lower back and legs with decreased range of motion due to pain. All right, so before moving on to the next one, we're getting a sense of what's going on with this patient, what's likely happening with her. Anyone can speak out, but OK, let's go to the next side. So laboratory tests are CBC, notable for hemoglobin 7.2. White blood cell count 11.5 platelets 300. Particulocyte count is elevated. Purple blood smear shows presence of sickled cells. Comprehensive metabolic panel is normal. All right, so what's happening at this with this young lady? So she's in a sickle cell crisis, right? But there may be more, so let's keep going. X-ray of the lumbar spine is normal. OK, if you want to keep reading, that's great. Can we have another or we can offer another volunteer so everyone can participate who wants to? Someone up front who can see. I'm up front, but I will do my very best from the back. Dr. Smith, an ER physician, reviewed Stephanie's medical history and noted multiple prior visits for similar pain episodes managed with opioids. Given her history, they were concerned about potential histrionic and drug-seeking behavior. Dr. Smith focused on managing her pain conservatively, ordering IV fluids and acetaminophen while monitoring her response. OK, any comments about that? Not addressing her abnormal lifespan or her pain, right? Stephanie's condition began to decline. She experienced worsening chest pain, increasing respiratory distress and a notable drop in oxygen saturation. Dr. Smith ordered additional tests and interventions. Clinical management, hypoxygen administered, chest x-ray and blood gas analysis ordered. Stephanie's condition continued to decline. She exhibited shallow breathing, cyanosis. Despite Dr. Smith's intensive efforts, including intubation and the administration of appropriate medications, her condition did not improve adequately. Stephanie went into cardiac arrest and did not respond to resuscitation efforts. Time of death, 1532. All right, so let's debrief this case. So I know that that was probably not unexpected. So someone comes in with a sickle cell crisis. But she also had what? What else did she have? So she had acute chest syndrome. And one of the things that we saw was that there was a focus on her opioids and some of the other symptoms that she had were forgotten. And so. So sometimes when patients come into the hospital and I'm going to share a story of mine. Can you guys see this? The slide? Yeah. OK. It's assumed automatically that they're pain seeking that or that they're drug seeking. So. When my mom when I was in medical school, I lived in L.A., my mom was in San Francisco. And literally three days before every single major exam I had, I got a call from her in the emergency department at SF General, letting me know that she was crying, that the nurses weren't listening to her. And they thought that she was there just to get drugs. And I had to explain to them. So I said, OK, mom, put me on the phone. So I let them know my mom had ovarian cancer. She has a history of small bowel obstruction due to adhesions. May you please admit her and call her for treating physicians. But before she even got to, you know, the place of them recognizing or going through her chart to see that, you know, she had that history of ovarian cancer, a decision was made. A biased decision was made and that clouded their judgment for the rest of her care. And so this is what we're doing right now. We're looking at how can we disrupt that? How can we disrupt that type of immediate assignment or immediate labeling to take a step back and look at the whole patient? And I know that that's something that they're working on at DHS. I know it's probably hasn't gotten to your setting right now, but they are looking at whole person care. And so looking at that whole person, their whole chart, not just the medications. So what was the role of unconscious bias or racism in Bailey's case? The consequence was that there was a delay in recognizing and treating her acute chest syndrome. And that may have, again, stemmed from the fact that Stephanie was undervalued. Her experiences or her presentation was exaggerated or not genuine. I remember Dr. Smith thought she was hysteronic. So she was crying. And, you know, why are you crying so much? Right. And that can be the case if someone has not treated a sickle cell patient before. Or actually, it's worse if the person has been to the hospital, to that particular hospital, multiple times. They're called frequent flyers or, you know, they're always here. They always want drugs. Those are things that I heard over and over again in hospital settings. So we want to go ahead and we want to talk about, you know, the word racism. So racism can manifest in health care in both overt and also subtle ways. Right. And it does affect the quality and the timeliness of care. Now, I know what you, some people might be thinking. You might be thinking, but was that really racism? Was it or was it just the fact that, you know, that the doctor, yes, you had a bias or they had a bias and they, they didn't make the right decision. They made the wrong call. Right. And that's what we hear often. But if we don't take a step back, if we don't take a step back and look at the root cause. And if we don't address that root cause, then cases like Bailey's will continue to occur in our health care system. And if we don't address that root cause, then cases like Bailey's will continue to occur in our health care system. So what is racism? Racism is racial prejudice plus power. So I want you to think about