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1.6 Padlet Discussion: Who am I, First Experience With Race & Sense of Self Brainstorm

Theme 1:

Who am I?

I am a man with different talents. I am a father, grandfather, brother and friend. Years ago I learned the trade of a locksmith which I used to have a key truck, I also had a ice cream truck back in the 90's but my children didn't want to take it over. I pretend to always be confident in everything that I do because I don't want people to view me as weak.

Many people believe that I always have it together, when in reality I struggle with different things in life. I came back to school to further my education. Even though I graduated from High School I never really been computer savvy. I have to ask my daughter or grandson to help me out a lot when it comes to doing things on the computer.

I really do not wish to be any different because all of these things made me who I am today.

Race or ethnicity has not played a role in my answers.

Theme 2:

First Experience With Race Activity

My first experience with race was when I was about 8 years old. I was walking to the store and a white man stopped me from entering the store and told me that the N word couldn't come inside.

The emotions I felt were scared and sad.

Yes, with my parents and they explained how people feel different about one another.

Actually, it has not because everyone is not ignorant.

Theme 3:

Positive Sense of Self Brainstorm

I really feel that people who have a negative sense of self do not have a positive sense of ethnicity. Many people feel like they should or belong to a different race. What I mean by belong or to is many feel like the color of your skin color make you who you are. For example, if you are dark skinned with coarse hair that you would not get far in life and means that you will be considered ugly. While light skinned and good hair has a better future and pretty. So many men and women feel like they have to date and reproduce with a different race to have mixed children.

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2.4 Ubuntu, Afrocentricity and Nguzo Saba.

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2.4 Ubuntu, Afrocentricity and Nguzo Saba.

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Theme 1: Ubuntu

I believe the spirit of Ubuntu does not exist in African American culture. Due to the fact that many people have the mindset of if I gave someone something, what would I receive in return. Also having the feeling of who will do this for me. For example, when someone passes away people makes a GoFundMe page asking people to help out. Some people will donate but many will not. Either way people are only helping because they were asked not just because. However we cannot count out the 10% of people that will give to others unwilling without having to be asked. For example, if they see someone at a drive thru and ask if they are hungry and buy them something to eat. Some of the similarities that Africa American And Africa cultural has would be the family structure they way each cultural has a strong connections when it comes to families and they way they come together. The oral traditions with telling different stories about the family. Music and food plays a big part in both cultures and another way to bond with each other.

Theme 2: Afrocentric

The concept that is most present in African American cultural would be spiritness which means to be full of life. Many people attend church or worship the god that they believe in in order to help them spiritually. This gives a person the ability to feel that sense they believe in a higher power that anything is possibly as long as they believe. That their bodies could be healed and sins are forgiving. African American cultures have a strong belief in God. The least concept would be the veneration of the person which means value of all life. Many African American people have no regard for another life. We sit around yelling black lives matter to only turn around and kill each other. All because of a set you claim or an argument that could have got talked out. Many people do not even fight anymore they are so quick to pull out a gun.

Theme 3:

7 Principles of Nguzo Saba

The principle that resonates with me would be kujichagulia which means self-determination. I feel like this describe me because I am determined to make my family proud. Even at the age I am right now I want to open my own auto shop and leave it behind for my children and grandchildren. Many said to me that you are to old to try and open a shop. However, I am determined to prove them work by attending school and completing my education and have a degree behind my name. Also while learning how to put together a business plan.

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3.4 Three Self-Assessments, Racial Identity Development and Identity Resource

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3.4 Three Self-Assessments, Racial Identity Development and Identity Resource

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3.1:

Under natal measure I choose the extended family. The reason for that is that a lot of people do not know there extended family well. You can run into a family member and not know. For example, I remember going to a friends family picnic and we were playing dominos. I was talking with the guys and we start talking about family and where our parents was from. One guy stated that his father was from Louisiana so I asked what was his family name. He stated Sanders and I was like I know some Sanders he state naming his grandparents and aunts and uncles. Come to find out that my grandmother was his father's 2nd cousin. Small world after that I realize that extended family was important.

Behavioral Measure:

Under the behavioral measure I would say print and electronic measure. The reason I choose is this because you can learn a lot from books and online. For example, My grandson had a report on Africa a certain tribe they wanted to know what they are, the type of clothing they wore and how they get their food. He basically ask Google.

Subjective Measures:

Value preferences would be my choice because I like values. Values means a lot to me and I like when people teach their family about values and other things in life. For example, one value that I teach my family is that the man is supposed to provide for their family. You cannot make a family and not take care of them. They cannot sit at home while their women goes out and bring everything back. There is nothing wrong with a strong woman and she needs to make sure that she can stand on her own two feet.

Situation-contextual Measures:

Home-Family and education I had to pick both. You have to have family because that is who helps uplift you and need an education. Examples, Family will be there when you hit rock bottom and help you to understand that things happen. But your education can depend on when everything else fails. I instill in my family that a good education is key.

3.2: Multi group Ethnic Identity

1. My Multigroup Ethnic Identity Measure score is 32.

2. To me this score means that I am aware of the things that are happening in my Ethnic group.

3. I think that this means that I have a strong bond with the African American because when I do not know something I will research or ask someone about it. That way the information that I am seeking is correct.

4. Explain anything that surprised you about this analysis?

The reason why this analysis surprised me is because some of the questions asked I would have not asked myself. So it made me think a little about the way that I answered.

3.3: Rosenberg"s Self-Esteem

1. State your score after taking the Rosenberg’s Self-Esteem Scale.

My Rosenberg's Self-Esteem score is 25.

2. State what your score means to you and your understanding of your self-esteem.

It stated that I am in the normal range. Self-esteem is the way you carry and view yourself.

3. State why you believe your score is the number that it is. Provide examples.

I believe that because my self-esteem is okay. I do not feel like I lack self-esteem but I could work on it more. For example, When I have class work to do I will doubt myself and feel like I cannot do it. But when it is all over and done I do better. I need to work on self doubt.

3.4:

1. State your stage of Racial Identity Development (they are in bold on the summary document provided).

Immersion/emersion:

2. State why you think that you are in the stage that you identified.

Growing up blacks were not idolized or even talked about with good context. Around that time I was born we were still in the civil rights movement Rosa Parks was boycotting the Montgomery bus. Fast forward 10 years later and Martin Luther king was still marching to Selma, Alabama for rights to vote. So I can actually say that I am still trying to educate myself and my family.

3.Provide an example of how you know that you have passed through all the previous stages.

The reasons now I know that I passed all the other stages is because pre-encounter I know that white is not always right and black is wrong. Everyone has had a time or two when they have been wrong no matter the color of their skin. Also the stage of encounter I have been in racial encounters with many people from just a kid with being told that black people couldn't be there. Are even when wanting a position and being looked over because of the color of my skin. The positions was giving to a person less qualified with a different skin color. All because they feel like a person of color should be in a position to lead.

4.State one thing you learned from this process.

What I have learned from this process is that there can still be some unresolved feeling that you did not know you still have. This makes you really think about life and how you grow up.

3.5: Find your racial identity resource

My racial identity resource would be Martin Luther King speech "I have a dream"

https://youtu.be/vP4iY1TtS3s?si=aCsfVSAoRvVzB0AY

The reason this speech speaks to me is because coming up in that time that was all we wanted. To be able to be treated equally. I have always said that I wanted my children and grandchildren to never feel the way I had growing up and be mistreated.

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I Have a Dream speech by Martin Luther King .Jr HD (subtitled)

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1. Please post a response to the google slide above. What types racism from slide 2 have you seen in the world? What examples from slide 3 have you seen in the world?

The racism that I saw from slide 2 is institutional racism I remember one time I was driving and got pulled over my oldest grandson was in the front seat. When the officers approached my vehicle they asked me for my license and registration after handing everything over he then said this is a nice car who's is it. I state it is my car. Why would you ask that. He then says you know! My grandson all of a sudden moves and they pill their gun out and say don't move your hands up. I was like hold on that is my 13 year old grandson. Everything end up working out for me.

2. From the chapter reading, do you think that we live in a post-racial society? Please state why or why not.

No, we do not live in a a post-racial society. Post-racial society means a theoretical environment in which the United States is free from racial preference, discrimination, and prejudice. The world that we live in still has all of the above racial preference, discrimination and prejudice. Imagine going in a store and someone begins to follow you around. Trying to see if they see you stealing and then looking crazy when you are not taking anything. Many people still have discrimination in the work place many people will chose someone else less qualified because they do not want to see a person in color in charge.

3. What is your personal definition of race and do you think that race is a social construct, a biological construct or something else? Please explain your reasoning.

Race to me means the way you look and the group that you identify with. I would say that race is a social construct because it is based on characteristics which consist of the color of your skin, features and the texture of your hair.

4. Search and find one resource regarding race being a social or biological concept and post it to your Padlet. State its significance and if you agree or disagree with the resource based on your definition of race.

https://medium.com/fearless-futures/what-is-a-social-construct-a29fdb481a31

After reading the article I would say that I agree with what it states. It basically describe how many people factor how social construct is looked at. How people features, hair or color of their skin plays a part. It also talkings about race/ethnics, nationality and disability.

5. State one thing that you learned or one thing that stood out to you from the unit required reading, optional reading or audio material in this unit. State its significance

One thing that I learned from the reading is that there are so many different forms of racism. Many people would not know that these exist because they are so used to the norm of thinking it is just a single form of racism.

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In creating a socially constructed category, people chose to look at certain arbitrary similarities between a group of people, and socially…

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1. From the reading, what do you think makes the Black family unique? Please provide descriptive examples.

From the reading what makes black families unique is it explains that a black family is a household related by blood, function or marriage. There are also different type of family components like kin, function. Also the family types like nuclear, extended, immediate, and augmented. The reading also speaks on single mothers and single fathers also co-parenting. To be honest I really didn't know that there was a title for everything.

2. What do you think are the strengths and challenges of the Black family? Please state why you think so and provide examples.

The strengths that black families have would be how they come together as one to help each other out. How friends become family and even have a name for the action which is called. The challenges would be the growing number of single mothers, also the children that end up in foster care.

3. How do concepts such as racial socialization affect parents and children in Black families? Please explain.

Racial socialization affects parents and children in black families in a positive way. It helps families to teach their children how to function in our society today. By keeping them aware of the black cultural experiences.

