At Deborah- So true and well said, unfortunately, truth is not what the powers that be really want.

Deborah, Thank you for sharing with us your feelings, thoughts, and suggestions. Many of our health systems are indeed set-up in ways that perpetuate injustice. We will continue to look for training that addresses health system change and how health systems can be a partner in eliminating racism and injustice. If you become aware of these types of trainings, please let us know. Your comments reminded me of a situation a number of years ago when we convened a group of experts – physicians, researchers, educators, community members – to address asthma. The physicians several times referred to their “non-compliant” patients. Eventually, one of the community members asked if a parent decides to feed her family rather than purchase her medications, is this being “non-compliant?” The physicians at the end of the meeting thanked the community member for helping them understand the struggles their patients may face. To this day, the physicians no longer use the phrase “non-compliant” and have worked with their patients to better understand their struggles and have even been able to help them overcome some of what their patients face.

As an African American in Newark NJ who has worked in healthcare for 20 years and public health for 19 years.( 39 years), I am totally exhausted and worn out with academic study etc of this and other issues which has gone on over 401 years since slavery. Fast forward HHS developed Healthy People in 1990 representing 4 decades of plans and hopeful improvements, trainings, research etc) to address health disparities to no avail. However, upon closer look much of the disparities have been perpetuated by institutions which in many instances have taken advantage of populations for financial gain ...an inherent trait within healthcare systems among others. There has been more than enough exhaustive research, "scholarly" exercises, data collection and publishing in academic and peer-reviewed journals publications which have served to develop the latest sterile clinical terminology i.e. the "social determinants of health" which blames the victims and circumstances. How about a fresh perspective with a purview toward change of systemic practices with implementation of practical applications to address health disparities which can yield immediate results. There are studies by Kaiser Permanente to address this with perceptions among practitioners in services rendered to privately insured patients v Medicaid patients....the changes came when cards were identical and the providers didn't know who was privately insured or a Medicaid patient....which changed patient outcomes. Simple as that. There was another study conducted and published in the New England Journal of Medicine which looked at two cohorts of men...one black, one white, same presentations heart problems. Here again the white cohort received better alternative treatments, therapies and medications vs the black counter parts who received substandard care. Oh an BTW one would think it is because blacks were indigent. However, with the black cohort, it mattered not if the black patient was indigent/uninsured or the PCEO of a major corporation with multiple health insurances and CASH...they all received substandard care. What does that tell you? I'm sure there will be more money floated for grants for research and trainings to understand what we already know...the bottom line has been the sicker these groups are (without accountability or performance based outcomes of health systems) the more money they make. Most if not all health systems will want to help change the trajectory.... only if MONEY is attached. This is the sad reality. Think trainings need to be geared in this manner and produce the most immediate results.