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good morning everyone I'm Suzanne Lawson.with constellation consulting and we are.pleased to present the 2020 New Mexico.summit on health equity virtual series.this series is funded by the New Mexico.Department of Health tobacco use.prevention control program and will take.place each Thursday through June 25th.for more information about the summit.and our upcoming presentations please.visit our website at nm health equity.org while originally intended to be an.ampersand summit the 2020 in New Mexico.summit on health equity became a virtual.series this year due to coded 19 we.appreciate the efforts of everyone.involved in transitioning this event.online including our presenters the.Department of Health Alliance.audio-visual and the members of our.constellation consulting team for a.session today attendees webcams and.microphones have been disabled if you.need assistance during the session.please utilize the chat feature within.zoom if you have a question for today's.presenter please use the Q&A function.and we will address as many questions as.time allows at the end of the.presentation any materials provided by.today's presenter will be posted on our.website at nm health equity org.following today's session you will.receive an email with a link to an.online evaluation if you would like to.receive community health worker or.social workers that you use or.continuing medical education units you.must complete the evaluation CEUs.certificates will be emailed out within.30 days of completion of the evaluation.and finally before we get started today.we are excited to offer you on.additional ways to engage in connect.with others participating in this year's.summit on health equity and virtual.series as an illustration of our.continued growth as a community we.invite you to participate in our virtual.mosaic this mosaic will be built over.the next six weeks and will be made up.of photos that you all send in to us you.can send in one photo or several they.can be of you of those that you may be.with during this time or even images.that you find that you're inspired by.that are inspired by this week's.presentation to be a part of this please.send your pictures and images via email.to info at constellation in M comm with.the subject mosaic the mosaic will be.live on our web site beginning on Monday.May 25th and we will continue adding.photos each week today we are excited to.host dr. jamal martinez our first.presenter in the summit on health equity.virtual series dr. mark team has an a.distinguished career of administrative.professional technical and clinical.experiences and community health and.prevention medicine he has conducted.interdisciplinary teaching research.service and public health practice and.epidemiology within local national and.international settings including with.the World Health Organization and UNICEF.as a past director of the University of.New Mexico's Peace Studies Program dr..Martine recognized the structural.violence as a global health challenge.and advocates for strategic peace.building education and health diplomacy.his current research focus lies in.forensic epidemiology and public health.law studies.mind brain and education sciences you.can read his complete bio on our website.at hint nm health equity org.please welcome dr. Jamal Martin thank.you.Thank You Suzanne and thank you.attendees it's a pleasure and an honor.to be here to share what I know in terms.of this New Mexico 2020 summit and.health equity and so without further ado.let me begin but before I but before I.get into the meat of this matter let me.say that the information that I'm.providing with is is my perspective on.my views and my professional experiences.and I guess the disclaimer is this is.not the views of the Health Sciences.Center so resistant pathologies of power.and place and the focus on this really.has been about the opportunities to.achieve optimal health experiences for.all population groups and communities.and I think at some point this is really.about bringing theory to practice for an.inclusive culture of health so I'm gonna.start off with the learning objectives I.have five learning objectives and we're.gonna start with the first one but.before I get into this if you notice at.the bottom the screen I have one of my.favorite words that I give students it.and that word is metacognition.and if you don't learn anything else.today at least act on this particular.word and I'm gonna define it for you.right now.metacognition is thinking about thinking.while thinking to improve your thinking.let me repeat that thinking about.thinking while thinking to improve your.thinking and I think this is a necessary.concept because the critical problems.that we need to solve today really.require a great deal of critical.thinking as well as creative thinking in.many ways so with this first learning.objective we're going to review and.recall the importance of echo social.models and the role of social.epidemiology and support of health.equity.but before we begin that I should say.that we need to do an analysis of power.and leadership okay and as we talked.about analysis of power leadership keep.in mind the types and sources and the.gender setting and so in highlighted in.yellow here I have power over power with.others and power from within and as we.think about this we have to think about.these issues in terms of the positional.status.you know the obstructive are the.institutional Kotal is structural par.with others influencing others based.upon action on some type of unity can be.coal powering collaborative transcendent.institutional culture and power from.within expert ideological personal.cultural a transcendent and so they're.three different forms of power that have.a role in this in this discussion and.what is the agenda setting the context.the process and content how we stream.for change and how we work with.street-level bureaucrats you know for.example community health workers and how.do we work with those who can implement.change because of their congruence with.working routines values and interests so.power is a very important concern as we.talk about pathologies of power so what.do I mean by pathologies of power I'm.talking about privileges and power.associated with whiteness and when I say.whiteness folks I'm talking about an.ideological issue I'm not talking about.a skin color I'm talking about an.ideology and the disadvantages of color.we're talking about the persistence of.prevalence of racism and racial.prejudice and discrimination and and.again it's important to understand it as.we talk about pathologies of power to.understand it is a you know about.process and outcome you know what those.are in this situation and how this.relates to their health equity also to.realize that this notion of pathology.power is rooted in the ideology of.inferiority if somebody is in fear that.means somebody else must be superior and.with that notion of this ideological.difference you have long term consistent.economic social political inequities.that are based on the myths and lies of.race the divergent views about the.definition of prevalence of these things.particularly since we've seen the advent.of SARS Cobra - - you know the actual.name of this virus and Cove 8:19 disease.so we have to think about the.microscope that were under now as we see.these in equities exposed under this.microscope but when we look at the.literature and culture we see that.non-whites perceive discrimination is.institutional in character and white see.it is discrimination as a historical.legacy of the past or idiosyncratic.behavior of an isolated bigot primarily.as we talk about implementing health.equity and New Mexico and it's in this.country and around the world we have to.give some thought to institutionalized.racism and I say that because I was born.during the days of political apartheid a.Jim Crow and I remember as a child being.told that I can sit at this particular.counter because I'm a colored person.which it says in my birth certificate.that I'm a person of color and while.we've seen individual racism improve.somewhat we have not really addressed.institutional racism so what is.institutionalized racism again it's a.systemic step again a systemic set of.patterns procedures practices and.policies within organizations that.penalize disadvantage and exploit.individuals it also includes.organizational procedures hiring.promotion and evaluation it effects.recruitment information promotion and.they're three different levels of.institutional racism at the individual.level where we talk about staff member.attitudes beliefs and behaviors which.we've seen lots of people now talking.about implicit bias training okay they.do a staff member attitudes beliefs.beliefs and behaviors then there's also.the internal climate the inter.organizational issues issues which have.as a referent point peopies policies and.procedures what are the policies and.procedures that exist within an.organization that may seem to be unfair.and then the third characteristic is the.extra organizational how an institution.influences communities public policies.and institutions through regulatory.issues economic political professional.shapes what is the social political and.economic context of those policies.procedures and functions another way of.looking at this is just calling an.administrative evil so.place you know people where are we if.you take a look at this mosaic you'll.have to understand the pathologies of.power in the place where we are right.now I'll let you just sort of gaze at.this for a moment and as you gain.through each one of these slides they.should evoke you know an image in your.mind that sparks your metacognition as.well as your feelings because as we.think about brain function you know you.know the primary functions of the mind.is thinking feeling and wanting so I'm.going to read the bottom-left slide.which is a quote for Martin Luther King.before his assassination in his death.and he said we must rapidly begin to.shift from a thing oriented society to a.person oriented society when machines.and computers profit motives and.property rights are considered more.important than people then giant.Triplets than the dried ripples of evil.racism materialism and militarism are.incapable of being conquered and so the.top three slides and this represent that.notion what he was talking about racism.extreme materialism and militarism and.how that's had an impact on our society.and I see that the views of our pictures.and things may be blocking some of the.things from where I was but I hope you.can see the entire slides in the middle.of the slide you see an impoverished.person saying I became sick because of.my poverty and another person saying.well I became poor because of my.sickness and we have the quote from.Nelson Mandela this says poverty is not.an accident like slavery and apartheid.it is a man mate and can be removed by.the actions of human beings and it's.that