Episode 30: Health Inequity

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Episode Summary:

The long-standing and large disparity in longevity and life expectancy between Black and White Americans is hard evidence of serious health inequities.  Disparities in health result from factors influencing both the 80% of health that happens outside of the doctor’s office, as well as the 20% that happens within the healthcare system. This episode talks with two leaders who are doing transformational work at many levels.

Episode Guests:

Dr. Aletha Maybank, M.D., MPH, Chief Health Equity Officer for the American Medical Association, Pediatrician, and Preventive Medicine Specialist.

Dr. Willie Underwood III, M.D., MSc, MPH, FACS, Executive Director of Buffalo Center for Health Equity, Member of the American Medical Association Board of Trustees, Urology Specialist

During This Episode We Discuss:

  • Health inequity and health disparities; a multifaceted issue.
  • Barriers to equitable care.
  • Recommendations for improving system inequity.
  • Working toward achieving optimum health for all of the population.
  • The individual, the family, the community (of individuals of color) having a plan to improve life expectancy equal to that of everyone else.
  • Institutions that value the lives and strive to improve the health of their community.
  • How to provide a healthcare product that caters to the population of communities of color.
  • Antiracism/ transformational work in health departments, institutions of care.
  • Directions, actions, and programs to enable change.

Quotes (Tweetables):

“We know that African American Men are 1.5x times more likely to be diagnosed with Prostate Cancer and half as likely to be treated, even if they have a high-grade high-risk cancer, and that leads to them, in my perspective of having a mortality rate that’s 2 times greater than a white male.”

More than that, it’s not just prostate cancer that kills men, but heart attacks, colon cancer, diabetes, hypertension, so our goal has to be to improve the health and healthcare of those who have been historically disenfranchised with the system. That’s a multifaceted issue, but the main thing is that it starts with our system, how they interact with the system and how the system interacts with them.”

Willie Underwood III, M.D.

“How Systems are working for people and how they are not working for people, because our data shows that there are gaps, there are differences, there are disparities, between the health outcomes blacks and whites specifically between black men, black women, between black men and white men, black women, and white women, and some of the largest gaps we have in this country. The life expectancy for a black male is 72 years, which is the lowest life expectancy in the country… These differences do not need to exist, they are avoidable, they are unjust, and we frame them in the context of inequity.”

“As institutions, we can’t presume or expect folks to have trust unless we have actions committed to that.”

Aletha Maybank, M.D.

Recommended Resources:

Episode Transcript: 

Dr. Pelman (00:00):

This is a joint statement from the Washington state urologist society and from the National African American wellness initiative. The Washington state urology society stands in solidarity with our local black community partner, national African American wellness initiative to join together to make changes in our local community regarding the need for law enforcement reform and an increased focus on health disparities for the black community. The recent events across America have significantly impacted us all, especially members of the black community. They have served as a reminder of the ongoing systemic racism that still exists in our country. The recent deaths of George Floyd, Ahmaud Arbery and Brianna Taylor and numerous others, along with the glaring outcomes of COVID-19 on our black communities are stark examples of how far we have yet to go in our quest for Liberty and justice for all. Together, we actively condemn these inherent acts of violence. Urologic ailments are not protected from racial inequities. Black patients have poor outcomes for many urologic conditions, including prostate cancer. Standing in solidarity, we pledged to actively promote and sustain equity through education, alliance and advocacy.  Racism, brutal attacks, subsequent violence and health disparities must end. We are grateful to the thousands of peaceful protestors who are helping to raise awareness of issues still observed in the black community. We invite other organizations to join us in efforts to truly work toward change.

Dr. Pelman (02:03):

A Baseball game. A day in a park with friends and family. Fishing in a remote stream. Work, travels, providing for loved ones or heading out for adventures. Whatever you do, whatever you enjoy, you need your health. The original guide demands health is presented by the Washington State Urology Society to help take you through the steps necessary to get the most out of life. If you have invested in a retirement plan for your future, why not invest in your body. After all, it makes better sense to retire, healthy and enjoy your future. These podcasts are a guide for how to take care of yourself. If you take care of your car and maintain it, why not do the same for your personal machine in your body? If you know you should, but haven’t yet, the information in these podcasts contains some easy recommendations for where, when, and how to get started. Follow the podcast as we explore men’s health with renowned experts and embark on a journey towards better health.

