Pandemic & Protest: Racism As A Social Determinant Of Health

Hey everyone, Dr. Z. We are live, I think. I’m gonna save the comments for the end, because I think this is a important enough topic that I wanna talk honestly and authentically about it from both a health care perspective, and a human perspective, and a moral, sort of foundations perspective.

And that is the current state of the protesting and the massive response to the George Floyd, I’m gonna call it a murder. Because that’s how it feels and that’s how it looks. And of course, a jury’s gotta decide that, but that’s how it feels to hundreds of thousands, if not millions, of people in the United States who have historically felt disenfranchised, who are terrified that their children are gonna be stopped at a traffic light for something routine, and killed because of the color of their skin.

And this is an emotional conditioned elephant response. Right, our unconscious emotional state. And it is leading to an outpouring of outrage because it triggers every single moral taste bud that we have. And remember in the previous videos, we’ve talked about these moral taste buds, fairness versus cheating. How can it be, that you can die because of the color of your skin? How can it be that we have cycles of poverty and poor health, chronic disease, hypertension, diabetes, obesity in poor African-American, Hispanic communities, when there’s nothing that they did that deserved that.

Are we still paying the legacy of slavery so many decades later in segregation and the civil rights movement, all of this still feels incredibly unfair, especially if you’re a member of that group. So when you see George Floyd on video in this new weaponized age of social media, basically dying with a white person’s knee on his neck, how can anyone imagine that that’s not gonna lead to incredible amounts of hurt trauma, outrage? So the first thing I wanna advocate for is for anyone who denies that this is a thing, you just need to wake up. All right. Because it’s not just a thing.

It’s one of the most powerful things we as humans feel, because every single moral taste bud, fairness versus cheating, it’s absolutely unfair, that you would die at the hands of an organization that’s designed to keep us safe, right.

Loyalty versus betrayal. How can it be that our own society would betray its most vulnerable or if you’re an in group if you’re, you know, a Black American. You would wanna stand with your own in the face of injustice. And the same may go for people in other groups, right. So loyalty versus betrayal is such an important one. And then you have, you know, care versus harm. How is it that we cannot extend our circle of compassion to those that look different than us? And that includes anybody in any racial group. We have to be able to put ourselves in the mindset of all conscious entities, right and say, “You know what, “they’re all deserving of love and care.” And and again, so this triggers us to say, “Wait, what is going on?” Right. Authority versus subversion another moral taste bud. We have the police who represent law and order and this is where there’s so much tension, right. Because when you start seeing protests, and innocent small business owners and large business owners are targeted, and people are there are clear opportunists in the group that are running a muck that are creating havoc that are putting people lives and livelihoods in danger, that isn’t authority versus subversion or fairness versus cheating. All of those are triggered there on the other side of that. So we have a mess, right. And don’t forget, don’t forget, you have sanctity versus degradation, that moral tastes bud when you see a black man like George Floyd being treated as less than human, that’s how it feels.

That is a degradation of the sanctity of human life. So all the taste buds are triggered and on all sides of this. So if you’re law enforcement, how is it fair that you’re painted with the same brush as that criminal who murdered George Floyd? And how hard it is to be a law enforcement officer in this country today, you think about the frontline health care workers that suffer so much of violence, right, that’s completely unfair, but law enforcement officers who are doing their best, you see some them out there taking knees with the protesters doing their best are painted with the same brush as this criminal in Minneapolis. And of course, there’s systemic, systemic racism. Of course there is. The American Academy of Pediatrics went so far as to say it is a root cause a social determinants of health, triggering high cortisol levels, high stress levels in say, black the black community. So what does that mean more hypertension, more diseases of stress related diseases like chronic illness, poor sleep, and what does that do then? What does that do? It ends up putting you at risk for dying from a disease that it has already been shown preferentially seems to claim the lives of those that are poor, and of racial minority groups and that’s COVID-19. So now you have a situation where you have a pandemic. Just walk through this with me for a second ’cause I want people to do the exercise if you haven’t done this, of understanding why we are where we are in terms of the emotional and moral foundations element of this.

And then we’re gonna talk about the healthcare elements of this, and how we can mitigate some of the harm that’s coming of this because believe me, harm is coming of this. If we don’t pay attention, if we don’t grow our rational side and start to look at our emotions and say, “How can we do this more wisely? “How can we do this more compassionately?” All right. So you have a situation where you have a pandemic that then leads to a poor response, a lot of unknowns, and a big economic lockdown that has shut down the economy and put in Las Vegas 30% of workers are out of work, unemployed record levels never seen since they started measuring it. And these are often people that are already on the margins. So again, we’re talking about the Black community right. The Hispanic community, people that are already on the margins because of guess what institutionalized generational systemic bias and racism, which if you deny it exists, I think you need to wake up. All right. Doesn’t mean it’s your fault, but it means that it exists.