type of agency that's one that's.required for us to actually bring about.the benefits of health equity so where.people place in power matter within a.slide you see the representations of.equality and the tagline from this is.that equality does not mean equity if.you look at the kit slide very carefully.you see that people are in different.stages of development their lives and.different circumstances and the quality.just means sameness in the same type of.resources but the quality doesn't mean.justice equity means justice you know.those who have the least deserve more in.order to reap the benefits of having.social inclusion as well as equity and.justice and fairness the same thing.applies when we use the term disparities.disparities are just differential counts.you know and that's one of the things.that we know more about we seem to.collect more data on disparities in this.country.so we know their their differences but.we should be talking about equity and.inequities because when we talk about.inequity and equity we're talking about.applying a sense of justice as a.corrective measure for making a.difference and what are the resources.what are the fair resources application.of those resources to give people the.optimum circumstances they need in order.to survive so where people place in.power matter so let's say a little bit.about public health practice and.epidemiology as you can see here this is.you know and folks some folks are trying.to change this model now to the left of.the screen you see the three core.functions of Public Health which those.three core functions are assessment.policy development and assurance and.inside of the circle you see the 10 the.10 elements of of public health services.monitoring diagnosing and investigating.informing educating empowering.mobilizing community partnerships.developing policies enforcing laws.linking to provisions provide as a.caring competent workforce and.evaluation and research in the center.and those are the essential elements of.public health practice now under this.you know as we talked about social.determinants of health or infectious.diseases you know the notion that comes.out of these three core functions and.Tenace 10 essential services our.surveillance the collection analysis and.interpretation and dissemination of that.data and how that leads to public health.action priority setting planning.implementing and evaluating disease.investigation control of prevention and.I should mention with the slide to take.away message from this is that public.health surveillance is not the same as.medical surveillance public health.surveillance is monitoring health events.and populations medical surveillance.again is monitoring potentially exposed.individuals to detect early symptoms and.to tell you the truth most medical.surveillance takes place in hospitals.and doctor offices public health.surveillance is about the larger issue.in terms of communities in the.population thing is jumping ooh why is.it jumping.you go maybe backtrack a little.you.okay this lie basically just represents.you know the primary prevention issue.the secondary prevention and tertiary.prevention at the different levels and.what that means in terms of initiating.you know the process itself to.understand the cause of the disease you.know you know an understanding if it.becomes irreversible or not then a.colonial detection clinical detection of.the disease and onset of signs and.symptoms and they now comes the.expression of that how we can make.substance of changes and health status.of disease again from another way of.looking at this from the perspective of.health promotion protection disease.prevention and control you see the.primary prevention is about looking at.individuals in the population we who may.be susceptible and we do that because we.want to reduce the number of new cases.secondary prevention is where we look at.people a symptomatic and we want to.reduce that background prevalence of the.consequence of the disease and keep it.from spreading and tertiary prevention.is actually working with symptomatic.people who have a single illness of.multiple illnesses but coexisting.illnesses and how do we reduce the.complications and the disability that's.associated with those symptomatic.illnesses and as you have probably heard.right now within America's populations.of color we're really finding out that.this virus right now is having a huge.impact on those who are symptomatic who.have pre-existing conditions and tell.you the truth within our healthcare.budget in this country.which is close to three trillion dollars.a year ninety-five percent of healthcare.dollars spent and tertiary issues.they're treating and working with.symptomatic issues are reducing.complications and disabilities and five.to ten percent is somewhere between.primary and secondary prevention where.we know that most of the things are 100%.preventable one of the reasons why I.want to go through this is because.sometimes public health folks in the.training is still rooted in biological.determinism versus chronic stressors and.by that if you look at the chart here.and let me get my laser pointer going.again as you look at the cellar and.molecular.this is where a great deal of our money.is spent in these three columns looking.at organ systems cellular and molecular.issues related to pathology or disease.we know far more about disease processes.than we do about actually curing things.we know more about the science of.disease than we knew about hearing and.at some point what I'm arguing for is.that we have to move to this issue of.the chronic stressors and this is where.we get into the issues of social.epidemiology by understanding behavioral.psychological issues in terms of what.you see listed in column here and the.social environments and issues in terms.of stressful life events social support.social cultural groupings family.environment environmental simulation of.environmental hazards so let's talk.about the strategies of power and.oppression and how pathologies of power.and oppression yield structural violence.so we started with this notion of.supremacist ideology you know you know.this belief that someone is superior so.someone else must be inferior and.therefore there's a need to be.subordinated in to control their lives.so what we see with race and racism and.racial ization we see 500 years of.whiteness in the colonization of this.issue and I have race in quotation marks.because without work with the Institute.of race and social justice on main.campus at UNM we've decided that we want.people to understand that race is a myth.but racism is reality and race primarily.is a social and political economic.construct but not a biological one and.so this notion of this supremacist.ideology leads to discriminatory acts.which leads to culture historical trauma.disparities in iniquities it also leads.to structural dominance in terms of.power in place in terms of you know.whiteness is property possessive.investment privilege performance.terrorist supremacy social systems and.the Triplett's of evil is Martin Luther.King.you know once outlined in terms of.racialization materialism and militarism.and that structural dominus leads to.oppression and when I say oppression I'm.talking about ages and gender ISM sexism.ableism languages as disability you know.you know racism those are all forms of.oppression and they lead to five forms.of injustice its distributive injustice.procedural injustice retributive.injustice moral exclusion and cultural.imperialism and so with distributive.justice we're talking about you know how.resources are allocated or not we're.procedural injustice we're talking about.you know substantive and procedural.issues that determine what rules are.made to govern those things retributive.justice is about punishment plain and.simple we believe more on punishment in.this country than we do about.restorative justice and then moral.exclusion you know and cultural.imperialism other factors in under they.fall under injustice is under oppression.so what are the alert signs of.structural violence disease outbreaks.poverty line indicators basic needs.index unemployment youth without jobs.food shortages famine food deserts.violence oppression political.instability corruption disintegration of.government and institutions and.migration of people people migrate and.move because they're looking trying to.find some some optimal way of surviving.and it's all the medicine throughout the.structural violence what are the effects.of struck.violence and racism health status they.can be direct and indirect and as we.talk about the life course trajectory.there can be three pathways latent early.life environments affect adult health.independent of intervening experience.pathway.early life environment sets individuals.or into the life of course trajectories.that affect health status over time and.cumulative the intensity and duration of.that exposure to unfavorable.environments and how that adversely.affects health status the dose response.effect indirect can be the material.interpretation of the psychosocial.interpretation but there is a graded.relationship between socio-economic.position and access to tangible goods.and services particularly public goods.by race for example why is that we have.to pay for bottled water when the waters.are public good that should be shared.for everyone next we'll be buying here.which if I recall probably I remember a.few years ago there were air bars or.people go in breathe in oxygen you know.in order to you know try to cured you.know certain ailments and things so I.got the psychosocial interpretation can.be directed indirect effects of stress.from being either lower on the.socio-economic hierarchy or living under.those conditions of relative you know.disadvantage so again look at this look.at the two trees that I have here and.you see you know again how our.environments cultivate our communities.and our community's nurture our health.and um with a tree diagram on the left.of my screen if you see that way you see.one tree is obviously thriving and the.other one is the tree that's not.thriving the roots of that tree are.being fed on adverse living conditions.poverty segregation poor quality schools.marketing of tobacco and alcohol.unemployment underemployment.environmental toxins discrimination.institutions racism.occupational hazard support quality.schools and those.phenomena have a have a direct impact on.the growth of the trunk of the tree.which results in fragmented systems.restrictions on power disinvestment in.communities and disconnected members and.the stresses from those feeds into the.chronic diseases that we see there so.inequities are high and community assets.a low health outcomes are their worst.but if we move to the tree that's.flourishing if we look at the roots of.that tree and why it's thriving is.thriving because they're quality schools.access to healthy foods access to health.care access to recreational facilities.adequate incomes