March 21, 2020

A Virus Without Borders: The Design of Public Health, Inequality, and Hope

A Virus Without Borders: The Design of Public Health, Inequality, and Hope

Produced in collaboration with Experience by Design.  We are witnessing a moment in our lifetimes that we will hopefully never see again. The world is gripped in a pandemic of a scale unseen for a  century. Beyond the human toll, we are seeing how healthcare systems  people once had trust in crumble before their eyes. In this episode,  Adam and Gary talk with Shelley White and Meenakshi Verma-Agrawal of the  Simmons University Masters of Public Health program on what we learn  from this moment, and how we can design a more inclusive healthcare  system.

Shelley White is an Assistant Professor of Public Health and Sociology, and Program Director of the Master of Public Health.

Meenakshi Verma-Agrawal is the Assistant Program Director and Associate Professor of Practice at MPH@Simmons.

What  a difference a week makes. Or does it? With the expanding pandemic of COVID-19 disrupting more lives, many here in the United States might  feel caught off guard, or that things have changed to rapidly. Now  health care is a constant concern.

What Shelley White and  Meenakshi Verma-Agrawal help us put in perspective is that even though  we can all get sick, public health and care has always been political,  and who has access to care, and even what diagnoses one gets, have been  deeply tied to class, race, ethnicity and other socioeconomic  classifications. Public health, in fact, is designed. Moments of  pandemic, where a virus crosses borders and bodies with no care for the  social structures we’ve erected, brings to light the radically unequal  way our public health systems are designed. For middle class families  who find themselves for the first time concerned about the lack of  available health care or beds at a hospital, must now contend with the  fact that this is a common reality for many poorer communities and  communities of color.

But moments of crisis like this are also  moments of hope. As Dr. White notes in the conversation, we have to  remember that there are more people who seek equity and change than  those who benefit from the status quo. What's radical is to acknowledge  the racial, social, and economic injustices that frame our public health  system and to then set about to change those inequities for a more just  world.

  • covid-19
  • public health
  • healthcare design
  • experience design
  • health inequalities

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A Virus Without Borders

Adam Gamwell: [00:01:07] They folks, Adam Gamwell here. Given the worldwide public health crisis from COVID-19, it's more important than ever that we come together to hear one another,  to be there for one another and to take seriously this as a moment to name the injustices that help perpetuate health crises so that we can better and more effectively redesign our social systems.

I wanted to share an important conversation that Gary David and myself had on a sister podcast, Experienced by Design about the design of public health, inequality, and hope with Shelley White and Meenakshi Verma-Agrawal  from the school of public health at Simmons University in Boston. 

I hope you enjoy. And please get in touch with comments and let me know what other content you want to hear on this podcast. And we'll see you on the other side.

Gary David: [00:01:20] Hey everybody. Welcome back to Experience by Design podcast, where we explore experience designs of all kinds. I'm Gary David handling the intro duties for this episode. What a difference a week makes right? Or two weeks or three weeks you think back to where you were and what you're doing even a month ago.

It might seem like another lifetime. It was when this weird new virus that we didn't know what it was called was being talked about only a little bit in the news, if at all. And it seemed really far off at this distant land called Wuhan. It feels like a whole lifetime ago and that sense of lost footing, underlines the suddenness with which it all seems to have happened.

You know, problems always seem less significant when happening somewhere else to someone else, we might feel badly about what is happening. When we watch the news, we might see something happening in another place and feel horribly for the people that it's happening to, but it's hard to really feel connected to it when it's happening someplace that far off, it seems so “disattached” or detached from what's going on in our own lives.

A whole city in China that you've never heard of before being in lockdown is tragic but not necessarily consequential to how you're living your life. We have more pressing issues to deal with in our own lives, on a daily basis. And besides what can you do about it anyway? What could you do about the city in China if you want to do anything at all? And then all of a sudden here it is on your doorstep. On my doorstep, businesses, schools, borders all shutting down within the scope of a week. And while it might feel sudden, we can't say the warning signs weren't there all along. We can wonder why we didn't listen to them more.

And we can also wonder why many people still aren't, but we can't say they weren't there gone from our public consciousness, our accounts of how many points were scored or wins tallied and then replaced by accounts of how many respirators are left, how many hospital masks are needed, how many new cases have occurred and how many people have died. Also are the counts of what is the gap between what is needed to deal with this crisis and what we have, and it's in that gap that lies what's long been apparent to many. Our healthcare system that is in some ways, the best in the world is in many ways, far behind.

And that access to healthcare that does exist is an equal or limited basis where in society you find yourself. The dark joke going around the internet has been, if you want to get tested for COVID-19, you really need to bring your IMDB page, your sports stats or your investment portfolio, as it seems that the connected are the only ones to get connected to these resources.

Which brings us to today's podcast and today's podcast might sound a little bit more academic than our previous podcasts and that's for some good reason. The first reason is that the guests we have on today's podcast are, as we say, in Boston, wicked smart, very intelligent and accomplished professionals in the space of public health.

The second reason is that the complexity of our system, as well as it's inherent problems, are pretty significant. And it's a lot to untangle and understand them. But at the same time, a lot of the origins of it's inequality are pretty simple if we only look. And so today, unexperienced by design podcasts, we have Shelly White and Meenakshi Verma-Agrawal from the Simmons University masters of public health program here in Boston.

Both Shelly and Meenakshi have a long career examining the issues of social inequality and health disparity when it comes to public health access and it's outcomes. In our conversation we do cover a lot of ground in a short period of time around the design of the healthcare system overall, how it has been historically designed in many ways to be unequal, and how it can and should be designed for the most marginalized populations and persons among us. And rather than this being a zero sum game where those who win come at the expense of those who lose, we can decide to design for the most marginalized as a win for all of us, by taking in those marginalized voices, it actually improves the design outcomes for everybody involved.

It's a timely conversation. It's an important conversation as we look to not only how to deal with this current moment. But also we start to envision the moments we want to come after. I hope you enjoyed the conversation.

Thanks for both coming out for this podcast. And we have not had Adam, I don't think we've had a situation where we've had two guests at the same time. Have we? 

Adam Gamwell: [00:06:57] this is the first time. So we appreciate you experimenting with us. even as your stocks are being sold. Still hanging out, 

Gary David: [00:06:01] have you found, I mean, Shelly, have you found that people suddenly find a value in sociology at times like this. Whereas other times, no one values what it is that we do in any kind of way whatsoever. 

Shelley White: [00:07:21] I think so. I hope so. It's been interesting this semester, I'm teaching a sociology course called intro to transnationalism and it's been really interesting, like the evolution of our dialogues in that space about thinking about theories of transnationalism concepts of citizenship, of borders, of identity and the building of nationalisms including just really toxic nationalisms and all of the inequities that are sort of layered into those systems of identity. So I think so. I see my, I will at least say in the classroom that I feel like students are really responding to the moment and thinking more deeply simply about these issues of inequity and the structures that are perpetuating them.

Gary David: [00:08:07] Is it more so than they were before? I, you know, it's one of the things I've been talking about with my faculty, which full disclosure your husband is among them, is this idea of you can feel free to toss out anything you had in the syllabus. And just jump into the moment right now because it demands, people have questions and I don't know that we have answers, but at least we have perspective. We have theoretical frameworks, we have concepts that we can hopefully rely upon. To give us a sense of what the hell is going on in the world at this moment. 

