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COVID – 19 CRISIS
WORKING TOGETHER
Town Hall Meeting:
August 19, 2020 5:00pm PDT | 7 PM CDT | 8 PM EDT
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Presenters
Afua Bromley, MSOM, Dipl.Ac. (NCCAOM)®, L.Ac.
Immediate Past Chair, NCCAOM
LiMing Tseng, Lac., Dipl. O.M. (NCCAOM)®
Board Member At Large, ASA
Kira Banks, PhD
Professor. Consultant. Co-Founder at Institute for HealingJustice and Equity, Saint Louis University
Ninochka McTaggart, PhD
Diversity & Inclusion Strategist, Los Angeles Metropolitan Area
Safiya McCarter, ND, L.Ac.
Naturopathic Doctor, Acupuncturist,
Diversity Consultant at Project X: Authenticity, Adaptability, Transformation
Kira Banks, PhD
Associate Professor in the Dept of Psychology
at Saint Louis University
Raising Equity, LLC, Co-Founder
Forward Through Ferguson, Racial Equity Catalyst
Institute for Healing Justice and Equity, Saint Louis University,
Co-Founder
The Saint Louis University Urban Underserved MD/MPH
Program and Medical Curriculum- Training Grant
Foundational Concepts for
Understanding Racism and Cultural
Competence
Dr. Kira Hudson Banks
Associate Professor of Psychology
Co-Founder Institute for Healing Justice and Equity
Racism
▪ (a system) Racism: A system of privilege and disadvantage
on the basis of race
▪ (within individuals) Internalized/Appropriated Racism: Acceptance of negative messages about ability and intrinsic
worth by members of oppressed groups.
▪ (within an institution) Institutional Racism: Unfair and
disparate norms, policies, and procedures within an
organization on the basis of race
▪ (across institutions) Structural Racism: Unfair and disparate
norms, policies, and procedures across institutions on the
basis of race, which accumulates and compounds inequities.
White Supremacy
System of structural or societal racism which
privileges white people over others, regardless of
the presence or the absence of racial hatred. White
racial advantages occur at both a collective and
an individual level, and both people of color and
white people can perpetuate white dominant
culture, resulting in the overall disenfranchisement of
people of color in many aspects of society.
Race Based Traumatic Stress (Bryant-Davis, 2007)
▪ Emotional injury that is motivated by hate or fear of a
person or group of people as a result of their race
▪ Racially motivated stressor that overwhelms a person’s
capacity to cope
▪ Racially motivated, interpersonal severe stressor that
causes bodily harm or threatens one’s life integrity; or
▪ Severe interpersonal or institutional stressor motivated
by racism that causes fear, helplessness or horror.
Cultural Competency (McAuliffe, 2008)
▪ Awareness of own cultural values and biases
▪ Knowledge of client worldview
▪ Intervention strategies and skill
Dadlani’s Cultural Principles
▪ All Patients Have Social Identities and Are Affected by
Cultural Contexts
▪ Multiple Social Identities Are Experienced Simultaneously
▪ All Clinicians Have Privileged and Marginalized Social
Identities that Influence Diagnosis and Treatment
▪ The Therapeutic Relationship Is a Cultural Context That Is
Informed by the Social Identities of Both Patient and
Therapist
Think about….(adapted from Hays, 2016)
▪ How culture has influenced who you are, how you see yourself
and how clients see you
▪ How do these influences affect your comfort with or feelings
about certain groups?
▪ What is the relationship between your visible identity and your
self-identification, and how is this influenced by cultural context?
▪ What kinds of assumptions are clients likely to make about your
based on your visible identity, your sociocultural context, and the
information you share?
▪ How might your areas of privilege affect your work (e.g., clinical
judgments, theoretical preferences, views of clients, beliefs about
health care)?
Intent ≠ Impact
Ninochka McTaggart, PhD
Co-Author of White Privilege: The Persistence of Racial
Hierarchy in a Culture of Denial
Geena Davis Institute on Gender & Media, Senior Researcher
Chinese American Museum LA, Guest Curator
University of California, Riverside, Former Lecturer on the
topics of power dynamics of race, class,
gender and sexual orientation
White Privilege and Disparities in
Healthcare
Dr. Ninochka McTaggart, PhD
❑ Unearned advantage that whites
experience in a racially stratified society that
often go unnoticed or taken for granted
❑ This privilege tends to be special and
unchecked
❑ White privilege and its invisibility
❑ In the United States, whiteness frames
preconceived notions about what makes up
a healthy individual and who has access to
that status
What is
White
Privilege?
What is
White
Privilege?
▪ A “health disparity” refers to a higher burden
of illness, injury, disability, or mortality
experienced by one group relative to another
▪ Causes
▪ Socioeconomic factors/environmental
disadvantage
▪ Insurance status
▪ Healthcare provider bias
▪ Education
▪ Why do healthcare disparities matter?
▪ More important as the country becomes
more diverse
What are the causes of
healthcare disparities?
What is
White
Privilege?
What are the
effects of these
outcomes?
