Uprooting the Structural Drivers of Health Inequity: Policy Solutions for Improved Community Health

Sarah de Guia: We're an interdisciplinary team of lawyers, planners, policy analysts, and other health professionals.

Sarah de Guia: We collaborate with community organizations, local and state governments, and anchor institutions to create thriving, just communities.

Sarah de Guia: Our priority is helping communities who are at the highest risk for poor health.

Sarah de Guia: Our strength at Changelab Solutions lies in using the tools of law and policy in a collaborative and cross-sectoral way.

Sarah de Guia: We ensure that policy solutions are both practical for government systems and institutions, and meaningful for the people they are meant to help.

Sarah de Guia: Changelab also works with change makers to improve their knowledge and capacity to use law and policy to change systems, policies, and practices to advance health equity.

Sarah de Guia: Again, thank you for joining us today, and before we dive into the conversation, there's just a couple of logistical issues to cover. Next slide.

Sarah de Guia: First, this event is going to be recorded and it will be posted on Changelab Solutions' website within the next week. You should also receive a follow-up email with the link to the recording once it's ready.

Sarah de Guia: The chat function is open, as you can see; I already see a lot of greetings and well wishes from folks. We encourage you to share any reactions and engage with each other.

Sarah de Guia: If you have questions that you'd like to specifically dedicate to the speakers, please use the Q and A function.

Sarah de Guia: And if you'd like to join us in live tweeting during the event, we invite you to use hashtag #uprootinginequity. Next slide.

Sarah de Guia: I also want to let everyone know that a live transcript option is available for today's session. In your Zoom window, you should see a button that says "Live Transcript," pictured here on the slide.

Sarah de Guia: If you click on that, you have the option to either show or hide subtitles, and you can also adjust the font size to your preferences under subtitles settings.

Sarah de Guia: Our colleague, Bernard Lim, excuse me, is here to help ensure that all of our tech runs smoothly, so if you run into any issues, please send him a direct note via Zoom.

Sarah de Guia: Next slide. So this is the kickoff to a series of webinars that are going to look at the five drivers that we'll talk about today, and they're going to be looking at them through a specific topic area.

Sarah de Guia: Each of the sessions will feature a practitioner, community member, or funder advocate who will share their concrete actions, policies, and resources to help improve health equity. Next slide.

Sarah de Guia: So I'm really thrilled to have our panelists here today. They have a distinguished history of working on health equity and serving as advocates for those communities who are the most underserved and often experience structural discrimination at much higher rates.

Sarah de Guia: Dr. Oxiris Barbot is an Adjunct Assistant Professor at Columbia University Mailman School of Public Health and Senior Fellow for Public Health and Social Justice at the JPB Foundation.

Sarah de Guia: Dr. Barbot has been at the center of public health, health equity, and healthcare delivery.

Sarah de Guia: She's previously held positions as the Health Commissioner of New York City and of Baltimore City, where she helped introduce the Health in All Policies approach.

Sarah de Guia: She is a recognized leader in local government as well as nonprofit leadership, and we're really proud that Dr. Barbot serves on our board of directors here at Changelab Solutions.

Sarah de Guia: Dr. Cara James is the President and CEO of Grantmakers in Health. Before joining GIH in 2020, she was the Director of the Office of Minority Health at the Centers for Medicaid and Medicare Services.

Sarah de Guia: And under her guidance there, CMS developed an equity plan to improve quality in Medicare, which is a fantastic plan—I've reviewed it—and also the rural health strategy.

Sarah de Guia: She was previously employed and worked with the Henry J. Kaiser Family Foundation, and also at Harvard University.

Sarah de Guia: And Wendoly Marte is the Director of Economic Justice at the Center for Community Change, where she has been fighting for economic justice, education reform, and progressive political engagement for over 14 years.

Sarah de Guia: Before joining the Center, she coordinated local, state, and federal campaigns with the goal of building political power for young people, immigrants, and low-income communities of color in the Bronx and beyond.

Sarah de Guia: She's committed to building a progressive political movement in New York City that is founded on the principles of economic democracy and places the value of people over capital.

Sarah de Guia: Well, now that you've had a chance to get to know us a little bit, we'd like to get to know you in the audience as well. So next slide.

Sarah de Guia: Before we dive into the discussion, we want to do a quick poll. So Bernard, if you want to launch the poll, and we'd love to get a sense of who is the primary audience that you're serving through your work.

Sarah de Guia: So if you want to take a moment, we will—if you could go ahead and vote—and we can see what the poll is and get a sense of who it is that you are primarily working with.

Sarah de Guia: We'll give it about 30 seconds or so.

Sarah de Guia: So if there's specific communities you work with, go ahead and note that. But if you're working more broadly, you can also note that.

Sarah de Guia: So if the poll comes up, if you can click that poll, that would be great. Otherwise, you can also introduce it into the chat where we have the other functions. Great. So I see a couple of names coming in.

Sarah de Guia: Lots of local health, also some education, diabetes folks. That's great.

Sarah de Guia: Elected officials. World government. Amazing.

Sarah de Guia: All right, so we can go ahead and close the poll, Bernard.

Sarah de Guia: So lots of more general kinds of public as opposed to very specific audiences, but we've got a few who are also working with low-income communities. OK. Great.

Sarah de Guia: Okay, we'll do one more just to get a sense of what are the primary issue areas that you're focusing on. So if we can go to the next slide, Bernard, and then, if you don't mind launching the poll. So this is just to get a sense of if there's a primary area that you're focused on.

Sarah de Guia: We'll give it a couple of seconds.

Sarah de Guia: It's great—quite a wide range of different issues, some very specific, some more broad.

Sarah de Guia: Great.

Sarah de Guia: Okay, so Bernard, if you want to close this poll, we'll kind of get a sense of that, and you can scroll through the chat to just get a sense of the wide range of different issues.

Sarah de Guia: Public health, broadly, some food, health care issues. Quite a bit of "other."

Sarah de Guia: All right, thank you for sharing that; we really appreciate it, and you can continue to enter some of those in as well. Next slide.

Sarah de Guia: So just to orient ourselves today, I wanted to spend just a few minutes sharing some definitions and frameworks to help us frame the discussion because sometimes we tend to use terms like "health disparity" and "health inequity" quite interchangeably. And so I wanted to take a moment to clarify how we at Changelab think of these things. Again, just as we're starting to define and come into conversation today, there are a lot of different definitions of health inequities, but today I'm going to use the one from the National Academy of Sciences.

Sarah de Guia: And they define health equity as the state in which everyone has the opportunity to attain their full health potential and no one is disadvantaged from achieving this potential because of social position or any other socially defined circumstance.

Sarah de Guia: And an influential researcher on social inequality added a moral dimension to the concept of equity and inequity. This was Margaret Whitehead, and she defined inequities as the differences in health that are not only unnecessary and avoidable, but in addition, are unjust and unfair.

Sarah de Guia: So we at Changelab, when we talk about health inequities, we are explicitly talking about those differences that are avoidable as well as unfair and unjust. Next slide please.

Sarah de Guia: And this image that we like to use—the image that's going to be coming right up—really shows the difference between equality and equity. And so this is a good demonstration of that. So um, Bernard, if you can advance the slide for me.

Sarah de Guia: So the image at the top has an illustration of a type of intervention that's focused on equality, and that would mean that it's a one-size-fits-all solution.

Sarah de Guia: So here you're giving individuals the same bike. It's a bike, which is great, but it's the same bike, and so it's not necessarily fitting everybody's needs.

Sarah de Guia: It's great for the two people in the middle, but for the person in the wheelchair or the younger person who's a little smaller, this size bike doesn't necessarily fit what they need.