Shelley White: [00:08:40] Yeah. And we've tried to create that opening as well. I think within our program Meenakshi and I are both part of a master of public health program, which is really a cool space where we're taking, we are very interdisciplinary myself as a sociologist. We have folks who are trained in public health, but also folks with backgrounds in economics and political science and education and community organizing. And it's just like an array of different disciplinary perspectives.

I think we're sort of like drawing on all of those variety of perspectives and theories and frameworks, and then how we're adapting in the moment to create space for this. I hope we're doing it. I think we're really thinking about how humbling this is in terms of how it's impacting students' lives, students' everyday life.

And also people's bandwidth to like be in an intellectual community at this moment. It's everyone, even for our program, which is largely an online program used to meeting in virtual communities to do our learning. That stays relatively stable, but what's shifting is like all of us and people are doing triple roles of homeschooling and parenting all day long at home.

Balancing new work scenarios like some people still being on the front lines and being called to pretty high risk situations. And what that means for them in terms of what they're carrying home to those who are currently working at home, like in their bedrooms and so spouses and partners and roommates can also function in their new work realities.

And then I think just like the relative cutoff that we're all experiencing from community. So like the stressors are high and this is not a short term situation. So yeah, I think as faculty, as administrators of this program, we're really thinking about what it means to hold community through this and to create space for what is somewhat of a collective grieving and collective processing moment.

Gary David: [00:10:38] One of the things, I’ll be interested in  your comments and Meenakshi ‘s comments as well. I just read a blog post on intersectionality and COVID-19 for organizations primarily understanding that we're not all experiencing this moment in the same way. So while we all are experiencing it at the same time, depending upon who we are, our what our social classes, what our gender, our background, our marital status, our family status we're experienced, or if we're Asian American or not.

Right? How we're experiencing this differently, even though we're experiencing it at the same time. And I guess that's not unusual for you all to talk about because public health is about that very thing.

Meenakshi Verma-Agrawal: [00:11:22]  Yeah, Gary, if I can step in on that, I really appreciate you bringing that up because in our program specifically, we look at health equity from an intersectional lens.

So basically that means that depending on the multiple marginalizations with this term was coined by a black feminist and scholar Kimberlé Crenshaw. And she said that the more marginalizations that you experience, the worse off your outcomes are. Especially looking at COVID-19, all of the inequities are starting to bubble up to the top, which have been fundamentally created through structural racism and other forms of oppression in our society.

But now, the spread of this virus is like spreading through the cracks. Like you wouldn't be able to believe because we haven't had a social safety net in reality for many of the people living in this country. So that's why I look at the example of my city. We have about 70,000 people, 40% are children who are children of color, their families are immigrants.

And it took us a while to cancel the schools because we had to figure out a plan for their food security. So in a way the addressing of the pandemic was harder to do because so much of the social support comes from what's happening at the schools. And so this is where those things intersect and, we're seeing that the people who are experiencing the greatest impact of this are our frontline workers and also people who don't have access to paid leave or health care. So in that way, the intersections are really showing up. And I think that's a really important part of the conversation. 

Adam Gamwell: [00:13:01] I think that’s a really great introduction to think about the topics at hand in one of the pieces I'm really curious about  both as an anthropologist but also just, as a perspective of thinking about this as public health, right.

And that as an intersectional space it's so interesting to contemplate for me at least how public health inequities as well as transnationalism and a virus that hops borders,the virus that has no borders., how, something like that again, doesn't have any borders so clarifies and highlights the ones that we have built. Right? Societally  because it just runs over them and suddenly it's now this, on a very crass way, it's become a middle class and upper class problem now to like health and that it's like, it's sad to see that's when you kind of see politicians starting to do something, which is pathetic. Right?

But l it's interesting too, when on some level you see these kinds of biologies in this case the virus to that  my hope is that it brings these conversations more forward, right. That we can talk about intersectionality, that we can talk about basically how this is systemic racism and systemic violence has attempted to push health inequities down the socioeconomic ladder but then something like a virus pushes it back up.

I guess I'm curious to think about in a broad sense too, Meenakshi  in your work as doing programmatic work that you've both done in Bombay India, as well as in the States. I was reading that one of the projects you're working on was working at patients' rights and thinking about  how health rights and patient rights get changed by focusing on these issues? So I wonder if you could talk a little bit about that, cause I'd love to reflect on what this might help us think about. In the current situation too. 

Meenakshi Verma-Agrawal: [00:14:58] Yeah, absolutely. When I was working in Bombay I was working with their municipal corporation and, you know, Bombay is the financial capital of India. It has an exploding population that grows by 10,000 every day, even though it looks like there's no more space for any one person to join. And I think at that time we were really working to deeply reinforce this idea of patients' rights when they come into the hospital, it's a very different system from what we're used to here.

And really your social class and your income or your wealth determines your quality of care very much like in this country as well. And what we were seeing was that patients and I mean, I just see so many parallels with what we're doing here is that understanding our rights as patients there and for the patients who are coming into the community health centers, they did not understand. And were just not aware of their rights or that they had the rights. And so the municipal corporation really did buy into this idea, because I knew that equity by design is a superior principle. And if the patients begin to understand their rights, it actually got better for the providers.

It got better for the administrators as well. And so I think that that's the critical analysis that we try to bring through our program about equity is because it's kind of misunderstood as a zero sum game that if you get something Adam, then I'll lose something or Gary gets something, Shelly will lose something.

But it's really not about that. I mean, it's about how can we understand our history? How can we understand those with the greatest marginalizations and then create a solution or create a design that actually is created for those with the most marginalizations and work better for us.

I'm sure both of you are familiar with curb cuts as an example principle of universal design is a key part of that. The American disabilities act allowed people with disabilities to get curb cuts and we all benefit from them, whether it's a parent pushing a stroller or a person doing a delivery or all of the other various ways that's supposed to support folks.

So even in this situation where we are with COVID-19 right now, if we try to create our solution based on those where the most marginalized, those with least amount of days off those with the least amount of healthcare, those with the least ability to be able to take time off from their job. Then our solution is going to look very different from the sort of band aids that we've been putting on our society to try to, okay.

We'll address racism today and sexism tomorrow. If it's not intersectional and it's not looking at those who are most marginalized people of color, immigrants, undocumented immigrants, those who are earning less than minimum wage, those are who's who are houseless. We're seeing all those inequities really emerged through all of those systems.

Gary David: [00:18:02] As you're talking there, I was starting to think that we could live in a very empathetic moment right now where people who are saying things like, what do you mean? My hospitals didn't have enough medical supplies and not understanding that from a middle class or upper class perspective. Are coming to terms with the situation that people, certain people deal with all the time, right?

That the idea of medical shortages is not a new concept, but it's a new concept for some who are not used to having to deal with it. Food insecurity is not a new concept but now it's a new concept for people who never had to deal with it before. And it's one of the things that as a sociologist I think about is how do we make that thing stick?

How do we let people connect the dots that Oh, that thing you're experiencing when you go into the grocery store and there's no food on the shelves, that's what certain people deal with all the time. And to create this awareness and this connection to the larger lived experience of others.