Dr. Pelman (03:21):

On this episode of the original guide to men’s health, we’ll be speaking about health inequity. We’re fortunate to have Dr. Aletha Maybank. Dr. Maybank is the chief health equity officer for the American Medical Association. She’s a pediatrician and preventive medicine specialist. We also have Dr. Willie Underwood 3rd. Dr. Willie Underwood is a urologist and a member of the board of trustees of the American Medical Association. I’ve known Dr. Underwood for years and when we first began to support men’s health. Dr. Underwood, I remember that after we were discussing the issues that guys tended to not be involved in men’s health, he said that he told his guys that it doesn’t do him any good to save you from prostate cancer to have you die of a heart attack and he thinks that’s amplified for certain communities. So we’re here to discuss health and equity. So I’m going to give it to Dr. Underwood first. Thanks for being here, Richard.

Dr. Underwood (04:20):

Thank you very much. I think this is an awesome program and an opportunity to discuss some very critical issues. Number one, as a urologist mostly dealing with men with prostate cancer, we know that African-American men are one and a half times more likely to be diagnosed with prostate cancer, half as likely to be treated, even if they have a high grade/high risk cancer.  This leads to them, from my perspective, having a mortality rate that’s two times as high as a white guy. More than that, we have to add to the fact that it’s not just prostate cancers that kill men, but heart attacks, colon cancer, diabetes, and hypertension. So our goal has to be to improve the health and healthcare of those who have been historically disenfranchised from the system. Now that’s a multifaceted issue, but the main thing is that it starts with our system, how men interact with the system and how the system interacts with them. 

Dr. Pelman And Dr. Maybank

Dr. Maybank (05:25):

Good morning. Thanks for having me today to speak with you all. It’s a pleasure being with Dr. Underwood to have a conversation. I come from the perspective of looking at how systems and structures are working for people and how well they aren’t working for people. This is because what our data shows is that there are gaps. There are differences. There are disparities in terms of the health outcomes of society, not just between blacks and whites, but specifically between black men/black women, black men/white women, black men/white men. It’s some of the largest gaps that we have in health in this country. The life expectancy for a black male is 72 years in this country, which is the lowest life expectancy in the country.

Dr. Maybank (06:15):

In my frame, these differences don’t need to exist. They are avoidable, they’re unjust, and we frame them in the context of inequity. When we say inequity, we’re saying that there needs to be an opportunity where there is more resources and attention provided to those who have the worst health outcomes and black males. We are working towards helping all of us really achieve our optimal health. We are working to make sure people have the opportunities, the power, the resources, and the living conditions so that they can actually achieve and maintain optimal health. There is a lot of work that goes into doing that, including work at an institutional level, work at a neighborhood level and work at the policy level. A lot of that work is happening here at the American medical association. 

Dr. Pelman (07:05):

We have listeners across the population. Let me have you address a population of black men who maybe have not plugged into the system, who we hope are listening to this podcast to get information on how to take care of themselves. What’s your message to them about how to access the system? Of course, it’s a broad issue because it’s socioeconomic, it’s geographic, it’s rural versus urban. How do you start?

Dr. Underwood (07:33):

Wow, that’s a very complex question. Let’s start with this. I guess first we need to discuss from the perspective of those with insurance and those without insurance. So I’ll start with those with insurance first. If you have insurance, that is considered an opportunity for access. I call it an opportunity. That still means that there could be co-pays and things along those lines about what healthcare really costs you. However, if you have insurance, then the question becomes do you have providers who you trust? Do you have providers who you want to engage with? So if you have opportunities, then the key is to find providers that you can trust and who are trustworthy. Then you can start working towards “Hey, my goal is to live as long as possible.”, “My goal is to be as healthy as possible.” That’s the start.