Sarah de Guia: So it just goes to show that even though there may be an equal approach and it's well-intentioned, it's not necessarily going to benefit everyone equally.

Sarah de Guia: So the second illustration is the equity approach, and that's when we're ensuring that people have what they need in order to thrive.

Sarah de Guia: It also acknowledges the reality that not everyone is starting off in the same place. What one person or even population might need is different from another's needs.

Sarah de Guia: And so, when we fail to design interventions with equity in mind, we can see that there's the potential—even where it's well-intentioned—to not only maintain inequities but in some cases to widen them. So here, providing the same bike to everyone would allow those two individuals in the middle to just take off, while the other two are left far behind.

Sarah de Guia: Before COVID-19, health inequities were already entrenched and growing. And COVID-19 has only demonstrated to everyone just how those inequities are really affecting people's lives.

Sarah de Guia: And so, these factors that impede health, such as discrimination, poverty, and disenfranchisement, they're really embedded in our systems, policies, and laws, and those are the things that often shape our physical, economic, and social environments.

Sarah de Guia: And those are what have led to the proliferation of health inequities over many generations.

Sarah de Guia: And so, our present-day gaps in health and prosperity are actually rooted in historical injustice and systemic inequities.

Sarah de Guia: But we're now starting to see more and more individuals, advocates, funders, and governments who are starting to recognize the existence of these inequities and the need to reverse them through structural change. Next slide please.

Sarah de Guia: At Changelab Solutions, we believe that one of the most powerful risk factors for health are unjust laws and policies—those that have perpetuated racism, discrimination, and segregation through our nation's history.

Sarah de Guia: And yet, laws and policies are also powerful tools for change, and this is because: one, they have the power to undo historical harms; two, they affect large groups of people; and three, they engage the change makers themselves.

Sarah de Guia: So in 2019, Changelab released our Blueprint for Change Makers, and that proposes that achieving health equity requires addressing the structural barriers to health.

Sarah de Guia: We call them the fundamental drivers of health inequities, and this includes structural discrimination and racism, income inequality and poverty, disparities in opportunity, and disparities in political power and governance that limits meaningful participation.

Sarah de Guia: So we believe that using tools of law and policy, we can help to undo those fundamental drivers of inequity and thereby increase health equity.

Sarah de Guia: So I'm not going to define all of them, and in the next series of webinars, we will get into various different aspects of the drivers.

Sarah de Guia: But I want to touch on one of them, which is taking a moment to describe structural discrimination. The way in which we describe it in our blueprint is that it refers to discrimination against a historically oppressed group of people that is built into how systems, operating systems, and institutions operate.

Sarah de Guia: So it's about the systemic injustices. It's not necessarily the individual acts of discrimination or bigotry. Examples of this include redlining, defunding schools, and policing tactics that target homeless and poor people or people of color.

Sarah de Guia: So we created the Blueprint for Change Makers as a guide for all of us to help start discussions, to build on our partnerships, and to really start to offer tools to shift power and resources to improve health.

Sarah de Guia: So before we dive into discussion, just one last poll.

Sarah de Guia: So we can go to the next slide and go ahead and launch the poll, Bernard, because what we want to hear from is—we want to hear from you all—what are some of the barriers that you're facing in your own organizations in your efforts to advance health equity. So we want to get a sense of: is it a lack of definition? Is it a lack of buy-in from various different individuals? Is it political divisiveness? So if you can start to kind of register what is that one biggest barrier that we're facing, and that's also going to help us as we launch into the discussion here today.

Sarah de Guia: So give just another couple of seconds here to fill out the poll.

Sarah de Guia: And then, Bernard, if you want to close the poll, we'll take a look.

Sarah de Guia: So it's pretty evenly divided, and we kind of think about this in terms of level of readiness as well, but um, so some of them I'll just call out here is a lack of shared understanding.

Sarah de Guia: And the biggest one that looks like—or there's kind of a tie—between the lack of funding and capacity, as well as practical tools and steps, and followed by political divisiveness, that is a pretty big one. And also challenges to implement. So hopefully we'll be talking—we'll be touching upon kind of all of these different issues as we talk today.

Sarah de Guia: So with that, next slide, this is just a transition slide to say we're ready to dig into our conversation. So we're going to turn off the PowerPoint and we're going to dive into a discussion here with all of our panelists.

Sarah de Guia: So again, Oxiris, Cara, and Wendoly, thank you so much for joining.

Sarah de Guia: So I want to first just ask each of you could kind of take a moment or two to introduce yourselves and your organizations.

Sarah de Guia: And maybe share a few recent examples of how you have been working to address health inequities through law and policy in your work, and I will just let whoever is ready to jump on in.

Cara James: I can start. So hello everyone. Good afternoon for those on the east coast and good morning for those on the west coast. My name is Cara James. I'm the President and CEO of Grantmakers in Health, and we are a philanthropy support organization that works with about 230 foundations, corporate giving programs, and others to achieve better health and better philanthropy.

Cara James: We do that by working with the foundations to help them learn about health issues as well as programs that are effective in reaching communities and helping to improve outcomes, as well as to connect with each other and to policymakers and stakeholders and partners in the work, since we know that no one sector is going to be able to solve the challenges that we have.

Cara James: And to grow in their efforts, we have been focusing on health equities. The foundation—the Grantmakers in Health, I should say—is almost 40 years old. Next year is our 40th anniversary, and we have been focusing on health equity for almost as long as we've been in existence.

Cara James: Specifically, with regards to what has been happening in the last year, we—as many people have—expanded our focus and pivoted a lot to support the foundations as they have been expanding their work, some for whom this is new and others for whom it has been added for a long time. But we have been convening some of our CEOs to talk about health equity and some of the work that they're doing specifically around COVID—vaccine distribution, dissemination, countering outreach, education, and some of the messaging that is hitting communities of color—as well as how they can support some of the early-on testing outreach and education in the communities around some of the social determinants of health: food needs, transportation, and others.

Cara James: We also focus on rural health and so have a rural health leadership group that is also looking at some of the needs in rural communities and the…

Cara James: We have a learning community that's focused on healthy eating and the sustainability of food programs in those communities, so those are a couple and the very quick overview that I've done. But it is something we also are looking at: maternal health issues and kind of weaving throughout a number of our programs. And really, I want to thank you, Sarah, for organizing this and am so happy to be here and be part of a conversation with my colleagues.

Oxiris Barbot: Great. I guess I'll go next. So currently, I am, as you mentioned, Senior Fellow at JPB and I am with the Mailman School of Public Health.

Oxiris Barbot: My work really is focusing around continuing to draw attention to the ways in which COVID has been, and continues to be, in essence, a masterclass in how the social determinants of health collide with a vicious virus to really rip the scab off, if you will be, inequities that underlie a lot of the health outcomes that we have. And so, for one of the examples of the ways in which we—when I was at the health department here in New York City—addressed the underlying drivers was really looking at not just risk factors for why people became infected with the COVID virus, but how it was that we could specifically and immediately address those underlying drivers as a way of reducing transmission. And so what that's been translated into was, for example:

Oxiris Barbot: providing free hotel rooms for people who had unstable housing, were living in overcrowded conditions, were living in multi-generational households.

Oxiris Barbot: All of which were underlying risk factors for ongoing transmissions for COVID-19. And so, you know, I think, as our conversation goes along, we can highlight other ways in which this pandemic has really been an opportunity for us to bring more people into the fold, if you will, in terms of connecting the dots of what difference social determinants of health really do make on an everyday level for Americans across the country.

Wendoly Marte: And everyone, I'm Wendoly Marte. I am the Director of Economic Justice for Community Change, which is a national organization that is in the business of building power for directly impacted communities, predominantly advancing racial, gender, and economic justice and equity across low-income communities of color.