4. Based on our reading, what factors do you think have impacted Black families the most since slavery and why?

Based on the reading the factors that still impact black families would be the need to be married or being content with ones mate leaving. So many people want to keep their family together that they will accept anything just because of different stereotypes about African American people.

5. Search and find one academic resource that helps you understand this topic better.
https://ifstudies.org/blog/less-poverty-less-prison-more-college-what-two-parents-mean-for-black-and-white-children .

One point that stood out to me is how it states that children who grow up in a two parent household would flourish more than children who grow up with a single mother. I can understand why they would feel that way because there are two parents in the house but some single mothers will guide their children better because they do not want a repeat of themselves. Another point would be how they feel like black kids who live apart from there families would mess up a lot of experiences for them while if it was a white kid it would basically affect the different. when a child is in foster care some of the foster parents try to help educate our children. The last point would be they also give facts and statistics about black children's family structure and the outcome of the black child. They go on to explore the family structure of how black children living with a two parent household, single mother household and step family can affect the child.

6. State one thing that you learned or one thing that stood out to you from the unit required reading.

While reading different information about kinship and family I learned a lot of different things about the black families like the type of family components which are kin, function,structure and more. I also learned about the different family types such as nuclear, extended and single parents. Also the meaning of black families that you don't have to blood relate only but by marriage and function.

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"Children who grow up in a household with only one biological parent are worse off, on average, than children who grow up in a household with both of their biological parents, regardless of the parents' race or educational background."
~ Sara McLanahan and Gary Sandefur,Growing Up with a Single Parent: What Hurts, What Helps

Princeton University sociology professor Sara McClanahan summarized the social scientific consensus about the importance of family structure for children with her colleague Gary Sandefur in this passage from their magisterial 1992 book, Growing Up with A Single Parent. In recent years, many other scholars have come to similar conclusions, from Paul Amato at Penn State to Isabel Sawhill at the Brookings Institution to Melanie Wasserman at UCLA. The consensus view has been that children are more likely to flourish in an intact, two-parent family, compared to children in single-parent or stepfamilies.

But this consensus view is now being challenged by a new generation of scholarship and scholars. For instance, sociologist Christina Cross at Harvard University recently published an op-ed in The New York Times entitled, "The Myth of the Two-Parent Home," that contended "living apart from a biological parent does not carry the same cost for black youths as for their white peers." In The Times and in another op-ed this month in The Harvard Gazette, she draws on her work indicating that black children are less affected by family structure on a number of educational outcomes to make the argument that family structure is less consequential for black children. In recent years, other family scholars ( here and here) have also called into question the idea that children do better in stable two-parent families.

One practical implication of this revisionist line of research is that children may not benefit from having their father in the household. Another implication is that the value of the two-parent family may be markedly different across racial lines, with black children less likely to benefit from such a family. Accordingly, in this Institute for Families Studies research brief, we investigate two questions:

1) Are black children more likely to flourish in an intact, two-parent home compared to black children raised by single-parents or in stepfamilies? We focus on these three subgroups because they are the largest family groups for American children today, including African American children. And we answer this question by looking at three important outcomes: child poverty, college graduation, and incarceration.

2) Is the association between family structure and child outcomes markedly different by race? Here, we focus on comparing white and black children in intact, two-parent families to their peers in non-intact families-single-parent families, stepfamilies, and other families. Our aim is to determine if the association is different for black children compared to white children on the three outcomes noted above.
Family Structure and Black Child Outcomes
Today, 37% of black children are living in a home headed by their own two biological parents, 48% are living in a home headed by a single parent, and 4% are living in a stepfamily with one biological parent and one non-biological parent, according to the March 2020 Current Population Survey (CPS). ¹ In this research brief, we explore how these three family structures are associated with child poverty, college graduation, and incarceration. We draw on data from the American Community Survey (ACS) 2015-2019 Five Year Estimates 2 and the National Longitudinal Survey of Youth (1997 cohort). Specifically, NLSY97 follows the lives of a national representative sample of American youth born between 1980 and 1984. The survey started in 1997 when the youth were ages 12 to 17. We used the wave that was surveyed in 2013/2014, when the cohort was at least 28 years old.

Figure 1 indicates that black children in homes headed by single parents are about 3.5 times more likely to be living in poverty compared to black children living with two parents in a first marriage, our measure of intact families in the ACS. ³ Those in likely step-families are approximately 2.5 times more likely to be poor. ⁴ Moreover, after controlling for maternal education, age, children's age and gender, we find that the odds of being poor for black children in non-intact families are 3.7 times higher than for black children in intact, married families. ⁵ Clearly, black children in stable, married families are better off financially.

Figure 2 shows that college graduation is markedly more common among black young adults raised by their two biological parents, our measure of intact families in the NLSY97. ⁶ Specifically, data from the NLSY97 indicate young adults from intact families are almost twice as likely to graduate from college than their peers who grew up with single parents, and approximately 1.5 times more likely to have a college degree compared to peers in stepfamilies. After controlling for maternal education, as well as young adults' gender, age, and AFQT scores, we find the odds of black young adults getting a college degree are almost 70% higher if they were raised by their own two parents. Clearly, on average, black young adults from families headed by their mother and father are more likely to be flourishing educationally than black young adults from non-intact homes. ⁷

There is also a clear connection between family structure and incarceration for black young adults. Black young adults who grew up in a single-parent home are about 1.8 times more likely to have spent time in prison or jail by their late twenties, compared to their peers from a home headed by two biological parents. Those from stepfamilies are also more likely to have been incarcerated. In a multivariate context with the same controls noted above, young black adults in non-intact homes have about two times the odds of having ever been incarcerated compared to their peers in intact homes.

Because patterns in college completion and incarceration vary by gender, we also explore the link between family structure and these two outcomes separately for young black men and women. Figure 3 indicates that young black men from an intact, two-parent family are much more likely to graduate from college than their peers raised by single parents and stepfamilies, and their incarceration rate is also much lower (14% vs. 24% for single parents and 26% for stepfamilies). A similar pattern applies to young black women as well. More than one-third of young black women (36%) from intact families have had a college degree by their late twenties; the share among black women raised by single parents is 18% and among stepfamilies is 25%.
Black-White Comparison
Clearly, there are differences in poverty, college graduation, and incarceration by family structure among African Americans. But are these differences similar or different to the ones for whites? Note that 67% of white children today are in homes headed by their biological parents, 21% of white children are in homes headed by a single parent, and 6% are living with a biological parent and stepparent, according to the March 2020 Current Population Survey.

The first noteworthy finding in comparing patterns across race, gender, and family structure is that black children from intact families do uniformly better than white children from single-parent households. From poverty to college graduation to incarceration, black children and young adults from two-parent families are more likely to be flourishing than their white peers from single-parent families. For instance, 36% of young black women from intact families have graduated from college compared to just 28% of young white women from single-parent families. Likewise, 14% of young black men from intact families have been incarcerated, compared to 18% of young white men from single-parent families. Moreover, 13% of black children in intact families are poor compared to 33% of white children in single-parent families.

At the same time, it is important to note that the figures also show that whites are more advantaged within each family structure category. For instance, only 28% of black young adults from intact families have graduated from college compared to 47% of white young adults from intact families. This is a large difference and is but one example of the fact that a stable two-parent family is not a panacea when it comes to addressing racial inequalities in America. The nation's legacy of racial discrimination, unequal access to a quality education, concentrated poverty, and ongoing experiences with racial prejudice are among the structural factors that help explain the racial differences in outcomes this brief finds between blacks and whites who have the same family structure.

The third noteworthy finding here is that the family structure association for black and white children is similar when it comes to poverty and prison. Net of controls, being in non-intact homes more than triples both black and white children's odds of being in poverty. As young adults, those growing up from nonintact families are twice as likely to have been incarcerated compared to those from intact families, regardless of race. For both black and white children, growing up in a home with your two parents seems to reduce your risk of poverty and prison in about the same way.

But, consistent with Cross' research, the link between family structure and college completion is clearly weaker for blacks than for whites. Net of controls, growing up in a non-intact family reduces the odds of college graduation by 60% for white young adults, but only by 40% for black young adults. Nevertheless, both black and white young adults from non-intact families are still at a disadvantage relative to their peers who grew up with both parents. In other words, it is also clear that black young adults from intact families are markedly more likely to graduate from college than their black peers in non-intact families-and white peers from non-intact families.
In Conclusion
Using new Census data and the National Longitudinal Survey of Youth, this brief finds that black and white children from intact homes are significantly more likely to be flourishing economically, educationally, and socially on the three outcomes examined here: child poverty, education, and incarceration.

At the same time, consistent with Cross' research, we do find that the association between family structure and one major education outcome, college graduation, is weaker for black children than white children. Nevertheless, young black adults are significantly more likely to graduate from college if they grew up in an intact family.

Our results also indicate that a stable, two-parent family is no panacea for African-American children. Black children in stable, two-parent families are more likely to experience poverty and incarceration, and less likely to graduate from college, compared to their white peers from stable, two-parent families. Racial inequality casts a shadow even on black children in intact families.

To be clear, this descriptive brief does not make claims about causality. A number of factors not measured in this brief may confound the associations between family structure and child outcomes documented here. Young adults' family structure growing up is obviously endogenous to their family income, for instance, given that married parents tend to have a higher income than single parents. Here, progressives tend to minimize the ways that family income is a consequence of family structure (two parents can more easily earn a decent income than one parent) even as conservatives tend to minimize the ways that a stable marriage is a consequence of a decent income (relationships are stronger when they are undergirded by a steady income).

What we can conclude is, consistent with a longstanding social scientific consensus about family structure, children are significantly more likely to avoid poverty and prison, and to graduate from college, if they are raised in an intact two-parent family. This association remains true for both black and white children. In the vast majority of cases, these homes are headed by their own married mother and father.

