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COVID-19 and the Black Community with Dr. Aletha Maybank
21 Plays5 years ago
We invited Dr. Maybank, Chief Health Equity Officer of the American Medical Association, to the Lounge to discuss how we got here, where we are currently, and where we go next in regards to the COVID-19 pandemic.
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Transcript
VIP Interview Introduction
00:00:00
Speaker
Family, it's Dre, one of the producers of the show, bringing you a very special interview. We want you to sit back and enjoy this VIP experience here in the lounge. Enjoy.
Meet Dr. Alitha Maybank
00:00:34
Speaker
Welcome back everybody to SNMA Presents The Lounge. I'm student Dr. DeAndre, the executive producer of the show, and I'm excited to have this opportunity to interview Dr. Alitha Maybank.
00:00:47
Speaker
Dr. Maybank is a pediatrician working in preventative medicine and public health. She is currently the inaugural Chief Health Equity Officer and Vice President of the American Medical Association. Prior to this, Dr. Maybank became Deputy Commissioner in the NYC Health Department over the Brooklyn District Public Health Office and launched the Office of Minority Health as its founding director in the Suffolk County Department of Health Services.
00:01:14
Speaker
Outside of all of this, she teaches medical and public health students, was former president of the Empire State Medical Association, and is co-founder of the We Are Doc McStuffins movement. Welcome and thank you so much for taking the time to speak with us, Dr. Maybank. Thank you. Thanks for having me.
00:01:33
Speaker
So I know as a worker in the public health sector, you have no choice but to be working through everything COVID-19 related. So we wanted to take a little time to get your perspective of where we're going with this pandemic. COVID-19 has disproportionately affected the black community.
00:01:57
Speaker
We have to consider racism as a public health issue in all of the many ways it plays into how the Black community is being affected by COVID-19.
Impact of COVID-19 on Black Communities
00:02:05
Speaker
In a piece you wrote for the NY Times, you spoke about the importance of addressing structural inequities in communities of color when combating the disease. What must be done in your opinion to ensure that we are actively and effectively addressing these inequities?
00:02:25
Speaker
Yes, so thanks for having me. I think a big important part of it, and we've seen this happen so far, is for us as physicians, black physicians, but any physician, to kind of elevate their voice and to use their voice and their power in that way. We're credible messengers. So I think it's really important for us to call out
00:02:50
Speaker
disparities, inequities, injustices in health, and to really call in demand for action that we know we deserve as communities of color, as communities of color, as it relates to us being physicians, but also the people that we're serving and our family and friends. And so I think that's a big part of
00:03:12
Speaker
you know, starting to address is naming the injustices and demanding action from them and putting action forward. I mean, the reality is, is that, you know, our systems were never designed really for black and brown communities to be able to thrive. And they were designed mostly to exclude. And so we see that play out in the data that is
00:03:39
Speaker
presenting itself all across the country, it's really hard to run from in the way that folks have been able to in the past. And so in order to like really rebuild our systems of health, both the healthcare system and public health system, you know, we have to look more towards like the structures and the policies that produce those inequities in the first place and then address the structural racism and the values that people have about black and brown bodies and really challenge them.
Building Trust in Medicine
00:04:09
Speaker
Yeah, and I love how you go into the fact that we haven't had the best track record with the health systems that America has set up. And so I know that you were featured in an NBC News article highlighting some of the importance of including black participants in vaccine trials for this specific pandemic.
00:04:36
Speaker
Um, there is a long history of mistrust and medicine in general, uh, when it comes to black communities, uh, notably Tuskegee, Henrietta Lacks, the, the stories go on and on. Right. Um, so I want to know what steps, uh, you think we have to take to build trust between, uh, the medical community and, and black patients. Yes. Well, I think, you know, as you said, you know, this is, this is a repeated story on and on Henrietta Lacks.
00:05:06
Speaker
We just have done a lot to celebrate her life and her contributions recently as a nation. And then Tuskegee, very well known, but the reality is that folks are experiencing this
00:05:19
Speaker
experiencing these realities of injustice and lack of trustworthiness, right? It's one issue for us not to trust institutions, but institutions have to own up and take responsibility that they have not been trustworthy.