And it’s our fault if we don’t wake up and say, “How do we address these things rationally?” Right. Because they’re leading to bad outcomes across society. This is a we’re all in this together kind of moment, right. This is not the time to really be so divisive, which we’re seeing from leadership across the board. So we have a pandemic that shuts down the economy. Now you have people at home who are despairing because they cannot support their families. Then you have this event happen where you can watch it on TV, and it’s already a super polarized society because of social media and all the things we talked about, right. Everybody’s elephants are immediately unleashed to Stampede and we have a disaster situation where people are emotionally active. And going out. And listen, protesting is that is America. That’s what we do in America. Right. We do it peacefully, we do it organized. And we do it in a way that’s, that’s absolutely non violent. We don’t burn down the very communities we’re trying to advocate for.

Now, in the setting of this, though, what’s happening is emotions are running so high that people are ready to throw away all the gains that we’ve made through this very painful and economy destroying lockdown that we’ve had. So we’re gonna take all the sacrifice we collectively made and throw it away. Why? Because mass gatherings of people who are partially unmasked who are not social distancing, and who are doing things that have been shown to spread the virus which is screaming, talking loudly projecting their voice, getting sprayed with tear gas or pepper spray which causes fits of coughing. When we know now that 40 to 50% of everybody who’s infected, may not have any symptoms, but can go out and be a part of a large crowd and spread the disease to people who are vulnerable in the very communities that are the worst hit. In New York, it was the patient transporters. It was the clerks, it was people who worked in healthcare that were that were racial minorities that were making, you know, not much above minimum wage that were getting sick and dying at higher rates. This is the community that’s already at risk, partially because of because of the very thing they’re protesting, which is generational systemic racial bias. And so now what we have is people going out standing up and protesting which is there right in the US and actually is so appropriate given what’s been going on. However, we throwing out all the gains we’ve made in putting people at risk not only the the law enforcement people that are actually there that are that are put at risk, right, which is not fair. But the community that’s most at risk. And if you look back to 1918, we know that large crowds during the Spanish flu pandemic at that time, large crowds are a huge risk. So troops coming home had a big pray 200,000 people I forget the city, huge outbreak of flu, because that’s how the thing spreads close proximity respiratory droplets now, how can we actually make this better? You can actually protest in a way that won’t cause that will mitigate some of this harm. You’re not gonna lower the risk to zero, but you can mitigate the harm.

So what do you do? Wear a damn mask and you guys know I’m equivocal about cloth masks in a lot of public settings, but in settings where you cannot social distance, and you have large groups, which we shouldn’t be having anyways but in this case, this is an extraordinary circumstance, well, wear a mask, cover your face because you’re gonna protect others from your droplets. And you might get a little protection for yourself. But really, it’s protecting others from the droplets now you want protection for yourself and others in those circumstances. What do you do? Don’t let that mask make you think that you’re impervious, you know, and police that are wearing these face shields. They’re not impervious. Okay, they’re not they’re not wearing N95 mask under that they’re not social distancing. They’re up in everyone’s face. This is a false sense of security, which means you do your best to keep your distance and protest peacefully. And in terms of projecting your voice if you’re wearing a mask, at least, you’re helping keep this projection from infecting other people which we know can happen. If you’re gonna protest with a group of, of people, you know, stay with that group, but try to keep a distance from other groups as much as you can and I know it’s gonna be hard and I know it sounds naive, but you have to try if you care at all about the very community that you’re advocating for so appropriately, right. And, and, you know, this is something that can be done, we can do it more wisely, we can make our voice heard. And we can continue to agitate for progress and change in a way that actually puts puts the circle of compassion out as widely as it can.

And that includes from the communities that are suffering under this towards say law enforcement saying, “How can we work together “to overcome these shorthand heuristics “you’re using where you equate black man “with potential threat?” How can we how can we even have a dialogue about that until you put out on the table, what’s going on. How can we keep those communities safe from COVID and then my tribe, if we’re talking about loyalty versus betrayal, my tribe of healthcare professionals. That are then gonna be put at risk from overwhelming our healthcare system with exactly what we’ve been all sacrificing so much to prevent. And we’re gonna throw it all away if we don’t do this wisely. So let’s not let the actions of a criminal racist piece of crap. This officer, I won’t even say his name, destroy what we as a society have sacrificed to do. Let’s never forget that race, racial bias and racism, systemic or individual is a social determinant of health.