And I'm not necessarily being a sociologist optimistic that people are going to make that connection. So how do we get them, or is there a way to get people to connect this, this unique experience they're having right now with the medical center and food shortages and,, work shortages, how do we get them to connect that to the lived experience that some people have to deal with all the time so that it translates into a different kind of policy or to social change. 

Shelley White: [00:19:34] Yeah, I can say a bit. And then Meenakshi, please jump in. I mean, I think that it's  when you put this in perspective of the history of public health, what you realize is like, as a nation and you were speaking to this earlier, is that once this touches those who are already advantaged in society, all of a sudden they realize. Right?

 And Adam, you were saying that about infectious disease kind of creates one of those moments of realization that we're all in it together. Like our health is inextricably linked to one another. And I think we see that in these moments of an infectious disease threat, but unfortunately as a country that has moved so far away from a sense of the commons, right.

Where we've privatized water and land and air and taken away indigenous and native rights. And like our whole history is founded on exclusionary processes that are deeply racialized. And so these are histories that run really really deep. And I agree, I'm generally an optimist or at least I like to think of myself as a possibilist Gary, but...

Gary David: [00:20:40] Someone needs to be, cause I'm absolutely not. If you relied on me to have a sense of optimism this would be a very, very depressing show. 

Adam Gamwell: [00:20:46] I like the term possibilist. 

Shelley White: [00:19:44] Well, I borrowed that from Hans Rosling, who is a pretty cool demographer who talks about basically the demographic transition and the fact that Like what it takes to go through the demographic transition and to get people to a space of holistic wellbeing as nations is ensuring that we reduce child mortality, that we take care of the basics of adequate nutrition. And for all right? But also recognizing that the entire society benefits when that happens. So that idea of shared benefit is actually really the foundations of public health as a whole, is that you actually can't really create, or you shouldn't create exclusive systems because that degrades health for everyone in the system, even those that are advantaged. Right?

And so I think public health carries a lot of lessons for us as to your question Gary of whether those will come through to people in this moment I hope I'd like to believe, I think we're seeing the extremes of both those who are digging in and doing everything they can to protect themselves and others in this moment and creating remarkable communities of shared response in this moment in virtual ways and otherwise as well as those who are really bunkering down to individualistic self preservation. So I think we're seeing both ends of that spectrum right now.

Gary David: [00:22:06] Like the toilet paper. You mean the toilet paper, right?

Shelley White: [00:22:09] As one example. Yes. 

Gary David: [00:22:11] The world may go to hell, but I'm going to have my toilet paper if it does. So at least I got mine. 

Meenakshi Verma-Agrawal: [00:22:20] I heard a good reframe about toilet paper was if you're worried about how people are hoarding toilet paper. Think about who's been hoarding the wealth in this country for all these years. I was like, okay, okay. 

Gary David: [00:22:33] That's a metaphor. Right. You know, if the idea is hoarding toilet paper, then the idea is toilet paper is a metaphor for wealth. And I don't know what the equivalent of one role is in terms of dollars, but the market will decide that at some point.

Meenakshi Verma-Agrawal: [00:22:47] Yeah. I'll just add to Shelley's point. I agree and I think it is an optimistic time especially in our program. We are one of the few public health programs that are being very explicit about the impact of structural racism and other forms of oppression on all outcomes but specifically health outcomes. And we like this metaphor that structural racism is in the groundwater of society.

So we can't just fix it away by starting a diversity program here and giving scholarships to poor kids from low income communities and all that coded language that we hear. And so if we truly want to address it, this is the moment because I don't know if you all follow Naomi Klein, but she's a reporter for The Intercept and I've really been thinking about her work, because she talks about, she wrote this book called the Shock Doctrine, which I haven't read, but I've seen her speak and she talks about how she uses this quote from Milton Friedman. He said “Only a crisis actual or perceived produces real change. When that crisis occurs, the actions that are taken depend on the ideas that are lying around.”

And so I think I'm optimistic because this is a real moment because people are seeing that their healthcare isn't actually working for everyone and this sort of piecemeal program that we have in this country for your ability to access certain tiers of healthcare based on your income or your job, which of course is racialized just isn't actually working for everyone as Shelly said. MAternal mortality rates and infant mortality rates in our country are some of the worst in comparison to other developed, as developed in quotes, nations. And that's a real bellwether for society and if we can’t keep our mommas and our babies alive, then we are really doing a disservice, the entire structure as it's constructed.

So I think it really does require an analysis that says, let's look at the groundwater of how the society was actually built. So changing it by giving this group of people food pickup today and then tomorrow they can get access to live in a house for a week is just not, it's not working.

And so I think that that's really like where we want to center the conversation of optimism is that this is a shocking moment and we have a real opportunity to make a shift. Otherwise we know that the administration can take the ideas that have been lying around like the payroll tax cut or bailouts for big corporations and just put them through because it's a shocking time and people are just so dysregulated that they aren't able to really focus on what needs to shift.

Gary David: [00:25:24] One of the things I think that's raised is you're talking about people, other people can't get access to healthcare. The people who have access to healthcare, can't get access to healthcare. And there’s a saying from sports, “don't believe your own press clippings” for so long speaking, as the healthcare system, people have talked about the United States is the greatest healthcare system in the world even though the metrics, the numbers would say otherwise, this is not opinion. This is the scoreboard. You can look at a lot of different metrics, which you all know better than me cause this is your space that shows that the United States lags behind other countries, industrialized countries, in terms of healthcare outcomes, we are lagging behind undeveloped countries in terms of outcomes around this virus. 

I think it's like Senegal or Cameroon, were testing more people than we were. And it's a shocking moment, but it shouldn't be. That's one of the things about being an internal pessimist is that I am not surprised. I have my mother to thank for my voice of doom and my fatalistic thinking, but it does serve me well at points. Thank you very much, mom, because you're looking at this and saying none of this is really surprising. I mean, it was all there is there from a pandemic report that was provided that was gaming out a possible pandemic situation in 2017or 2015, I should say, or even 17, all of this was there. And it goes to part of what, experienced design, how to get people to believe not what they want to be true, but what is actually true and how to convince them from a policy position to look at what the actual case is, and not what they hope to be the case.

You know what I mean? I don’t know if that's a question or a rant. I guess it's both, but it's just frustrating for me to say, oh yeah. Oh, that's surprising. Really? Is it? I don't know, because you could count the number of respirators and you could count the number of hospital beds and you can count the impacts of the plague and it’s just math. You know, subtraction and addition that could kind of tell you we were going to be in a world of hurt. And here we are.

Shelley White: [00:27:30] I agree with the framing you just shared Gary. I mean, it is remarkable. Like I've heard folks talk about the U.S. health system is one where what we suffer from is just incredibly poor expectations of our system, right?

Is like that we can be in 2020 and we're spending, we've spent, our spending as a proportion of GDP as hovered between like 17 and 18, sometimes up to like 20% of GDP that we're paying into health and of that we spend about third on just pushing paperwork, just administration. And it's a reflection of the fact that we have the most, one of the most fragmented health systems of any industrialized country where we have about half of it that's being absorbed  in the private sector through employer based insurance, which means it's also contingent and makes folks vulnerable intentionally. So, those are intentionally placed vulnerabilities in a system that's designed that way. And then of course we have our public system and nobody wants to talk about, you say Medicare for all, and everybody labels it socialized medicine.