In sum, it is no "myth" to point out that boys and girls are more likely to flourish today in America if they are raised in a stable, two-parent home. It is simply the truth that white and black children usually do better when raised by their own mother and father, compared to single-parent and stepfamilies. Our results, then, also suggest the fraying fabric of American family life, where more kids grow up apart from one of their two parents-usually their own father-is an "equal opportunity tsunami," posing obstacles to the healthy development of children from all backgrounds.
Brad Wilcox is professor of sociology and director of the National Marriage Project at the University of Virginia, a senior fellow of the Institute for Family Studies, and a visiting scholar at the American Enterprise Institute. Wendy Wang is director of research at the Institute for Family Studies. Ian Rowe is a resident fellow at the American Enterprise Institute and the CEO of Vertex Partnership Academies. Acknowledgements
The authors would like to thank Samuel McIntyre, Joseph P. Price, Peyton W. Roth, Scott Winship, Jared Wright, and Nicholas Zill for their input and assistance. Any errors are our own.

1. Courtesy of Nicholas Zill, the analysis is based on March 2020 Current Population Survey (CPS). The vast majority of black children in two biological parent families are in families headed by married parents; only a small fraction are in cohabiting families. See: https://ifstudies.org/blog/1-in-2-a-new-estimate-of-the-share-of-children-being-raised-by-married-parents.

2. Authors' analysis of American Community Survey (ACS) 2015-2019 five-year estimates. Data were accessed at Steven Ruggles, Sarah Flood, Sophia Foster, Ronald Goeken, Jose Pacas, Megan Schouweiler and Matthew Sobek. IPUMS USA: Version 11.0 [dataset]. Minneapolis, MN: IPUMS, 2021. https://doi.org/10.18128/D010.V11.0

3. This includes intact, same-sex families and intact, adoptive families. However, the vast majority of children in intact, married families in the ACS are in intact, heterosexual families. See, for instance, https://ifstudies.org/blog/a-portrait-of-contemporary-family-living-arrangements-for-us-children.

4. For poverty estimates, households were identified as likely "step-parent" families if the parents were married and either parent reported they had been married more than once. Families headed by a single widowed parent were excluded from the analyses. Data were accessed at Steven Ruggles, Sarah Flood, Sophia Foster, Ronald Goeken, Jose Pacas, Megan Schouweiler and Matthew Sobek. IPUMS USA: Version 11.0 [dataset]. Minneapolis, MN: IPUMS, 2021. https://doi.org/10.18128/D010.V11.0.

5. The comparison group is children in single-parent, stepfamilies, and other families not headed by an intact married couple.

6. The vast majority of these families are headed by married biological parents but also include a small number of cohabiting biological parents. See: https://ifstudies.org/blog/1-in-2-a-new-estimate-of-the-share-of-children-being-raised-by-married-parents.

7. The comparison group here is children from single parent, stepfamilies, and other families not headed by two biological parents.

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Less Poverty, Less Prison, More College: What Two Parents Mean For Black and White Children

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Princeton University sociology professor Sara McClanahan summarized the social scientific consensus about the importance of family structure for children with her colleague Gary Sandefur in this passage from their magisterial 1992 book, Growing Up with A Single Parent.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6673646/

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Copy of Template: Racial Autobiography Outline (Larry Mitchell)

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1. What is the Imposter Syndrome?

Imposter syndrome is the inability to absorb one's accomplishments and the persistent fear that one would be exposed as a fraud.

2. How does the Imposter Syndrom affect a student in their educational journey AND into their career experiences?

How impostor syndrome can affect a student in their education is by having someone doubt their abilities, always accusing them of lying or cheating when doing something. With their careers having to prove that they have a right to be there or in the position that they hold.

3. How does the Imposter Syndrome specifically affect the self-esteem and mental health of African American women in the workplace.

The way that impostor syndrome affects African American women self-esteem or mental health in the work place is by having a feeling of not belonging. When I say not belonging is they feel like they our pretending to be great at what they do and always thinking when is someone going to take what I work so hard for away from me. This plays a part in mental health also because they begin to stress out which can cause other health issues.

4. How do race and gender play into the African American woman's experience in the workplace?

First off African American women in work places are most of the time overlooked. Even looked down on them because they are women and because of the color of their skin. They have to prove themselves more than anyone because most of the time people feel like they should not be there anyway no matter the degree they have. They wonder how they get that degree and what they did to get it.

5. State one strategy that you believe would be successful in addressing this issue and improving the workplace for women of color.

By going into the workplace with their heads held Hugh because they know they belong. No waiting until everyone else speaks in order to voice their opinion.

6. State one thing that you learned or one thing that stood out to you from the unit required reading, optional reading or audio material in this unit.

Listening to the young speak about how the teachers told her parents that she was cheating and that not only did the white teachers feel like black people would fail even some black teachers felt the same way. That made me say wow that is crazy.

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7.5 Intersectionality, Bias and Microaggressions

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7.5 Intersectionality, Bias and Microaggressions

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1. What would you say are the psychological consequences of experiencing subconscious racial slights as a person of color?

The psychological consequences of experiencing subconscious racial slight could lead to mental health concerns like anxiety and depression.

2. What stereotypes are perpetuated when racial microaggressions are thrown around towards a person of color?

A stereotypes that is prepetuated due to racial microaggressions would be when a Caucasian couple is walking down the street and they see a black man about to walk by the woman grabs here purse. As if the man is going to take her purse.

3. Considering Intersectionality, what other issues does this theme affect in the African American community?

Issues that affect the African American community are access to healthcare. The price is too high and most have to pay out of pocket. No matter if it's a copay payment for visits or medication. Limited resources the time it takes to approve or not approve services. The cost of services because insurance does not want to pay for major surgeries.

4. State how these theories of intersectionality, racial microaggressions, bias or white privilege affect one's understanding of "sense of self" or ethnic identity?

How intersectionality, racial microaggressions, bias or white privilege affect a person's sense of self is by you make a person feel. This can make an African American person feel less than enough like they are not supposed to be somewhere or around certain people. This will make a person's self esteem lower.

5. Search online for a resource that helps you understand this topic more and post it to your Padlet. State why the resource shines some light on a perspective of this issue.

https://www.womankind.org.uk/intersectionality-101-what-is-it-and-why-is-it-important/ This article acknowledgement that everyone has their own unique experiences of discrimination and oppression and we must consider everything anything that can marginalize people.

6. State a strategy that you feel can be successful to address the use of microaggressions especially when the offender is unaware of how their reactions affect people of color.

The best way to help a person know that their microaggressions is offensive behavior is by letting them know. Tell them that what they are saying or doing is inappropriate and unacceptable.

7. State one thing that you learned or one thing that stood out to you from the unit required reading, optional reading or audio material in this unit.

The one thing that I learned from this reading is that many people have microaggressions behavior and do not know. This is a behavior that comes in different forms.

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9.5  Thesis, Direction and Resources for Critical Analysis Project

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9.5  Thesis, Direction and Resources for Critical Analysis Project

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Copy of _Psych 110: Resources and Questions for Critical Analysis Project 

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1. STRENGTHS: What are the strengths of Black neighborhoods and communities and how have they manifested over time?

One strength of the black community is togetherness

The black community believes in coming together to possibly make the community better

You can see the manifestation in community days where communities come together by giving things the community need such as backpacks,food and other items needed in the community

2. WEAKNESSES: What are the weaknesses of Black neighborhoods and communities and state one solution to an issue you have raised?

One weakness the black community has is sticking and staying together we come together and always speak on how the community can do better if we come together as a community hole. We come together but that togetherness does not last long. My solution would be the community needs to get together and start planning events that will keep us doing things together always.

3. OPPORTUNITIES: What are three ways in which Black neighborhoods and communities could play a role in the progressive movement of the Black community?

Black communities hold a lot of power in the movement of them. One way these neighborhoods could play a role in the progressive movement is by putting out positive ads (billboards, post, etc). People are influenced by what they see. So in doing that, grabbing their attention with these positive notes could influence a brighter society. This act would in return progress towards something positive according to the progressive act itself. Moving along, another way black neighborhoods could contribute to progression is by creating positive environments and clubs for youth. Community clubs are essential to the youth, it gives them a sense of direction at those young ages. Furthermore contributing to the progressive act, making sure the neighborhood strives to move forward. The last way I would say neighborhoods could play their role in the progressive movement is simply by creating safe spaces for people to voice their opinions. A lot of times the best advice for change comes from the people that are living in the situation. Doing this, these black neighborhoods could hear each others voices and increase positive change. This would furthermore move the neighborhoods towards progressive change.

4. THREATS: What are three ways in which Black neighborhoods and communities could have a detrimental effect on the progressive movement of the Black community?

In the same sense black neighborhoods can also be detrimental to the progressive movement of its own communities. As a black woman myself I have seen the negative ways we contribute to tearing our communities down. For example, spray painting walls with gang officiated or hateful messages. In black neighborhoods you see this a lot. I have seen it persuade many to do awful things, and all in all it gives the neighborhoods a bad look. This shows no progression and it inflicts the a negative image upon it; something we don’t want to go back to. Another way black communities tend to have a detrimental effect on the progressive movement of themselves is by misinforming one another. In a black neighborhood the number one way to find things out is by word of mouth; in other words gossip. Spreading misinformation often leads to misinformed opinions that in return lead to destruction. A misinformed opinion creates chaos based on something that isn’t true, with again moves further away from the progressive movement. Lastly, the final way black neighborhoods play damaging roles to their communities is by limiting resources. Honestly, people in this community tend to get greedy, resources go to those who feel like they deserve it. It is a harmful way to do things and shouldn’t determine the help someone gets but it’s what we’ve come to. A lot of times the recourses are limited because the information just isn’t there for the people to grab. It’s a sad reality but some people would rather put themselves on and only them. Spreading these resources could take our communities so far, and some people don’t see last that. Again, this is additionally another way black neighborhoods could play a detrimental role in the progressive movement.

5. Find one resource that helps you understand these themes and post it to your Padlet. State the resources' significance to this unit's material.

https://endhomelessness.org/blog/homelessness-and-black-history-poverty-and-income/ This article helps us understand the difference between a white household income and a black . It also points out that some black work hourly poverty jobs. Also that many black do not have wealthy homeowners parents. It just ties into why the black community is struggling.

6. State one thing that you learned or one thing that stood out to you from the unit required reading, optional reading or audio material in this unit

This unit showed me how our action plays a role in the way our community can either grow or not grow. We have to come together to be able to help each other out. If we as a people do not make change for our community no one else will do it for us. It starts with us first.