that for a minute, because a lot of people can be prejudiced. Right. We can be prejudiced against a lot of different things. But what makes racism different? There's a lot of things. There's a prejudice plus someone has the power to do something, the power to decide whether someone gets a job, the power to decide whether someone's admitted to, you know, nursing school, PA school, dental school, or not, or to a residency program, right. To decide whether they get a medication or not. So it is prejudice plus power. So was this racist? Yes, we can say that. Because it was prejudice because this patient, and if you recognize there were some terms that were used, you know, the histrionic. And then, you know, it was prejudice because it was prejudice. And then there was the power to decide to withhold treatment. That's where the power piece comes in. And so this is what we're looking to check. Are we looking at our patients and seeing them, seeing the whole picture? Or did we have an assumption, a bias, a prejudice? And then use our power to make a decision about that patient. What we're going to look at right now is what are some of the greater manifestations of this? We're going to go into some of the systemic and individual, and give me just one second, guys, because my laptop is not advancing with this. So let me get out of this. Okay. Out of the pen. Okay. So this image is from the National Equity Project. So this is a website you guys can go to as well to see So this is a website you guys can go to as well to learn more and get more information, go more in depth about what it means. What does systemic oppression mean? And see different points of view. So we have individual. And that is a person's beliefs and actions that serve to perpetuate oppression. So again, this could be conscious or unconscious. It could be externalized or internalized. There's interpersonal, which is between people and within people. There's interpersonal, which is between people and within and across differences. Then there's institutional, where there's policies and practices at an organization, at an organizational level that perpetuate oppression. And then it's structural. How do these effects interact and accumulate across institutions, across history, across cities, across counties, across states, across nations? So that's more of the systemic and structural pieces. So I have a question for you. In our individual institutions, what policies exist to address patient deaths? Well, generally we have internal peer review, generally called M&M. And what is, remind me what is it called at your institution? We have an interdisciplinary death review and we also have a peer review committee and sometimes they intersect. Okay, awesome. Each institution has its specific name. And so I wanted to clarify that. Generally, what are the consequences? And I'm not speaking to your institution, I'm speaking in general. Consequences are generally none. Oftentimes patients are blamed for their own demise. The doctor or healthcare provider is defended and protected by a circle of friends. Now, am I trying to put us down? No, I'm talking about a process. I'm talking about a system. And so, and it's not one individual person. And this is really for an illustration. That is the institutionalization of racism. So within the institution, the root cause is not addressed. Now, the next question is, for patients' families, what practices exist to address patient deaths? So for families, it may be lawsuits, right? I'm not saying that I want this for anyone. I'm just saying that this is a process. This is an illustration. And so when this pattern persists, again, across departments, divisions, the justice system, when a judge rules in the doctor's favor despite evidence, that is systemic racism. So we cannot eliminate healthcare disparities without addressing the root cause of health disparities, which is systemic racism. Now, my goal right now is to empower you, to empower us to use our lived experiences, to use the experiences that we've had, to also use our voices to address this. But before we do that, I wanna look at some of the barriers to change, because it's like, by now, we should all know about this, right? But why doesn't it change? Why does it continue? And then we're gonna look at, how do we address those specific things? So oftentimes, there's a fear, there's a culture. It's a culture of fear and retaliation and intimidation. Right now, I'm at Morehouse School of Medicine. I'm originally from California, Bay Area, San Francisco, Oakland, Berkeley. And moving now to other places, you can see that there's oftentimes a lot of social pressure. So if folks don't do what others want them to do, then there can be pressure on them. So some of the driving factors of health disparities, and this is gonna go both ways, but it's that outside the greater system, the system allows it, then the institutions allow it. So if the institution allows it, then it's okay for the person to do it. And then what does that lead to? Persistent poor health outcomes, morbidity, and persistent premature death, mortality. But I don't want this to discourage you. There is a way that we can address this. But before we do that, let's go ahead and look at one of the other things, which is this fear, these barriers. The root causes are fear of changing, perhaps a sense of overwhelm that this is too big to change. So I'm just gonna keep doing what I've been doing. And this need, our need to pay our bills. So when we look at why this continues, after every, especially for those of us who've