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A disparity, by definition, is just
the difference between two groups,
or two different locations.
But it has no explanation as to why.
What people are demanding now is sort of the why part of it.
But when you look at the data citywide,
particularly when it comes to black, African-American people,
we're the sickest people in San Francisco.
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With HIV, black, African-American,
tend to have the highest rates of new HIV infection.
We also see disparities when we think about viral suppression
as well, among black communities.
I think Black Lives Matter has helped
ensure that racial disparities aren't just
the topic of public health officials, or government
bureaucrats.
But really, is the topic of conversation at dinner tables
across the country.
Sometimes, it's a question of being aware of it,
and then other times it's a question
of how we analyze data.
If we aren't looking at breaking down data, say,
by race or ethnicity, or by neighborhood poverty level,
if we're not looking at it geographically,
then we'll miss things.
I think when people understand that that agenda is really
about supporting communities that they will rally behind it.
Black Lives Matter is a human rights movement,
which is so different than it being a civil rights movement.
Because civil rights movements are historically
organized around the acquisition of a particular kind
of legislative gain.
Or legislative goal.
The right to vote.
The right to marry.
The right to choose, the right to live
wherever you want to live.
But human rights movements are different because human rights
movements are cutting at that deeper existential
core, that question of who gets to be counted as human?
People won't rally behind it unless they
have an understanding that those communities are deserving.
There's a lot of preconceived notions about black people
in this country.
We're a presumed threat, period.
For too long, we have used tropes like the welfare queen,
the super predator, really, to blanket entire communities,
particularly black and brown communities, as undeserving,
or deserving only of punishment, incarceration,
and criminalization.
One of our challenges is to understand
how this all traumatizes us, how we as African American people
have consistently lived in historical trauma,
since slavery.
There is this kind of mythology that after slavery,
for example, ended, well you know, everything was fine then.
And of course now we become welcome members
of the society, and began to partake
of all the rights and privileges of our white counterparts.
And that simply is just not the truth.
After the Civil War, we have slaves that are now free.
They're no longer saying black people
are supposed to be slaves.
But what we're going to do is, we still see them as inferior,
so we're going to put in systems in order to keep them inferior.
Then you have this entire caste system
of Jim Crow, where there is separation and segregation
among black communities, where they are not
given the proper resources.
And they're aren't being able to have that access to wealth,
as much as white people have.
And then we have this push for the war on drugs.
So after the Civil Rights movement,
you now had this initiative where you start turning racism
into a social process.
So now it becomes institutionalized racism.
And so Nixon started it, and in trying to really lock up
people of color, we'll call it what
it is, it says it was a war on crime, but it was a real push
to lock up black and brown people.
So when we start looking at why these things exist today,
we're seeing similar kinds of conditions of discrimination
that exist.
Again, we all pretend that there is this level playing field.
But it's just not the case.
It's not the case economically, it's not the case socially,
it's not the case even ecologically.
It's just simply not the same.
In certain places, there aren't healthy food stores,
or there aren't any banks, or the educational outcomes
are bad, or the housing quality is really bad.
People are looking at that going OK, this is part of the issue.
We really do have to talk about these things as well.
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So if we understand the conditions under which people
are living, we understand that these
are social determinants of health,
that we have to wear several different hats here.
We have to help people survive within their environment,
and then we have to also insist that the conditions that
are producing this injury be addressed.
So, for example, if my diabetes is
manageable in our medical records,
it looks like I'm doing better.
No, I still live in a community that has huge toxins,
we're policed to death, lots of violence,
mental health issues, gentrification,
mass incarceration, lack of support for our disabled
and elderly.
So because my diabetes is managed, I'm better?
I'm better to have to engage in this continuum of racism?
Look, I went to Harvard as an undergrad.
I grew up in East Oakland.
I saw young people doing the same things at Harvard
that they were doing in my community in East Oakland,
but with much different results and outcomes.
Young people at Harvard got time off,
they got the support and services they needed,
they were treated as if they were more
than their worst mistake.
And as a result, they went on to do great things
and continue their studies.
Or if they didn't go on to do great things,
they certainly went on to be well paid, remunerated,
and considered productive members of our society.
Contrast that to the treatment of young people
from East Oakland, who don't have those services
and supports to begin with.
And if they do make a mistake, are much more
likely to be sent to the juvenile hall, or sent to jail.
There is a parable about fish swimming in the ocean, right?
And so there is a school of fish swimming one way.
And one fish swimming on his own the other way.
And the one fish says to the school of fish
that is swimming by him, how's the water?
And they ignore him, and they keep swimming.
And then when he's gone, the fish turn to each other
and say, what's water?
Right?
Because what we're in we're used to.
And once in a while we get a flashpoint.
And I think Black Lives Matter, some of the other movements
that we've seen, they say you know,
as we've been living there's a crisis.
And there's something new and different to be done about it.
Or something that should have been
done at a much bigger scale than we've done it.
I think it's important as we start
talking about health disparities or health equity
to really highlight the conditions that people are
living, that many people would say,
I wouldn't want to live in that condition,
or nobody should live in that condition as well.
I would want public health officials
to understand that they must be advocates, that they can't just
sit on the sidelines, or think of themselves
as neutral parties.
You are taking an active role, especially
as a government institution, to address and ensure
that what you do moving forward doesn't
have the same effects as what things that
have happened in the past.
One of the first conversations we had
was about the language in the platform.
Part of the language is about ending the war on black lives,
and some people got really afraid of how that sounded,
and what it meant.
But we've had data for a long time that tells us
that we're talking about decades span differences
in life expectancy between some communities.
So there's a way that public health
can help frame that for people to hear and understand.
Well, the difficult thing is that you
have to talk about them because they're usually
things out of your control.
So as a health department, I don't really
have any control over transportation.
I don't have any control over housing.
I don't have any control over education.
I don't have any control over the local economy.
But I think that we are being given an opportunity that we've
never had before.
I mean I think that there is nobody
who is complacent anymore.
There's nobody who sees that it's not
their job to do something.
And so what Black Lives Matter has done, and particularly
the moment for black lives platform,
has really bulleted out those points.
They bulleted out a series of economic opportunity points
that are really solutions to things we know are different,
and challenges we know have been specific to
the African-American community.
It's really made a statement on economic opportunity,
on housing, on immigration, in a way that
helps focus those solutions so that when
we look at a problem that's a problem for everyone,
we have solutions that are also working for everyone.
When everybody comes together, you
have a pretty powerful force.
We're all connected.
So the key here is to look at our common humanity,
in all cases, as opposed to us and them.
Or my issue here is more important than yours.
When we start to talk to people who are actually
in the community, who are living in those places, who
are working in those places on a day-to-day basis,
we get another perspective.
And that perspective helps to improve whatever we do,
and many times what they do as well.
What I hope that public health officials,
other government officials understand,
is that we're in it together at this point,
and if we don't actually see social movements
as relevant to democracy, as relevant to our struggle
to actually maintain some level of autonomy and capacity
to support the public health of our region,
then we're going to be in big trouble.
There's a preponderance of evidence.
You know, there's data coming out of our ears around this.
It's now applying that data to change.
So it's not simply we know this, and it's sitting over here,
we are now going to, based on that,
it's going to inform practice.
The beginning of the conversation
has to start with being authentic and transparent.
We must say we have created a racist system
for the black people in this city.
And we need to start dismantling that as we're trying
to engage people to be well.
I can't be well if your system is continually robbing me
of my health and wellness.
How can I be well?
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