▪ Maternal Morbidity and Mortality
▪ Underestimating Pain Levels of
Patients
▪ Obesity
▪ Substance Abuse
▪ COVID-19
▪ Cancer
▪ Cardiovascular disease
What is
White
Privilege?Weathering
▪ Term derived by Arline Geronimus
▪ Continuous discrimination distresses
the body and speeds up aging at the
cellular level
▪ Increases susceptibility of blacks to
diseases like diabetes and
hypertension
▪ These findings have led some
healthcare researchers to suggest that
the experience of being a black
woman in America is, itself, a risk
factor
Safiya McCarter, ND, L.Ac.
Member, Board of Directors: American Association of
Naturopathic Physicians (AANP), Chair: Diversity & Inclusion
Committee
Member, Board of Directors: Midwifery Education Accreditation
Council (MEAC), Vice-President of Accreditation, Chair: Equity &
Access Committee, Education Standards Committee
Co-Founder & Consultant: Project X: Authenticity, Adaptability &
Transformation
Founder & Consultant: Safiya M. Consulting
Conversations Around Racism, Bias,
Equity & The Acupuncture Profession:
Cultural Competency in Acupuncture
Education
Dr. Safiya McCarter
19 August 2020
Disclosures:
The views expressed in and during this presentation are those of
Dr. Safiya McCarter and do not represent the views of the
organizations in which she holds membership.
“NOT EVERYTHING THAT IS FACED CAN BE CHANGED, BUT NOTHING
CAN BE CHANGED UNTIL IT IS FACED”
~JAMES BALDWIN
Why this conversation…Why now?
▪ The current pandemic is serving as a great revealer…
▪ Shining a spotlight on :
▪ Access to healthcare
▪ Health Disparities
▪ Racism & its impact on quality of care, health, and
health outcomes
▪ Various organizations & institutions publishing statements
Why this conversation…Why now?
Health Disparities
The Heckler Report: 1985
Heckler Report
Catapulted Racial and ethnic health disparities to the
national stage.
Per year, Black people were dying at a higher rate than
any other racial/ethnic group.
Lead to the establishment of the Office of Minority Health
(under the Department of Health & Human Services).
US National Library of Medicine: www.collections.nlm.nih.gov
Institute of Medicine
Unequal Treatment:
Confronting Racial &
Ethnic Health
Disparities in
Healthcare (2003)
Institute of Medicine
Sought to find the cause of health disparities “assuming that access-
related factors such as insurance status and the ability to pay for
care are the same…”
Examined the persistence of racial & ethnic disparities in health &
healthcare:
▪ How disparities arise?
▪ What is/could be happening in the clinical encounter?
Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in
Health Care, Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic
Disparities in health Care. Washington (DC): National Academis Press (US); 2003
Institute of Medicine
Among their findings:
▪ Some evidence suggests that bias, prejudice, and stereotyping
on the part of healthcare providers may contribute to
differences in care.
▪ The vast majority [of studies] indicated that minorities are less
likely than whites to receive needed services, including
clinically necessary procedures.
Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in
Health Care, Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic
Disparities in health Care. Washington (DC): National Academis Press (US); 2003
Racial Bias in Pain Assessment and Treatment Recommendations, and False
Beliefs About Biological Differences between Blacks and Whites.
“Second, they reveal that a substantial number of white people—laypersons
with no medical training and medical students and residents—hold beliefs
about biological differences between blacks and whites, many of which are
false and even fantastical in nature.”
“Beliefs that blacks and whites are fundamentally and biologically different
have been prevalent in various forms for centuries. In the United States, these
beliefs were championed by scientists, physicians, and slave owners alike to
justify slavery and the inhumane treatment of black men and women in
medical research (20–25).
Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A. 2016;113(16):4296-4301. doi:10.1073/pnas.1516047113
Racial Bias in Pain Assessment and Treatment Recommendations, and False
Beliefs About Biological Differences between Blacks and Whites.
“Extant research has shown that, relative to
white patients, black patients are less likely to
be given pain medications and, if given pain
medications, they receive lower quantities”
“…recent work suggests that racial bias in
pain treatment may stem, in part, from
racial bias in perceptions of others’ pain”
Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment
recommendations, and false beliefs about biological differences between blacks and whites. Proc
Natl Acad Sci U S A. 2016;113(16):4296-4301. doi:10.1073/pnas.1516047113
Racism is a Public Health Crisis
American Public Health Association (APHA)
“Racism is an ongoing public health crisis thet needs our attention now”
Statement from APHA Executive Director Georges Benjamin, MD
Franklin County Commissioners Declaration of Racism as a
Public Health Crisis. (May 19, 2020)
https://crms.franklincountyohio.gov/RMSWeb/pdfs/68146.FINAL_Resolution_FCPH_
DeclaredRacismPublicHealthCrisis.pdf
Addressing Law Enforcement Violence as a Public Health IssueThe 2018 Statement
“Physical and psychological violence that is structurally mediated by the system of law
enforcement results in deaths, injuries, trauma, and stress.”
https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2019/01/29/law-
enforcement-violence#.Xxf9zC38ipo
Racism is a Public Health Crisis
Racial Disparities in Health among Non-Poor African Americans and Hispanic.