Addressing Institutional Racism
00:05:33
Speaker
And I think that provides a different frame and a different kind of sense of responsibility of who needs to get through this. And I think for being able to move forward this work,
00:05:47
Speaker
There hasn't been much conversation about the role of institutional racism within the context of medical institutions and what we need to do. And so now I think many institutions are confronted with asking, what is the value proposition that exists in this country that produces these harmful realities for black and brown people?
00:06:08
Speaker
And there are these myths that we have to undo in order to really see the path forward. We have to undo the myth of hierarchy, right? Based on one skin color and that white is supreme. And many folks will say, you know, they don't believe this, but our data and our outcomes show something differently, right? And the systems also tell us differently based on people's experience.
00:06:30
Speaker
So these institutional failures have definitely been exposed over and over again. The refusal to test, as we've seen now, little to no treatment, turning people away, not paying attention to symptoms. All of this creates that kind of sense of mistrust. And so, you know, as a way forward,
00:06:51
Speaker
And actually, another piece of how this shows up, just to mention real quickly before the way forward, is that there are a lot of false perceptions even amongst us as physicians. And it creates outcomes in which blacks are less likely to receive pain meds, so we don't experience pain in the same way. Children are less likely to receive antibiotics as a standard of care when they're there.
00:07:13
Speaker
And we know we did this study with med students in 2016 that they still believe that blacks have less nerve endings or they have thicker skin. And so, you know, looking at this, we have to, as institutions, again, be able to reckon with that history that we have of kind of exploitation and exclusion of people. In the more immediate future, what we need to do is a lot of focus around trust and building trust.
00:07:42
Speaker
with our communities. And this isn't, to me, I say this all the time, it's not a rocket science thing. We all need trust in any relationship that we have in order to help us move forward and to help us thrive. And so institutions are not outside of that need for our communities.
Global Health and U.S. Policies
00:08:04
Speaker
And so I think this trust really should be built long before COVID.
00:08:09
Speaker
But being present is going to be absolutely critical. Being transparent in communication. Risk communication is absolutely critical during this time from a public health standpoint. If we aren't transparent, we aren't communicating risk in a very clear way that also is accessible in many people's language, accessible in different reading levels, we aren't going to get that message forward. And that builds up
00:08:33
Speaker
those walls and those barriers that actually exacerbate mistrust within our communities. And I think there's going to have to be lots of efforts to work directly within the context of neighborhoods in which people live. I think messengers become really important. I think about us as NMA and NMA.
00:08:53
Speaker
positions of color and black positions, we're going to need to be messengers of what to do, the information that we have to help build trust as well, especially when it comes to vaccines and the trials that are happening right now for the vaccines and participation of black and brown folks in these trials. And then when the vaccine is ready, you know,
00:09:14
Speaker
um, uptake of that vaccine as well. But it's a, it's a double-edged sword in some level because I completely get, um, the lack of trust that's there. And it doesn't only exist for black and brown communities in this particular circumstance. Trust overall is that it's kind of, um, at risk right now for the entire country. Absolutely. You couldn't have said that any, any better. I truly do believe that we can't just expect trust.
00:09:43
Speaker
We have to put in the work to gain the trust that we lost because we have had a terrible history of injustices in this country. So thank you for explicitly saying that there has been a lack of trust and a lack of effort on the part of our health systems. I do want to touch on the piece about institutions that you were talking about.
00:10:12
Speaker
Last month, our country officially withdrew from the World Health Organization, which is an organization for global health efforts. What implications do you anticipate this having on us as far as testing and access to newly developed treatments and vaccinations when those things are concerned? And how do we address it? How do we address it moving forward?