Or are you talking about universal health provision and because of our individualistic orientation as a culture, the response to that is harsh. And yet what you find is people then compelled to vote against their own self-interest. So, I mean, it's just, it's remarkable what we've accepted.

And if you look at like the long 100 year history of attempts to create a universal health system and the basis on which that could be resisted and sort of like the ethics that we call on in this society it's pretty frightening. So yeah, I mean, we haven't designed a system that is there to provide the basics of health for everyone.

We have designed a system that allows for a huge proportion of folks to go uninsured and even though we passed the Affordable Care Act the only, palatable design there was one that honored a largely privatized health system. But what folks won't talk about is that for instance, the VA is a great example of universal health that exists within our own health system or take something like Medicare. We actually do have the foundations for a rational health system, but I think we don't have the cultural appetite for it, which is super unfortunate. 

Adam Gamwell: [00:29:47] I mean, so what in your perspective or experience, have you seen, are there any ways? Tactics? Things that we might think about and how do we begin to change that appetite?

You know, is it just by getting more enticing food? As it were. And because I think it's really, interesting and a tough question. I mean, as this is a side example, so I did my PhD research in Peru, working with indigenous farmers on quinoa production and we did it kind of as participatory design projects about what does it mean to design incentives to help, basically to see, do farmers want to grow aggro biodiverse quinoa versus monocrop food for the market?

And so it's an interesting scenario in which indigenous farmers, as you can imagine in most communities, most indigenous communities are the most vulnerable. They suffer from the highest rates of malnutrition in the country, particularly in the region of Puno where the quinoa agrobiodiversity is strongest.

And so it's this deep irony of having one of the richest foods in the world that has been actually socialized to be seen as food for the poor. It's not a good food to eat for 300 years. And it's slowly coming around now because again industrialized nations have said that it's suddenly this cool, hip food to eat.

What's interesting about this is that it's really like racism made the food bad and then racism was trying to make the food good and then indigenous farmers are kind of caught on both sides of that. One of the parts of the project I was trying to figure out with farmers and with scientists and NGO workers was what does it mean to take indigenous knowledge and positionality around quinoa? What has it been and meant to them both historically as well as  Pre -Colombian through the dealing with colonialism to contemporary racism to the next idea that this might be the food that we can send to Mars and watching this food kind of trace across these things. And then it's really interesting to see a lot of community members and farmers begin to take on this new identity that they themselves chose that it's like, we're now the guardians of the future, which is really interesting and nice. Not everybody felt this way, but this is like a nice thing to see.

This community that's traditionally just been marginalized begin to then say, well, actually, how do I take these pieces around me? I don't know if this is kind of a shock doctrine, but like take the pieces that are around us to deal with this self crisis of malnutrition in this case. And to find our way through life and to do better with that.

I dunno it's interesting too. I mean, that's why I think the appetite question made me think of this, but just it's kind of thinking about in the broad sense, what does it take on a design level or a community level to sort of change those metrics or those ways of thinking so that we can actually create an appetite for doing good or doing more equitable good. Right?  It never happens evenly. Right? But it's just Is there anything that comes to mind or do you have some. What can we hope for? 

Meenakshi Verma-Agrawal: [00:32:45] I mean, I think that some of the shifts that have begun to happen because of COVID-19 or just kind of revealing, as the slate article so aptly put  America Is a Sham and that we're made up of these rules and laws that just ended up further marginalizing people. And the small example of that is that airlines were prohibiting more than three ounces of any liquid, and now they allow 12 ounces of hand sanitizer, which is a flammable liquid, you know?

And so presumably not say for that reason, but now because of COVID-19, it's suddenly been allowed and that's like a simple one and the deeper one is, you know, wifi, inequity, and you know how communities of color have been racial, racially, red lines, wifi access so bad that New York city actually sued Verizon for inequitably charging people of color, way more for their wifi and internet access, which goes back, if you don't look at it historically to see where the telephone poles went up, then, you know, we're missing the whole historical lens to it. I think that some of the quick fixes we're trying to do right now are an indication that some of these things can change.

And like Walmart has offered two weeks of paid leave to its employers, which they've been fighting for for so many. So I think, I think there's an opportunity, but also that they're kind of sliding these things through without having a real analysis cause they're trying to do a short term fix and I think it's on us to propose something that's largely liberatory in its approach and probably more radical than anyone has ever imagined for this country.

And it means that telephone data did not need to be capped or, we don't need to put limitations on snap benefits if it's, if you start to earn a little bit more than the income bracket. And so what does that mean again? I think it requires us to have wildly radical leaders, which we do have some right now who are willing to talk about The Green New Deal. The other aspects of what is possible for us as a society, and then we have the stalwarts who are still holding still and saying, we're going to bail out the corporations because that's the bread and butter of the society. So I think it depends on where we want to go with this and how hard we want to push.

Sitting from our situations of advantage and we have structural advantage right here. Um, how can we push to change that? And Shelly and I were just talking about the poor people's campaign, which is calling for a moral response to COVID. So, let's not just think of the economic response, but what's the moral response we have as a society.

And they've been rallying the work of Dr. Martin Luther King Jr. For years about how he was just on the cusp of uniting people over poverty versus us being delineated over racial lines. 

Gary David: [00:34:34] That's one of the things you mentioned, both Shelly and Manashi is this issue of expectations and expectation setting.

So one of the people I like to listen to on the radio is another sociologist by the name of Joe Madison. He's on Sirius XM, Urban View in the mornings, and he talks about cultural conditioning. And so when experienced design, there's part of what we expect to happen in an interview reaction with a company, a product, a good, a system, and what actually happens.

And you can have really low expectations and your interaction with that thing meets those really low expectations. It doesn't make it doesn't make it a good experience. It just means it met your expectations. And Ryanair is a perfect example of this. You don't expect. You know, or Spirit Air, or any other like low budget, airline, or low budget hotel, you're not expecting a lot so that you don't get a lot and it's not great.

It doesn't really mean you had a bad experience. It just means that it met your expectations. And so we are culturally conditioned to have these really low expectations of our healthcare system of these companies, like with the broadband issue you mentioned, then we were assured that. If they didn't have these caps on wifi and data limits, the whole system was going to collapse.

It turns out it didn't. We were assured that if we don't follow a broken windows theory of policing and we don't check every low level offender, that jail cell community is going to fall apart. And what are police being told to do right now? Don't arrest people for low level offenses. We’re not gonna put them in prison.

We're going to release them. We're not going to prosecute. So we do have this, I know the article you're reading about this moment of where it's almost the blinds falling off of our eyes and going, oh, you mean, it didn't have to be that way and it could have been this other way. And so it's going to be interesting to see how, and if those expectations shift, and if they're able to shift back. If there's an attempt to say no, we gave you two weeks vacation, but it was only a temporary stop gap.

Now we're going to take it back away again. And so the, and it actually goes back to really quick, this concept of the Overton window on, have you ever heard of the Overton window political scientist basically talked about how there's a range of policy options that are seen as being possible, and that has shifted over the last 30 years away from what would be called more conservative point of view, such that the idea of Obamacare, which was the heritage foundation was a conservative proposal now is considered to be like a radical leftist thing. And, we can't even consider a single payer or Medicare for all, because that's just like, quote, unquote socialists. Even though we have those systems in place. And so it gets back into shaping public perception and framing and messaging become a crucial part to getting policy conversations on the table and getting people engaged with them beyond rhetoric and in substance as well.