Wendoly Marte: And time to really advance transformational change to improve the material conditions of our folks with a path to making sure that every family can thrive.

Wendoly Marte: And I would say that, in terms of our work and how it's connected to this conversation we're having today, I think as community organizers for us, health and equity is an intersectional thread that cuts across a lot of these core structural issues for families.

Wendoly Marte: And we work directly with grassroots organizations that work with directly impacted folks. We work directly with individuals and building a core base of caregivers, childcare providers, parents, and just low-income communities of color across the country to be able to really create a space for them to fight for themselves and to have the tools to be able to move a just recovery. And so our work around health equity for the last few years—our organization has been around for over 50 years—but our work sort of traces back to decades of organizing to make sure that low-income communities are cared for, working to pass and defend the Affordable Care Act, expand Medicaid in states across the country to make sure that…

There's integrated inclusion and all of our sort of public policies and making sure that we have our systems; I really sort of work for families.

Wendoly Marte: And now, our work is really sort of centered around a just recovery and what does it look like.

Wendoly Marte: Not just for immediate relief at the state, local, and federal level, but even beyond that, how do we actually set the sort of clear foundation for a just recovery that works for everybody.

Wendoly Marte: That actually includes equity across the board and then make sure that our families have a path to be attached to, come out of this thriving.

Wendoly Marte: And I'm very, very excited to be part of this conversation today.

Sarah de Guia: Wendoly, I want to continue and just kind of keep the conversation going with you for a minute because

Sarah de Guia: I think what would be really helpful to hear is a little bit like maybe a specific example of how you've seen those power dynamics shift when you are including and centering community and also

Sarah de Guia: maybe a word or two about how do we bring community voice into and connect with other systems, whether it be local government, state government, or in some cases even bridging that connection to funders or the philanthropy world, so the other partners as you're talking about working across different sectors.

Wendoly Marte: Yeah, well, you know, the, you know, I think the one of the things that I appreciate about the way that, that you've laid out the sort of five fundamental drivers is that they're intertwined, right. Um. I think oftentimes in our sort of advocacy work

Wendoly Marte: that's that's very well meaning; it's missing a very key component, which is the people that are most impacted

Wendoly Marte: are at the table; they ought to be part of every step of the process, not just at the end when they're getting the benefit.

Wendoly Marte: But, at the very beginning, when the policy is being designed. When decisions are being made. When compromises are made. When decision makers are at the table trying to figure out what goes in, what goes out.

Wendoly Marte: And how those things are sort of determine who gets included and who gets left out. And I think oftentimes those decisions are made without people directly impacted being in the room.

Wendoly Marte: And I mean that every level; I mean that in terms of like how we're actually just signing federal policy that's moving more money into states and localities and how sort of work just signing these big sort of universal sort of focus on

Wendoly Marte: policies, but also have the implementation of them actually happen. And what we're seeing in a lot of the state and local work that our partners have been doing

Wendoly Marte: over the last year since the pandemic is that it actually makes a difference when folks can actually be in front of the decision makers and not just those that are elected, but the administrations at the state and local levels that actually implement

Wendoly Marte: how money is spent. How, you know, how they're going to actually provide real support. How hazard pay is distributed. Who gets included, right? There's so many aspects of

Wendoly Marte: the implementation and development of policy where our folks are incredibly brilliant.

Wendoly Marte: They understand this because they live this every day and just creating the right spaces where folks can actually be part of the conversation and contribute in meaningful ways,

Wendoly Marte: I think it's, you know, it's sort of like the core sort of tenet I think of having real civic participation and engagement; directly impacted folks in the process.

Sarah de Guia: That's helpful. So Dr. Barbot, I'm gonna, I'm going to kind of pick on you next because I also heard you say this in a different,

Sarah de Guia: in a different venue, which was engaging community and so from the perspective of local government.

Sarah de Guia: And I, you know, I'm really curious to hear your thoughts on that and also just where do you see local government doing good and including some of those structural drivers and like what are some of the opportunities to that COVID has really lifted up.

Oxiris Barbot: Thank you for that. You know, I, let me start off by saying that I think that

Oxiris Barbot: the times that we're living in demonstrate that community inclusion has never been so important, right. Having, as when the lead mentioned, having community at the table

Oxiris Barbot: is critical in order for us to put COVID behind us in a way that's just and equitable, right. We were only as healthy as our most challenged community and unless

Oxiris Barbot: we fully understand what the issues are in different communities that keep people from being able to adhere to recommendations that keep communities unable from fully participating, then, then we all lose. So, for example

Oxiris Barbot: in New York City, we stood up a community advisory board early on. Especially when we knew that Black and brown people were being disproportionately affected by COVID, so that we could

Oxiris Barbot: engage higher numbers of trusted messengers to get the message out, in any way, in every way possible to ensure that we were getting

Oxiris Barbot: real-time feedback about what was working with our response and what was not working, and where it was.

Oxiris Barbot: That we needed more community partners to have more resources from the city so that they could meet their community's needs.

Oxiris Barbot: I think that the other thing that I will say is that that work then should translate, hopefully, into more communities being engaged in conversations that we're currently having around, for example, vaccine hesitancy.

Oxiris Barbot: And so the importance of having communities at the table is that this is a way to engage communities,

Oxiris Barbot: typically think about in terms of community engagement, which is getting the message out, getting people, you know, engaged in processes all the way through

Oxiris Barbot: to the power that communities have in engaging their members, their constituencies, creating bridges across communities

Oxiris Barbot: that government could never do in a short amount of time like we haven't or could, right. I think what we have learned is that especially when we think about vaccine hesitancy,

Oxiris Barbot: the underlying issue here is trust. And trust doesn't develop overnight, and the importance of having

Oxiris Barbot: true meaningful community partnerships is that government then leans on communities, for community to lead, and that takes, I think, evolved leaders to understand that having community at the table doesn't mean giving up power. And that's is actually building more power for everyone.

Sarah de Guia: Yeah, and I want to come back to that because there are, there were some questions

Sarah de Guia: that the audience submitted in advance and some of those questions were

Sarah de Guia: What if we don't have the leadership right? And we saw that in some of the poll to where people are saying what happens when we don't have those evolved leaders or maybe they're just not on the same page at or there's not a readiness there. So

Sarah de Guia: I will, I will put that in your feet, Oxiris, and Wendoly and also I'd love to hear from from Dr. James because

Sarah de Guia: you were in at CMS, you know, during an unfriendly administration, if you will, and so you kind of bring that perspective. But I'd also like to hear from you in terms of

Sarah de Guia: where do you see funders, you know, plugging into some of these opportunities. So Cara, if I'll give you the floor here, and then we can circle back to Wendoly and Oxiris too to hear more about this like, how do you make change to, potentially from the middle.

Cara James: Now, so thank you, and I think, I have all, let me say on making change from wherever you are, change takes time.

Cara James: And it's not something that happens overnight. And when I think about even in my experiences at CMS when I first started,

Cara James: it was a new office. So, you know, Medicare and Medicaid have been around for 50 years and minority health was not a focus of that until the passage of the Affordable Care Act, so starting in that.

Cara James: And, even in a quote, unquote, "friendly administration", there are challenges, and so the approach that I took and moving forward with the work is one of, you know, of community-based participatory research model,

Cara James: meeting people where they are. So for some people,

Cara James: you know, honestly, I never really said racism at CMS, not because I didn't think that that was a problem or that it existed, but because that wasn't necessarily going to be helpful in moving the conversation forward. So I think,

Cara James: you know, approaching people where they are, understanding that

Cara James: organizations, governments, foundations, anything, is on, they're on a continuum. So for some, again, you know, we think about

Cara James: foundations like the Robert Wood Johnson Foundation, who've been talking about a culture of health and health equity for for years and years,

Cara James: and others who are newer to the game, you have to meet people where they are. Seeing with community, you meet them where they are and engage them.