00:10:39
Speaker
Yes, I think this also falls in line with another myth. And Dr. Camara Jones, if you all aren't familiar with her by now, definitely an icon in the space of health equity, a living legend, and talks lots about these myths that prevent us from advancing. And one of them is American exceptionalism. It totally undermines our opportunity as it relates to equity. But it undermines our opportunity as a country to fully realize and appreciate
00:11:08
Speaker
all of the opportunities and advances and learning lessons that there are worldwide.
00:11:14
Speaker
that there are to improve health. So withdrawing from the World Health Organization is just another example of that American exceptionalism that we don't need, you know, others, we don't, we can do this by ourselves, you know, we're the best, you know, in the world and, you know, all of that has consequences, you know, and we're seeing it now. And so the idea to kind of pull out from the World Health Organization and to be kind of connected and
00:11:44
Speaker
collective with other countries is quite bizarre and it's really quite dangerous. And, you know, AMA, the American Medical Association that I now kind of sit in and represent, you know, released a full statement back on July 7th, you know, about this and how it is potentially a major setback to science, public health and global coordination kind of as you already mentioned. The World Health Organization has played a
00:12:13
Speaker
very leading role in protecting and supporting and promoting health in the United States and other places. And so to withdraw at this point in time, when we desperately need leadership, it just doesn't make full sense at all. So we've called on Congress and folks to definitely reject the administration's withdrawal from the World Health Organization.
00:12:40
Speaker
Um, because ever, I think even the pandemic itself represents that we need to be part of a global effort. This is a pandemic. It is global. So for us not to be connected to that global conversation in a structured way, um, you know, we'll have our relationships of course, but in a structured and formal way, uh, it definitely puts us at risk of the country.
Envisioning a Healthier Future
00:13:03
Speaker
Absolutely.
00:13:03
Speaker
Absolutely. And I want to piggyback off of that and how you're mentioning American exceptionalism. We seem to be one of very few countries who pride ourselves in individualism, not necessarily the collective effort of trying to do anything, honestly.
00:13:32
Speaker
A common theme in our media has been how do we adjust to our new normal as if we can't get this under control if we all decide to be and act as a collective? So I want to just see your opinion on how do you envision life after COVID? If there is a life after COVID, will life return to normal? Are we expecting a new normal? What are your thoughts on that?
00:14:02
Speaker
Well, I mean, life is still here, right? To some level, to a large level. We're still in life and life is going to exist post COVID. How that life exists is your question. And the context, and I'm sure others have said this already before of normal versus not normal. I don't feel our norms pre COVID were healthy.
00:14:29
Speaker
and just and right. And so should we be going back to that? I would say no. And I think COVID really elevates that and exposes that even more so. And so what are we going to do and how do we capitalize on this opportunity with these doors being open that we create a society and a country that values human beings, no matter what their skin color is, they value human beings. And
00:14:58
Speaker
to the point where we claim and name that health is a human right and that access to health care is a human right. That's one of our other gaps that we have within this country. And it's going to be really critical for us to have that in order to move forward. I think also how our systems are able to respond, and I think how we as leaders, systems don't just respond just because.
00:15:23
Speaker
they respond to some external impetus that's out there, right? So COVID is one, so systems are responding, but we as human beings, we as leaders within the health space can also serve as impetus for change. So what are we going to do to vision a new future that does dismantle, that does
00:15:47
Speaker
you know, dismantle racism within our health care system that does force us to move more upstream in our solution. So it's not just about the downstream aspects of health care and care and services, but that our efforts and our advocacy are talking about more of those structural opportunities as it relates to housing, as it relates to wealth building, right? Wealth building is tremendous in terms of its connection to health outcomes in this country.
00:16:17
Speaker
And how do we push ourselves and push our institutions to look at those areas? How do we push medical education, residency education,
Reforming Medical Education
00:16:28
Speaker
to broaden what you all are taught and what med students are taught in school beyond what's happening in terms of clinical and basic care? How do you learn more about what's in the healthcare delivery system?
00:16:42
Speaker
How do you learn more about, again, what really fully creates health and what produces inequities? That should be a core part of medical curriculum. And there is movement in that, thank goodness, at this point in time.