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installment in a series of posts examining the historic roots of homelessness and African Americans. Prior posts can be found here, here, and here.
Both poverty and income strongly correlate with race in the U nited S tates . Among all racial groups, Black Americans are second most likely to experience poverty, with living below the poverty threshold , following Native Americans at 25%. Black Americans in particular have only ten cents for every dollar in wealth that white families have.

The hardships of poverty and lack of a robust social safety net make it extremely likely that a person experiencing poverty will be unable to afford necessary expenses like food, health care costs, and housing , making it a key predictor for homelessness. Therefore, Black people's overrepresentation among people living in poverty directly leads to their overrepresentation in homelessness.

Black people's inability to build meaningful wealth has its roots in the very inception of this nation. While on its face the end of slavery should have meant the opportunity for Black people to build wealth, in reality each generation of Black Americans since the end of slavery has faced a new, even more insidious set of obstacles to obtaining and keeping wealth, status, and stability .

The abolition of outright slavery in the US quickly led to the introductions of even more insidious barriers to equity , including sharecropping, forced prison labor, Jim Crow segregation laws, and voter disenfranchisement. These new institutions made life very difficult for Black people in the nineteenth and twentieth centuries, and made wealth accumulation nearly impossible.

Modern we alth disparities are also exacerbated by factors like patterns of inequity in income and employment . In 2019, the white household income was $76,057 while for Black families it was $46,073 , a difference of around forty percent. Reasons for this gap are varied. First, Black people are comparable more likely than white people work hourly, poverty-wage jobs . Black people are also about twice as likely as white people to be unemployed (actively seeking work) than white people, a figure that has held steady for the last seventy years. And when they do find employment, workplace discrimination means that Black workers are still paid their white counterparts at every level of employment , even with ualifications. q

Generational Inequality

Black people are also less likely to have wealthy, homeowning parents. Research shows that having wealthier parents correlates strongly with economic stability later in life. Having parents homeowning parents increases the likelihood that a child will eventually go on to become a homeowner themselves. Historical forms of racism like housing discrimination mean that the parents and grandparents of Black people living today are far less likely to have owned homes than white members of their cohort. This means that where white people are more likely to benefit from generational cycles of wealth and ownership, Black people are less likely to go on to have wealth, own homes, or have stable housing. B ecause homeownership is a key strategy for accumulating wealth, these conditions even further entrench racial wealth disparities.
Like many other modern outgrowths of in equit y , the overrepresentation of Black people in homelessness is direct result of slavery. As Black History Month closes out, it is imperative to keep in mind that addressing inequity wherever it exists, both within and outside of our work, must be a consistent, year-round effort if any progress is to be made.

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Homelessness and Black History: Poverty and Income

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This is the fourth installment in a series of posts examining the historic roots of homelessness and African Americans. Prior posts can be found here, here, and here. Both poverty and income strongly correlate with race in the United States. Among all racial groups, Black Americans are [...]

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1. State the most important thing that you learned from this unit's readings and how it has deepened your understanding of Black male and female interpersonal and close relationships.

What I learned in this unit reading was that there are different types of relationships. I would have never known that there were so many that represent the different types. Also the different reason that male and females need strong relations during their adolescence.

2. How do long-standing stereotypes in the media of African American females being portrayed as property (i.e. in rap videos etc.) affect the psyche of those seeing these images and the African American woman's dating prospects?

The way that media sterotypes African American females will be by the way that people feel they should be for instance they should have a certain type of body shape. If they are built different from what social media portrayes then there are not good enough. It makes people think very superficial about the next person which in turn cause them to have superficial relationships.

3. What factors are contributing to the rising number of single Black unmarried females?

A lot of factors play a part in the rising number of single Black unmarried females like the woman can have a higher education then their spouse and the man do not feel needed. Men want to be needed, they do not want who doesn't need them and that's a fact. So when there is a strong presents from the woman male tends to fall back.

4. Why is there a stigma in the African American community against the LGBTQ community?

The stigma in the African American community against the LGBTQ community is that due to religion a lot of parents do not want or believe in individuals being gay. They feel like it is an embarrassment to their families. Which in turn makes people afraid to come out to their families.

5. Find one resource that helps you understand these themes and post it to your padlet. State the resources' significance to this unit's material.

https://www.treatmyocd.com/what-is-ocd/common-fears/fear-of-being-gay-ocd

This article is significant to the unit because it helps you understand what a person of the LGBTQ community feels. It is something called sexual orientation OCD is a obsessive-compulsive disorder focused on someone's sexual orientation. This can make someone have guilt or shame which could cause anxiety which leads to them needed therapy.

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Homosexual OCD includes having obsessions surrounding the uncertainty of attraction or potential attraction to people of the same gender.

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1. What does it mean to code switch and how does this affect an African American's success in life?

Code switching is where a person changes the way they speak around a different group of people. This code help someone excel in life as far as better jobs and a better education. So that wherever they land they would be seen as belonging there.

2. How does expecting code switching threaten diversity?

Code switching makes a person feel like they do not belong to a certain group. Like they have to act or speak a certain way to fit in. It also makes others feel like you were a sell out because of changing your way for others.

3. How do the effects of code switching intersect with a persons' mental health?

Code switching can affect a person's mental health by stressing them out to trying to be somebody else. Like when there are at work or school they have to act, dress or speak a certain way. But When they get home or around what you call there people they have to change everything all over again to fit in with them. Which can start multiply personalities from changing so much. It can also cause stress because they have to remember when to change.

4. Search online for a resource that helps you understand this topic more and post it to your Padlet. State why the resource shines some light on a perspective of this issue.

THis resource basically tells is about how 48% of blacks under the age of 50 code switch for their career. That there is only 3% of Africian Amercians in leadership positions. How blacks have to basically jump through hoops to make it.

https://neuroleadership.com/your-brain-at-work/code-switching-mental-toll

5. State a strategy that you feel can be successful to address the misconceptions about code switching that exist inside and outside of the African American community.

The best way to help with the misconceptions about code switching would be to teach everyone that is it okay to be who you are. You do not have to change your appearance or the way you speak to fit in.

6. State one thing that you learned or one thing that stood out to you from the unit required reading, optional reading or audio material in this unit

I learned that the pressure to belong causes a lot of people to be different meaning changing who they are. They feel the need to fit in to please everyone around them. They have to change their personalities to make the group they are around.

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You’ve probably heard about code-switching and why some people do it, but what you may not know is the mental toll it takes.

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1. State at least three similarities that you can identify between African American religious practices and African religious practices.

In terms of religious and spiritual practices, there are many that show a similarity between the African American and African communities. Both African and African American cultures share a deep belief in a Supreme Creator who watches over or governs the world. In African religious traditions like Yoruba (Ifá), there is a belief in a singular, supreme god such as Olorun or Olodumare. Similarly, African Americans, especially those who practice African-derived religions like Vodou, Santería, or Yoruba-based faiths, maintain this belief in a higher spiritual force.

Another similarity I found interesting were the ways each culture had their usage of rituals, songs, and dance to express themselves spiritually. In West African religions like Ifá and Vodou, drumming, singing, dancing, and trance possession are necessary to worship and communicate with deities. In the same way in African American religious practices, such as Santería, Voodoo, or the Shango religion, music and dance play a vital role in rituals, often serving as a medium to connect with the divine.

Lastly, a similarity I found in the reading was how each of these cultures place a significant importance on the glorification of ancestors and the role of spiritual intercessors. In traditional African religions, ancestors are appreciated as important spiritual guides, and their influence is felt in daily life. Similarly, in African American spiritual practices, the honoring of ancestors is a central theme. In religions like Vodou, Santería, and various African-based spiritual systems, ancestors are called upon for guidance, protection, and assistance. This shared belief in the importance of ancestors emphasizes the lasting connection between the living, the dead, and the divine in both African and African American cultures.

2. State at least three differences that you can identify between African American religious practices and African religious practices.

African American religious practices differ from traditional African religions in several key ways. First, African American religious traditions, particularly those who were shaped by slavery and forced conversion, are heavily influenced by Christianity. They used syncretic forms like Vodou and Santería merging African deities with Catholic saints, whereas African religions, like Yoruba (Ifá), often retain their indigenous structures and are not typically influenced by Christianity.

Second, while both traditions involve collective rituals, African religious practices are more deeply embedded in the daily life of the community and often take place outdoors or at sacred natural sites, involving public ceremonies with drumming, dancing, and trance possession. In contrast, African American religious practices, especially those influenced by Christianity, often occur in structured, indoor settings like churches, with a focus on sermons, hymns, and prayer.

The last difference I noticed while reading was, while ancestor devotion is crucial to both traditions, in African religions, ancestors are viewed as active spiritual guardians and intermediaries in daily life. In contrast, in African American religions, ancestor worship often serves as a symbol of resistance and survival, reflecting the historical context of slavery and the upholding of African heritage in the face of oppression.

3. Give an example of how the history of slavery affected the religious practices of African Americans.

One way that slavery affected the religious practices of African Americans was through the adaptation and unification of African spiritual traditions with Christianity. Enslaved Africans, forced into Christianity by their captors, were able to preserve aspects of their traditional African beliefs by blending them with Christian teachings. For example, African spiritual practices often involved belief in a Supreme Being and intermediaries like spirits, divinities, and ancestors, which were incorporated into African American religions such as Vodou, Santería, and Candomblé. Furthermore, the belief in ancestral power and the use of spiritual practices for healing, protection, and resistance became a vital part of African American religious life.

4. Please locate a resource that helps you understand this theme. Analyze the resource and state the most important thing you learned from it about this topic.

This article basically tells us how African Americans and African wanted to make sure that they were categorize their selves away from each other. However are similar in many different ways.

https://www.aaihs.org/the-relationship-between-african-americans-and-africa/

5. State one thing that you learned or one thing that stood out to you from the unit required reading, optional reading or audio material in this unit

One thing that stood out to me was how focused our culture was on these different practices. Growing up you thought it was the African community who held all of these practices so to find out how it translated through AFrican American communities was interesting. Since I grew up in a Christian church, I was taught to focus solely on God through prayer and worship, often without much thought to the belief in other spiritual entities like divinities or ancestral spirits so this was great to read about and gain knowledge/an understanding on.