Cara James: in a level that makes the most sense. We don't talk down to people. We approach them with cultural humility. We

Cara James: engage with them and understanding that everybody has something to learn from each other. So I think those are just some of the things that I would think about. And

Cara James: you know, I had a professor from a communication standpoint said, "You have to say things seven times, seven different ways in order for people to hear it."

Cara James: And it's the same thing with this work; you have to continue with the message. Bring the information, bring the data, bring the stories, so that people do hear it, but is presented in a way that

Cara James: allows them to receive it, where they are.

Cara James: So that would be one. I think in terms of where we have seen specifically health funders over this past year, the conversations around power sharing are very much happening. Understanding that there needs to be engagement with community.

Cara James: Even in just identifying the problems that those are, you know, co-creating those problems as well as the solutions and that engagement.

Cara James: And again, foundations are on a continuum. There are some that are embracing this and really trying to engage and others who are still struggling with that and coming at that model of.

Cara James: "here's what's best for you" and "here's what we're going to give you the money to do". I think the other thing that we've seen foundations really understand is that

Cara James: you know, ideally, we know that the best way to give the grants is to give it an unrestricted funding to allow the community and the organizations to

Cara James: meet those needs. And we saw some of that and pivoting where foundations relaxed restrictions on the dollars, required less reporting, allowed for general operating funds to be used so that people could quickly get

Cara James: those resources where they were most needed. I think the question that a lot of people have is "is that going to last?", as we move forward because there have been some successes with that.

Cara James: But it also is hard when you're trying to show the impact of what you did if it's "I gave general operating funds to", you know, an organization to do X, Y, and Z.

Cara James: I think the other thing that I would say, and I saw in some of the chat as people are saying sort of the large national funders not necessarily getting the money into the community.

Cara James: We are seeing some of the large vendors who are thinking about how do they build stronger relationships in those local areas to be able to reach them because it's not

Cara James: necessarily that they don't want to, but they don't necessarily have those ties into community to be able to fund in a way that can be effective. And so they are thinking about how do they build that

Cara James: sort of resource and engagement to be able to kind of get what, what is needed there.

Cara James: So let me stop there because I could keep going. But I think those are some of the things that we are seeing and how we think about an approach, but it is again a journey that everyone is on, in a different place on that journey.

Sarah de Guia: So Wendoly, Oxiris, do you want to chime in on the comment or the the idea of, you know, how do we,

Sarah de Guia: how can we be more thoughtful in engaging community. Kind of what are some of the steps or tools, because I mean,

Sarah de Guia: Cara, you're right, there is no one-size-fits-all model right for this. You have to really assess where people are at. And,

Sarah de Guia: and part of that is like understanding some of the data,

Sarah de Guia: and not just about the numbers. But part of it is also, like, looking at the patterns of discrimination across the past and really understanding what has driven us to where we are today.

Sarah de Guia: Who are the fundamental communities who are there. But a lot of it is trust and relationship building and sort of, you know, taking some small steps in order to start to make some of those big steps.

Sarah de Guia: I've done some work in California where, you know, for 10 years, we spent time working together to then finally put forth a really proactive agenda.

Sarah de Guia: And, but it took time, and it took working together, and it took just really them trusting us as the intermediary advocates.

Sarah de Guia: And, and being able to understand the process as well. And then being able to feel really comfortable and confident to be able to engage in that process.

Sarah de Guia: So, again, Oxiris, Wendoly, I don't know if you want to chime in with any kind of additional thoughts or perspectives around the community engagement side.

Oxiris Barbot: Sorry, Wendoly, I'll go after you.

Wendoly Marte: Um. So I mean this, this concept of power sharing that's that's been named in the chat, I'm just saying, we'll call it, I call co-governance. Um. And at the core of it is this belief that community needs to be part of the governing

Wendoly Marte: equation.

Wendoly Marte: When it comes to trying to figure out how our, our government serves its people, and I think that

Wendoly Marte: there are, there are different ways that you know, there're different sort of experiments that are going around across the country. I think most of the successful ones

Wendoly Marte: are really start at the local level. And because of the local level, I think, presents a lot of opportunities. And we often talk about sort of local and state sort of policy fights this way, but I also think it applies to some of these governing models

Wendoly Marte: that are pop up, you know. I also lived in in New York. I'm from the Bronx and many sort of examples of how, whether it is through participatory budgeting or a lot of the sort of like broad

Wendoly Marte: ways in which different local elected officials are trying to think about civic engagement, not just have sort of like active citizen voters, but a broader community folks that would often be left out of a process collectively, to be able to contribute to

Wendoly Marte: sort of determining priorities for their own communities and, and there's, you know, there's lots of ways in which that work needs to happen.

Wendoly Marte: And I also liked one of the comments that it's happened that I saw sort of like this sort of into the sort of.

Wendoly Marte: play between our folks. Are folks renters in their democracy or are they actually owners in it? And, and I think that that is, that is, of course,

Wendoly Marte: of course, tension that as organizers, we wrestle with often, which is, are we trying to just sort of come in at key moments for key interventions or are we actually trying to be

Wendoly Marte: here long term, and we have a lot of funders that are listening; I think we often tend to approach

Wendoly Marte: the way that we support local organizations from this sort of like very intersection insert in transaction a way

Wendoly Marte: that often doesn't lead room for folks to be able to build long-term sustained power that actually allows for community to be a real power broker in, in the, in the dynamics.

Wendoly Marte: And I think that you know there's obviously a 501c3 conversation. But I think that the the approach to actually building long-term political power that allows for community to really be at the decision-making table and be able to co-govern

Wendoly Marte: and, and sort of keep pushing from the inside and the outside of government,

Wendoly Marte: it requires a comprehensive approach that means not just policy development and outside pressure, but also being able to actually put

Wendoly Marte: people that look like us, that are coming from our communities in those positions of power. And 501c3 doesn't always allow us all of the sort of bandwidth to be able to do that, but I think it is a key, sort of,

Wendoly Marte: it's like keys or a way in which we're going to be able to advance, and not just the sort of like immediate wins, but like the long-term narrative shift that is needed for us to be able to even, you know, get some more proactive.

Wendoly Marte: Proactive fights that we're trying to take on over the long term.

Oxiris Barbot: So actually, I'm glad that I'm going after Wendoly, because I think it builds both on what she mentioned and what Cara raised and

Oxiris Barbot: I'm going to meld, you know, sort of influencing the trajectory of organizations from the middle and how we do that with

Oxiris Barbot: organization. So from my perspective, you know, whether you're in the middle of an organization or at the top of an organization or on the outside of an organization, an advocate trying to influence internally,

Oxiris Barbot: I think those dynamics tend to be somewhat similar, right. Because it's looking for opportunities and it's keeping in perspective that this is a long game, right. And so that

Oxiris Barbot: the types of individuals who are, I think most successful at influencing agendas are those that can

Oxiris Barbot: toggle between short-term wins and long-term objectives, as well as realizing that you don't have to be in charge to be leading a charge, right. So that, if someone is perhaps at the middle of an organization, there's a lot of

Oxiris Barbot: flexibility, a lot of power that can be gained from that. And you know, waiting for the opportunity, perhaps, when a more open leader comes in

Oxiris Barbot: to then have your issue rise to the top. Or if a leader comes in that's not open to to leverage the power of the outside advocates to then put pressure on that leader, and so, you know, I think in terms of

Oxiris Barbot: the five drivers that we are talking about, that to health and equity and how we can influence it from both a power sharing or a co-governance perspective, I think the opportunities are really ripe for the taking and that COVID presents a really urgent

Oxiris Barbot: let's say palette for us to release, working on.