Meenakshi Verma-Agrawal: [00:37:45] I could add to that really quick is that Marshall Ganz talks about storytelling, and I think we have to get back to that idea of telling the stories that are not told, telling those that are concealed.

So much of movement work that started in this country has been started by black women, trans women, indigenous people, and that work is often erased. And so I think in order to be truly intersectional and really understand who has been living at the margins of society, That means that, if we design the program to work for transgender, black women who are living in some of the poorest  locations in this country and might also be undocumented, it's actually gonna work better for us.

It's going to work better for people who are more advantaged white people. Jonathan Metzl wrote this book Dying of Whiteness andShelley can speak to this more, but he just talks about how being white in this country is actually a risk factor now because of the same thing that she said about, you know, sort of wishing like voting away, social safety nets, particularly even depend on those social safety net.

So there's a real framing issue. I agree, like our stories need to be reframed and we need to tell those stories and we need to design our re-imagined framework around those stories, because that will reveal what it's like to live on the margins of society. Because again those people living on the margins are the ones who are protecting the country at this moment. And suddenly we're talking about who are the essential people. And so I think that this is an opportunity to reveal those stories and begin to talk about them and to elevate that in a way that can inform our design. Shelley I don't know if you wanted to add anything about that.

Shelley White: [00:39:29]  I was just thinking actually of Metzl’s book, Dying of Whiteness and just the fact that I think it also draws her attention for me, the ways that Camara Jones talks about racism, right? So in our program, we talk about racism as a system of advantage really acknowledging the ways that it was historically created and continues to be perpetuated, to benefit white privilege or white advantage in society.

Dr. Camara Jones, who's done a tremendous amount of work of really raising up the dialogue around racism as it connects to public health. In her definition of racism, really talks about how it degrades and really saps society of its full potential and just acknowledging what it means when you exclude a majority of our population, the populations of color, to the advantage of whites, what that means in terms of the degradation of our society as a whole.

And then I think with what Metzl has done to add to this dialogue. It was really pointed out how particularly low income white Americans have been compelled to vote against their own interests on issues of universal healthcare, on issues of gun safety and control, on issues of reproductive rights. And the list goes on really out of racialized stoked sentiments, which builds on again, this long history of the ways the coloniality on which our U.S. history is based and continues to be perpetuated. And I think that that's where to think about the potential of sociology, especially the study of social movements.

And, and what celebrates the principles of organizing the concept of building a power base within a community and sort of thinking about, as Meenakashi, she spoke to the power of reframing. There's always going to be the dominant frames and we have to be able to, identify and name those, but then hopefully to use those.

And I think that in this age of the digital age, social media and so forth, there's a lot more potential to possibly democratize the ways we can reframe the conversation and can recenter those who have generated these incredible ideas into name the possibilities of decoloniality.

What does that look like? And I think actually in moments like this, we can talk about like, and there's some really good dialogue. I think happening virtually at this time, is COVID-19 an opportunity for us to raise up this deeper historical structural analysis of like histories of colonialism and how that continues to show up in our current systems of neocolonialism or ongoing coloniality.

So I do think there's an option to retell the story or to reframe the story and hopefully to invite people to understand that. And it really brings me to the work of Paolo Freire, his conversations of like, we always live  in a moment where two realities face us, the possibility of humanization and also the very real possibility of dehumanization.

And I think we're exactly at that crossroads of which will we choose and recognizing that it should we choose to humanize that the mutual benefits run deep and run broad. 

Gary David: [00:42:42] Actually, I said that yesterday, but I didn't quote him. I thought I created it. Do you ever have one of those situations where you're like, wow, I just said something really cool. And then someone says, yeah, so, and so said that? It’s like there really are no new ideas. I guess I should just go home now. But now I’ll sound smarter because I’ll say as Paolo Freire says, and it might make me sound smarter.

Shelley White: [00:43:12] There it is. Right? Like, that's one of those. It's really interesting. I feel like, I dunno, one of the things I always like to share with my students is like having, having a text or a piece that you read regularly in return to like, at least once a year, maybe every six months.

And for me,  Pedagogy of The Oppressed and MLK’s letter from a Birmingham jail. And some of these pieces that like the wisdom is constant. And I think that those are ones that at this moment really invite us to think about what urgency means and those of us that have the luxury to opt out of urgency drawing on the work of MLK.

And then also like from Friere, I think pushing us to assume the agency that we can, and to recognize where agency has been depleted, again, intentionally placed. And I know I keep using that language and should name who I should attribute that to as well.

But like when we talk about defining inequities, as we talk about outcomes and health that are unjust and unfair that are preventable, right? If we actually care to prevent those inequities. And one of the reasons APHA, APHA is the American Public Health Association. One of the recent presidents, Tom Quade said, they're also often intentionally placed.

I think what he did there was, invite us to acknowledge that like how deeply health is political, like it is constantly politically constructed. And reconstructed and therefore we know what the patterns are, right? Like we can look at  the city of Boston and look at the distribution of like even the MBTA and look at the differences and just by zip code of like life expectancy, as deep as like 10 years difference, just some blocks away.

So realizing that that is politically constructed and that these patterns and health outcomes are generational and intergenerational. But acknowledging the number one that that is a political construct. It's something that we're constantly reconstructing. Then also invites us to understand that our work in health has to be political.

Like we have to be training health professionals, future sociologists, future anthropologists, political scientists, all of our students. You have to be thinking about how we will engage the next generation to recognize that it's actually our responsibility to be engaged politically and otherwise in ways of organizing collectively around hopefully a different system, different experience.

Meenakshi Verma-Agrawal: [00:45:42] I'll just add to that, Shelley is that, we've taken an explicit lens in our program to name where structural racism is operating. And frankly, I'm done sharing data without the “why”  in the public health field, we show data over and over again, these are the black women dying.

These are the black babies dying, you know, blah-blah-blah over and over again. And we never talk about the intergenerational impact of structural racism on the body. And I want to, we're starting a movement, so like really name that because we are not in a neutral position as public health practitioners, as sociologists, as political scientists, we have an opportunity to name the history that's impacting that data.

And so I want to really call in all of the people who see themselves in that data. And so the greater burden is on people of color this country. And we can say that as we talked about earlier is that the rest of the population is doing horribly in terms of our health outcomes as well. So how do you see yourself in that data?

And let's stop sharing data without seeing the why, because that's deeply problematized and it just goes back to people having this perception that race is not a social construct, that there's something biological about it. When in fact it's a social construct and yet the impact of racism in this country has a very real impact on people's health and education and housing and job mobility and economic mobility. So we really want to name that because that's our power in the fields that we're in 

Adam Gamwell: [00:47:08] The power of names, you know? You got me thinking, Shelley, I'm curious. In your experience of working with HIV/AIDS in Maine, you did some policy work there as well because I really appreciated your thinking with Paulo Freire a bit ago in terms of we are in the space where we may choose to humanize or to dehumanize. The HIV epidemic hearkens to this question, right? You're not going, it came from again, LGBTQ lens,, and then has had racialized tones and class tones too, but I'm kind of curious, in your experience of working either in and with that too, where like basically, how have you seen that this course change over the past few years or a few decades?