00:16:55
Speaker
And so I think that evolution that's gonna come forward, and we're in the next couple of years, there will be competencies and standards that are built into medical education and residency curriculums. And then requirements for licensure, that's already happening actually in Michigan State. They have to have, this is bias, I think it has to go beyond just bias training, but there are some mandates that are starting to happen that folks need to have this type of
00:17:22
Speaker
education in order to become a physician in this country. So I think that's where we need to start moving towards. That's good to hear that we're moving in the right direction, at least. Slow, but it's better than nothing, honestly. And you were talking about the side from the health care system. How do we go about working with our communities that
00:17:51
Speaker
I don't want to say they seem like they aren't interested anymore in what COVID is doing or are just pretending like it's not there anymore. How do we go about, you know, making this a collective effort with the communities that we're serving? Because it's over and you know, people are pretending or just going about life as if it was normal again anyway.
Community Engagement in COVID-19
00:18:20
Speaker
Yeah. I think this is another area of trust and why people disengage, I think the reasons can vary. Once you start to see the community kind of transmission and spread go down, you start to see less effect in your neighborhoods. People start to get comfortable. It happens. I'm in New York City and I see it.
00:18:45
Speaker
around friends and family and I see it and I experience it. But we have to keep telling ourselves and we have to keep spreading the messages of the basics of wearing a face mask. We just launched a campaign on face masks and wearing them, you know, our social distancing, you know, our hand washing techniques, our sneezing in our elbows. All of those things are absolutely critical that we still continue to message at this point in time. And so work with others and frame like, look,
00:19:14
Speaker
You know, we're we're good now, not in all places. I'm in New York City. So we're in a better place than we were, you know, a few months ago. But there are places across the country that are not doing well. Right. So we know this. And in those areas and in these areas, we just have to constantly share those messages with each other and our families and friends. You know, I had the experience of having
00:19:39
Speaker
a death about two and a half months ago from an extended family member. And it was really difficult because when you have, you're trying to grieve during a time like this year, our tendency is to be close to one another, right? And to want to, to hug and to interact. And
00:19:59
Speaker
And you're upset and the message that I told one of my friends is that, you know, we have to say, you know, we don't want to have to do this over and over again. You know, so it's up to us to like wear our face masks and to do the social distancing. And we know we're upset, but how many times do we want to go to somebody's funeral, you know, in this sense?
Mental Health Challenges During COVID-19
00:20:20
Speaker
And so that's the message, you know, to one another. I, you know, the larger message though, that I think is important is that, you know,
00:20:28
Speaker
Black people aren't to blame for COVID. We have to look to the structures that create greater exposure, the jobs that we are forced to have because we don't have those same wealth building opportunities, the lack of investment within our neighborhoods in which our hospitals are not equally invested at all as compared to wealthier or whiter neighborhoods.
00:20:55
Speaker
And then, you know, the long history of kind of trauma and chronic stress that already puts us at increased risk for having certain diseases. And that, you know, the underlying conditions that everybody was mentioning initially. So all of those are really important to highlight as well, because we don't need to be blamed any further for our existence.
00:21:20
Speaker
Yeah, absolutely. I thank you for reframing it in that direction because I see oftentimes that, yeah, we are placing the blame on ourselves. And it is increasingly frustrating to just be sitting in the house sometimes. So I understand that people feel the need to want to get back to lives that
00:21:48
Speaker
that we were living before. So in that same vein, we haven't been talking a lot about how this is affecting people's mental health. We've been talking a lot about the somatic symptoms, but not necessarily about how people are dealing with this on a mental level.
00:22:16
Speaker
during this entire pandemic. Life has changed drastically over the course of, honestly, less than a year, losing jobs, losing insurance, like you were mentioning, family member funerals. So how do we best address the negative impacts that COVID is having on our mental health? Because I don't see a lot of that being taken into account, at least from a community level.
00:22:45
Speaker
Yeah, I think there's not a lot that has been able to address it on many levels.