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AAIHS - African American Intellectual History Society

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The Relationship Between African Americans and Africa - AAIHS

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Negro, African, Colored, Afro-American, African American, and Black are identifiers that reflect the variety of ways African Americans have identified themselves in the United States since forcibly landing on American shores in the 17th century. Historian Nemata Amelia Ibitayo Blyden’s African Americans and Africa: A New History explores African Americans’ connection to the African continent

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L Mitchell Psych 110 Spring 2021 Google Slide 

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1. After reading this Washington Post articleLinks to an external site., can you explain why there are disparities between the amount of pain medication an African American woman would receive compared to other women in the same hospital complaining of pain?

According to the Washington Post article it stated that many healthcare professionals believe that African American woman are able to tolerate pain nore than non black woman. Which in turn causes them to overlook African American woman when they complain about the pain they have.

2. What factors are contributing to the disproportionate number of African American infants who die in childbirth and African American mothers who die in childbirth?

The factors that contribute in African American deaths during child birth would be the doctors and nursing not paying attention to what the mother is complaining about when they come in. They tend to sweep it under the rug instead of listening to them. They always says listen to your body and when they do the healthcare professional does not hey think they lying.

3. What are some solutions that can be implemented to improve the experiences of African American mothers giving birth and African American infant survival rates?

The solution would be better training on how to treat African American woman while pregnant. Also listen when they speak and let you know that something is going on with them. Investigate when they tell them that something does not feel right and get it on right away and treat it. Do prescreening for people that arise in the African American woman while pregnant.

4. Find one resource that helps you understand this theme and post it to your Padlet. State the resources' significance to this unit's material.

This article helps us understand what we can do to help prevent pregnancy related deaths. It also explains how the mother to be and her family can come together and discuss different options with the doctor.

https://www.cdc.gov/womens-health/features/maternal-mortality.html

5. State one thing that you learned or one thing that stood out to you from the unit required reading, optional reading or audio material in this unit.

I would the nature vs nurture how one is because of the make up of your genes and the other because of the environment that you are raised in. How both of these are equal but plays a certain role in your life.

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Working Together to Reduce Black Maternal Mortality

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Learn about working together to reduce Black maternal mortality.

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Copy of 13.5 Film Analysis Outline Template (Insert Name Here)

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1. Provide specific examples of the various types of racism that can be seen in this documentary.

Some of the examples of racism that could be seen in the documentary would be how they felt to sterilize the women because of their race. Also because they felt that it would cut the cost of help from Welfare from the government. Also it was mentioned that they were only doing this to the African American and Hispanic women.

2. How has the medical system fostered distrust in the African American community?

The medical system has fostered distrust because of what they have done. Not given African American women the right to choose. Now they feel like when they go their voice will not be heard and the doctors will basically do what they want to do to them when they want. African Americans already feel like when we state that something is wrong that a doctor does not take us seriously.

3. State THREE strategies or programs that you feel can address the issues raised.

The three things that can help address the issues that are raised would be 1. Diversify the healthcare workforce 2. Training healthcare professionals in understanding the culture of their patients. 3. Having community outreach and education programs.

4. Search online for a resource that helps you understand this topic more and post it to your Padlet. State why the resource shines some light on a perspective of this issue.

This article helps people understand why there is distrust within the medical field and why Black Americans feel like they do not receive the same medical treatment as Whites. Trying to provide ways to help people understand the frustration.

https://www.commonwealthfund.org/publications/newsletter-article/2021/jan/medical-mistrust-among-black-americans

5. State one thing that you learned or one thing that stood out to you from the unit required reading, optional reading or audio material in this unit.

It was a lot of things that stood out to me in this unit. However, what really got to me was the documentary Belly of the Beast. While watching this my wife cried because she said that no woman want her right to have children taking away from her. While talking with her it made me realized that as men we really do not understand what women actually goes through.

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In this issue, we focus on the topic of mistrust of health care providers or systems among Black Americans, who are much more likely than whites to get seriously ill and die from COVID-19 but less willing to take the coronavirus vaccine.To draw lessons on ways of building trust with Black patients, we looked at clinical encounters in which the stakes of not addressing mistrust are high, including childbirth, childhood vaccination, and the care of patients with HIV, cancer, and substance use disorder. Many of the programs we found have focused on improving communication, increasing transparency, creating welcoming environments, and attending to access barriers, among other approaches for engaging patients who have been poorly served by the health care system.

The medical establishment has a long history of mistreating Black Americans - from gruesome experiments on enslaved people to the forced sterilizations of Black women and the infamous Tuskegee syphilis study that withheld treatment from hundreds of Black men for decades to let doctors track the course of the disease. So it's not surprising that just 42 percent of Black Americans said in November they'd be willing to take a COVID-19 vaccine. As Michael Che, one of the stars of Saturday Night Live, quipped last month, "I've got mixed feelings about the vaccine. On the one hand, I'm Black, so naturally I don't trust it. But on the other hand, I'm on a white TV show, so I might actually get the real one."

Mistrust of the health care system persists even among some Black medical professionals such as Oni Blackstock, M.D., a primary care physician, researcher, and former assistant commissioner of New York City Health Department's Bureau of HIV. When Blackstock's seven-year-old son needed to go the emergency department (ED) for a skin abscess, she hesitated. The last time Blackstock had taken him to the ED - for a broken wrist - a white orthopedist reset the bone without giving him a painkiller. "I have never seen so much fear in my child's face," Blackstock recalls, "and I felt completely responsible." To avoid a similar experience, she phoned her twin sister, an ED physician, who called ahead to ensure that a trusted colleague would treat her nephew.

Studies have found Black Americans are consistently undertreated for pain relative to white patients; one revealed half of medical students and residents held one or more false beliefs about supposed biological differences between Black and white patients, like the former have higher pain tolerance than the latter. In addition to this kind of differential treatment, the health care system often gives short shrift to the physical and emotional tolls of exposure to police brutality; substandard housing and schools; polluted neighborhoods; or other parts of the daily experiences of some Black Americans. Our September 2018 issue of Transforming Care described how health systems are working to reduce health disparities by confronting racism head on. In this issue, we look at the problem of mistrust, which has risen to the fore during the pandemic amid concerns about its effects on Black Americans. As a group, they are much more likely than whites to get seriously ill and die from COVID-19 but less willing to take the coronavirus vaccine.

What Is Medical Mistrust?

A growing body of researchers is exploring the factors that fuel medical mistrust, particularly among Black and other patients of color. Laura Bogart, Ph.D., a social psychologist and senior behavioral scientist at the RAND Corporation whose research has documented the effects of medical mistrust on HIV prevention and treatment outcomes, defines medical mistrust as an absence of trust that health care providers and organizations genuinely care for patients' interests, are honest, practice confidentiality, and have the competence to produce the best possible results.

Bogart and other researchers have found that medical mistrust is not just related to past legacies of mistreatment, but also stems from people's contemporary experiences of discrimination in health care - from inequities in access to health insurance, health care facilities, and treatments to institutional practices that make it more difficult for Black Americans to obtain care. As she describes in a Q&A below, lack of trust can either be harmful (e.g., by causing people to avoid care) or empowering (e.g., by encouraging people to pursue health system reform and broader social change).

Often, patients who don't trust their health care providers are labeled as noncompliant and blamed for their failure to benefit from treatment. "Even the term mistrust is victim blaming," says Kimlin Tam Ashing, Ph.D., director of the Center of Community Alliance for Research and Education at the cancer center City of Hope in Los Angeles County, whose research assesses the biological, psychological, and cultural underpinnings of racial and ethnic disparities in cancer outcomes. "It puts it on the community when in fact the community has been let down by the medical system and by providers who continue to discriminate."

Improving Patient-Provider Relationships

Strengthening relationships between patients and their health care providers may be a means of building trust as some studies have found that people have more confidence in their providers than "the health care system" or "Big Pharma" writ large.

Treating Patients as the Experts

One such effort is part of the Merck for Mothers initiative, which aims to reduce maternal morality worldwide; in the U.S., Black women are three times more likely to die from pregnancy-related causes then white women. Among the explanations: providers spend less time with Black patients, ignore their symptoms and complaints, and lose contact with them during the postpartum period when women undergo major physiological changes that put them at risk of death.

In 2019, the Merck for Mothers initiative brought together Black women in New Orleans; doulas from Birthmark Doulas; OB-GYNs from Touro LCMC Health, a local community hospital; and other perinatal care professionals for "Equity Action Labs." During the labs, women described the problems they'd experienced during delivery and with prenatal and postpartum care with local providers and helped design solutions. Their accounts were troubling: one mother described her child's long-term health problems that resulted from having her concerns discounted, and many said they'd felt judged by providers or had procedures done to them (e.g., having internal fetal monitors inserted) without their permission.

The women offered suggestions to avoid these experiences, which Touro providers have begun to test, including having OB-GYNs and pregnant women take part in a trust-building visitmidway during a pregnancy to explore women's past experiences with the health care system, their goals for childbirth, and their safety concerns. "Our hope is that by having someone take the time to sit with them and ask these questions, women will feel enhanced trust between themselves and their providers," says Stephanie Visco, manager of Birthmark Doulas, a collective that is working to improve birth outcomes among low-income women.

Touro is also piloting a navigation program to offer women postpartum supports that are more comprehensive and longer than the typical six-week period. In addition, the hospital has begun to offer providers case-based training in structural and institutional racism and mandated implicit-bias training for all providers and staff.

Using Empathy, Not Arguments

In an effort to encourage Black patients to participate in COVID-19 vaccine trials, Pfizer partnered with clinical research sites in minority communities and worked with community organizations to have trusted leaders make appeals. Black representation in Pfizer's and other clinical trials reached 10 percent, an underrepresentation of the overall population of Blacks in the U.S. (13%). Black medical professionals had some success in recruitment by listening and responding to individuals' concerns, but public health authorities still face an uphill battle in convincing Black Americans to accept the new vaccines.

Pediatricians who've had success persuading skeptical parents to accept vaccinations for their children say effective approaches turn on empathy rather than information. At Kaiser Permanente in Northern California, providers who've undergone the health system's Effective Communication without Confrontation training program are encouraged to understand parents' challenges (e.g., by acknowledging there's a lot of information about vaccinations and mixed messaging to sift through) and recognize their shared goal, which is to protect children.