And does it give us anything to think about in terms of obviously COVID is not the same kind of epidemic, you know, we're in a pandemic state, but it seems like it operates differently. I'm just kinda curious, is there anything we could learn from that work that may inform how we could approach tomorrow?

Shelley White: [00:48:09] How much time do we have Adam?

Adam Gamwell: [00:48:12] Seven hours left? 

Gary David: [00:48:16] Do you mean how much time, do we have worked in our world?

Shelley White: [00:48:18] Oh, there's that too. Thanks for asking. I mean, to me I feel like the history of HIV/AIDS is literally the history of the human condition and teaches us so much about actually, I like to talk about it is it's literally a story of how we've decided to answer the question of whose lives matter.

So yeah. If we go deeply into history, like my work has brought me to Southern Africa where I did some work in Lisutu, a country that's completely landlocked by South Africa. It still continues to have the third highest prevalence in the world and when I arrived there in 2004, 2005 to help roll out like the first voluntary counseling and testing and some of the broader public health responses 30% of adults were infected and 40% of young women and  Mennakshi was talking about like how we have to bring it up analysis of deeper historical perspective of why that might be because of course it was at a time where people were racializing across Africa sort of, we're talking about the over-sexualized African, like all the frames that we'd like to say about the other. And so it's like a history of othering, like a textbook of that in so many different ways. And of course, if we actually name what happened historically, it's that populations were placed for extractive purposes, under systems of colonialism and apartheid rule as families were disintegrated and like social cohesion was disrupted. 

So for the extraction of minerals and diamonds and other goods, families were pulled apart and then all of the gender dynamics that were imposed through histories of colonialism are really salient in that history as well.And then I was also there in 2004. And so here we were like two decades into the epidemic globally, where in the U.S. by 1995, we had rolled out triple combination therapy. Right. And what we saw was our death rates were cut in half, within two years in the U.S. and cut down by 70% across the U.S. and Europe a few years later.

Right. And so what we knew was that success was possible. And yet we were limiting who could get access to that. And the very year that we rolled out triple combination therapy and response to HIV was the same year the WTO was created, the World Trade Organization, and we enshrined patent policies that would create 20 year patents on innovations.

That literally was a death sentence, we constructed that, we chose that as a global economy. We chose to honor patents over people in essence. And of course, there's this deep rationale of like, Oh, if we allow the pharmaceutical companies to retain profit, they'll use that for deeper innovations.

And there's really great work since that has shown that the profits from these number one go much more deeply into marketing than they do into R and D or research and development. And if you look at the 2000s, the top 50 best-selling drugs in the U.S market, 45 of them were produced by public entities, by universities, by public dollars, not by private pharma.

So like there has been a really good body of literature that has really revealed the dynamics behind patents. But I guess what I'll say from my work in HIV, both in Southern Africa, and in the U.S. is that you realize that it's a history where lives, like the ability to live, the ability for people to survive in that epidemic was constructed and it was constructed in a political economy where we've honored like the corporate entity to the expense of human survival like time and again, over and again. 

And then to your point Adam about the ways that this, the history of HIV/AIDS has been racialized globally and in U.S. history is again, really like a textbook of inequities, right? So even the fact that in the U.S. in 1990, we passed the Ryan White CARE Act. That was huge, and a major success story. So I don't want to discount that. And Ryan White was a really remarkable young man, he passed away when he was 19 years old and he had been really deeply stigmatized in his experiences being kicked out of school and so forth once he was diagnosed as after he was a hemophiliac but he was also like a white, young middle-class boy. And so a lot of the history, there's some really good sociology that sort of talks about the deviance that has been framed into the history of HIV/AIDS. Right. But he was like this palatable face of the epidemic whereas he really wasn't the demographic of who was being, who was dying. 

Gary David: [00:53:11] I do remember that it was pretty shocking at the time, because at the time it was GRIDS, it was gay related immune deficiency syndrome and a person who was not gay getting HIV really called into question everyone's thinking around that. And I can't remember how old I was, but I do remember Ryan White and I do remember all the media coverage around it and shifting that narrative from it's not them, it's all of us who have to deal with this issue. And as I  just got done watching all the seasons of this TV show called The Deuce, which was on HBO.

And I don't know if anybody's seen it, but it's fascinating because it gets into, especially the last season, the rise of the AIDS epidemic and the lack of attention given to it by politicians, including Ed Koch in New York and how a lot of mobilization was happening around that, because it was just thought to be a gay disease and all the demonization that went along with that. 

Meenakshi Verma-Agrawal: [00:54:11] And I mean, that's just been replicated recently with what's called the opioid crisis and what was the crack epidemic? Right? I mean, everything is repeating in history and it is in a way and our treatment is determined by our diagnosis.

Is this determined on someone's race or is this determined on, Oh, it's an addiction, it's not criminalizing a group of people that has totally shifted the way that we're looking at that. And so, yeah, it's a very American, maybe colonial practice to just say, like, we're gonna sort of codify this group of people as being demonized in this way.

But when it happens to a group that's advantaged and it shouldn't be happening, then it becomes a whole different treatment. Because the previous treatment was criminalization and incarceration, and now it's deeply tied to, go to a police station and tell them you need help, which I think is great and I think if we had designed our treatment for crack and opioid addiction, back in the seventies, when we were criminalizing people for it, then it would have even worked better for the people who are getting addicted right now. So that's the whole point of this like equity as a design principle, being more superior.

Gary David: [00:55:24] And you make me think of something that I wanted to ask, cause this has been a theory of mine. I have not heard it talked about even by Paulo Freire. So I think it's unique to me. I don't know for sure, but I have not mapped this. This is all anecdotal, but the states that are taking the COVID-19 situation, shelter in place, taking strong public action and social action policy action measures tend to be those that you would associate with quote unquote, blue states.

Those that have taken a much more casual approach to this. Are those that you would consider to be red states? Again, I haven't mapped it for all the states, but this is just kind of what I've been kind of taking a look at. And those same red states are the ones that have rejected medicaid expansion.

They tend to have poor social determinants of health anyway, in terms of just lived experience, higher rates of obesity, diabetes, congestive heart failure, all that stuff. So for me, looking forward I'd be interested in hearing your reaction to this. It's going to be interesting to see how this thing manifests itself differently in different parts of the country, based on the public policy and the social policy, that those who live in those areas have by and large, not completely.

But by and large elected people to be in positions to deliver on those things, like no Medicaid expansion. And I know that that's a complicated thing that we can get into voter suppression and all that. And we don't have time for that now, but I think I'm going to be curious that you have in Florida, everyone hanging out at the beach or the guy in Oklahoma, the mayor, the governor in Oklahoma being like, oh going out to dinner with my family.

And you're like, really? I'm curious. Yeah. I wonder if you've thought about this in terms of a public policy issue of how this thing's going to spike or recede in different parts of the country at different rates, based on the policies of those parts of the country. 

Meenakshi Verma-Agrawal: [00:57:25] That's a good question.

Shelley White: [00:57:27] I think you made a pretty sage prediction there, Gary. We were talking earlier about comparing this or learning from histories of the HIV epidemic, which is of course a much more slower moving phenomenon.