living wages health.insurance clean environments quality.housing jobs living wages transportation.resources access to health care and the.branch the trunk of that tree has means.that community has great organizational.networks political influence leadership.participation social support social.networks and sense of community and.those chronic diseases are minimized.so again when health inequities are low.and committee assess are high health.achoms are the worse so now let's talk.about structural violence as we talk.about structural violence we have to.talk about disparities and disabilities.and deaths that result when systems.institutions policies or cultural.beliefs meet some people's human needs.and human rights at the expense of.others.structural violence creates.relationships that cause secondary.banister curve and we never talked about.structural violence in this country we.always talk about secondary violence for.the most part either as self destruction.community destruction when national.international destruction and as you see.some constructions about alcohol abuse.drug abuse suicide depression.internalized depression community.destruction crime interpersonal violence.domestic violence rape and at the.national level and international level.you see rebel movement terrorism suicide.civil wars revolution schools and Wars.and we have to understand that secondary.violence our reactions and responses to.structural violence you know we really.not to sleep we really need to start.looking at the roots of this and dealing.with the causes and not just the effects.you know no problematically when we talk.about the structural violence and we.look at this through the lens of social.epidemiology.we'll see the notion of embodiment in.health inequities and health.inequalities bodies tell stories about.human beings that cannot be studied a.divorce from the conditions of their.existence bodies tell story.that often but not always match people.stated accounts and bodies tell stories.that people either cannot or will not.tell either because they are unable.forbidden or choose not to tell so.within clinical care you know we always.ask people what's wrong with you we.never say what's happened to you to try.to understand what is actually happening.in their in their lives and what a dead.background in terms of those social.toxins in the environment so it is a.truism population health is shaped by.social and biological processes there's.a contrast between biological.determinism you know that says that.you're determined things happen you.because your biology is defective and.the biological expressions of inequality.a discrimination which is a process it.maintains privilege and subordination.and and we have to when we look at.discrimination that process we have to.think about the aspects the type the.form the agency the expression the.domain and the level the cumulative.exposure the timing where this.intrauterine infancy childhood.adolescence adult the life course.injector II and most diseases start you.know at the interview neural into utero.level or the infancy level the intensity.from mild to severe the frequency is a.chronic acute sporadic and the duration.of time spent over the time and with.that last checkpoint there you see all.the other issues that have an impact.understanding these social biological.processes in terms of gender sexism is.six human rights and social justice a.life course perspective you know all.these things you know social class SES.social tremors filth social production.of scientific knowledge stress or the.structural interpersonal behavioral or.cognitive the role of human agency is.determined by theories of disease.distribution you know all these things.have an impact and how we use social.epidemiology and not just the old model.of Epidemiology that treats people.primarily from the biological.perspective and overlooks the social and.psychological issues so learning.objective number two what are the merits.of risk versus promotion and in fact you.know what are the signals that occurred.to people when we don't observe the.issues of using social epidemiology and.understanding power and privilege as we.talk about social epidemiology and the.embodiment and the geographic study of.life and death you'll see that social.determinants of health are basically.about where you live work and play and.go to school house it has impact during.life many of you probably heard that you.know what we've.from social determinants of health and.social epidemiology that where you live.work play and go to school it's more.important than your genetic code so this.is more than looking at the individual.lifestyle factors of age sex and.heredity factors but looking at the.issues of the social and community.networks and the general social economic.cultural and environmental conditions in.terms of agriculture and food production.education the work environment.unemployment water and sanitation health.care services and housing this is how we.achieve we achieve health equity by.working on those issues working upstream.Bekele social model I put this year.because donabedian you know who talked.about a structured process model is a.framework for understanding health.services and outcomes so when we talk.about an eco social model we're talking.about structure and process and outcomes.structure refers to the physical and.organizational properties of a setting.in which carries a variety the process.is the treatment or service being.provided to a patient and outcomes the.results of that treatment of service so.again this is more than just looking at.individual knowledge about attitudes and.beliefs or the interpersonal issues of.family provider peers and social.networks but really how we begin to.understand the organization of the.community into policy issues you know.the state and local health department's.the employee work sites health insurance.plans public and private healthcare.systems academic medical institutions.tribal urban health clinics professional.organizations community-based.organizations this is where you know we.have to apply our knowledge about how we.undo this to slice racism and how it has.impact on the communities and as we go.further upstream how do we look at.policies at the local state and national.legislatures how we look at the federal.government agencies and issues regarding.national advocacy and nonprofit.organizations now downstream upstream.interventions if you look at this graph.you'll see that again in the far right.hand corner of this gram this is a.histogram you see that a clinical care.basically just focuses on individuals.and it's a good thing but as you look at.how health outcomes improved you see.that is it's tremendously improved when.we understand how we work and help with.health promotion and prevention at the.community level and at societal and.institutional level and how public.advocacy help promotion to prevention.and intersexual issues in terms of.working jobs of housing and education.increased export.initially health outcomes improve when.we moved further up that at that level.but again most of our concentration.seems to be at the individual end and.clinical care issue and we all know that.in America most of our work our.conversations in America not about.families and communities it's always.about the individual and that's.something that we have to you know.disconnect so we really spent need to.start moving upstream and looking at the.policies and procedures that exist which.are right or wrong or an ineffective.what new ones need to take in place and.that's important for it you know why.voting is important in a true Democratic.Republic.this is just a model saying the same.thing but it's about clinical and.prevention services and again you see.the types of interventions and services.on the horizontal axis and and on.vertical axis you see primary care.offices health system community-based.organizations and built environment of.works and sites and schools community.states and nations and once again when.we move from screening tests to.preventive medications to pervade.behavior change and counseling to.information education organizational.policies and public policies the issues.are increased tremendously when we move.along that spiral along that trajectory.to working further upstream and they're.great stories about that I can relate.this is just I'm going to just go with.quickly these slides will be made.available to you folks later also to the.population of key elements you know and.how the things highlighted in red.represent population of key elements in.terms of measuring population health.status and allows you to tip.determinants of health basing decisions.on evidence and health systems.determinations interventions increasing.upstream investments which I was just.talking about multiple strategies public.involvement into sexual collaborations.and accountability with the goals of.improving health of a population and.increasing health status inequities and.so the blocks which are solid blocks are.the generic process steps I think this.is important thing to understand about.social determinants of health there's a.non relation of linear relationship.between education health and as we.talked about you know everyone has so.much you know early childhood brain.development and ace every child.experiences you know what it means to.the life course trajectory and.importance of.people the health of the educated will.see that if we're bringing up children.and socially toxic environments that's.gonna have impact on the academic.performance that's gonna hold us up.which is going to transform into having.a negative impact on educational.attainment and within adult health.status so education is the strongest and.most robust predictive health and.education and well-being but in this.country we tend to think about education.as being primarily about the.accumulation of wealth so under this you.know this crisis right now we can just.look back at what's happening with our.schools being shut down and what the.digital divide means for students who.don't have access to computers or.information technology this again this.is just about the relationship between.health education health promotion and.how we the environment is so important.in terms of how we understand the social.the economic the political the policy.issues the regulatory and the.organizational issues you know and and I.say this because I think at some point.you have to stop talking about people.are risk and creating stigmas people are.doing some things which are solid.interventions for improving the health.of status well-being but we need to give.them more opportunities to have that.optimum opportunities increase so we.need to do that through health education.and health promotion and not just say.they have a risk factor but what are the.promotion factors what are the things.what are the protective factors that.they have and what are the things they.need to continue to help them protect.their health