Jessica Jaiswal, Ph.D., assistant professor in the department of health sciences at the University of Alabama, says providers may feel compelled to try to dispel patients' conspiracy beliefs, but hearing and validating patients' concerns before offering new information may be a more helpful approach to building trust. "I don't know if it's useful to try to convince someone that the government did not create HIV to kill Black people," Jaiswal says, referring to the theory that the U.S. military deliberately created HIV. "However, I think it's worthwhile to acknowledge the hundreds of years of institutional racism that make someone think that."

With COVID-19 vaccines, Kenneth Hempstead, M.D., a pediatrician who serves as vaccine communications lead for Kaiser Permanente in Northern California, says both empathy and information are important; because these are new vaccines, clinicians need to be extraordinarily transparent about what we do and don't know about long-term safety concerns. "I'm optimistic about the vaccines," he says. "But if we say we have 100 percent confidence in them, and there turns out to be a problem, we run the risk of ruining the public's trust in all vaccines."

Building Relationships Outside Exam Rooms

Some advocates say that engendering trust among patients and providers will require carving space outside of the exam room. That's the idea behind 3rd Conversation, a program led by X4 Health, a social impact design firm, and funded by the Andrew and Corey Morris-Singer Foundation. The program's designers recognized patients and providers were having separate conversations about their health care experiences and frustrations. 3rd Conversation provides a space where they can come together to share their experiences and strengthen their relationships, with an eye toward finding solutions together.

At 3rd Conversation events, pairs of clinicians and patients get together for facilitated conversations; each is asked to share a personal story about when a relationship with a health care provider or patient made a significant difference to them. The sessions have revealed that clinicians and patients often want similar things, like more time during visits to get to know each other and less time spent looking at screens. Clinicians have also expressed frustration at their inability to help patients with social and economic challenges. "It demoralizes them when a patient comes in and is sick from pneumonia and they can give them medication, but they know the patient is going to sleep in a homeless shelter where they are apt to become sick again," says Jennifer Sweeney, cofounder of X4 Health.

Sweeney says interest in 3rd Conversation remains high, even amid the pandemic, with requests coming in from large health systems and academic medical centers to private physician practices, and federally qualified health centers.

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Making Institutional Changes

Studies that rely on surveys such as the Medical Mistrust Index - which asks respondents how strongly they agree with statements such as "When healthcare organizations make mistakes they usually cover it up," and "Healthcare organizations are more concerned about making money than taking care of people" - have found that many people distrust the policies or motives of institutions, not the people who work there. Building trust will require coupling efforts to improve interpersonal relationships with broader efforts to change health care institutions, ones that involve clear-eyed examinations of how these institutions have and have not supported the communities they serve.

Uncovering Instances of Institutional Racism

At Boston's Brigham and Women's Hospital, staff have deliberately sought to uncover instances of institutional racism - that is, differential access to goods, services, or opportunities by race - as part of the work of the Department of Medicine's Health Equity Committee. The goal is to find concrete examples of how racism affects care within the walls of their institution and use critical race theory and quality improvement methodologies to change the status quo. "After much conversation and debate, the concept of institutional racism was no longer distant, abstract, or someone else's problem," says Michelle Morse, M.D., M.P.H., former co-chair of the committee and a hospitalist at Brigham and Women's.

One project grew out of an analysis showing that, from 2008 to 2017, Black and Latino heart failure patients admitted to Brigham and Women's were significantly more likely to be admitted to the general medical service than the specialty cardiology service. Rates of comorbidities and insurance status didn't explain the differences. Nationally, heart failure complications are one of the most common reasons people are admitted to hospitals, and several studies (for example, here and here) have shown that patients who receive care from cardiologists have better outcomes than those who don't receive this specialty support. At Brigham and Women's, heart failure patients who were admitted to the general medicine floor were more likely to have unplanned hospital readmissions within 30 days. Unlike those discharged from the cardiology service, patients discharged from general medicine aren't given extra supports, such as home monitoring and check-in calls.

Leaders have taken immediate and longer-term steps to try to reduce this inequity, including surveying physicians to elucidate what influences their decisions about where to admit patients. In preliminary results, providers said they perceived white patients to advocate more often and more vigorously for access to specialty cardiology services, and that this impacted their decision-making - a phenomenon that hasn't previously been well described in the literature. They're also trying to improve the quality of heart failure care on the general medicine service, including by offering follow-ups after discharge. "We've already seen shifts in practice, we think in large part because of the ripple effects of the discussion that came about after finding this example of institutional racism within our walls," Morse says. The next step is an effort to give hospitalized Black and Latino patients preferential access to the subspecialty cardiology service to redress this longstanding injustice.

Attending to Affordability, Access Barriers

Some patients say they are treated with less respect by health care providers because of their income, type of insurance coverage, and/or race, and some fear they may have care withheld or may not receive the best-quality care. To try to engage Black, Latino, and other people of color, the cancer center City of Hope is taking several steps to engage patients and dismantle emotional, financial, and other barriers to accessing and engaging in care.

All patients are invited to complete a survey, SupportScreen, which asks if they are experiencing social, emotional, or financial problems that may affect their ability to follow treatment. The automated system then directs social workers, financial services staff, chaplains, and other supportive care medicine staff to offer help.

Leaders are also trying to make it easier for Black patients and others to take part in clinical trials. Nationally, minority patients are less likely to do so due to restrictive inclusion criteria and patient-level factors, ranging from lack of transportation to concern about lost income from missing work and other costs associated with participation. Communities and potential participants also need assurance that therapeutical clinical trials provide the standard of care at a minimum (i.e., treatments known to be effective won't be withheld, as happened during the Tuskegee study). To make it easier to take part in trials, City of Hope has partnered with community hospitals and built or acquired community practices, some in parts of suburban Southern California that lack oncologists or oncology subspecialty services. In a trial funded by the Patient-Centered Outcomes Research Institute and led by City of Hope researcher Ashing, the cancer center is training community ambassadors and research navigators to increase awareness and acceptability of biomedical studies, including clinical trials, among underrepresented populations.

Ultimately, it will be important to encourage more people to receive timely cancer screenings, Ashing says. Nationally, Black people have worse outcomes for many types of cancer, including lung, colon, cervical, breast, and blood cancers, due in part to the fact that they are often diagnosed at later stages.

Creating Safe, Welcoming Environments

While reviewing historical practices, health systems can take immediate steps to make patients who've been marginalized feel more welcome. UnityPoint Health system, a network of hospitals, clinics, and home care services in Iowa, Illinois, and Wisconsin, sought to redesign care for its LGBTQ patients after hearing about the challenges Kyle Christiason, M.D., one of UnityPoint Health's physicians, faced finding appropriate medical options for his son after he identified as transgender.

Together, Christiason and UnityPoint Health created the system's first LGBTQ clinic in Cedar Falls, Iowa, in 2018. In developing it, Christiason and his colleagues proceeded with an attitude of cultural humility: acknowledging what they didn't know and getting input from LGBTQ community members by holding town hall meetings and focus groups and fielding surveys. One of the clinic's first patients told Christiason he hadn't felt comfortable telling his primary care physician of 20 years that he was gay because he hadn't wanted to disappoint him. Nationally, many LGBTQ people say they don't trust their providers enough to divulge information about their gender identity or sexual orientation; more than half say they've experienced some type of discrimination in health care, including having providers refuse to treat them.

All of the clinic's staff take part in regular Safe Zone training on LGBTQ identities and how to serve as allies. Christiason says having consistent routines, like asking people about their pronouns, makes a difference. "If I know your behavior is going to happen this way every time, that starts to create trust," he says. The clinic, held two evenings each month, provides routine primary care as well as pre-exposure prophylaxis to help prevent HIV transmission, gender-affirming hormone therapy, and postsurgical care following gender-affirming procedures.

Staff end each clinic with a huddle to review what did and didn't go well, discuss ways to improve, and share examples of what brought them joy in their work. "Sometimes they're tiny, like 'I got someone to smile,'" Christiason says. "Sometimes they're quite profound. Once, someone came out of an exam room and said, 'I just want you all to know that because you chose to let me be my most authentic self, I decided not to kill myself after my last visit. I've been thinking about how I can end my life for 10 years, and now for the first time, I think I can take care of myself because you showed that I matter.'''

After receiving positive feedback on the first clinic, the health system established a second LGBTQ clinic in Des Moines.

Signaling Commitment to Improving Patients' Experiences

Geisinger Health System's Proven Experience program encourages patients who have had a poor experience to apply for no-questions-asked refunds of copayments, coinsurance, and deductibles as a way of building trust. Applicants are told, "You placed your trust in us, and we place our trust in you."

The idea for the refund, which came from an incoming CEO, initially met with resistance from other health system leaders who worried about financial losses, the legalities of such a program, and the possibility of specious complaints, says Greg Burke, M.D., chief patient experience officer. Burke says these problems haven't materialized since the program's inception in 2015; instead, it has helped leaders spotlight and correct problems and sends a signal to patients "that the system wants to hear how we are doing," he says. Complaints related to perceived lapses in quality or differences of opinion about the course of treatment are excluded from the refund program and are referred to Geisinger's internal safety division instead.

Most complaints (70%) relate to communication failures, such as providers saying something hurtful or not following up as promised. Geisinger gives all new physicians and advanced practitioners a four-hour training course on effective communication, with a focus on making eye contact, introducing yourself, informing patients of what you are doing and asking permission, being personable, and ending on an upbeat note. Providers who have persistent problems are offered individual coaching sessions.

Involving Patients in Research

Involving patients in research aimed at improving care, known as participatory research, is another mode of building trust. Starting in 2015 at Yale School of Medicine's Department of Psychiatry, researchers engaged in a participatory research training exercise with members of the local community who were in recovery from substance use disorder and other behavioral health conditions. One of their goals was to make behavioral health research more responsive to the concerns of community stakeholders, particularly for people of color.

Over the course of two years, people in recovery met with clinicians, researchers, policymakers, and community advocates to explore ways they could work together to conduct participatory research. Participants were given opportunities to share their stories and offer suggestions. One finding was that researchers and patients may have different priorities, with the latter often focused on practical changes that help them achieve their goals rather than on clinical diagnoses or effects, says Miraj Desai, Ph.D., an instructor at Yale's Program for Recovery and Community Health and the project director. "People overwhelmingly focused on seeing concrete meaningful changes in their communities and lives and wanted to know how research can be more closely aligned with these goals," he says.