But what we're going to see is fairly quick spikes with the epidemic curve of COVID-19 and you're right. We've literally been in the window of possible responses for a few months now, actually in certainly a few weeks, quite acutely, and to see the spectrum  of political modeling of our response, right.

The political will in response to this is pretty disconcerting, from those states that have taken it lightly, have allowed the spring breakers to come into, again, like the oldest state in our country, in terms of thinking about vulnerability and truly like the concept of like the anticipated loss of our elders, like as a society, what that means, that we're willing to accept that vulnerability for our own, for like at various levels of self-interest that people continue to exhibit is really astounding. And yes, I think there is a pattern here that you acknowledge in terms of, if we look at the history of the Affordable Care Act in the states that most needed that Medicaid expansion and opted out, right?

Especially our Southern states, which again goes into like the racialized histories of the more vulnerable States in terms of certain comorbidities or health outcomes have higher incidence of diabetes and other complications and so forth. So yeah, I think there is certainly a pattern here.

And then I think at the same time, as we're talking earlier about possible perspectives, like this moment has also raised the possibility of like paid sick leave on a national level under this admission straight from, which is kind of an astounding twist. Right. And even the fact that we're talking about honoring, like testing for all, regardless of one's immigration status, like at the, at there's some like them, some interesting moments, I guess or possibilities in this where some more, what we would talk about as like progressive platforms or being entertained out of necessity and should be a lesson to the broader possibilities to have a more cohesive system that allows all to live and thrive. 

Meenakshi Verma-Agrawal: [00:59:52] And I'll just caution that we have this red and blue trap that we sometimes have, and I think in the Northeast and I've grown up here is that this narrative, that some of those things aren't applicable to us.

But when I've worked with the Racial Equity Institute and they've looked at this data across systems with lots rigor and seeing that for incarceration, Massachusetts is doing very close to places like Texas and, for out of school suspensions or in school suspensions were very similar to other parts of the country who are not as progressive as us.

And we have some of the highest infant mortality rates for the kind of, especially in Massachusetts considered this modern centerpiece of medical innovation. We have some of the highest rates of those really horrible outcomes. And so it's like, to me, it's a yes and

Yes as Shelley said, we've been talking about it’s a real opportunity for us to be radical and to not get into the, I do think some of the more progressive leaders are definitely making some of these decisions. And it's really amazing to see that. And we have to honor that and also, recognize that our history is also in each state and is playing a deep role in how people are reacting to this crisis.

Adam Gamwell: [01:01:12] Yeah, I appreciate that. That thought too, because I know I live in Boston now but I am from Texas and it's funny cause you know, I've been living here for about 10 years so this is up North is now home. But I simply recall to when I tell people now that's where I'm actually from, sometimes the responses is like, Blatant as Oh, but you're not dumb, or much more subtle than that?

But I just, I really appreciate the point that like, actually one of the biggest traps we live in right now, politically is this red, blue, that we think we simplify it to that level. And I get, because the human brain likes simple answers. We know as much as we are capable of thinking complex would love to read that we love reductionism.

But I think that's a really powerful way to flip it. We're in, like in the case of COVID-19, it's like that even like in a very stupid sounding slogan way. Right. You know COVID-19 has no political colors on who it will attack. However, like how it gets there and like basically what responses are political, is racial, is kind of, as you said before, I love the idea about, how health is politically constructed. Right. So we're seeing those politics kind of come out regardless. I don't know. That's not a question, but it's an interesting framing that I think is really good to think about.

And one of my hopes out of this scenario is that we might on some level begin to recognize that if we're seeing policy changes, that seemed impossible just last year, if not a few months ago, a few weeks ago, right. That if we're seeing things that was the Overton's window is shifting elsewhere, right.

There is like, we are seeing these possibilities and that is really quite interesting. The small wins, I guess, right. Social movement, they move slowly, but they move powerfully. And so it's interesting to see the window shifting, I guess. 

Meenakshi Verma-Agrawal: [01:03:09] Yeah. 

Shelley White: [01:03:10] Yeah. I think too, I just wanted to pick up on this idea of radical change, because I totally agree. This is a moment for us to hopefully propose some radical shifts in our systems, the systems and structures that allow for these fissures that become so deeply accentuated in a moment of crisis, a moment of pandemic. Right? But I think we should also raise the fact that we live already in a radical society.

Like it is radical that we have the highest child poverty rates of an industrialized country. It is radical that we live in a society that allows for infant mortality rates amongst black Americans, to be as high as what we talk of in, developing nations, right? It is radical that we have the highest uninsured rates of any industrialized country.

It is radical that we have the levels of adult and elder hunger in this society that are completely preventable in an economy of great abundance. It is a radical that we allow like three billionaires to have more wealth than half of our nation, that’s radical. We have to actually name it.

This system is radically unjust and therefore it needs radical shifts, I just say that because when people across the political spectrum hear about  radical social change, like. There's this quick appetite to move away from that or to dispel it as deeply activist and wrong.

And there's just like a framing of it. That makes it unattainable. But actually I think what we need to name as a radical is the level of injustice that we have allowed and that we tolerate and that we have some somehow an appetite for in this broader society that has a time clock to it, right.

In terms of, if we place this in context of what we've done environmentally over time to honor profit or what that means for the future of our children and grandchildren, that's radical that that we've allowed our society to arrive at a place of such deep inequities that we we've put our planet in peril and that are broader survival as humankind is in question. 

Gary David: [01:05:22] So it's kind of  bring it all home because not there's nothing that I enjoy more than seeing the bottom with a bunch of social scientists talking about how everything is horrible, cause we're good at it. And you know it's a skill that's evolved and developed through years of doing PhD programs.

That's an important skill, but like, I think it was since we've been citing people. I think Cornel West said something to the effect of it's not enough to not be racist and to be anti-racist. So if people were looking to be engaged, involved, if they listened to your, both of your sage words and they're like, yeah, you know what, this is pretty screwed up. In terms of designing a better system in terms of getting involved and not just sitting it on the sidelines, what are some practical, short term, long term steps that we might leave people with that might give them a sense of direction around what it is that they could do now just to feel bad, but to take action, to feel good.

Meenakshi Verma-Agrawal: [01:06:20] Yeah, and I actually really liked the thing you were saying about feeling good. There's an activist that we love named Adrienne Maree Brown and she says that we have to make this work pleasurable.  We have to make it fun. We have to laugh with each other otherwise no one's going to want to do it.

So we've actually in our practice have incorporated different ways of building relationships and the same person talks about instead of making your movement a mile wide, think of it going a mile deep. So get deeper in relationship with each other, which is hard thinking about social isolation, but hey we have zoom, we have other ways to communicate with each other, but how do you get deeper in relationship with the people that you see that want to have these conversations with you?

I'm not talking about the as I hear white people talk about their uncles at Thanksgiving, that they want to convince those aren't the people well that I'm talking about, I'm talking about the people who have an opening, who are like yeah, this is unfair. And I want to learn more about why, and for people of color, there's a real role in healing.

There's a role in coming together with other ethnicities and coming into a place of healing from the trauma that is racism that has been structurally inflicted on multiple ethnic and racial groups across society over the history of this country. So I think one part is building relationships.