Empathy and Advocacy in Medicine
00:22:53
Speaker
And, you know, you think about this decision about your children and going back to school, parents having to stay home, you know, and parents not being able to stay home, all of this affects our mental health. So, you know, it's going to affect every single one of us.
00:23:08
Speaker
at this point in time, you know, we just did a, we do this series called prioritizing equity about every other week. And this one, this last week was on mental health. And so we had two kind of experts, actually the former AMA president, Dr. Patrice Harris, who's the first black female president of the AMA and a psychiatrist was on the show. So if y'all want to check it out, please check it out. Absolutely.
00:23:35
Speaker
you know, COVID again shines and sheds a light that, you know, access to mental health services is an issue. The hope is, you know, with telehealth, that there may be a little bit of a greater opportunity to have access, but there's still issues of access as it relates to cost, there'll still be issues of access as it relates to, you know, do people have the band?
00:24:00
Speaker
In order to to be able to have internet There's access to even having enough mental health providers That is still of concern. So there's a lot of work and that's part of the visioning of
00:24:13
Speaker
I think that we have to do the future like how do we not how do we vision a future that integrates as you said earlier somatic but how does it integrate our physical and mental emotional health. So we're sending up systems in that kind of way so that they can be responsive they can be trauma informed for times like this during COVID. Absolutely. Thank you for for that. I
00:24:42
Speaker
have one more question for you as medical students this this podcast and SNMA in general is dedicated towards um you know underrepresented minorities in medicine but we also have a vast network of alumni we have a vast network of pre-medical students so what advice do you have for us as
00:25:04
Speaker
medical students, pre-medical students, residents, about how to relate and engage our patients who are dealing with this during this time. What can we do?
00:25:17
Speaker
Yeah, I think, you know, continue being empathetic and humble, right? And ask the questions in which you need to ask. I think start asking questions as it relates to people's experience of racism. Because, you know, even going back to your former question, you know, oftentimes when we talk about mental health, we're not also talking about like the incident as it relates to George Floyd. So there was like all these confounding
00:25:47
Speaker
moments, right and And really exacerbating One another and the effects of one another so it's really important that we create and talk more about these particular issues and our patients experience with racism and how it's affecting themselves and their families within the context of the interviews that we have and
00:26:10
Speaker
And then, you know, as students, and I think students are quite remarkable, you know, is to advocate. You all really understand. You get structures better than my generation did and the impact of structure and the production of inequities. And so continuing to kind of use your voice to elevate those stories of your patients and using the privilege that you have
00:26:40
Speaker
that you learn from them, but the privilege that you have in order to actually create change in the future, I think is really critical at this time.
Inspiration for Advocacy
00:26:50
Speaker
And I think that when you start to voice, you also people will model after you, right? So it's not just about you, but it's about all those students that are going to be coming after you to also have them model you.
00:27:03
Speaker
And I think about the late Congressmen, John Lewis, who said it's not enough to say it will get better by and by, but that each of us has a moral obligation to stand up and to speak up and to speak out. So when you see something that's not right, you must say something and you must do something. And I get there are risks. There are always risks in doing that. But many people fought, and his life is an example of that,
00:27:31
Speaker
before us, you know, with their own lives that we could have the freedoms in quotes that we are able to have today that some of us are able to have today. I can say it better myself. Thank you Dr. Maybank for for just taking the time out to talk to us. We just appreciate everything that you do.
00:27:50
Speaker
to advocate for us as well as your patients and the health of this country, honestly. Thank you, Dr. Maybank. Okay. Thanks for the opportunity. I appreciate it. Okay.
Closing and Listener Engagement
00:28:06
Speaker
We hope you enjoyed that conversation with Dr. Maybank, but now it's time to hear from you. Email us your thoughts on this discussion and suggestions on who you'd like to have in the lounge next at podcast at snma.org.
00:28:20
Speaker
And we wouldn't be us if we didn't plug our socials. So don't forget to engage with everything SNMA on Instagram, Twitter, and Facebook. We're here in the lounge every first Friday. So we'll see y'all next month. Peace.
00:28:57
Speaker
you