Participants also suggested researchers should create opportunities for trial investigators and community partners to get to know each other, such as by sharing meals; address the challenges patients may face in joining projects (e.g., finding transportation or missing work); and create opportunities to discuss racism, poverty, and other social problems that affect health.

Moving Forward

These and other efforts suggest that some health care professionals and systems had begun taking the problem of medical mistrust seriously well before the need to vaccinate most Americans made it urgent. Some of the work was driven by professional societies, including the American Board of Internal Medicine, which has worked to rebuild trust in the medical profession since 2018, in part by building a compendium of trust-building practices. The Journal of the American Medical Association, Behavioral Medicine, and other journals have also devoted commentaries and/or issues to the subject.

Not all of the initiatives we've featured are focused on the particular experiences of Black Americans. To move forward, efforts are needed to document and understand the many reasons fueling medical mistrust of health care providers and institutions among Black patients by documenting the problem and learning from patients about what may help. The Institute for Healthcare Improvement recently launched its second round of the Pursuing Equity Learning and Action Network, in which teams of community health centers, free clinics, and large health systems are examining the impacts of racism within their organizations and communities and deploying improvement strategies to close specific equity gaps.

Changing facts on the ground will be important, including reviewing not just hiring, promotion, and procurement practices at health care organizations but also where they have chosen to locate and upgrade facilities. Including more Black people in clinical and leadership roles will also be necessary but not sufficient. Efforts are needed to expand the health care workforce to include peers and navigators in supporting patients, make the history of racism in medicine a required part of health professionals' training, and create systems to identify and address instances of disparate care.

Ultimately to earn Black patients' trust, policy changes are needed to make it easier to access and afford care. When asked if seeing President Obama receive the COVID-19 vaccine on camera would persuade them to get vaccinated, two Black men pointed out to a Washington Post reporter that should the former president experience serious side effects he'd have access to the best doctors and receive care that is unimaginable in their own or other low-income communities.

Q&A: Broaching Conversations About Medical Mistrust

Laura Bogart, Ph.D., is a social psychologist and senior behavioral scientist at the RAND Corporation whose research has documented the effects of medical mistrust on HIV prevention and treatment outcomes. Transforming Care spoke to Bogart about how clinicians and health systems can broach conversations about mistrust and ameliorate its effects.

Transforming Care: You've described medical mistrust as a form of resilience and a healthy survival mechanism that arises in response to oppression. How does framing mistrust in positive terms change how we go about addressing it?

Bogart: If we recognize that mistrust isn't necessarily harmful, it changes how we frame our response. It's very natural that people would want to put their guard up and ready themselves for the possibility of discrimination after experiencing so much systemic racism. If channeled effectively, mistrust can empower people to protect themselves and pursue changes at the institutional and societal levels. Mistrust becomes problematic when it stops people from engaging in healthy behaviors or when it leads to avoidance of the health care system.

Transforming Care: What advice would you give to providers who are interested in talking about mistrust with their patients?

Bogart: I think it has to start with education to raise provider awareness about the levels of mistrust in communities, the origins of it, and its impact on engagement, adherence, and treatment outcomes. In the case of HIV, in a national survey of Black Americans in 2016, we found that a high percentage of Black Americans believe that the virus is manmade (31%), that a cure is being withheld (40%), and that antiretroviral treatment is poison (33%). We also know medical mistrust is correlated with not adhering to medical advice, filling prescriptions, and delaying cancer screenings and other preventive health measures. It's also higher among patients who have experienced discrimination.

Transforming Care: What are some of the signs of it in an exam room?

Bogart: It could be a lack of engagement during the health care interaction. A patient may not ask questions. They may not make eye contact or may seem uncomfortable. Some patients won't verbally agree with providers. They may just take the prescription and leave. These behaviors can be indicative of mistrust. Some patients may be more direct and say they don't like medication or don't trust the medication.

Transforming Care: What sort of techniques do you suggest providers use to broach a conversation about mistrust?

Bogart: There are lot of different techniques and strategies. First and foremost, it's important to validate mistrust by acknowledging and affirming experiences of discrimination and conveying that patients' thoughts, behaviors, and emotions are well grounded, justifiable, relevant, and meaningful. Their mistrust may stem from recent negative experiences or be a response to historical injustices including unethical experimentation in health care. When exploring mistrust, it's important to ask open-ended questions in a nonconfrontational, nonjudgmental way while also providing accurate information. A provider might say, "It's totally understandable that you might be apprehensive about getting vaccinated given what's happened in the past and even now with inequality and mistreatment in health care. What have you heard about the vaccine?" A provider could then offer further information if needed by saying, "It sounds like you have been hearing a variety of things. Would it be okay if I told you a little about what I know about the vaccine?"

Transforming Care: You created the HIV Conspiracy Belief Scale to assess the prevalence of beliefs that HIV is manmade and a cure is being withheld. What have you learned about what drives conspiracy beliefs?

Bogart: I define the term conspiracy more neutrally than others do - as an effort to explain the cause of an event, practice, or circumstance by referencing the actions of powerful people who attempt to conceal their role. They may be true or untrue. It's important to avoid putting a value judgment on them. They can serve several psychological needs by helping to explain why one group isn't doing as well as another. They can also provide a sense of control and security for people who are feeling threatened or powerless, such as in the face of discrimination, or have an expectation of future mistreatment.

Transforming Care: You've also distinguished mistrust that is based on suspicion of malicious intent, such as genocidal beliefs, and mistrust based on concern about benign neglect - more of a carelessness or indifference that may lead to bad things happening. Are there differences in the characteristics of people who hold one view or the other?

Bogart: In terms of sociodemographic characteristics, we have found that people with lower levels of education and income may be more likely to have mistrust-related beliefs, but these are not strong effects, and we don't find either education or income accounts for a lot of the variance in how much people hold these beliefs. There may be a social norm around medical mistrust, which means that it may be acceptable and common in communities, families, and social networks, to have such beliefs - which is why it is important to tackle mistrust at the community level.

Transforming Care: What are some strategies health care organizations can use to address mistrust within the communities they serve?

Bogart: It requires genuine partnership. There are a lot of organizations - churches and community groups among them - that can help elucidate reasons for mistrust, where the mistrust is coming from, and what specific kinds of mistrust-related beliefs are common in communities. The key is that health care organizations need to act on the feedback they receive and not just pay lip service to it.

Transforming Care: What about when it comes to providers having conversations with patients? Someproviders may have less empathy or difficulty restraining their desire to correct the patient, what you call the "righting" reflex? Do you think everyone can be trained to be responsive to patients' concerns?

Bogart: I do think people can be trained on very basic skills. Some people are going to take it further than others. Some people are going to be better at it. But as for the basic skills-providers can learn them. People who do try actually may find that it's gratifying, because it doesn't take that much or any more time, but you see better adherence among patients and better patient satisfaction and outcomes.