and well-being of their.lives in the communities so learning.objective number three we're going to.review and analyze the impact of.emerging infectious diseases you know.iid such as SARS Cobra two which is the.actual name of this virus.this is SARS Colgate - and Kobe 19 the.disease process and what that means for.health equity so as we look at the.Anthropocene right now and we talk about.human security societal stability.climate systems and natural resources.will see that we have tremendous human.vulnerabilities conflict sensitivities.climate sensitivities and environmental.vulnerabilities and over the last five.years we see that you know these issues.are public good in terms of water food.energy health income livelihood.sensitivities in terms of little events.migration violence conflict climate.sensitivities in terms of extreme.weather ocean currents sea levels issues.the natural resources.all adversely affected by what's.happened over the last 500 years of.history and there are several factors.that influence that you know so we need.to have more adaptive capacities for.major emergency responses and understand.that public health no longer refers only.to medical care but more accurate Forex.governance transportation communication.Public Safety the judiciary and other.civil sectors but nobody cares about.Public Health until there's a natural or.human generated disaster that occurs so.again I'm gonna skate over this for a.moment but I just wanted as we're.talking about emerging infectious.diseases what happened with Ebola a few.years ago is very similar what's.happening now and now we see that bats.are strong implicated as most reservoirs.and hosts for that virus which out of.the five Ebola viruses subtypes four.capable of human-to-human transmission.and response that came place for dealing.with this particular disaster was well.intended and well matched but that has.not happened with the present emerging.infectious diseases which such as SARS.but the factors you know for emerging.infectious diseases and these are.borderless impacts by human demographics.and behavior technology and industry.economic development and land use.international travel and commerce.microglia adaptation and culture and.change and breakdown to public health.measures you know and when the paucity.public health measures we have in place.have broken down and I've been.supporting that increases you know dare.I say the probabilities right now the.risk of something going wrong as it does.so I think the take-home message from.this is that as you look at this notion.of emerging infectious diseases.understand soon gnosis which is what.SARS is it's a complex disease problem.that can't be sung without partnering.with professionals from different.disciplines to identify these.interrelated human animal environmental.risk factors but 60% of all infectious.diseases are caused by a gnosis so when.we look at the interactions between.livestock wildlife and humans we'll see.that we have exposure of Lyme disease.monkey pox hantavirus is Ebola SARS.rabies you know West Nile virus.tuberculosis anthrax tularemia plague.brucellosis Ecola cow pox Rift Valley.fever.again at all the transmitted to humans.so we have to really think about these.interactions between livestock and wild.like and how that interacts with the.factors that I've described for emerging.infectious diseases now with with cope.it nineteen of SARS 42.0 problematically.there's something with our tonight scale.and with this COBIT infection you see.that if one person is infected they they.can pass this on to at least two and a.half other people Ebola if one person is.affected they can act you know effect.anywhere between one point six to two.people with h1n1 the flu but one person.can affected anywhere from one to one.and a half people MERS and SARS both.SARS basically SARS 1.0 one person could.infect two to four people and murders.can infect two and a half to seven.people fortunately don't see much of.that of MERS right now but this just to.show you just how serious this situation.is and how it affects the lungs and.causes so many different types of issues.because of the immune response that.takes place in the body with the.cytokine burst and the invasion that.takes place which can run anywhere for.miles of the air so right now I just.want to say this this was happening at.the cellular level the iceberg effect of.cope with 19 of SARS at the post.response to the right of this pyramid.you'll see that as we talk about.symptomatic and asymptomatic s' with the.solid Dhokla.solid line going through this pyramid on.the right hand side you see the arrows.going up with and downwards representing.subclinical disease and you can have.people who are exposed without infection.and you have some people who have.infection without clinical illness and.depending on you know the resources that.you have in their communities you know.they could be infected without clinical.illness and still infect others but it.could lead to clinical disease they can.lead to moderate severity of mild.illness clinical and severe disease and.sometimes fatalities on the human host.side at the cellular level you see that.things happen below that solid line.which is below the visual change exposed.without cell entry incomplete bio.maturation and then discernible effects.until in terms of cell transformation.with cell dysfunction and the death of.that cell and a soli response where.trans play states so that's pretty much.the physiology what's happening.in most cases what we are seeing right.now are those issues of clinical disease.and discernible effect but we do have.many people who are trying to understand.what's happening at the sub clinical.level or the visual change and and I.have another slide later that I'm going.to relate to this that talks about you.know the issues that's below the visible.level that we have to deal with but the.take-home message here social toxicity.gets under the skin and when we have a.toxic environment it affects the.physical and social and cultural issues.and depending on the intervening.variables that people have at their.disposal has impact on the nervous.system and that response you know their.response you know the exposure to that.gives off you know sort of.correspondence with whatever intervening.variables they may have for support and.resiliency and it can lead to.psychiatric illness or physical illness.so trauma is social location we're.learning now you know to see this in.terms of what happens to children were.very vulnerable and right now what we're.saying is that we thought at first that.aids that aids I'm sorry us ours was not.only having an impact only on older.adults we sing it at the middle age.groups to town but we're seeing now how.this exposure is having impact on.children also too and it's very similar.to something that I've worked on years.before moving to New Mexico I was.trained in a work of Kawasaki syndrome.about one of the first founders of this.illness in America and for three years.it was my research project working in.Kawasaki syndrome and we're seeing.similar illnesses like that in children.now but as you can see from conception.to death with early adverse adverse.childhood experiences with children and.exposure there's an impact on the social.cognitive and social-emotional cognitive.impairment adoption of health risk.behaviors as they move role is to become.older you have disease disability and.social problems and early death and so.as we talk about the microaggressions.and implicit bias and epigenetics we.have to talk about trauma and social.social location that exists within our.communities and what are those.generational embodiment issues the.social context of complex trauma issues.of allostatic load and weather and.hypothesis coping the burden of diseases.and early death and these are things.that people are just hinting at when we.talk about coexisting conditions but.from what we know about social.determinants of health one zip code.heavily impacts.based on external stressors and.awareness of this concept allows for.paradigm shift to go to asking what's.wrong with you.- what has happened to you so chronic.stress and life events again the.stressor the uncertainty the fear and.anxiety and then there's appraisal of.the exposure and personal factors and if.people have the resources then as you.stressed there's good stress which we.see you know in every day of our lives.you stress is a good thing but distress.and distress response is what's really.problematic and with distress and the.stress response we have coping and.intrusive thoughts that lead to you know.you know smoking alcohol abuse diet you.know improper dicen adequate diet.substance abuse physical inactivity.adherence and compliance to medical.treatments the physiological effects in.terms of immunocompetence you mean a.suppression immune deficiency and on the.far side of things suicide homicide and.genocide so chronic stressors and life.events are intimately tied in with this.and again as we talk with the weather.hypothesis and the disease burden people.have comorbidities of coexisting.conditions which in some cases blackness.may be a pre-existing condition in this.country and how the chronic stresses are.dealing with you know institutionalized.racism personal racism it has an impact.you know eventually that happens to the.brain your heart the blood the kidney.the muscle deliver the lungs you know.become impacted and again you know the.issues of what happens to the immune.functions that take place in terms of.how the body recognizes self from.non-self we've been hearing a lot about.flattening the curb and.can help reduce the number of daily.cases and reduce the burden on the.health care system but what I really.want to refer to now is that and I'm.gonna move past this notion types of.immunity right now but I want to say.that our watchword right now should be.more than just about flattening the.curve from an infectious disease but how.hashtag equity flattens the curve again.let me repeat that.hashtag equity flattens the curve when.we focus on you know the social.determinants of health so in this.diagram here you see I have an.impoverished person who's complained to.to a you know health care provider and.after he registers his complaint that he.provider says well you know you're.coughing and I would prescribe a syrup.for your call but meanwhile you know the.person continues to grieve in the toxic.smoke from poverty and justice caste.systems and lack of facilities myths.exploitation and so what I want to say.is that people need protection from.negative social determinants and when we.think about these social determinants of.we need to think about the negative.social determines and how we develop a.new herd immunity and whims and Cooper.in 2020 just published a new article and.is talking about this this notion of.negative social determinants and.developing a new herd immunity and I'm.tying that into how medicine alone.cannot deal with the many factors that.cause