The Role of Acute and Chronic Discrimination
"Exposure to interpersonal discrimination has also been implicated in important
subclinical physiological processes that are thought to be a marker of accelerated
aging such as higher allostatic load scores and shorter telomeres (Brody et al.
2014; Ong et al. 2017)
“…growing body of empirical evidence which shows that everyday discrimination is
more consistently associated with higher rates of morbidity and mortality than
acute instances of unfair treatment.” (Paradies 2006; Williams and Mohammed
2009).
Colen CG, Ramey DM, Cooksey EC, Williams DR. Racial disparities in health among nonpoor African Americans and Hispanics: The role of acute and chronic discrimination. Soc Sci Med. 2018;199:167-180. doi:10.1016/j.socscimed.2017.04.051
What do we do?
Health Equity…The Ultimate Goal
Health Inequality
“…systematic, avoidable and unfair differences in health outcomes that
can be observed between populations, between social groups within the
same population, or as a gradient across a population ranked by social
position.”
McCartney G, Popham F, McMaster R, Cumbers A. Defining health and health inequalities. Public Health. 2019; 172:22-
30.doi:10.1016/j.puhe.2019.03.023
Health Equity…The Ultimate Goal
Health Disparity
“A particular type of health difference that is closely linked with social,
economic and/or environmental disadvantage. Health disparities adversely
affect groups of people who have systematically experienced greater
obstacles to health based on their racial or ethnic group, religion,
socioeconomic status, gender, age, mental health, cognitive, sensory or
physical disability, sexual orientation, gender identity, geographic location or
other characteristics historically linked to discrimination or exclusion”
Healthy People 2020: Office of Disease Prevention & Health Promotion (ODPHP)
Health Equity…The Ultimate Goal
Delivering care that is culturally informed,
culturally responsive and free from bias.
▪ This must be present in academic programs
▪ This is NOT extra or elective information
Health Equity…The Ultimate Goal
What can we do? What must we do?
▪ Acknowledgement & Acceptance
▪ Learning & Unlearning
▪ Personal
▪ Interpersonal
▪ Institutional
▪ Hold institutions and organizations accountable
▪ Leadership
▪ Staff, faculty
▪ Curriculum
Health Equity…The Ultimate Goal
What can we do? What must we do?
▪ Professional
▪ Accreditation & Licensing standards
▪ Continuing Education requirements
▪ Systemic
▪ Strategic Planning & Implementation
ACUPUNCTURE MEDICINE
CULTURAL COMPETENCY SURVEY
AFUA BROMLEY, MSOM, L.AC., DIPL AC (NCCAOM)
LIMING TSENG, MACOM, LICAC, DIPL OM (NCCAOM)
Female
74%
Male 23%
Non-binary 1%
Transgender
0%Prefer not to
say 2%
Self Identif ied Gender
Female 74%
Male 23%
Non-binary 1%
Transgender 0%
2%
20%
18%
18%
16%
12%
6% 4% 3% 1%
Years of Practice
Student 2.04%
0 - 5 yrs 20.15%
6 - 10 yrs 18.22%
11 - 15 yrs 18.19%
16 - 20 yrs 16.07%
21 - 25 yrs 11.92%
26 - 30 yrs 5.9%
31 - 35 yrs 3.61%
36 + 3.13%
N/A 0.77%
1%
16%
2%
3%
68%
1%
4% 4%
Ethnicity
American Indian/Native American/First
Peoples/Alaska Native 0.62%
Asian or Asian-American 15.71%
Black/African(including North African)/African-
Diasporan/ African-American 2.11%
Latino/LatinX/ Hispanic 3.46%
White - European-American 68.40%
Middle Eastern 1.06%
Multi-racial 4.26%
Other (please specify) 4.37%
10%
37%
15%
27%
10%
How much do you feel discrimination
affects your l i fe
Very much 10.35%
Somewhat 37.14%
Neutral 15.31%
Not very much 27.37%
Not at all 9.84%
86%
7%5%
1% 1%
How important is it that practit ioners in our profession
be respectful of or sensitive to cultural or ethnic
differences, sexual orientation, gender identity, or
religious differences?
Very Important - 86.22%
Somewhat Important - 6.81%
Neutral - 4.77%
Not Important at All - 1.24%
Don't Care - 0.95
0
200
400
600
800
1000
1200
556 584
714
1044
724
1074
343
Identify any of the following classes you have taken related to
cultural competency/health disparities/etc.
0
200
400
600
800
1000
1200
1400
1600
1800
What are your concerns in the area of diversity/equity/inclusion?
AcupunctureMedicineDay.org
Video Contest
The video(s) must reflect one of three categories below.
1. Acupuncture Safety During COVID (eg: Inform the public that
acupuncturists are open and ready to treat safely)
2. Demonstrate Diversity, Equity and Inclusion in Acupuncture
3. Acupuncture Accessibility and Community Engagement
All participants with approved video entry will be awarded two (2) PDA Points.
The winners (chosen by the public) will receive a voucher for a free NCCAOM recertification or
towards NCCAOM certification fees.
Thank you!
Questions regarding certificates of completion?
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