gone through these trainings before, and maybe it was, you know, 20 years ago, I remember I was in a program, it was in the mid-90s, and we had lectures on racism. It was by the UCLA Department of Public Health. They came in, they spoke with us. And so we knew about it back then. We knew about it, you know, prior to the civil rights movement. So what we have now is that the major perpetrator, again, that I'm alluding to is this fear of change or fear of speaking out. And so that's one of the main things that we have to address. What are people afraid of? Those who speak out may be afraid of being silenced by someone who's in a higher position than they are. They might receive a pay cut. They might receive a demotion. They might be railroaded. They might be fired or reassigned, or they may experience social isolation. So has anyone seen the movie 42 with Jackie Robinson? Yes? Okay. And so imagine what he went through, right? How many of his teammates initially stood up for him? Not many, right? And what was that? Why did they not stand up for him? It was this fear, this fear that they would experience social isolation, this fear they would be silenced, this fear from the other group. So that's the institutional systemic portion. So one of the things that we have to do to fight systemic racism, to fight institutional racism, is we have to figure out the ways that we can protect those who do speak out. So what does that look like? Maybe that's an anonymous link that someone can fill out. If a link, if you're concerned about IP address, then maybe it is something else, but we have to overcome the fear so that we don't maintain the status quo. And I'm also speaking particularly about individuals who may be culturally congruent, right? Or what they call racially congruent. So those are some of the things that we have to address. And I know that we only have a few minutes left. So I'm gonna take you to one more space. So we've talked about implicit bias. We've talked about what that means. We've talked about explicit bias and what that means, and shown some examples of that. We've also gone through a case where we looked at perhaps an individual who, or not perhaps, we did say an individual who had a bias and also had power that translated to racism in the way that they treated that particular patient, even though we've seen that before and it looks almost benign to us because we've seen it so often, we're accustomed to it, but we are now seeing it and we're now calling it out. And one of the things that I want to do is I actually want to address one of the major issues when we are talking about this. And that is actually, is race real? Is race real? Is this biological? And so I want to let you know that when I was in the California Healthcare Foundation, UCSF Leadership Fellowship Program, my topic was very, very simple. We had to do something called the California Health Improvement Project, a CHIP. And my project was how do we uproot the root causes of racism in medicine? Very, very simple, right? Very straightforward. And I talked to lots and lots of people. And the thing that was really discouraging was that a lot of folks, particularly those of color, not only in the community, but those who were actually healthcare providers, they said, it can't be done in our lifetime. We cannot end racism in medicine, disparities in medicine in our lifetime. And I thought, you know, I know that we're better than that. I know that we can actually do this. So I did a lot of research and I really got to thinking, where did this come from? What is the root cause of this? And so I found it. So I'm going to share that with you right now. And I'm going to start with this. What is this a picture of? And what is happening with this picture? Don't be shy. So it's the earth, right? But what is different about this earth? This is a picture of earth from space. Which continent is this? Yeah, someone noted it was upside down. Okay, it's upside down, right? But is it upside down? This is a direct picture from space. What if I told you that when they send it to us, they turn it around so that this is the actual look of our planet? And did you know that, so if we look, this is the Saudi Arabian Peninsula, this is Egypt, this is the Mediterranean down here, that this portion of Egypt is actually called the South, and this portion is North. So different cultures interpreted the world in different ways. So where did racism come from or where did this idea of race come from? So it really didn't come about until the 18th century. The idea of race is only about a little over 200 years old. This is not something that was part of our human culture prior to that time. So there were a group of people who got together, and they were part of this Enlightenment movement. And this is also around the time when we start to look at looking at different species, what helps one species survive over another, the classification of species. And then what we see is that, particularly, there are certain groups that are classified. And this is what we call, this is racial, what's the best word, like scientific racism. And what they were looking at is, how can we make the world population more pure, to have better outcomes, a better species? And so the ideas of eugenics started to be distributed on a very, very wide scale. There's additional arguments, additional books. Release the strong stranglehold of hereditary disease and unfitness. Who were the people who were unfit? So we knew at that time, it was people who were in mental health institutions, individuals of color, people