the ill health so health equity.can build a new herd immunity by dealing.with how we reduce racial and ethnic.inequities and what are the efforts that.are necessary to address the social.determinants of health and a new herd.immunity in that sense could be like a.vaccine.you know alligator analogous to a.vaccine that improves population health.increased his herd immunity against in.those inequities but most importantly I.think the thing that I want to deal with.us right now is that how do we close the.empathy gap and how the empathy gap.matter is profound because empathy.predicts policy preferences to address.the needs of disadvantaged populations.let me say that again if if we're gonna.go by the hashtag equity flattens occur.then we have reduced the empathy gap.that predicts the policy preferences to.investment the needs of disadvantaged.populations so equity flattens occurred.we have to think about in a case of.african-americans who like the canary in.a coal mine the issues of historic and a.culture trauma the slave health deficit.issues of Negro phobia anti-blackness.pigment aqua sea and other.issues and identity due to dislocation.the internalized oppression that people.of color sometimes deal with pathologies.of power structure violence stigmas and.institutionalized behaviors posters.post-traumatic slave dysfunction deficit.the types of races and related stressors.life events which time limited the.caries experiences observations and.shared reports of others living through.others the daily micro stressors the.chronic contextual issues institutional.and systemic ones the transgenerational.or historical fix and social class I'm.gonna skip over this notion right never.nonspecific responses adaptive responses.of celery immunity and antibody related.immunity we'll come back to that later.learning objective number four analyzing.the merits of critical legal studies and.its use in transforming public health.systems and services and public health.law Research for improvements in a.culture of health equity and that's what.we need a culture of health equity and.that gets back to the statement I made.about well how do we improve closing the.gap for having more empathy about those.who have little so let's talk about the.root cause analysis sweared as I put the.root cause analysis where mr. slice.racism and I called it root cause.analysis squared because it's just not.about the analysis but it's about action.okay so when we talk which are the root.causes an action for dealing with.exercise racism we have to talk about.the structure of violence and.pre-existing conditions under the social.terminus belt and so when we look at.root cause analysis this is about you.know moving from beyond just the symptom.of the problem read about the surface.issues which is very obvious and.cognitive studies you know and behaviors.show that most people have been trained.to think about let's look at surface.similarities let's just look at the.surface let's only obvious and he.refused to go below the surface to look.at the root what's not so obvious and.and and I think we have you know more.intervention if we can eradicate the.root causes of so much of this we can do.much better in terms of developing.health equity so I saw a student give a.presentation for community engagement.and I thought I have to borrow this.slide because this is perfect for.dealing with the issues that you know.the you know what people see on the.surface and so when we talk about overt.white supremacy people just see the.surface of this and they just see the.issues that are related to lynching hate.crimes swastikas KKK the n-word racial.slurs racist jokes burning crosses.neo-nazis that's the overt white.supremacy that's related to you know the.ideological conditions of supremacist.ideology that I'm superior to some of.the supposed to be inferior well we.never look at the covert white supremacy.issues which is socially acceptable.again socially acceptable but people are.talking about it now more but it hasn't.become unacceptable yet making America.great again hiring discrimination police.murdering people of color discriminatory.lending confederate flags school to.Prison Pipeline not believe in the.experiences of people of color the.virtuous victim narrative denial of.white privilege and I love racism but.what about me blaming the victims.tokenism the white savior complex.colorblindness english-only initiatives.Eurocentric curriculums police brutality.mass incarceration paternalism.anti-immigration policies and practices.housing discrimination see here for.fearing people of color particularly.ounces people to call it wearing masks.believing we're a post-racial race of.mascots is just a joke claiming race.reverse racism not challenging racist.jokes cultural appropriation to.bootstrap theory don't blame me I never.owned slaves they need a self-appointed.white allies that some of the good.intentions are enough we have to move.beyond these socially acceptable.microaggressions and move to making it.socially unacceptable so we have social.cohesion.so ha you know.did you give you a further cool about.just where America is right now terms of.institutionalized racism I use this in.one of my classes once before and look.at the history of this you know as we.look at the three-fifths compromise in.US Constitution in 1787 1791 article one.you know section 2 Clause 3 three-fifths.compromise you know people of African.descent and consider three-fifths of a.person for the purposes of voting rights.people who cover outnumbering the.colonists and so they couldn't you know.they were not allowed to vote and.participate you know so this clause was.put into the Constitution and if you.look at the statistics and data to date.you know from 1791 to the present black.folks you could say that maybe some not.so much three-fifths of a person well.maybe now 376 percent of a person the.Naturalization Act of 1790 only free.white person's are permitted to become.naturalized citizens which over-the-door.to European immigrants but not others.only male citizens and votes serve on.juries whole office a whole property.Fugitive Slave Act of 1793 enforces.article 4 section 2 the Constitution.required the return of runaway slaves to.their masters Black Codes 1804 to 1865.the deep south and southward estates.restrictions on civil rights and.liberties the Indian relocation Act of.1830 forced relocation of Cherokee.creeks and other eastern Indians west of.Mississippi to make room for white.settlers the Fugitive Slave Act law of.1850 the law enforcement officials.everywhere we're required to arrest.people suspected being a runaway slave.the kidnapping and conscription of free.blacks and some of this one I made when.I talk about the future Slave Act of.1850 and of 1793 these are the.precursors really of the prison.industrial complex the Supreme Court.decision Dred Scott vs. Sanford you know.a Negro free otherwise cannot have US.citizenship we're still having these.conversations in American today but who.as a citizen who was not a citizen the.Homestead Act of 1862 they converted 270.million acres of native land to white.settlers the northern apprenticeship.laws self-sufficiency discouraged the.slaughterhouse cases of 1873 where the.privileges and immunities clause --is.were applied to national citizenship for.corporations and gave corporations dual.as dual citizenship you know under the.rights of the 13th and 14th amendment.Supreme Court decisions all we're trying.to reconstruction of 1877 the Chinese.Exclusion Act of 1882 the Gary act of.1892 related to that Jim Crow laws of.1892 1965.Supreme Court decision Plessy vs..Ferguson separate legal racial integrity.Act of 1924 to 1967 and other access to.the Federal Housing Authority Act from.1934 to 62 the Social Security Act and.wag Max and their more this shows you.just how ingrained this is in policies.and procedures and why we need to.correct that now again the context you.know for understanding institutionalized.racism and inequities is understand the.context of the dominant consensus on.race and whether it means in terms of.white privilege its national values.contemporary culture the current.manifestations the social and.institutional dynamics the processes.that maintain those racial hierarchies.that keeps equity out of sight.racialized public places and.institutional practices the outcomes.racialized inequities and current levels.of well-being and diminished capacity.for individuals and communities you know.to have improvement to the right of the.cervix basically you know if you haven't.seen understand Noam Chomsky you have to.review his if not your book but read.view his film the American Nightmare.record for American dream which I called.American nightmares Malcolm has called.it but he talked in it he discusses you.know the 30 or more issues they have.taken place to transform American.culture Blair's 30 years but within that.you know of whiteness you see the issues.of property possessive investment.privilege performance terror for the.supremacy racialized social systems and.the Shock Doctrine written by Naomi.Klein dit talks about the creation of.creating risk and populations to bring.about you know change after people are.disoriented and and excessively.distracted emotionally physically and.how that puts corporations in profit and.privatization further in power which.increases pathologies of power and one.of the things that you know Noam Chomsky.talked about in terms of this.pathologies of power reductions in.democracy reshaping ideologies.redesigning the economy shifting tax.burdens to those who can least afford it.attacks on solidarity and unions control.run of regulators you know reducing.regulatory issues that keep our.environment safe engineering elections.keeping unions in line manufacturing to.sit through the media and.marginalization of populations it's all.there so if we're going to do.institutionalized racism and.and come forth to address health equity.we have to remember that oppression from.use all different types of.organizational characteristics and.dimensions and systems and how we need.to look at systems and organizational.theory and how that interacts so you.know again I mentioned the three levels.individual level the staff members.attitudes beliefs and behaviors the.inter organizational level operations to.internal climate the issues that staff.relationships in hierarchical power.relationships decreases in psychological.empowered and promotes powerlessness and.among staff and clients and extra.organizational level as an instrument of.domination and in how it limits the.viability and sustainability of.organizations communities to serve.because they're being contracts as to.resources being controlled and so I.think we really have to understand how.we come about with organizational.theories to dismantle this this this.this administrative evil again emerging.issues the phenomenon of structural.racism again folks that exist the.historiography racism in u.s. high.education