Dr. Underwood (08:36):

Second is to feel worthy of having longevity in life. So those without insurance through employers or Medicare, there’s also an opportunity through the exchanges and through Medicaid to basically have an opportunity to have providers. Now, some of those insurance plans are not as “welcome” by certain providers or certain hospitals due to their reimbursement. But again, your life has value. And if your life has value then you need to take advantage of whatever opportunity necessary to assure longevity of life. That has to be the community dialogue. In Buffalo, we’re creating a community-based health equity center to begin to look at what’s going on in Buffalo. We know that there are several zip codes within Buffalo, there’s five of them. These locations aren’t representative of the country as the mortality rate from diseases is 300% higher than the rest of the city, the rest of the county, and the rest of the state.

Dr. Underwood (09:36):

So as a community, and those who are being negatively impacted by that, we basically said, look enough is enough and too much stinks as my mother would say. So we’re now trying to put a strategic plan together to resolve these issues. That’s where I think it really starts.  The individual has a strategic plan of how you live long. The family has a strategic plan. The family has longevity in death, longevity of life. The community itself says “enough is enough, we demand to have a life expectancy equal to everyone else. What do we need to do to make that happen?” That’s a long drawn out answer to a very complex question, but hopefully there’s something in it that is helpful.

Dr. Maybank (10:17):

From my lens, what I look at and the work that I’m doing at the American Medical Association and what I’ve helped support at other institutions, is making sure that institutions are ready and prepared to not only physically treat, but respectfully treat folks with dignity as they walk through their doors. We are  really looking at how people are doing their work. I work at an institutional level and we call it kind of transformational work. In my previous role we called it anti-racism work and work to ensure that the health department was becoming an anti-racist organization, a multicultural organization that  valued and understood and affirmed the humanity of folks who had the worst health outcomes. In order to do that, we had to really build the capacity of our staff, employees, and teams.

Dr. Maybank (11:08):

So we’re working on that at the American Medical Association. We are providing institutions time to build a shared language around the meaning of inequity? How does it show up in society? How does it show up in the day to day decisions that you’re making that are influencing the decisions that we make as AMA? Then we’re working on how we can build an infrastructure of sustainability? A lot of the work as it relates to diversity and inclusion falls a little short. It’s important, but falls a little short. It’s usually just focused on hiring practices and that kind of inclusion. This is broader than that. We’re looking at inclusive hiring, how we’re hiring, who we’re hiring, how we’re retaining folks, but also pay equity or where we are actually giving our dollars as AMA? who are we giving it to?

Dr. Maybank (11:52):

What are the vendors that we’re giving it to? Is it equitable? We’re looking how we communicate with folks. Are the materials that we’re using really right and relevant? Are they visually inclusive? Our organizational commitment in many ways. So equity plays out in a much broader scope than diversity and inclusion. We are working on how to ensure that this work becomes sustained. What’s our accountability infrastructure to do that? How do we need to organize within our institution to assure that? Oftentimes you don’t know what you don’t know. People need tools to help them get there. So we call this operationalizing. What are the tools that folks need in front of them as they make these day-to-day decisions? A lot of times equity feels unreachable and impossible for people so we try to bring it down to a couple questions.

Dr. Maybank (12:42):

What is our data showing? What potentially is missing from our data?  You may not know that answer unless you have different people at your table. So who’s potentially missing from your table that could help provide that information or has that expertise to ask questions in a different and more complete way? What are the unintended consequences of the decisions or choices we may be making that we’re not thinking of? A lot of this I frame in the context of not only needing to do this to improve health outcomes, but to close the gap. We needed to do it to make sure we’re not causing any harm or any further harm, which is part of our code of ethics as physicians.

Dr. Pelman (13:21):

It’s difficult for a lot of guys to seek care. I mean, you give up some control. It would be, I imagine, much more difficult to come into a unwelcoming environment. So on the receiving end, when an individual is going in for care, we want it to make certain that they feel welcomed and that the system is nurturing for them. How would you get a message to men? We all have our health belief systems and we have so many cultures entering the country now with their own unique health belief systems. We have people within this country who have generational health belief systems. How are you approaching that?