That is costing us trillions in health care costs. So we need to come to forget about care versus harm and compassion. Just think about the practicalities. Use your “Rider,” the part that’s rational and say this has to stop if we’re gonna have a functioning economy, an effective and cohesive society and a safe world for our children. It has to stop. So means we have to talk about it openly, without fear across these tribes that we’ve created, that feel right to our elephant, but are just simply not the way we’re gonna be better as humans. All right, guys. That’s really what I wanted to talk about today. And I know it’s broad, and I didn’t prepare anything. And I know I like to ramble. But that’s what I think about this. And that’s why it’s so hurtful to see people on one side or the other, just ignoring the bigger picture. So we have to try. We have to try harder. All right. You can stop here if you’re YouTube. I’m gonna take comments.

Don’t pretend slavery and segregation didn’t exist Kuleana Coleman. This is what that boggles my mind. You know, you cannot hold an individual white person accountable that one person accountable for slavery, but we can hold a society and say “This thing happened.” It was only a few generations ago. We’re still feeling a collective hurt from this across races. I mean, this was insane. You could buy a human being and sell them like they were property. And then what happens. It’s recapitulated when you see a knee on the neck of a black man who ultimately dies in front of you on video. How does that not recapitulate a trauma? It’s this, it’s been called post traumatic slavery disorder. That’s a real thing. I think we deny it at our peril. Now we can have educated conversations about what’s the best way forward, right. But we got to have the conversations. So anxious for the next few weeks I work in a hospital at the respiratory dedicated units is Arian.

I think we should be anxious because what we’re gonna see is in a couple weeks, we’re gonna see the fruits of mass gatherings where people a lot of people aren’t wearing masks and they’re shouting and projecting we’re gonna see that bear very bad fruit. Now if we don’t if we don’t, it means that the temperature change and the summer and the sort of drift of the virus that will tell us something too. Right. It means that hey, we’re something is changing here and how this pandemic is playing out, we need to pay attention and study it. So I don’t I do not think that that’s entirely unlikely either. But we have to watch and it doesn’t mean we wanna do the experiment. ‘Cause there’s simple ways to prevent that possibility. Right. I have several law enforcement officers as patients one came in Friday and was almost in tears about Mr. Floyd’s death, Jody chance. It is so inconceivable to imagine being a human being and wanting to condone the harming of another human being who is unarmed and I wanna say this to our law enforcement officers. I personally and this is my bias. When when I was in medical school, there was a guy ran a red light.

I was driving back from Berkeley where I was teaching MCAT on our Wednesdays, and I was a UCSF Medical student. And I remember stopping at a red light, the light turning green, in San Francisco and me going through the light and just a blur, seeing bodies flying a car, my hood crumpling up in my face. And I don’t think I was hurt and I got out of the car and there were people lying on the ground. And two things happened. Somebody ran out of a building, showing a badge, but they were dressed in civilian clothes and it was an undercover white police officer. Actually, I think Hispanic police officer who stopped whatever they were doing undercover broke their cover and ran to the street to deal with the two bystanders that were hit by the person high on cocaine, who ran the red light hit me and killed a pedestrian and seriously injured another in front of me.

And I was a 20 something year old medical student. He broke his cover ran out to help these people to call for backup, and to call for an ambulance. And after that, a police officer came and they had no reason to do this, but they drove me all the way across town to my home. And at that point, they were telling me the story of their own child because they knew I was a medical student and they saw that I was shell shocked because I just seen somebody die. And I was wondering, was I responsible for this ’cause I didn’t know what it played out. And they were telling me about their own son who suffer from asthma and how hard it was, and they were connecting with me as I was sitting in the back of the squad car and drove me home. And I will never forget how how compassionate both of those two were in the setting of a large city in a part of town that was predominantly you know, poor and black. And they showed love and compassion. And I was deeply affected by that. And so in the same way that if you can be a black man driving, you’re always looking and concerned and worried. I’ve always had this bias that police are there to protect us. And I think all of those biases are true. Everything is true impartial. So how can we elevate our love and understanding across the board to be better? Right.

So that’s just my personal story. So listen, guys, I’m gonna go now before I lose my mind and say something crazy beyond what I’ve said, but this is my call to action. Do something to watch what your emotions are doing. Take a pause and respond in a more wise and compassionate way than you would have if you had just knee jerk response across the board. Let’s try to come together. Let’s try to stay as safe as we can and not undo all the all the hard work that’s been put into this. All right, and that’s all that really I would love if everybody tried to do that even just today. It would be so huge. All right, guys. I love you. We out