and educational apartheid.right now you see hundreds of thousands.of books questioned firm interaction.anti-discrimination laws you're.questioning of the intelligence of.people of color increasing rate racial.rhetoric of some white politicians and.talk-show host multiple multiplication.of white supremacy organizations.bureaucratic and personality.discrimination of tokenism against.faculty colored curriculums destruction.of American liberal arts curriculum.regression of American scholarship you.know and liberal arts and again the.increases supremacist ideology and.global education you know similarity.differences one size does not fit all if.you're talking about you know reducing.prejudice reduction eliminating racism.you know you can see that discharges.with the levels of analysis and intended.outcomes which are personal awareness.and healing healing and reconciliation.deals with individual transformation.intergroup racial ethnic and cultural.groups anti racism deals with structural.systemic oppression and institutions.policies and practices reveals with.social change of social transformation.you know diversity and multiculturalism.which deals with individuals and.intergroup issues which is about.tolerance awareness of cultural.differences and then democracy building.which deals with intergroup issues over.analysis and engage synastry.and one size doesn't fit all but we need.to figure out what strategies are most.appropriate for the resource you have.for tackling you know taking on and.undoing oppression in all of us you know.hatred forms hideous forms my work in.public health is basically a mixture of.critical Public Health Public Health.critical race product practice and.anti-racism and at the core this is how.we do it for the racial ization racial.phenomenon race and ethnicity and racism.and how we look at this through the lens.of social epidemiology also too in terms.of social location an individual's group.or position and society within that.hierarchy privilege versus marginalized.minority versus majority understanding.how to eliminate racial inequities and.theories of experience or knowledge.where the tacit or implicit knowledge.science in action in the process.contemporary patterns of racial.relations issues of producing new.knowledge and in of a kind identifying.norms and other concerns and how this.operationalized what those actions are.and the ten principles you know race.consciousness you know deep awareness of.position the primacy of racialization.that exists significance of social.political history now it's embedded in.society the structure determinism power.in existence across place in time the.social construction of knowledge.reevaluate revaluation of disciplines to.the anti-racism lens critical approaches.how we dig below the surface to uncover.own biases as well intersectionality how.we interlock you know the nature of.court occurring categories a.disciplinary self critique your system.systematic examination of disciplinary.conventions and broader impact on.society and voice you know understanding.you know how we have to prioritize the.perspectives of marginalized people and.and their experience your knowledge of.you know from the mainstream and how.that has to be respected.meiosis my research also includes a lot.of work now and what's called mind brain.and education sciences and how I look at.the intersections of neurosciences and.brain and functionings pedagogy.individual education learning and.psychology and issues of neuroplasticity.and in functions of the minds in terms.of thinking acting and wanting and how.we move people from the low.level of functions you know of the.medulla oblongata the brainstem to get.people to move towards the most complex.issues by the prefrontal area we're.problem solving cognition and thinking.and learning and language takes place.now I mentioned it's nursing about.empathy for social justice and equity.and an important thing to remember here.is that when we look at this model of.the brain as we talked about what I have.here in the red box highlighted I have.the hippocampus we're learning a memory.takes place and the thalamus and the.amygdala and two things I want to say.about the you know the things of the.amygdala Argan dollar and hippocampus is.that when children are and particularly.are under a great deal of toxic.environmental stress did they carry with.them to adulthood.the hippocampus shrinks and function so.learning and memory are you know are.lessened because of that talk to stress.because of the build up of cortisol and.epinephrine and other things they take.place the amygdala you know that I want.to get to is part of the limbic system.is the issues deals with issues of.attachment sexual behavior emotional.reactivity and motor regulation and s.and that is that emotional reactivity in.the feelings that interaction that I.want to deal with because you know.people who don't understand social.justice something is wrong with their.amygdala and it's been hijacked you know.and what's happening is that when it's.hijacked like that there's an.intellectual there's well there's a loss.of intellectual empathy for social.justice as studies have shown that when.you lose your empathy for the suffering.of other people you become a sociopath.in nature again when you lose your.intellectual empathy for the suffering.of other people you become a sociopath.and so the amygdala is a storehouse of.emotional memories it's responsible for.severe instincts fight-or-flight it.results you know in different anxiety.disorders which we're seeing a great.deal in terms of public health neuroses.that's happening for a number different.reasons and the sciences and really and.you see this in terms of the strong.emotional reactions is happening within.society the sudden onset of issues and.you know we have to understand if they.post episode of realization if that.reaction was inappropriate the thalamus.in that area you know there.the brain overrides the cortex when.external stimuli triggers enough.capacity and the brain decides to send.data from that stimulus to the limit of.the cortex and Lords of moderate stress.levels you know affect the prefrontal.cortex we've seen messes of pro and con.reactions now thing I want to put a note.here for myself about the three.characteristics of whiteness and the.studies that I've looked at say the.three characters of whiteness are you.know are one that people who adopt the.supremacy attitude basically negate.democracy their own intellectual growth.is stunted okay and and when the owners.left the growth is stunted you know they.just you know they you know you had.these reactions and oh my gosh all of a.sudden I'm tongue-tied and I can't.remember the third one I want to use but.I come back to in a moment so stunting.her growth intellectual stunting.negation democracy and the third will.come to me in a moment okay.so we need to you know improve the life.scores trajectory we need to bring about.more effective public health services as.systems through academia which means.we've got to you know disembark or.disengage and sous-chefs racism in terms.of organizational structures to finance.the technology development methods with.the means of Workforce Development one.thing I want to say about kopaka the.Patient Protection and Affordable Care.Act.you know also known as Obamacare and.most of this conversation this country.has been about the insurance aspect of.this in terms of health care access but.if you read that Act very carefully.there are provisions which I believe in.title six that talks about monies are.available for prevention in terms of to.increase public health workforce.strengthen quality management loan.repayment programs for people working in.public health workforce grants for state.and local programs public health.fellowships and preventive medicine.training grants and reauthorization.public health workforce programs we need.to start accessing that and making that.work at the state and local level in.terms of one of my other force ideas to.work in forensic epidemiology is.understanding how to better use public.health law and my models for that are.really these two gentlemen that you see.Charles Hamilton Houston and Thurgood.Marshall and I put these two men here.both were lawyers and they both worked.for the n-double-a-cp.Charles Hamilton Houston on the left was.Thurgood Marshall's teacher in law.school and he had a statement that said.the Charles Hamilton nuisance said at.that time that a lawyer who isn't.working for social justice is a parasite.in society and after a while that's.pretty strong but he was but he led the.charge for the n-double-a-cp.to use public of law to bring Brown.versus Board of Education to the Supreme.Court and I think as we talk about.health equity that same model can be.followed in terms of public health law.which would lead to better health faster.for all by using public of law to.improve access to evidence and expertise.expertise in designing legal solutions.helping in communities engage in.roulette building political will support.for enforcing and defending legal.solutions and political and policy.surveillance and evaluation so you know.this can be transdisciplinary you know.in terms of building a culture health by.looking at public of law interventions.laws that influence outcomes of.mediators infrastructure laws that.establish the powers duties or.structures of public health agencies.which has been eroded before this this.SARS 2.0 really had an impact on our.country in other places in the United.States incidental public health law laws.that regardless of topic or purpose that.a study for the impact on public health.law and I say this because when I was.getting my training in public health my.Dean who is an assistant Surgeon General.youngest-ever in the United States he.told us I don't care what you learn.about epidemiology box just as.behavioral health environment health.never forget this is all public health.is all politics and it's all about you.know within a political definition about.who gets what when how where and why and.I'm kind of a political junkie so I.understand that notion by working with.policies and procedures and how we move.forward with that this is just a map.showing the influence of public health.law of research you know the inputs the.lawmaking.interventional infrastructural.incidental.the mediators what are the legal.practices you know C and D and that.leads to changes in behavior and change.in changes in policy to outcomes in.terms of population health so I'm trying.to spend more time working on those.issues.so my last objective learning objective.number five explain to support.progressive obligations for health.equity to human rights issue.folks unashamedly unabashedly I'm a.supporter of the United Nations.declaration articles 25 and 26.they say that health is a human right.and education is a human right so when.we have to look at human suffering on.instructor violence we have to look at.poorly designed policies that yield.inadequate