Dr. Maybank (13:58):

When folks walk into institutions, we can’t assume and expect them to have trust unless we have action committed to understanding their health belief systems. So we are acting on this now. At the AMA, we are just about to embark on an effort in partnership with Westside United. It’s really for us as AMA to do something in our own backyard, to say we are placed here. We see you. We see that the life expectancy gaps exist. We see that there has been a lack of investment. We see that there has been disinvestment over time. We are committed to working with you and other partners within the neighborhood to ensure health outcomes. Those are the things that people see. People are paying attention. They have paid attention for years.

Dr. Maybank (14:45):

They’re very clear how they’ve been either exploited or treated by institutions. So as institutions you have to show up and be present in ways that may not be comfortable for the typical institution.  You have to break away from the expectation of  people coming to them. We have to be willing to go to folks in their own neighborhoods and at their own tables in order to start building that trust that we are going to be there. Then when we are there, we have to be willing to listen in ways that are very meaningful and not become defensive over information we may hear that we may not like. So critical to that is really establishing meaningful community engagement that shares and builds power with others. I think that from an institutional level, that’s a way that we have to create spaces to help folks walk into our doors.

Dr. Underwood (15:37):

Just as a clarifying point, that’s the west side of Chicago, which is extremely important to me because that’s where my grandfather lived when I was growing up. I think tying this back to what I was talking about before is really important. So I started off talking about insurance and not having insurance, right? So if you have an inequitable employment and inequitable opportunity, then you have inequitable opportunity to have healthcare, to have health insurance. This then creates a barrier for you to have health care, which then creates a barrier for you to have health. So these things sort of all tie together. Now, in many cities and areas, the major employers are hospitals. So they’re not only healthcare delivery systems, they’re employers as well. So when you start thinking about how to improve the health and healthcare of an area, start by looking at your employment practices. Who you hire, who you fire, who you promote, all has an impact on the surrounding area of your institution. This is especially true when many of these institutions are in the same neighborhoods that have these health inequities.

Dr. Underwood (16:57):

Those things are critical. So the constant idea of moving beyond an individual and seeing your behavior is either good or bad to an idea of saying, “wait a minute, what’s our goal? What’s our charter? Why are we here? Oh, we’re here to improve their health. Okay, great. Then what do we need to do to make that a reality?” Now, when institutions and communities begin to do that, then you have a substantial change. I’ll give you an example. When we value the lives of those in the community (“we” meaning every single individual, be it from an institution or the individuals of the community) then you start to see a substantial change. That’s why I said, “Listen, if I say my life has value, my life matters, and my expectation is that if I go to you for help, then you will treat me in a way that I can receive the help that I’m requesting. period”. 

Dr. Underwood (18:00):

At the same time, the institution says that my job,  my goal, is to improve their health. So therefore I have to have an environment that is conducive to them. So I remember years ago I was  walking through  Chinatown in San Francisco. I saw Time magazine, Life magazine, and several other national magazines that had Chinese people on the cover. The magazines were written in Chinese. It was designed for them. I said “Wait a minute.” What they realized is that if I want to sell this magazine to that population of people, I can’t give them what I’m giving to everyone else. This is because they’re not  going to buy it. It’s not going to reflect them. It’s not going to be what they need. It’s not going to be what they want.

Dr. Underwood (18:47):

So I have to change, right? So I thought about it. I said, “How come no one else is doing that for other areas and groups that are saying I’m left out of the marketplace? If you actually want me in the marketplace, then you have to provide a product that is conducive to me being in the marketplace.” Someone once said to me in a talk “well, well, blacks don’t want to come to the hospital. They don’t want to come to the doctor’s office.” And I said, “years ago, decades ago, the Japanese auto industry said they wanted to significantly break into the American automobile market.” In my mother’s generation, It was unheard of for black people to purchase foreign cars. My mother has never had a foreign car. She was committed to the American automobile industry. The Japanese didn’t say “black people aren’t buying our cars because there is something wrong with them.”

Dr. Underwood (19:40):

The Japanese auto industry said “ what do we need to do to get black people to buy our cars?” So they hired the right marketing firm to create situations where black people wanted to buy their automobiles. I have never had an American automobile as a result. So if I’m a health system, then what do I say? I see people walking past me to go nowhere, right? They’re not receiving care anywhere. And I say, “wait a minute, what’s wrong with them that they don’t want to come in here?” Or do I say, “what are we doing wrong or right to make sure that they’re in our seats? That they’re coming to see us compared to going to see someone else, because I value that individual enough that I want to provide services to them.” It’s like anything else.