Cara James: And if I could just build off of something Oxiris said, I really love the sort of being able to wherever you are, to sort of have that influence, because the top,

Cara James: the top changes probably more than what's happening in the middle, and the middle are some of those really strong relationships. And so when you think about, you know, government, the career staff are there

Cara James: regardless of who's in charge at the top. They're the ones who really know the ins and outs of those programs and ways that can, you know, make changes

Cara James: that in, and can do that. And so I would say that you know when people sometimes are like "I can't believe you stayed",

Cara James: we were still able to do stuff. And we worked primarily with our career colleagues to continue moving things forward. So you may not have seen a press release about it, the way you would have it prior, but it didn't mean it didn't happen, and so I would

Cara James: say that I would encourage people to think about

Cara James: those relationships and forging those because those will also last a little bit longer than the political winds.

Sarah de Guia: I think there's, there's some really key, kind of nuances are, really key information that you know you're sharing with folks because, and I think that there are,

Sarah de Guia: there's other, there's a lot of tools out there that you can use within those different, with wherever you are within your structure.

Sarah de Guia: But I think a big part of it is like the strategy and the listening. And like Oxiris is saying, sort of the long game like it's not gonna, we're not going to flip switches.

Sarah de Guia: It's going to take time and building those relationships and also really understanding sort of what are the different tools that you have at your disposal, or the different strategies that you can use.

Sarah de Guia: to build those relationships and then slowly over time start to see

The shift so that when that person who's in power and who's ready to take on those issues is you, you're ready to, you know, to partner with them.

Sarah de Guia: I want to touch upon sort of to, we're coming we're coming close to the hour, so I just want to be conscious of time. We did have quite a few questions about working in rural communities.

Sarah de Guia: And so I'd like to tee up, I think, Cara, you in particular, you've worked on a rural health strategy, but I'm happy to hear from others as well.

But Sarah de Guia: are there particular differences, nuances, or strategies that we should be thinking about when really trying to build some tolerance and some readiness to move health equity issues forward in a, in a rural community that might be different from working in an urban community?

Cara James: So I think, for the most part, and one of the things that I wrote about, Cara James: in October is that in, really, rural advocates and health advocates, advocates, health equity advocates really should think about working together, because the problems are very similar. The challenges of Cara James: getting your voice heard, getting a seat at the table when decisions are being made are very similar. I think what is Cara James: a little different in some of those, we think about, you know, from a racial equity standpoint, Cara James: that's not necessarily on the minds of many of those in rural communities, in part because it's less diverse than urban areas. Cara James: That doesn't mean it's not diverse, just less diverse. So when we look at things like rural hospital closures, they have disproportionately affected rural communities of color.

Cara James: But some of the challenges around broadband, Cara James: you know, transportation, and one that often surprises people given where most of our food is grown in the country, is that there are food insecurity in many rural communities.

Cara James: And so I think there's a lot of commonality, that how people can kind of come together in that shared experience, the things that people value and care about - community, education, family, work.

Cara James: Those are similar issues, and so I think there's a lot there. I think one of the other pieces that sometimes, and I don't think it's any different necessarily than some urban communities, is there can be a distrust of outsiders.

Cara James: And so that sort of approach and how you approach people again with that cultural community humility.

Cara James: And one of the things that Wendoly was talking about, you know, sustained effort and attention, so you're not just popping in, swooping in, doing one thing and leaving, but Cara James: building those relationships over time. And it takes time to do this work. And I think one of the things we've had a challenge within the pandemic is we're trying to build trust when we haven't really engaged in the middle of Cara James: a pandemic, and so that's something that we want to build that in right, so that in normal times, Cara James: so that when there's an emergency, we can come together. But I think there are so many commonalities, but you do have some differences in terms of geography, terrain, access, the broadband pieces.

Cara James: But again, even those are somewhat common because when you look at urban households, who have individuals with less than high school education, they're less likely to have an internet. Doesn't mean that they don't have the ability to get it per se, but Cara James: it's still an issue. So, those are I think a lot of commonalities that are there.

Sarah de Guia: Oxiris? Wendoly.

Wendoly Marte: Yeah, ditto Wendoly Marte: to all of that. I think that's all that's all right on. I think, um, a lot of these communities, rural communities have been chronically, historically dis-invested, just have a lot of Wendoly Marte: trust issues with government. Um. And so I think that, you know, to all the challenges around, you know, public hospital closures, to childcare deserts, to food insecurity, like all of those things, I think contribute to Wendoly Marte: what I think is sort of like a challenge that we've identified and sort of like our organizing movement in general around, how do we Wendoly Marte: start to really engage deeply in rural communities where there is, a lot of what I would say, it's like a desert to in terms of organizing infrastructure as well.

Wendoly Marte: And how do we start to address those things. I would say that, despite all the challenges and you know a lot of what you were saying, Wendoly Marte: Cara, about sort of like access to Internet and and technology and and all those things are real.

Wendoly Marte: And since COVID, one of the things that we've been able to do because of digital organizing where we haven't had reach in terms of physical organizing in the past, Wendoly Marte: like in-person organizing in the past, is actually being able, again, how do we meet people where they're at? They're online. And so I think that are some really interesting sort of like, Wendoly Marte: sort of opportunities that we've been able to identify. I think the issues of unemployment, of frontal access of, of health care and food, but also even more recently now vaccine distribution are issues.

Wendoly Marte: That are really resonating in rural communities, and I think we have an opportunity, not just because of sort of like the struggle of, Wendoly Marte: of the pandemic, but also what might be possible in a just recovery sort of moment, to be able to really capitalize on that shared experience that we're all feeling around COVID.

Wendoly Marte: And be able to actually engage folks a lot more meaningfully in all communities across the country, rural and urban alike, to be able to be part of the fight.

Cara James: And one last thing I would just say there is a history of that working together in some respects. And I was watching Cara James: some documentary on the civil rights movement and there was a group that worked in Appalachia to help some of those individuals in Kentucky learn Cara James: how to advocate in their own community. Applying a lot of the civil rights techniques that were Cara James: taught in some of the citizens and other areas to engage in that. So there is a history of working together. Similarly, and I think building back on that to Cara James: lift up where there are those commonalities to increase that voice, increase the power, ability to make that change and the engagement and the governance process, I think will help all of us.

Sarah de Guia: I want to shift a little bit, kind of, you Cara and Wendoly, both you started to talk a little bit about trust and and that kind of building trust among organizations and also Sarah de Guia: kind of bringing in the theme of power sharing and that even when there's like a lack of, you know, sometimes there's a lack of trust between communities and government Sarah de Guia: because the community maybe doesn't trust the government per se, but I think there's also attention with government or, or, or other folks Sarah de Guia: with the idea of, like, sharing power with community and there's a real tension there. And so I wonder if we, if you could speak.

Sarah de Guia: Any of you could speak a little bit too, and I think Wendoly, you had started to share a little bit about, like it works so much better when you are sharing power with with community.

Sarah de Guia: But I think there's some, just hearing in some of the questions that are coming up too, it's like, how do we dispel any myths out there that sharing power is going to, Sarah de Guia: you know, result in more distrust or how do we kind of get over that, that, that mistrust that might be there around sharing some of that power.

Sarah de Guia: This is like where a light went out for you all.

Oxiris Barbot: You know, let me start as someone who ran the largest health department in the country. Oxiris Barbot: I think it starts with having leaders that come in with humility. You know, who are not afraid to say "We don't have all the answers", "We don't have all the tools", "We know that Oxiris Barbot: the best and most creative ideas come from community", "We're not interested in being an extractive entity in our community". Let's work together so that whatever Oxiris Barbot: we collectively decide is needed is done in a way that has sustainability, right. Because I think Cara mentioned it earlier, leaders come and go.