Publications of Note
Medicaid Work Requirements in Arkansas Led to Delayed Care, Medical Debt
Arkansas was the first state in the nation to impose work requirements to qualify for Medicaid coverage, compelling most adults between the ages of 30 to 49 to work 20 hours a week or participate in "community engagement" activities. Before a federal judge put the policy on hold in April 2019, 18,000 adults had lost coverage. A survey of low-income adults in the state found more than half of those who lost access to Medicaid after the work requirements were imposed delayed care (56%) and/or postponed taking medication (64%) because of concerns about costs, while half reported serious problems paying off medical debt. These rates were significantly higher than those among Arkansans who did not lose Medicaid coverage. The survey also found that the work requirement did not increase employment over 18 months and that awareness of the policy remained poor, with more than 70 percent of Arkansans reporting they were unsure whether the policy was in effect. Most of the coverage losses were reversed after the court order. Benjamin D. Sommers et al., " Medicaid Work Requirements in Arkansas: Two-Year Impacts on Coverage, Employment, and Affordability of Care," Health Affairs 39, no. 9 (Sept. 2020):1522-30.
Access to Midwifery and Birth Centers Under Medicaid
Interviews and focus groups with Medicaid officials and staff at birth centers in states that participated in the Strong Start for Mothers and Newborns II initiative - an effort to test different models of prenatal care for Medicaid beneficiaries, including comprehensive team-based care at birth centers - revealed that Medicaid beneficiaries chose birth centers because they preferred midwifery care, wanted a natural childbirth, or wanted other services that may be not available in hospitals. However, the key informants also said that beneficiaries have less access to birth centers than do privately insured patients because of lower Medicaid reimbursement rates, as well as the challenges of contracting with managed care organizations and participating in value-based delivery system reforms. The authors say addressing these barriers could improve birth outcomes for mothers and newborns while yielding savings for Medicaid programs. Brigette Courtot et al., " Midwifery and Birth Centers Under State Medicaid Programs: Current Limits to Beneficiary Access to a High‐Value Model of Care," Milbank Quarterly September 15, 2020.
Indiana's Medicaid Waiver and Interagency Coordination Increased Enrollment for Justice-Involved Adults
After Indiana's 2015 Medicaid waiver expanded eligibility for low-income adults, the state sought to increase the number of justice-involved adults covered by the program by increasing coordination between the state's corrections agency and its Medicaid program. As part of the effort, the Indiana Department of Correction began initiating Medicaid applications for inmates who lacked coverage and suspended rather than discontinued coverage for others while they were incarcerated. The Medicaid expansion increased the percentage of justice-involved adults who received Medicaid coverage within 120 days of release by nine percentage points. With coordination between agencies, the state saw an additional 29-percentage-point increase in coverage. The study also found a 14-percentage-point increase in the number of inmates who had coverage that was effective within seven days of their release. Justin Blackburn et al., " Indiana's Section 1115 Medicaid Waiver and Interagency Coordination Improve Enrollment for Justice-Involved Adults," Health Affairs 39, no. 11 (Nov. 2020):1891-99.
Early in the Pandemic Older Adults with Low Health Literacy Were Unable to Accurately Identify Ways to Prevent COVID-19 Infection
Researchers found older adults at higher risk for COVID-19 lacked critical knowledge about prevention in the early weeks of the pandemic. The surveys of adults with one or more chronic conditions, conducted at the outset of the U.S. outbreak (March 13-20, 2020) and during the acceleration phase (March 27-April 7, 2020), found that while participants increasingly perceived COVID-19 to be a serious public health threat and reported more changes to their routines, there was no significant change in the proportion who could accurately identify ways to prevent infection. Black adults and those with lower health literacy were more likely than whites and those with higher health literacy to report feeling less susceptible to becoming sick with COVID-19. In addition, individuals with low health literacy remained more likely to feel unprepared for the outbreak and to express confidence in the federal government response. The authors conclude that public health messaging to date may not be effectively reaching vulnerable communities. Stacy Cooper Bailey et al., " Changes in COVID-19 Knowledge, Beliefs, Behaviors, and Preparedness Among High-Risk Adults from the Onset to the Acceleration Phase of the US Outbreak," Journal of General Internal Medicine 35, no. 11 (Nov. 2020):3285-92.
Reproductive Health Issues May Foreshadow Cardiovascular Disease in Later Life
A review of studies that have investigated the association between reproductive risk factors in women and subsequent risk of cardiovascular disease found a variety of risk factors - from early menarche and contraceptive use to gestational diabetes and preterm birth - were associated with cardiovascular disease. The researchers found associations for composite cardiovascular disease were twofold for pre-eclampsia, stillbirth, and preterm birth; 1.5- to 1.9-fold for gestational hypertension, placental abruption, gestational diabetes, and premature ovarian insufficiency; and less than 1.5-fold for early menarche, polycystic ovary syndrome, and early menopause. The associations varied for ischemic heart disease, stroke outcomes, and heart failure. A longer length of breastfeeding was associated with a reduced risk of cardiovascular disease. The authors say policymakers should consider incorporating reproductive risk factors into clinical guidelines for cardiovascular risk assessment since the risk of cardiovascular disease may be modifiable. Kelvin Okoth et al., " Association Between the Reproductive Health of Young Women and Cardiovascular Disease in Later Life: Umbrella Review," BMJ 371, no. 8263 (Oct. 2020):m3502.
Declines in Non-COVID-19 Hospital Admissions Vary by Diagnosis, Patient Population
Researchers studying differences in hospital admission patterns among patient groups since the onset of the pandemic found that declines in non-COVID-19 admissions between February and April 2020 were generally similar across demographic subgroups and exceeded 20 percent among all primary admission diagnoses. By late June and early July 2020, non-COVID-19 admissions were 16 percent below pre-pandemic levels, but admissions were substantially lower for patients residing in majority-Latino neighborhoods (32% below baseline) and remained well below baseline for patients with pneumonia (down 44%), COPD and asthma (down 40%), sepsis (down 25%), urinary tract infection (down 24%), and acute ST-elevation myocardial infarction (down 22%). John D. Birkmeyer et al., " The Impact of the COVID-19 Pandemic on Hospital Admissions in The United States," Health Affairs 39, no. 11 (Nov. 2020):2010-17.
Complex Patient Bonus Unlikely to Mitigate Regressive Effects of MIPS
A review of the first round of performance data from the Merit-based Incentive Payment System (MIPS) found that compared with clinicians with the lowest socially at-risk caseloads, those with the highest had 13.4 points lower performance scores, were 99 percent more likely to receive a negative payment adjustment, and were 52 percent less likely to receive an exceptional performance bonus payment. The authors note the lower scores were partly explained by lower clinician reporting of and performance on technology-dependent measures, which may reflect lack of technological capability at the practice level. They also found that having a complex patient bonus in place would have increased performance scores and the likelihood of receiving an exceptional performance bonus for clinicians with the highest socially at-risk caseloads by 4.7 percent and 2.8 percent, respectively. However, the proportion receiving negative payment adjustments would have remained unchanged. The study included data on more than 500,000 clinicians. Kenton J. Johnston et al., " Clinicians with High Socially At-Risk Caseloads Received Reduced Merit-Based Incentive Payment System Scores," Health Affairs 39, no. 9 (Sept. 2020):1504-12.
Policy Changes to Improve Pandemic Response, Increase Health Equity
In a commentary in the New England Journal of Medicine, three health disparities researchers call for major policy changes to advance health equity and improve the pandemic response, including greater investment in hospitals and clinics that serve marginalized communities, the creation of a universal food income benefit, and reforms to unemployment insurance to increase income and broaden eligibility. They also recommend greater investment in community development, expanding affordable housing, and increasing economic opportunity to reduce income disparities. Seth A. Berkowitz, Crystal Wiley Cené, and Avik Chatterjee, " COVID-19 and Health Equity - Time to Think Big," New England Journal of Medicine 383, no. 12 (September 2020):e76.
Employment May Explain Disparities in COVID-19 Outcomes Among Minorities
Blacks and Latinos are more than three times as likely as whites to be hospitalized with COVID-19 and experience higher death rates from the disease. Using data from the Medical Expenditure Panel Survey, researchers found these disparities are not fully explained by health risks, such as diabetes or obesity. They found Blacks were substantially more likely than whites to work in health, public safety, and public utility jobs while Latinos were more likely than whites to work in food-related jobs, suggesting employment may be a factor in transmission within households. Blacks at high risk for severe COVID-19 illness were 1.6 times as likely as whites to live in households with health-sector workers. Among Latino adults at high risk for severe illness, 64.5 percent lived in households with at least one worker who was unable to work from home versus 56.5 percent among Black adults and 46.6 percent among white adults. Thomas M. Selden and Terceira A. Berdahl, " COVID-19 and Racial/Ethnic Disparities in Health Risk, Employment, and Household Composition," Health Affairs 39, no. 9 (Sept. 2020):1624-32.
Geography, Employment, Incarceration, and Other Factors May Explain Differences in COVID-19 Cases Among Minority Groups
Reviewing data from 351 cities and towns in Massachusetts, researchers found communities with a higher proportion of Black and Latino residents had higher rates of COVID-19 cases. A 10-percentage point increase in the Black population was associated with an increase of 312.3 COVID-19 cases per 100,000 residents, whereas a 10-percentage point increase in the Latino population was associated with an increase of 258.2 cases per 100,000 residents. For the Latino population, independent predictors of higher COVID-19 rates included the proportion of foreign-born noncitizens living in a community, mean household size, and share of workers employed in the food service sector. Higher COVID-19 cases among Blacks were not explained by these and other demographic, economic, and occupational variables studied. The researchers suggest higher COVID-19 cases among Blacks may be explained by other factors, including disproportionate incarceration rates, residence in multi-unit buildings, and segregation, which may produce variation in access to care and exposure to environmental hazards. Jose F. Figueroa et al., " Community-Level Factors Associated with Racial and Ethnic Disparities In COVID-19 Rates in Massachusetts," Health Affairs 39, no. 11 (Nov. 2020):1984-92.
Mental Health Disorders Linked to Grief May Increase with More COVID-19 Deaths
In a commentary in the Journal of the American Medical Association, three psychiatrists call for greater investment in mental health funding to address the psychological problems experienced by Americans who have lost loved ones to COVID-19, including grief, depression, and substance abuse. They also call for widespread screening to identify individuals at highest risk for prolonged grief, post-traumatic stress, and suicide and recommend training for primary care clinicians and mental health providers conducting screening and offering support to the bereaved who cannot participate in traditional mourning practices. Naomi M. Simon, Glenn N. Saxe, and Charles R. Marmar, " Mental Health Disorders Related to COVID-19-Related Deaths," Journal of the American Medical Association 324, no. 15 (Oct. 2020):1493-4.
Minnesota's Payment Policy for Medicaid Births
In 2009, Minnesota's Medicaid agency established a single payment rate for uncomplicated vaginal and cesarean births, a change from the prior payment that had given providers higher reimbursements for cesarean births. Researchers seeking to determine if the policy had differential effects on cesarean birth rates and maternal morbidity among Black and white women in Minnesota, as compared to six other states, found cesareans decreased among both Black and white women in Minnesota compared to the control states and this decline was greater among Black women (a decline of 2.88 percent from a pre-policy rate of 22.2 percent) than among white women (a decline of 1.32 percent from a pre-policy rate of 19.3 percent). Rates of postpartum hemorrhages increased, with larger increases among Black women. Jonathan M. Snowden et al., " Cesarean Birth and Maternal Morbidity Among Black Women and White Women After Implementation of a Blended Payment Policy," Health Services Research 55, no. 5 (October 2020):729-40.

Editorial Advisory Board
Special thanks to Editorial Advisory Board member Don Goldmann for his help with this issue.
Jean Accius, Ph.D., senior vice president, AARP

Anne-Marie J. Audet, M.D., M.Sc., senior medical officer, The Quality Institute, United Hospital Fund

Eric Coleman, M.D., M.P.H., professor of medicine, University of Colorado

Marshall Chin, M.D., M.P.H., professor of healthcare ethics, University of Chicago

Timothy Ferris, M.D., M.P.H., CEO of Massachusetts General Physician Organization and professor of medicine at Harvard Medical School

Don Goldmann, M.D., chief medical and scientific officer, Institute for Healthcare Improvement

Laura Gottlieb, M.D., M.P.H., assistant professor of family and community medicine, University of California, San Francisco, School of Medicine

Carole Roan Gresenz, Ph.D., senior economist, RAND Corp.

Allison Hamblin, M.S.P.H., vice president for strategic planning, Center for Health Care Strategies

Thomas Hartman, vice president, IPRO

Clemens Hong, M.D., M.P.H., medical director of community health improvement, Los Angeles County Department of Health Services

Kathleen Nolan, M.P.H., regional vice president, Health Management Associates

J. Nwando Olayiwola, M.D., M.P.H., chair and professor, Department of Family and Community Medicine at The Ohio State University

Harold Pincus, M.D., professor of psychiatry, Columbia University

Chris Queram, M.A., president and CEO, Wisconsin Collaborative for Healthcare Quality

Sara Rosenbaum, J.D., professor of health policy, George Washington University

Michael Rothman, Dr.P.H., executive director, Center for Care Innovations

Mark A. Zezza, Ph.D., director of policy and research, New York State Health Foundation

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Understanding and Ameliorating Medical Mistrust Among Black Americans

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In this issue, we focus on the topic of mistrust of health care providers or systems among Black Americans, who are much more likely than whites to get seriously ill and die from COVID-19 but less willing to take the coronavirus vaccine.To draw lessons on ways of building trust with Black patients, we looked at clinical encounters in which the stakes of not addressing mistrust are high, including childbirth, childhood vaccination, and the care of patients with HIV, cancer, and substance use disorder.

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