Dr. Pelman (20:35):

Dr. Maybank I think one of the things that you mentioned was coming to the community. I remember Willy talking about listening to this podcast while we’re commuting in our cars. However, you spoke of a patient who needs to take two buses and an entire day off work to come to the visit. Then they need to get scheduled for another test. That’s another two buses to go home and another day of lost work. So it seems like putting together a healthcare delivery system that solves that issue is brilliant.

Dr. Maybank (21:06):

It was what makes sense, right? I love the example that you just used. I am going to use that example Dr. Underwood. That was powerful and it made it easier to understand. The reality is that our system was never set up to value or fully contextualize the lives of most individuals in this country. It was really created by mostly white men in this country. So it reflects the realities of their lives and their families. They had transportation. They could get to different places. They had food. They had resources. I would say this system is not set up for a majority of Americans. I don’t even think it’s a brilliant revelation. I think it’s a reality check showing that our system is not set up in that way.

Dr. Maybank (21:55):

So what do we need to do at this point in time to ensure that our healthcare system is able to meet all aspects of our society. What do we need to do to make sure that our healthcare system understands and values the way we operate as human beings within this country. I think there’s a barrier based on dominant narratives about people being lazy and not caring about their health. They’re pervasive. They’re everywhere in our society. These barriers prevent us, especially in an elitist kind of profession, to really see our own mental models and assumptions about people. They prevent us from working to challenge those barriers and break them down. That’s the work that we’re embarking on at the Center for Health Equity. We are focusing on really getting people to see differently because once you start to see differently, then hopefully we can begin to do things differently. We can begin to think differently. We have people at our tables in a different way. We’re more open to being inclusive so that we can come to the solutions that actually make sense for people’s lives in this country.

Dr. Pelman (22:53):

Of course, all healthcare boils down to dollars. How do you fund this? I suspect that if you have projects that are able to demonstrate healthcare savings by prevention, by getting to the community and taking care of people before late disease, then you can actually show health savings. This can then generate dollars to promote more of what you’re doing.

Dr. Underwood (23:17):

That’s always an interesting point that is raised. Who’s going to pay for it? We’re already paying for it. We’re paying for a dysfunctional system.  So we have to decide what we value? And if we value it, then we will pay for it. An idea is only as good as the money that backs that idea. I say that over and over again. It is one thing to have an idea. It’s another thing to put money and resources behind making that idea reality. And people may think “That’s great. We’ll never be able to achieve that.” When we sit at our AMA meeting I’m often reminded that three people started a letter campaign that eventually created the United States of America by writing to each other and saying , “I’m sick and tired of given my tax dollars to England.”

Dr. Underwood (24:20):

That started it, right? John Hancock, Samuel Adams, and Richard Henry Lee. They said, “what are we going to do about it?” They started bringing other people together and this was through a letter campaign. Letters, imagine that. Letters being delivered by horseback. I write you a letter today, you get it next month, right? They did this to the point when they started bringing people together and the process moved forward over time. Now we’re in a country that has existed over 200 years. They did something that had never been done in the history of mankind. They are no different than us. If we decide that we’re going to create something that is great and we put our mind, collective will, power and resources behind it, we can have something tomorrow that we can’t even imagine today. However, we have to decide.

Dr. Underwood (25:11):

We. That’s why they said “we the people” The people have to decide what we truly value. That’s the bottom line. I value your life therefore I’ll give you an opportunity of life. I value what you can contribute to our world. Therefore, I’m going to make sure that you have an equitable situation. That you can be your best. I value what you will bring to the table, so I’m going to open up the door and let you bring it to the table. I value you. I don’t care who you are. I don’t care what your financial situation is. I don’t care when you were born. None of those things matter to me. What matters to me is that you are a human being on God’s green earth and I’m going to value you and give you a real opportunity. So let’s create a system that actually does that. When we do, America will be a greater place for it.