Oxiris Barbot: And the best way, from my perspective, that we can assure sustainability of how we influence, for example, the built-in environment, power dynamics, Oxiris Barbot: is to ensure that there's community ownership. And the way that we do that is by having community have equal access to decision-making, right. They're invested, this is what they need, this is what they want. Oxiris Barbot: This is what I want, and so I think that's from, from my perspective, the way that I would go about it.

Cara James: I was gonna, I saw you come off mute, so I was gonna let you go and then I'll follow up.

Wendoly Marte: Um. Yeah, I mean, I think that I can still get just a brief example of how I've seen this in action. And so for a few years, we've been working with this organization called Parent Voices Oakland in California. And in 2018 Wendoly Marte: the Board of Supervisors was, had on the ballot, an initiative to create something close to a universal childcare system and, Wendoly Marte: and they weren't able to win it. And it was a huge struggle with community, to have the community Wendoly Marte: sort of be part of the process, developing the strategy, from developing the policy itself, to the field plan, to the implementation of that. And they lost, but like point Wendoly Marte: 2%. They needed two-thirds and they didn't get it. And in 2019, the community decided we're going to take the lead this time. So this time, you board of supervisors, follow the communities' lead and we'll run an even bigger Wendoly Marte: initiative that will include both childcare and also funding for the pediatric sort of hospital in the region. So they sort of decided to run this initiative that won in March of last year Wendoly Marte: that will generate 150 million dollars a year out over 10 years for both childcare and childhood Wendoly Marte: health access. And there's just so much to learn about that entire experience. We have a case study that I'm happy to share.

Wendoly Marte: But there is a huge difference when community is at the table, and community is allowed to lead and to be innovative and implement the kinds of strategies that it will actually take not just to win the stuff, but now they have an actual Wendoly Marte: stake, right. Communities actually at the table in terms of how this thing is going to be implemented and we'll see what happens, but I, you know that the, Wendoly Marte: the possibilities are limitless, right. Because when you have community that are actually experiencing this thing every day, like it's actually, like see how it works and how it doesn't and innovate Wendoly Marte: in the moment, to be able to actually have just so that the thing actually works better for communities Wendoly Marte: is critical and we need more examples of that. We need more examples across the country where community is leading in partnership with government to be able to actually advance policies that are going to have a real impact in communities' lives.

Sarah de Guia: That is a fabulous example. Sorry, go ahead Cara. I just wanted to say and I'm seeing it in the chat to that people like that really concreteness of like "here's an example of how you see". And, Sarah de Guia: and that that failure doesn't mean you can't, like not, it's not failure, right, but like winning, if you don't win something, it doesn't mean you like have to go away.

Sarah de Guia: It means "Okay, what did we need to what do we need to do differently next time?" in order to move this the same process forward. So sorry, go ahead Cara.

Cara James: No, I'm gonna leave it at that. That was an excellent example, and I think very well said.

Sarah de Guia: And I think, and I'll also just raise to that I think it goes back to, you know, Wendoly, your observation about, Sarah de Guia: um, what we can and can't fund, you know, with it within the nonprofit structure, right. Like when you get dollars and how dollars are able to be used and, Sarah de Guia: and I think you know Cara, not to put you on the spot, but I do think that there's like, there's a sort of traditional kind of safe way that philanthropy has chosen to Sarah de Guia: work. I think, in some ways, government as well, too. And so how do we even push our sectors right to be thinking beyond and I, and I do feel like COVID is one of those moments where it's like "Okay.

Sarah de Guia: What we've been doing isn't working. How do we start to shift a little bit."

Sarah de Guia: And I think to your point Wendoly, about how do we allow people to be able to get engaged in policy change, how do we allow people to be able to have those seats at the table, how do we Sarah de Guia: build capacity, where it's not just about, you know, vaccine distribution is important, we want to get those shots in people's arms, but, Sarah de Guia: but the, the programs, the day-to-day programs that we also need to be looking at. What are the structural barriers on the shifts that need to happen and, and that there's partnerships around the table who Sarah de Guia: haven't always been given or this, the table hasn't been centered around them, maybe they have the seat, maybe they have a seat in the room, but they don't have a seat at the table and the table certainly is not centered around that.

Cara James: One thing I would just add to the conversation, and I think about, you know, again, my lens has been the world of health equity for years and Cara James: when we think about what's been successful, what hasn't been successful, I think there are things that we in the health equity field could do better. And I think when we're having the conversation Cara James: around that co-creation, collaboration, partnership, power sharing, whatever we want to call this, that one of the things that Cara James: everybody needs to recognize is, you know, the world that we live in is our world and not necessarily the world that those with the table with us live in. And so, how do we, Cara James: you know, think about and approach people in a way that Cara James: meets their needs as well. And what I mean by that specifically is one example, in which there was a health system in Cara James: Pennsylvania, who was working with their economic development fund to do housing to reduce the number of ER visits for people who were housing insecure because they were having lots of visits to the ER.

Cara James: And they showed that the program worked for reducing the visits to the ER, but that's not the outcome that the economic development fund needs to show success for them.

Cara James: So how do we sort of become a little bit more educated in each other's Cara James: outcomes, desires, and what people need to make the case for continued support so that we can build Cara James: collective evaluation of things that are meaningful for all of us because we all have to respond to somebody in terms of "Was this a successful use of our resources". And so I just say that to encourage all of us to become a little bit more Cara James: educated across disciplinary areas of what it is that people are needing to be able to show success and building that in together as we worked on all of these issues.

Oxiris Barbot: I'm just going to build on that really briefly to say that this is also from a different perspective on health equity. This is a moment for us to look at Oxiris Barbot: all of the rules, regulations, and laws that have been suspended because of the COVID response and to really interrogate those and say Oxiris Barbot: "The world didn't fall apart because that rule, regulation or law is no longer in effect. Do we really need it? How is it that it is contributing or not to health equity?" So that in this process of rebuilding, you know, it's, Oxiris Barbot: it's an opportunity for us not to go back to the way things were and to try to tinker around the margins. But to really draw on the experience, the creativity of communities working with government to have a more just and equitable rebuilt.

Sarah de Guia: So Oxiris, if you, can you say a little bit more to about because I want to pick up on this this kind of general theme about Sarah de Guia: what did COVID sort of teach us, where you know in this moment and where do we, how do we think about as we're thinking about building back and recovery?

Sarah de Guia: What do we need to learn from this moment in order to do things differently going forward. So that, that was a perfect point and then are there other sort of lessons learned that you've gathered from this pandemic that we need to be really centering as we move forward.

Oxiris Barbot: Wow, that's a great question. So I'll give you two responses, one is a very sort of succinct response. Oxiris Barbot: Using methadone as an example. Right. During COVID, New York City health department delivered methadone to people's homes.

Oxiris Barbot: Right. We suspend rules about you have to go to a clinic to get your methadone. You can't get refills, it's like, Oxiris Barbot: let's think about why is it that the rules, regulations and laws around methadone, around medications that support people in recovery are the way that they are, and let's unpack that Oxiris Barbot: history to think about when we move, as we move forward, we do it in a more just and equitable way. I, like the way we do methadone doesn't make sense, so that's one sort of example of a specific Oxiris Barbot: piece of of law that's in place that, that is disproportionately affecting certain parts of of our population and it's treating Oxiris Barbot: a chronic illness different from another chronic illness, right. Why can't we prescribe methadone the way that we prescribed insulin.

Oxiris Barbot: And off on that. The second thing is, as we look towards the rebuild, it's important for us to think across disciplines. I think as, as, both Wendoly and Cara have talked about.