who didn't fit the ideal. However, in 1950, UNESCO, which is the United Nations Education and Scientific Cultural Organization, they issued a statement asserting that all human beings belong to the same species or race. And that race is not a biological reality. It's a myth. Now, I know that there are differences. There are certain hereditary diseases that occur in people of a certain ethnic group. But is it only race? So I have this picture. What race are they? One sister, the other sister. What is their race? These are twins. How about this picture? We have a mom and her son. What is the mom's race? What is the son's race? And then what about this picture? These are brothers. What is his race versus his race? I had an opportunity to go to the Exploratorium a couple of years ago with my daughter. And there was this great exhibit there. And what we saw is that this is called Probably Chelsea. This was from the DNA of Chelsea Manning, who was in prison at the time. And they wanted a picture of her, but they couldn't get a picture of her. So they took some of her DNA, and they created a model based on her DNA to predict what she would look like. So she looked like this one in the middle. However, all of these other images came as well. What do you notice? It looks like there's different races in these faces. In this picture, there's a lot of different races. And so this is our genome. This is our human genome. So all of the characteristics are in our genome. They're just not expressed phenotypically. So what I want to convey is that race is a social construct. We've created this. So if we've created this, we can uncreate it. So race is part of a false reality. It leads to false fears. And it was used as a justification for social and economic inequality. So how can we change the narrative on race? What can we do with this new information that we have? So I am going to go ahead and stop right there. But I do want you to know that in our next portion, we are going to be talking more directly about correctional settings. But I want you to go ahead and find your partner again. And I want you to ask them, what do they now think about race after we've gone through this? And what are some of your thoughts on the structures that we've created around race in our minds, in our institutions, and in our systems? So I'm going to go ahead and give you guys two minutes with that. And then we'll just take two minutes to wrap up. Thank you. That's until the briefing. We'll just come in a bit. It's a little different, so it's not like there wasn't more to learn than anything else. If you ever visit it, it's a lot harder if you don't like it. I agree. It's a lot harder if you don't like it. It's really hard if you don't like it. Yes. I'm going to go ahead and bring us back. Thank you, guys. I hear some great conversation in the background. And I also want to share with you a personal story. So recently, earlier this year, I actually had a mammogram. And I had to have a biopsy. And so after an ultrasound, I met with the nurse. And I sat in the office. And she had a paper book in front of her. And she scheduled me one month out. Now, you know, as a health care provider, I was thinking, well, if you found something, wouldn't you want to look at it right away? Especially if, you know, this is suspicious for cancer. Why would we sit on it for a month, right? Had nothing to do with insurance. I was at Emory down here in Atlanta, which is, you know, equivalent to UCLA. That's an academic medical institution. And when I then opened my chart, I saw that she had put down a race for me. She put down Latina. And she put down Black. Well, she almost got it right. Or perhaps I could say that we may be. But my mom is from the Philippines. And I've never used, you know, our last name. My last name is based on my marriage to my husband. And Marcado is his last name. And so, you know, she put down the race for me. So that's an issue. And then I realized, ah, okay, I see what's going on here. She put me in a certain category. And when I then, you know, I talked to my physician who ordered it. And I said, you know, I think I'm going to try to get an earlier biopsy. I just called two of the local places around us. I got in, I think I called them on Thursday. I was in by Monday. And so, what I saw there is that, you know, just because I'm a healthcare provider, it doesn't mean that I'm immune to some of these concepts or constructs around race, which was developed to value people, who is superior to another. So I want you to sit with that over the next couple weeks until we meet again. And just think about in our everyday lives, how has this influenced us? How have we valued people based on their skin color, based on the way that they look, their hair texture, right? Because there's actually people, if they straighten their hair, they'll look one race versus another. Sometimes when I have my hair straightened, people assume that I'm a whole bunch of different things. And so, I just want you to sit with this, this idea that race is a social construct. And if it's a social construct, again, we can deconstruct it. Thank you all so much again for your time, for your attention, for your participation. I hope that I'll be able to see you again and hopefully next time in person. Have a great day and if you have questions, please do come up to ask. Thank you.

anti-bias training

inclusive healthcare

implicit biases

marginalized communities

health disparities

systemic racism

institutional policies

social construct of race

equitable healthcare

UCLA grant