Dr. Maybank (26:01):

I agree. We see it every day. We see it all the time. Where people put their dollars in value. Do you see it in commercial marketing? You see it on your phone for goodness sake. There are examples all around us in which we, as a society, have valued something. It’s been marketed. Even when people in power have created that value. We could do the same thing for health. We could do the same things for the lives of Elijah Cummings and Bernard Tyson because I think it’s very important to just elevate and demonstrate that these individuals are examples of what powerful, brilliant individuals who have fought for justice for all of us, have faced in terms of challenges. What ongoing intergenerational trauma is represented when these individuals die in their early sixties. That is what inequities look like from a real perspective. That’s what we have to remember. Those are the human stories of what inequities look like. They are reflections of the challenges and problems of our society and system.

Dr. Pelman (27:02):

Besides the project that you talked about in Chicago. Is this being rolled out across to other cities and how do you disseminate the information to the community? How do you let people know about availability? 

Dr. Maybank (27:14):

This is part of a movement that they’re calling “place-based investment”, “social impact investment”.  It’s not new. I think they’re pendulum swings. I know in the 1900s there was a movement for greater coordination at the neighborhood level looking at geographic boundaries. At that time health worked with other neighborhood associations and welfare agencies (as they called them at the same time) to figure out solutions together and value neighborhood residents. Now we’re in this new space. Public health has become very medicalized. Everything has really become about tech and the biomedical model, out of the whole neighborhood context and conditions of health. So now the pendulum has swung. Recognition from the healthcare side that our health is more than the 20% that happens within the hospital walls and the doctor’s offices, but also this 80% that happens where you live which is often determined by our policies and structures.

Dr. Maybank (28:17):

So there is a movement for hospital systems and payor systems to recognize that if they valued that part of somebody’s life, this other 80%, that maybe they need to invest dollars to go into that space. Investing in this space will help to not only improve lives in the end  (what they do within the health care context) but will have a more broad impact in terms of economic development, job opportunities and infrastructure improvements at the neighborhood level. There is a network that is building across the country that’s now two years old called the Healthcare Mission Anchor Network. They’re actually meeting this week in Utah. I think they’ve had over $700 million in investment across the country from healthcare systems within their neighborhoods. So that organization is easy for folks to look up and engage. I think there are budding models of how to accomplish initiatives like the Healthcare Mission Anchor Network. However, myself as well as the AMA in Chicago and our partnering institutions feel that there is not enough investment yet for initiatives like this. However, we’re hoping to generate more revenue or more investment into this space. We want to be an example to other healthcare leaders and folks who are connected with us. We need to connect with our membership as well, not only in our offices. We need to be connected to work in coordination and collaboration with others that are in our neighborhoods.

Dr. Pelman (29:42):

So I always like to ask about resources that people can find online or through a phone call. what’s available?

Dr. Maybank (29:50):

In terms of information, the Centers for Disease Control. I’m sure there are other national black men’s health initiatives. I’m not as familiar with them. I’m more familiar with the women’s health initiatives truthfully, specifically for black women. However, I think there are local resources such as the American Heart Association which always has some good information, especially around heart disease. They usually have campaigns that are specifically geared to us as African Americans. I think now there are a lot of faith institutions that are doing work locally to improve health and that have also developed health ministries. Some barbershops that we know across the country are also engaged as it relates to men’s health, specifically black men’s health. 

Dr. Underwood (30:32):

There are a lot of things going on, depending on where you are. Not only for what your needs are. So if it’s something as simple as being concerned with prostate cancer, we know that throughout the countries and most major cities, there are early detection programs. Additionally, in most states, if you are diagnosed with prostate cancer and you don’t have insurance, Medicaid will cover your medical costs.  I can’t think of a state that doesn’t cover a diagnosis of prostate cancer. It’s retroactively covered too. So that means that your diagnostic prostate biopsy (where they take samples of your prostate and look for cancer) and everything leading up to that procedure in most states will be covered as well. Those things are sort of easy to find. That’s sort of the way I think about it. We know that there are a lot of things related to hypertension and diabetes. Matter of fact, the AMA has a program that they’ve launched in multiple cities regarding the reduction of blood pressure and helping to reduce the number of prediabetic men. So we’re launching those programs throughout the nation in multiple areas.