Oxiris Barbot: And the example that I use is one that looks at early childcare centers. Right. Early on in the the shut down, everything closed down. We were looking to then reopen the city. We did a survey to say "you know, what do early childhood centers need in order to reopen?"

Oxiris Barbot: from all over the city. And what I did was I asked my staff, I want you to map out where we got these responses from because it actually turns out that we didn't get responses from Oxiris Barbot: parts of New York City that are most economically disadvantaged. And the reason was because these early childhood centers Oxiris Barbot: are small centers typically run by women of color and they didn't have the economic reserves Oxiris Barbot: to ride it out, even a short period of closure. Right. So we didn't get responses, because they had already gone under. And so in thinking about how is it that we support Oxiris Barbot: women of color entering or re-entering the small business market and how then supporting those women help other women of color Oxiris Barbot: re-enter or stay in the workforce. And beyond that, how do these centers provide access for high-quality early childhood education, Oxiris Barbot: which has been demonstrated to set children up for the greatest opportunities for success moving forward.

Oxiris Barbot: We need our leaders to be thinking that way. Right. Not to be thinking and "a five-old men" are, but to really look holistically at communities, because hey folks turns out that people live holistically. Right. We need leaders that can model that.

Sarah de Guia: That's, that is so well put and I just the way that you've connected all of those issues. Right. That everyday people live.

Sarah de Guia: But oftentimes as advocates or as government folks or whatever we're thinking about these in silos and that was just a brilliant way to like pull all of these things together, and just demonstrate how Sarah de Guia: they're interrelated. If you take one piece of the puzzle away, you know it doesn't work. So that was really, thank you for all of those examples.

Sarah de Guia: Wendoly and Cara, what, where were you thinking in terms of as we build back towards COVID recovery, what should we be really be focused, or what what's the lesson learned here.

Wendoly Marte: Um. So I want to ride the innovation train with Oxiris. Wendoly Marte: I think that is just key. I think the ways that we've seen innovation show up, and policies, in new revenue, and in an implementation of all the examples Oxiris Wendoly Marte: gave here on how implementation, how we can really be innovative and how we're implementing these policies is key. And I also think there is an opportunity Wendoly Marte: to

Think about not just a short term, but how are we sort of creating a real thread between the short-term needs, and the long-term possibilities?

Wendoly Marte: That we have in front of us, for, for to be able to really sort of advance health equity, racial equity across the board. Wendoly Marte: And then to this point around childcare, I'll just, you know, as someone who works with childcare, I just love. That was like music to my ears. Um. I think one of the things that, um, that the pandemic has done,

Wendoly Marte: which is, I think, really important. And Sarah, you and I were talking about this last time you were on a panel, I think, is how invisible work and care work, essential work, has become a lot more visible and. Wendoly Marte: And it has become visible in the way that we see it as like human beings because we're experiencing it every day. But it's also, I think, in terms of

Wendoly Marte: opportunities for exactly that, how we're actually serving, serving this population, all these populations because it's multiple constituencies that fall into this category, have traditionally been overlooked, undervalued, and that is predominantly women. Wendoly Marte: And because we know that care work, essential work, it's predominantly the work of women and women of color, and we just have a responsibility, I think, in this point in time

Wendoly Marte: to to make sure that they are centered in a just recovery. And that the work of caregivers, of providers, of nurses, of the folks that care for us every day, Wendoly Marte: who put their lives on the line, and their families on the line every day, that we are also creating policies that are about making sure that they're cared for

Wendoly Marte: by our society. Um. And so I'll just add, I'll just add that to the conversation because I think that there's just, there's just so much, there's so much work that we need to do to make sure that that happens over the long term.

Cara James: Okay, so I'm going to end, and I'm going to try and end on a positive note. But I'm also going to end on on a couple of things we haven't touched on.

Cara James: And when I think about the lessons that are, we should be learning from this, one is that when whatever happens next, Cara James: we should not be surprised that communities of color, low-income communities are disproportionately affected across the board by whatever. Cara James: I think the, the surprise that people continue to have at the fact that people are being disproportionately affected in

Cara James: job loss, housing, access to PPP, you know, whatever the case may be, not getting that, Cara James: that just really is no longer acceptable. I mean, it just we have those five drivers that you talk about, the structural discrimination, income inequality, disparities, and opportunity, those play out in every facet of our life. Cara James: And when we have an example of whatever the issue is, we need to be thinking about that and recognizing that even without the data, which is the second thing I'm going to talk about, that we don't have,

Cara James: we should not be surprised to see the disproportionate impact in these communities and need to be thinking about those before and, and how we build supports and systems to be able to help people get what they need. Cara James: The data is the second thing. It's, it's not okay anymore that we don't know what's happening. We need to build data systems to be able to track this and to be able to lift that up because,

Cara James: quite frankly, that's how people respond to some of it. If you can't quantify the problems and people don't advocate and release the resources that are needed to address these things. And

Cara James: the fact that it was four months before we could get data on race and ethnicity, to see who was getting tested

Cara James: is, is not acceptable. And the fact that we started vaccinating and didn't have data in so many places, and still don't have data in so many places really just has become unacceptable. Cara James: And there are real data challenges. So when we talk about infrastructure needs, we need to be thinking about how do we build infrastructure for data to understand our problems and monitor progress.

Cara James: And the other thing that the pandemic has lifted up which I'm hoping we're going to talk more about

Cara James: is our workforce. In again, everything, childcare, caregivers, healthcare. We have workforce shortages in certain communities. We have workforce needs, particularly when we talk about rural communities and other underserved. Cara James: We have not really focused on what does it mean to have a sustainable workforce for the future. And I would say, even before the pandemic with automation and opioid overdoses, that we were seeing in the depths of despair, people need to be able to provide.

Cara James: sustainable livelihood for themselves and their families. And jobs are an important part of that. And we need to think about what our workforce needs for the future and how do we get people trained appropriately to be able to

Cara James: meet those needs, and to have a life, because that is, that is really important. And the last thing that I will say is the, you know, short and long term, as means is we're looking forward, we still don't know.

Cara James: what the mental health fallout of this is going to be. But we do know we're not prepared to meet those needs because we've had a mental health system that has been challenged already before the pandemic. Cara James: And we should not be surprised because we already know

Cara James: communities of color are less likely to get access to mental health services. When you look at the statistics of those who will qualify for any mental illness compared to those who are actually receiving treatments, Cara James: communities of color significantly less likely. So can we try to build a plan that addresses some of those barriers on the front end so that we're not sitting a year and a half later saying "Hah! Look at that. They didn't get the services that they need."

Cara James: And the last thing I would say is, coming out of the recession of 2009, we know that the recovery is not going to be equitable. Cara James: So I think that it's important for us to think about how do we make sure that we don't pull the rug out from under some of our communities just because the national numbers say that we're back. Cara James: So, make sure that those supports give people the time and the resources they need to get their families back up because it takes longer, and a lot of these communities that have been hit hard had to get back to normal, and for some, it may not be quote unquote normal.

Sarah de Guia: I'd like to add to this conversation, just a moderator's prerogative here for a minute, but just.

Sarah de Guia: I want to add a couple of things that I think we've learned in this process as well because Changelab has had an opportunity to

Sarah de Guia: take some technical assistance questions from different organizations around the country, a lot of them legally related. Sarah de Guia: And so I think one of the things that really came to bear in this was like also how unprepared, we were around what are the legal authorities and what are the legal responses. Sarah de Guia: You know, how do we think about civil rights, you know, in the context of civil rights, how do we, how are we responding in a way that's not going to

Sarah de Guia: trigger those civil rights violations. Or how do we think about this in a way to utilize the protections that are on the books to really help some of the the communities that we're we're thinking about and talking about. Sarah de Guia: And it did not help necessarily that we had a federal legislation that was or federal administration that wasn't kind to that. Sarah de Guia: But I mean, I think it was also just, you know, how do we, how do we kind of think about the role of law.