food housing health safe and.just working conditions education.economic security clothing and family.relationships and understand that people.live a life of oppression exclusion.exploitation marginalization and.collective humiliation and.stigmatization as well as repression.inequities and a lack of opportunities.and it's no fault of their own per se.what happens people armed themselves to.protect their commodities and access to.them and that leads to overlooking.connections between consumerism and.oppressive regimes in terms of.governments and financial institutions.and transnational corporations now why.we see increases in the drug trade.military spending and human rights.violations and again the most vulnerable.in society women children elders those.different different ethnic racial.cultural religious groups and sexual.orientation I'm going to just glance.over this right now because I would just.say that nearly according to a new.survey from the American Psychological.Association nearly 7 and 10 adults in.the u.s. 69% report discrimination and.61% report experience in day to day.discrimination and again discrimination.is reported across subgroups of adults.including age race / ethnicity.disability gender sex rotation gender.identity and this most common reported.experience major discrimination related.to employment in fact when I look at an.EEO cirebon study that was done a few.years ago the.one offender in terms of labor issues.and discrimination employment our health.care institutions so that's what led.Martin Luther King at one point to say.that of all the in justices that exists.you know injustice in health care is.probably the most heinous and most.disturbing but these this these this.discrimination shake about the.distribution of money power resources to.local communities in the nation the.world and there are other words and.concerns and things also too so.frameworks for equity and justice you.know you know we have people who work at.the individual level the institution.over the community level and their.different theories for that you know.liberalism to person well-being.individual freedom the marketplace to.rule adjust everything to policies the.minimum of State individual rights and.the paradigm distributive justice what.can I just leek lame at the institution.level delivered to democracy public.governance public public popular.sovereignty responsive states civic.participation delivered justice who.decides and how and then have it the.community issue command at Arianism.what's the common good with a social.solidarity what is public welfare in.terms of responsive state a responsible.state and in social justice what's good.for us and as you look at these.different forms for a framework for.equity and justice and you look at how.Sarris 2.0 has affected the world and.put the social determinance wealth under.their microscope you can see how certain.governments you know institutions are.faring well and not so well depending on.their focus and what their theory.whether policies on with the paradigm.that exists so neoliberalism and health.inequities the brief critique again.neoliberal doctrines are either I'm.concerned with the positive endorsing.inequities inequalities nearly realists.are particularly individualistic an.attack into various forms of collective.a state action and two tentacles of.social cohesion of social trust.sanderson lugar gonna focus on human.well-being but only a macroeconomic.indicators and just recently I've just.learned that for those of you are.Democrats to support the Democratic.Party and again these are these are my.concerns not the concerns of the.university make so anything else like.that but um I just saw a very.interesting phenomena occur that took.place between Biden and Sanders and.they've come together with a coalition.and they put together some task force of.Pete.that represents some pretty interesting.task force that's going to lead to some.very very progressive ideas and things.to that nature and that's that's a sign.for hope.so anybody's interested in I'll send you.the the article that's look that looks.at that because that's an important.criteria as we talked about the.relationship between economic and the.political the social and health and what.kinds of political and social.arrangements are being made the preamble.of the UN basically to save succeeding.generations from the scourge of war to.reaffirm faith in fundamental human.rights in the dignity and worth of the.human person in the dignity and worth of.the human person and the equal rights of.men and women and of Nations large and.small and I want to focus on this.dignity thing in a moment because for.some reason another in this country in.many places dignity is not equated with.a human right we're still having the.discussion that is digging human right.or is it not but how we establish.conditions for which justice and respect.of those obligations arise from treaties.and basically to promote social progress.and better standards of life and larger.freedom in many ways as we talk about.dismantle whu-oh and other international.norms norms we see that these could be.gross injustice as that type of issues.because as it says we the people of the.United Nations which remember the United.Nations Declaration of Human Rights was.modeled after the US Constitution and so.for these ins to practice tolerance to.live together and peace with other with.one another's good neighbors to unite.our strength to maintain international.peace and security and to sure by.acceptance of principles and the.institutions of methods that armed force.have not be used saving the common.interest and deployed international.machinery for the promotion of the.economic and social advancement of all.peoples so human rights based approaches.HBR a state obligations respect protect.and fulfil the state who signed off on.human rights issues basically have to.fulfill these obligations not to.interfere with enjoyment of the rights.to health protect prevent third party.parties from interfering with the right.to health ensure that private companies.provide safe environmental conditions.for employees and communities now put.regulations that allow them card melash.fulfil adopt appropriate legislative.administrative budgetary judicial.promotion other measures to fully.realize the health.so again a state is obligated to respect.the protect and fulfill fundamental.human rights based approaches HR ba in.terms of health for all health and all.policies this is so amazing that in this.country now we're finally started to.talk about health and all policies back.in the 80s when I worked overseas with.UNICEF and W Joe many countries were.adopting this notion of health for all.under primary care issues and it's taken.us almost 30 years just to get to this.point with say Oh health for all is a.good thing to happen and you see it.disguised as universal care and other.types of things but the conditions and.resources for health health rights based.approaches for true health promotion.disease prevention you see to the left.of this the conditions and resources.piece is listed first on this list not.shelter education food income a stable.ecosystem sustainable resources social.justice and equity but peace and I say.that because you know peace is the.antithesis of violence and as we talk.about structural violence you know you.cannot have peace peace is hard to.define but we know advise absence so we.know that we're dealing with structural.violence and so with health emotion.improvements we have to talk about being.advocates you know be enabling.conditions to know to move towards those.directions and issues to mediate when.necessary and this is what we have.improvement in health because in.improvements in health requires the.secure foundation needs basic.prerequisites so the summary of health.and all policies are the roles and.responsibilities of the government to.bear its responsibility for the health.of the people it says this in the.preamble of the Constitution that the.government shall provide for the general.will for the people and what they means.and it means how we deal with health.authorities at all key levels with the.key actors and to governmental.organizations instructors and the.concepts of principles that relates to.human rights and obligations to.strengthen accountability that.contributes to sustainable development.while acting on the consequences of.those policies and determines health and.well-being sever insulated.HIC policies that u.s. is starting to.adopt nel developing and structuring.cross sexual relationships incorporating.health into decision making processes.enhancing workforce capacity.coordinating funding and investments.integrating research evaluation and data.systems synchronizing communications and.messaging and.accountability structures again all.Mahotsav Declaration of 1978 that came.up with health forms of primary care.number one education concerning.prevailing health problems and methods.for prevention control promotion of food.supply and proper nutrition adequate.supply of safe water and basic.sanitation maternal and child health.immunizations against major infectious.diseases provision control of endemic.diseases which SARS is going to be.endemic disease in the next few years.appropriate treatment of common disease.and industry's injuries and provision of.essential drugs the building blocks of.international law diplomacy treaties.conferences brutal warfare.collective security moves the world.government and you know social.cooperation universalism relationships.and the nine core international human.rights treaties isert International.Commission on the elimination of all.forms of racial discrimination the world.which the u.s. is finally about this you.know we some of these we haven't even.signed off on quite frankly in the.United States the International Covenant.on Political Rights these dates given.where they how these dates were ratified.around the world the International.Covenant on social and cultural rights.the Convention on the elimination of all.forms of discrimination against women do.convention against torture and other.cruel inhuman or degrading treatment of.punishment Convention on the Rights of.the Child.International Commission on the.protection of the rights of all migrant.workers and members of their families.protection on all persons from enforced.disappearance and Commission of the.rights of persons with disabilities so.it's just remarkable that our Senate has.not ratified you know a number of these.things in fact the government of Somalia.as it exists now hadn't had a stable.government in 30 years signed off on the.convention of the rights of children and.we haven't even done that in this.country so you know we got a lot to.think about in terms of metacognition so.you know again as we think about.obligations under in humanitarian law.equality and non-discrimination rights.of life liberty and security the person.administration judges of justice right.to privacy