Dr. Pelman (31:41):

Let’s talk about the opportunity for people to get information disseminated through a community. Obviously there are many ways. Churches and peer groups for example. Anything that you’re concentrating on that you found to be most effective.?


Dr. Maybank (
31:58):

It depends on who the audience is. I’m not a black man, but what we’ve done before with the New York City Department of Health was engage through barber shops networks. We had a lot of work that was geared towards this engagement. The frame was maternal health, but we evolved it to family health. So around the time a child is born or after a child is born into a home through the home visiting programs, we had found ways to more intentionally engage the fathers of the children. We actually started in the NIC in local communities. For example Dr. Daddy programs, where fathers are given tools and skill sets around the basics of child care. It’s not that they don’t know how, but these programs provided a door for us to talk about it and provide training on things like baby CPR or CPR.

Dr. Maybank (32:54):

Many men found it valuable to have that skill set. We also had community cooking classes. We had a Daddy Iron Chef Program, in which they were able to learn how to cook healthy meals for their family. They would bring their kids along as well. I think you have to find ways to engage and then this will invite other men to the program because it provides space where they could come together and not worry about stigmatization. I think black men especially get stigmatized for some reason. They don’t want to talk to one another. They’re closed off and untrusting. I don’t think that is true at all. It wasn’t demonstrated in some of the work that we were doing. But they want to have those spaces to talk. It’s very important that these initiatives are developed and run by black men themselves in order to engage one another properly. I think we must have a safe space where black men can talk about issues in the way that they need to talk about them. Not from my own lens as a woman or how I feel they should talk about them. They need to have those spaces.

Dr. Underwood (33:58):

To add to this. This way we don’t have to wait for anyone else to do anything. We can identify our needs and create infrastructures ourselves. There’s a group in Buffalo that said, “Hey, you know what? We need to talk about healing.” So they started by setting up a meeting once a month and put it out there and men started to show up regularly. They started talking about shared experiences and how to heal from hundreds of years of mistreatment. How our history has led to current day issues and how do we move forward? Again, this goes back to the reason I brought up the letters written by the three men. It’s because they were just citizens, right? Those are just people. So they didn’t wait for some larger body to say, “This is a problem.”

Dr. Underwood (34:51):

They said, “we see it as a problem. How do we put our collective thoughts together to move it forward?” So I recommend we call it the “I’m sick and tired of being sick and tired” club. Why don’t you come join me? Let’s talk about it. That could be less gathered information. Let’s read. Let’s develop. How do we create economic wealth? How do we look at a situation? We say, “We know that a store there would make money because we all need a store there. How do we get a store there?” And they say, “Well, the banks won’t give us any money. Okay, great. I got $2. You got $2, you got $5. How do we create a corporation?” And then we actually put a store there, right? That’s moving things forward. We can’t wait for something to fall out of the sky and land in our community.

Dr. Underwood (35:36):

It is better for us. Things don’t just fall out of the sky. Sometimes, but rarely. Now, when you get momentum forward, like our community-based self-equity center, that can be powerful. Once the community started moving forward towards equity, the university and other people came to the table because they said, “This is going to happen from my perspective. This is going to happen.” Now we’re in a situation where we’re either part of it or not. This is moving forward regardless. That’s my thought. Again, wherever you are, whatever situation you’re in, imagine it step by step. Think about it in terms of moving forward, discipline, dedication, time and faith. You’ll be surprised.

Dr. Pelman (36:20):

I think that is a perfect place to wrap up unless you have any other thoughts. I appreciate both of your inputs. Thank you for being part of this podcast. 

Speaker 2 (36:35):

This completes another podcast chapter of the Washington State Urology Society, “The Original Guide to Men’s Health. This is Dr. Richard Pelman reminding you to take care of yourself. Washington state Urologists Society wishes to thank all the contributors who volunteered their time and knowledge. The information presented in this podcast chapter is the opinion of the speakers. The society also wishes to thank Shawn Fox for his invaluable technical assistance. The music theme San Juan Bells was written and performed by Dr. Dave Whiting. The podcasts are the property of the Washington State Urology Society. Reproduction and use without the express consent of the society is strictly prohibited. For more information about men’s health, visit wsus.org or visit your physician or care provider.

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