Sarah de Guia: But I also wanted to raise that there was also a lot of attention paid to sort of the federal level responses and there were some very innovative local approaches. Sarah de Guia: And I think it was raised earlier that oftentimes, I think Wendoly, you mentioned that like

Sarah de Guia: local is oftentimes where it's at, right? There's a lot of innovation that's happening. There's more flexibility. There's more opportunity to bring community into the table. Sarah de Guia: And I think it is really helpful as we're building back to really understand how do we leverage the coordination between local, state and federal because not everybody's on the same page. And in fact, we've seen a bit of divisiveness happening.

Sarah de Guia: Even more so after this past election. And so, just really thinking about how do we, how can we promote, I mean Cara you wrote in a recent blog about, civility. Sarah de Guia: How do we kind of bring civility back and how do we think about this from a collective approach.

Sarah de Guia: And then the last point that I would make is just on our infrastructure. Sarah de Guia: And we've talked a lot about infrastructure today, and I think really also recognizing just the importance that our local infrastructure has. Whether it's community-based organizations who are serving those communities who didn't have access to

Sarah de Guia: or weren't able to get some of those federal or state funds, but that there was, there is an infrastructure of community-based organizations who are serving some of these most vulnerable populations. Sarah de Guia: And how do we bring them into the fold in this next time around. And actually start to think of them as an extension of our government infrastructure, even as our funding infrastructure in that to really leverage and rally around those folks as well.

Sarah de Guia: So we're coming close to time and I am, I want to thank you all so much. I want to give you a chance to also

Sarah de Guia: share any closing comments or thoughts that you have. Sarah de Guia: If you don't necessarily have closing thoughts at this moment, I'd be curious to hear to kind of just what gives you hope. And this time, like what are you most kind of looking forward to, or what are the opportunities that you're really hoping

Sarah de Guia: that we can leverage in this, in this, as we move look towards the future.

Oxiris Barbot: So I'll start and I'll say that what gives me hope is actually something that Wendoly alluded to, and it's this shared experience. I think that the way in which COVID has destabilized.

Sarah de Guia: Oh, we can't hear Oxiris. Oh, sorry, that's okay.

Sarah de Guia: Next.

Oxiris Barbot: Better now? Okay, um, has the way that people have been destabilized not only here in the U.S., but across the world, I think

Oxiris Barbot: from my perspective, seems to have opened a lot of hearts and minds to how is it that we build a better world where

Oxiris Barbot: being interdependent isn't seen as a weakness, but rather as a strength. And how to how is it that we take care of one another that goes beyond our physical health but that goes to our mental and spiritual health as well. So even though

Oxiris Barbot: there are a lot of co-occurring crises right now, I'm very hopeful for what lies ahead.

Cara James: And I'll build on that. I think, you know, I'm hopeful about a couple of things. One, I actually am hopeful that so many people are

Cara James: now sort of awakened to the inequities that we have. And so many organizations, entities across the board, are talking about this in a way that we have not seen in, in decades, really. And I think that the commitment to make change happen

Cara James: across all sectors, I mean I'm just looking at the business sector, and what they're doing and continuing to build on that, you know, everybody is kind of talking about this, I think it's a great moment.

Cara James: The other thing that I'm actually really hopeful for, coming back to, you know, sort of where we started in some of the community conversations is

Cara James: to some extent, the fact that we've all been home, we have actually built stronger community because we now know our neighbors in a way that we didn't before. Cara James: So I will just say for my own neighbors, they kind of joke they don't think anybody lived here because of the hours that I kept

Cara James: for work. But you know, that also is seeds that can help to build power in communities and to make change and address these issues, and I'm hoping that

Cara James: even as people start to go back to the office or to school and everything that we continue those connections and build to improve on our community. So I'm hopeful about those two things.

Cara James: And I would say the third thing is just that the innovation that we've talked about. The creativity, how people have responded and come together to help people out, continues to show that we are willing to help address these issues. And I just am, those are some things that give me hope.

Wendoly Marte: Yeah, ditto.

Wendoly Marte: I'm. Wendoly Marte: across both of, what's been, what Oxiris and have shared. I think, the creativity and the innovation, and the sort of sense of collective like,

Wendoly Marte: troubleshooting that I've seen across the board, right. Like that is not one sort of constituent's problem, but it's all of our problem. There's, there's sort of like lots of examples that are seen over the last year of,

Wendoly Marte: like just people showing up in solidarity in different ways that that are really sort of validating. And I think that points to

Wendoly Marte: what is possible and how we might actually have the new normal after the pandemic might be better than the normal before, right. Like there's,

Wendoly Marte: there's just so much I think that's pointing to what might be, what might be possible after that might be really empowering for our communities and that can can build sort of these deeper sort of

Wendoly Marte: pockets of connection and interconnectedness. And, and all of that, like you know the sort of like the possibility for humans, for human society afterwards.

Wendoly Marte: I think there's just so much that that's there. And then on the sort of equity front, it also feels that way, right. Like if we're a society where we are, we're seeing each other struggle differently as a shared experience.

Wendoly Marte: That I, as an organizer, I am like a hopeless sort of like an old romantic in the sense that, like that I think sets it's like all the right ingredients, right. To be able to actually advance like proper incredible

Wendoly Marte: policies in our society because of we're no longer seeing each other as others, but actually seeing each other, and to share struggle and experience.

Wendoly Marte: It can we also see each other in a shared vision for our future, right. Like, is it possible. Like all of those things just give me hope.

Wendoly Marte: And, and the creativity that I've seen in terms of how people are coming together, organizing each other, educating one another, like,

Wendoly Marte: building with each other, to all the things that folks have shared, just I think the all, the all, the sort of all the right ingredients are there, I think it's up to us now to figure out what is the sort of magical sauce that's going to bring it all together.

Sarah de Guia: That was really beautiful. I want to thank you so, so much for spending time with us today

Sarah de Guia: and sharing your experiences and and really for sharing, for ending this on a really positive and optimistic note. I know that we have a lot of work in front of us, but I think with leaders like you all

Sarah de Guia: we can absolutely achieve a lot in this time. And we have some some real big challenges in front of us, but I think again leveraging

Sarah de Guia: the strengths, that of our, of our connection and of our community, and really centering community, I think we will be be very successful.

Sarah de Guia: I'm going to ask for Bernard to bring us back to the slide show just for a really quick quick slide and you can go ahead and advance it to the last slide because we've we've run out of time here.

Sarah de Guia: What I want to just say is that we really want to stay connected with you all, and so here's the contact information for our. Sarah de Guia: colleagues here today. And please go to Changelab Solutions' website if you're interested in more definitions. If you're interested in looking at the Blueprint for Changemakers, which has

Sarah de Guia: all of our the five fundamental drivers outlined. It has much more rich information and frameworks principles to build upon today.

Sarah de Guia: And we really look forward to staying in touch with you. I want to also just remind folks that our next webinar will be March 30 at 10:30 a.m. Pacific time.

Sarah de Guia: And that will be focused on employment. So again will fold in these five drivers but we'll be doing a deep dive on employment.

Sarah de Guia: And we'll be looking at laws and policies that affect workers and how oftentimes are sometimes inequitable enforcement

Sarah de Guia: that is intended to protect workers can actually exacerbate inequities and disparities. So registration will be opening up next week and again we encourage you to visit Changelab Solutions, our website changelab solutions.org for more information.

Sarah de Guia: Thank you all again. Thank you to the panelists, for the Changelab staff, and for all of the audience members for your very interactive chat and your very important and thought-provoking questions. Thanks to everyone. Please be safe. We'll see you soon.