expression these are things.are worth promulgating okay prevention.of whom right.violations ensures social justice of all.people advancement of human development.prevention of human suffering it.provides two health security rights and.conditions that enable individuals and.populations retain and enjoy the full.potential for human life dignity I say.this because within the Office of.Community Health at our retreat last.summer we decided that dignity had to be.a part of our mission statement that we.had to support human dignity and so when.we look at dignity in loss of dignity.we're talking about degradation.humiliation shame loss of self-respect.loss of pride abasement mortification.and indignity and again the value of.human dignity.you know the violations are pervasive.events with potential severe and.sustainable sustained negative health.effects on physical mental and social.well-being health is not a commodity and.life and death matters across the.lifespan and we have to care for the for.those who left out by reaching pursuing.empowering and making reaching for those.left out using Universal policies.pursuing the measures for groups with.special needs empowering those left out.by upholding human rights ensuring.access to justice promoting inclusion.and cohesion ensuring accountability and.making human development resilient.addressing climate change maintaining.human wellbeing in post-conflict.situations embodied by honest addressing.epidemics and shocks and promoting.social protection and last but not least.folks why do I do this because I'm not.getting a lot of money that's today I'm.sure I do this for the generation that.is becoming behind me you know from the.from coming from my African tradition.and background and culture and people of.color and gentlemen indigenous people in.the world I stand on the back of so many.who suffered before me and it's to those.ancestors and people who sacrificed so.much me to get to this point I do this.for the generation that's coming behind.me thank you and references upon request.and thank you for your adept attention.and I hope it wasn't going too fast but.I hope you metacognition was challenged.and that you're thinking about thinking.about thinking to improve your thinking.thank you thank you dr. Martin we will.now move into our Q&A if any of our.attendees have any questions for dr..Martin please utilize the Q&A tab within.zoom and I will facilitate those.questions for him I'm so dr. Martine we.did.a question kind of early on I think it.was actually in your first learning.objective when you talk about upstream.what about what about role the role of.culture that drives what about the role.of culture that drives policies and.procedures about the role of culture.mm-hmm I think we have to define that in.terms of what it means to have a culture.of health and a coach of well-being in a.culture of dignity if the coaches does.not support those things then I think.it's ill-suited culture and I think that.it has a lot of discriminatory practices.to it so that culture has to be.questioned and where those motives and.what those practices are does it make.sense.we have a culture of denial in many ways.of human rights issues and things of.that nature and as they say denial is.more than a river in Egypt.okay that makes sense to me if there's a.follow-up question they'll go ahead and.put it in the Q&A tab we also had a.question regarding how do we close the.impasse gap Wow.that's a tough one and that's one of the.things that I'm working on right now as.I uncover the issues the newest studies.from social neurosciences and other.types of things you know as I said.before the three functions of the mind.are thinking feeling and warranting and.the reason why I challenge folks to use.metacognition for a moment was to think.about thinking about thinking to improve.your thinking and I say that because we.have had an imbalance where because of.the Shock Doctrine that's existed in.this country and the issues that are.taking place people have become more.reactive than proactive and so when.people become more proactive and I.understand the survival mechanism but.they jump from interpretation of their.feelings and they jump from feelings to.motivation and desires and so the.cognitive issues are missing from that.in terms of what's positive and negative.particularly if it's the recession of.threat or fear and what happens with.that neurochemical.hormonal cascade that takes place in the.body so there has to be a balance.between thinking and feeling because.thinking informs your your feelings.about what's right and what's wrong was.part of it what's negative and when.thinking and feeling is in alignment.then it's easier to figure out your.desires and your motivations for moving.forward this so that means at some point.the the education and training that we.have under this cultural model or is.calling this model we have to decolonize.that education system because from the.perspective of African American Studies.again you know the famous African.Scottish Carter G Wilson once said that.African Americans were not kidnapped and.brought here to be educated we were.brought here to be slaves and to be.trained and so we have to look at this.notion of what training and what.education is and where the balance lies.so finally that balance between one's.emotional state and how one deals with.ones fears isn't a proper concern.because we all know that when there's a.perception of threat our body.automatically responds to their.perception of threat to just to fight.freeze or run away we fight.fight or run boy we freeze to do nothing.we disassociate and beta endorphins.produce a good feeling about this some.useless pursue that so it becomes.notable so it comes down to what.resources do you have in your community.around you and personal resources like.once a need of American colleague and I.we were talking about our issues and we.talked about and doing this work what.first-aid kit do we carry with us every.day when we walk out of the house.because we know that we're gonna be.under assault and we know that by the.time we return home that that psychic.shield that we put ourselves in is gonna.have all kinds of cracks and breaks in.it so how do we heal again to restore.that sense to go back out and continue.dealing with the suppression and stuff.we deal with so if that person would.like to send me an email.I'll gladly and to send them some.resources some other things about.mindfulness and intentionality and how.we we think about not only metacognition.but also think about metaphysics what is.the ultimate issues of the world what.are those realities of the world and how.do we transform and bring back.indigenous ways of knowing you know to.counteract you know the nonsense that we.prevented with or presented with I hope.that helps a little bit and then we also.had we did have a request about having.an article that you mentioned regarding.the task force that Biden and you know.I'm making notes or then I'll send it to.you yeah and I'll get it posted on our.website we also I know we have a few.people on by phone and so we have.Christina who had raised her hand to ask.a question so we're gonna go ahead and.open her mic or unmute her so that she.can ask her question directly.sure so Christina whenever you're ready.go ahead.a little Christina I'm dr. Martin and.I'm listening sorry I accidentally.raised my hand okay.okay okay do we have any other questions.for today well thank you so much dr..martine for your time and expertise.today we appreciate all of your efforts.towards creating true health equity in.new mexico and thank you to all of our.attendees who joined us today we look.forward to seeing you back next week as.Amy Whitfield will present the inequity.of professional feedback beneath and.process of building an equitable.evaluation process hope everybody has a.great afternoon.

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Unm Doctors Note Form FAQs

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Is it illegal to forge a doctor's note?

You don’t trust your workers. If you trusted them, you wouldn’t have required a doctor’s note. Its painfully obvious to them, yet not you, so here it is: earn the trust of your workers by trusting your workers. You will be disappointed from time to time, but that’s okay. As long as you continue to extract profit from them, it shouldn’t really matter. Since you have apparently decided that you’re going to terminate them regardless of their reasons, don’t bother with the explanations, just do what you’re going to do without any further fuss on the matter. But you really should never have asked fo Continue Reading

Do employers check doctors notes?

If you mean do employers call to verify doctors’ excuses, the answer is occasionally and it often depends upon the employee, their perceived reliability and the nature of the excuse. My busy ER gets called a few times per month with employer questions about suspicious work excuses.

Can you fake a doctors note?

Absolutely. Plus, the chances of getting caught are not particularly slim: Airlines have doctors in their ground staff because no matter what *your* doctor may say, the final word is always with the airline (this is more relevant for the opposite of your case: when your doctor says you’re ok to fly but you really aren’t), so your medical certificate will probably go through more eyes than just a CS rep. As others noted, besides getting the paper dismissed and the refund denied, you may get blacklisted on the airline and even face serious charges for fraud which, make no mistake, on the best cas Continue Reading

Do you have to pay for a doctors note?

First is there a legal contract requiring payment for the treatment? The answer is most likely yes as hospitals in will have become very good at getting paid, and to do this they do need a contract requiring reimbursement. I don't know how the law would go should the individual arrive in hospital unable to give consent, but presumably the hospital has got the consent. But it is worthwhile checking out if the hospital followed the rules. If not they might not have any legal contract to stand on. As such the hospital might not be able to legally get any repayment. Second has a member of the famil Continue Reading

Do you have to pay for doctors notes?

First is there a legal contract requiring payment for the treatment? The answer is most likely yes as hospitals in will have become very good at getting paid, and to do this they do need a contract requiring reimbursement. I don't know how the law would go should the individual arrive in hospital unable to give consent, but presumably the hospital has got the consent. But it is worthwhile checking out if the hospital followed the rules. If not they might not have any legal contract to stand on. As such the hospital might not be able to legally get any repayment. Second has a member of the famil Continue Reading

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