So that's a key thing that gets this movement to really shift, systems and structures, the way they've been set up. The other thing I would say is that we have to stop personalizing the critique of systems. This is work that I've inherited from the Southern Jamaica Plain Health Center, which is a community based health center who is an explicitly racial justice organization. And they're really trying to move the needle in terms of not just training people on understanding the principles of racism's impact on public health. But can we, as organizations begin to share the way we're doing our work to reflect. A racial justice lens, which focuses on equity and not diversity.

So how do we critique systems? How can we critique higher education? We're in higher education? How can we simultaneously critique it and be tied into the shift that needs to happen in its organizational structures and culture? So I think it's largely not personalizing it and saying racism is like Gary being racist or Adam it's not about individuals who are racist in many ways society can function without racist acts between individuals, because our structures are set up to perpetuate racial inequity all day long, 24/7. So how can we critique structures? And then I would say also like in a small win is to follow the organizations that are doing this work. 

So Race Forward is doing amazing work, they have an online magazine called Color Lines where they're uplifting some of these stories that bring intersectionality into the conversation and they're making very explicit statements about how racism is impacting everything we've talked about in relation to COVID-19.

So follow those organizations, look at the agencies that are coming together, look at the movements that are coming together and start to follow them. Because as you talked about reframing, we have to begin to digest our information in that way. And this is the problem with algorithms and social media is that you could click, like on one thing, you're going to see five things that are related to those things.

But I think the intentional following and supporting of progressive organizations that are looking forward to this radical idea of single payer healthcare and decreasing food injustices in this country, understanding how we can reduce these inequities. So I would say those are the main things that if you want to take it from that activist vote is to stop personalizing the critique of systems and then following the organizations that you think are doing amazing work and building relationships through that effort. 

Gary David: [01:10:25] Great. Thanks! Shelley, what do you suggest building on that? 

Shelley White: [01:10:29] Yeah, well, I totally agree with what Meenakshi shared there. And to me, I think it's recognizing that actually like the folks that want change in the system are more than those that are working to perpetuate the system that's working as it is. And I think we can feel fairly alienated in these times. And increasingly, as we sit in our small spaces on our computers and isolate as we are required to do right now for public health and public safety, but actually like there's such a vibrancy of community online.

That's even growing with new innovations and new approaches. So, I follow the work of I think it's really well proctored in terms of  outlining the realities of racialized capitalism, and then thinking about what are the policy platforms and possibilities of new campaigns?

Public Health Awakened is a fairly recent organization that came together. To sort of look at how public health is being impacted particularly over recent years some of the work they're doing at the border or the Southern Border Communities Coalition,  the Poor People's Campaign, as we mentioned earlier, and it's Dr. Camara Jones’ campaign against racism. I mean, and I'm not the list could go on, but I think the point is like the issues that you care about, find your community of who's working on it. And as Meenakshi said, build relations with them and think about the world you want. I mean, I think what the history of social movements shows us is that social change is possible.

It's not easy. Right? Cause when you're talking about a systemic overhaul, it's not going to happen overnight, but I think there's an invitation here for us to move beyond a charitable frame and into actually a deep justice frame and I think that as a society, we are actually ironically, one of the most philanthropic society of industrialized nations and that's important to acknowledge, but charity, thats a bandaid. It might feel good at the end of the day, but what we know is that that person's going to be hungry tomorrow or have need tomorrow. Right? So, I think we have to challenge ourselves to think about what deeper systemic change could mean for a more just society. And then I think the last piece is I've been finding myself in these times, gravitating more and more to the work of like feminist radical poets.

So folks like June Jordan and sort of gathering inspiration from her work. As well as Adrienne Rich, someone who “ appreciated for some time and like maybe just to end with a quote, that for me is really inspiring is that she says “My heart is moved by all I cannot save, so much has been destroyed I have to cast my lot with those who age after age perversely with no extraordinary power reconstitute the world.” And I think in these moments where we feel like I'm only one, what difference can I make is to realize that it just takes more of us knowing that there's other ones just like us who want to make that difference and to find that community has been actually said and to realize that it actually doesn't take extraordinary power, it just takes the time, the commitment of coming together in community. And in dialogue with those who are most affected thinking about what differences and what change do we want to see? And then therefore, step by step. How can we get there? 

Gary David: [01:13:53] That's great. And it actually reminds me of a much shorter quote which I like to go back to quite a bit, a slogan on a different organization I belong to, which is “let it begin with me”.

And just this idea of the change starts with you. And you can change that you affect and create can be greater than yourself, especially when directed towards others. But first start with you, as you both said, finding those organizations, getting involved and caring about the outcomes beyond your own life.

So stop hoarding toilet paper, stop doing those things. Yeah. And, and look at, even though we're socially isolated, I take that back we're physically isolated, it doesn't mean we have to be socially isolated. And to extend that caring in this moment beyond just how it affects your own family and find those ways to have experience with others so that you can build that world. That's going to come out of this because a new world will come out of it. And we all can play a role in trying to figure out what that looks like.


Gary David: [01:15:00]All right. Well, thanks. You both can go back to solving all of our problems now. Justice never sleep Meenakshi. Tell those kids that they got to feed themselves. 

Meenakshi Verma-Agrawal: [01:15:20] Yeah. That'll be a bigger social problem to try to solve. 

Gary David: [01:15:23] Mommy's busy with saving people's lives, you know

Shelley White: [01:15:28] Even better, it's the kids that actually, I'm such a big proponent of youth activism that they're also wearing these lies, right? We got to follow their lead. 

Gary David: [01:15:36]  If it gets them out of the house I'm in favor of that too. If they just ask me for things right now, that'd be fantastic.

Shelley White: [01:15:41] Yeah, this is really terrific to be in dialogue with you.

Meenakshi Verma-Agrawal: [01:15:48] Yeah so great conversation

Adam Gamwell: [01:16:01] Thanks so for sticking around and joining us for the conversation today. We've been talking with Shelley White, who is an associate professor of public health and sociology, and the program director of the master of public health at Simmons college and Meenakshi Verma-Agrawal is the assistant program director of the public health program at Simmons College. It's been a great conversation. So we want to thank them again for joining us. 

Gary David: [01:16:19] We hope that you got inspired to take some time, to make a difference in whatever ways you can, as this moment is going to require all of our work to get through it together. 

Adam Gamwell: [01:16:28] And we want to hear from you, if you have any questions or comments from today's conversation or just from past conversations, we love getting feedback from you and you reach out to, or you can find us on Twitter at This Anthro Life, two places, one voice.

Gary David: [01:16:44] And if you'd like our content and want to support more of what we do. Check out our We really appreciate your help and putting this together. And we have a lot of fun doing it. 

Adam Gamwell: [01:16:56] We're living in strange times right now. So we hope that you and yours are staying safe and healthy out there. And remember to wash your hands. 

Gary David: [01:17:03] And we don't know what's going to happen this next week and we don't know what it's going to hold for any of us. It's hard to say. And even harder to predict. We do hope that no matter what happens, you're able to stay healthy. And you're able to stay hopeful. We do know one thing's for sure. And that's, we're going to see you again here next week on Experienced by Design Podcast until then, take care everybody.

Adam Gamwell: [01:17:26] From Experienced by Design and This Anthro Life. I'm Adam Gamwell. We'll see you next time.