>> Well, good morning. My name is Dr. Donna Hubbard McCree, and I serve as the Associate Director for Health Equity at the National Center for HIV, Viral Hepatitis, STD, and TB Prevention. I have the honor to welcome you to the Dr. William Bill Jenkins Health Equity Lecture. This lecture honors the late Dr. Bill Jenkins, and recognizes his outstanding legacy of innovative public health action, his dedication to the elimination of health disparities, and efforts to promote the highest ethical standards in public health practice. We collaborated with Dr. Jenkins' wife, Dr. Diane Rowley, to develop a lecture in his honor that will focus on initiatives to improve health, the communities of color, and efforts to promote public health ethics, social justice, and health equity. I now welcome Mr. Greg Bautista, who is a health scientist in the NCHHSTP Office of Health Equity. And he will provide some opening remarks. Mr. Bautista.

>> Thank you, Dr. McCree. It's a privilege to share how Dr. William Jenkins' legacy continues to impact our health equity efforts, and paves the way for future leaders in public health. Dr. Jenkins began his career at CDC in 1967 as one of the first African Americans to join the U.S. Public Health Service Commission Corps. In 1980, he joined NCHHSTP in what's now known as our Division of STD Prevention. While here, he served as a statistician, epidemiologist, and chief of the research and evaluation statistics section. Additionally, he managed the Tuskegee Participants' Health Benefits Program, which provides medical care to the survivors of what's now known as the Public Health Service study at Tuskegee. In the spirit of Dr. Jenkins' vision, and commitment to righting the wrongs of that infamous and highly unethical syphilis study, and ensuring that such things do not happen again, the program expanded to include a public health ethics fellowship, and an annual intensive public health ethics course. In 2001, Dr. Jenkins led a development of the NCHHSTP minority health strategic plan, which called for establishing an associate director for minority health in the NCHHSTP Office of the Director, the Division of the Associate Director for Health Disparities was ultimately created, along with a more expansive Office of Health Disparities, which is now our Office of Health Equity. After the office was established in 2003, Dr. Jenkins retired from CDC. And I had the privilege of meeting him in 2016 while supporting internships at NCHHSTP, with Morehouse College. There, I learned that Dr. Jenkins had founded Project IMHOTEP at Morehouse College in 1981, with support from NCHHSTP. Project IMHOTEP is an undergraduate public health summer internship program for developing knowledge and skills in biostatistics, epidemiology, and occupational safety and health. NCHHSTP has supported Project IMHOTEP since its inception. Each summer, several NCHHSTP colleagues served as mentors for scholars in Project IMHOTEP. It's exciting to see that CDC supports for the future of our public health workforce have grown substantially over the years, thanks in part to the inspiration of leaders like Dr. Jenkins. In fact, the CDC Office of Minority Health and Health Equity today coordinates CDC's support for several public health career development programs for underrepresented minority students. It's exciting to see that the support has grown so substantially. And in addition to supporting Project IMHOTEP, the Office of Minority Health and Health Equity supports several other fantastic programs that host hundreds of underrepresented students each year. You can learn more about the eligibility requirements and the application process for CDC internships and fellowships by visiting the links that my colleague posted in the chat box. Clearly, Dr. Jenkins' leadership and service extended far beyond CDC. And it's a privilege to honor him today. I'll now turn it over to Dr. Diane Rowley. Dr. Rowley is board certified in pediatrics and preventive medicine, and a [inaudible] professor of the practice of public health, and a senior researcher at the University of North Carolina, Gillings School of Global Public Health. She is also the wife of the late Dr. Bill Jenkins. You may learn more about her by viewing her complete biographical information at the link pasted in the chat box. Dr. Rowley?

>> Thanks so much, Greg, for describing some of the work that was so dear to Bill. My family is very honored to have this health equity lecture series named for him. I met Bill in 1980 when I was an EIS officer at CDC. Three years later in the fall of 1983, we were married. And our daughter was born in 1988. We had a wonderful family life. But today I will make brief remarks about Bill's community organizing skills as part of his professional life. Wherever he lived, he was always organizing people. My generation likes to talk about what life was like back in the day. So, I'm going to share with you three short stories from three different decades about Bill's organizing back in the day. Bill spent almost all of his career at CDC, and his first job was at the National Center for Health Statistics, where he was recruited into a biostats training program after he graduated from Morehouse College, probably around 1968 he organized an underground community of black federal public health workers. He circulated an underground newsletter called The Drum. The Drum was how he got the word out about his concern that the Tuskegee Syphilis study of the Negro male was unethical. The group alerted the National Medical Association and several newspapers about the study. But they were unsuccessful in getting anyone to pay attention. In 1980, when he joined the Division of Sexually Transmitted Diseases at CDC, there were only a few black people in positions in epidemiology, biostatistics, and laboratory sciences. So, he decided to bring the black people there together socially [inaudible] of getting us to trust each other and learn how to informally exert influence on CDC. In the early 1980s, we've been getting together on Friday evenings for happy hour under the name Social Health Society. When Helene Gayle arrived as an EIS officer, she influenced Bill to get the group to do what today would be called good trouble. For example, in 1985, when the report of the secretary's task force on black and minority health was issued, marking the first time the U.S. government had comprehensively documented health disparities, she led the group effort to plan how to get CDC to promote more activities on what at that time was an emerging issue. By the early 1990s, Bill felt comfortable moving from organizing underground and informal groups to directing the establishment of a national organization. That's when he created the Society for the Analysis of Public Health Issues, or SAPHI. SAPHI began in 1991, with an ad hoc executive community that he organized, convened the first meeting in Atlanta, just prior to the American Public Health Association meeting, that was also being held in Atlanta that year. Once again, Helene Gayle was co lead of that process. Bill was committed to using public health as a means of addressing injustice and inequity. Throughout his life, he worked on creating scientific knowledge on developing a diverse public health workforce, and on building organizational power to improve the health of underserved populations. Reflecting on his activities back in the day, I think for him the greatest compliment that he would want would be to be called a drum major for [inaudible]. And now I'll turn it over to Ms. Ati Kazari [phonetic]. And I apologize if I mispronounced your name. She's a 2013 alum of Project IMHOTEP, and health communications specialist with the National Center for Immunization and Respiratory Diseases. She will introduce and interview our featured speaker, Dr. Helene Gayle.

>> Thank you, Dr. Rowley. And good morning, everyone. It's an absolute pleasure to be here. My name is Ati Kazari [phonetic], and I started my career in the field of public health in 2013 through Project IMHOTEP. My experience with Project IMHOTEP was nothing less than profound, from diving into extensive educational training courses and public health, to gaining lifelong mentors, Project IMHOTEP certainly made a positive impact in my life. And as a matter of fact, through the relationships I made from Project IMHOTEP, I was fortunate enough to continue my journey in public health by working with CARE, an international humanitarian organization, and conducting qualitative HIV research in West Africa. Speaking of CARE, I'm very excited and humbled to introduce our special guest, Dr. Helene Gayle, a former president and CEO of CARE. Today, Dr. Gayle is the president and CEO of the Chicago Community Trust. But by the end of this month, Dr. Gayle will start her new role as the 11th president of Spelman College. Dr. Gayle, we are so thrilled to have you join us today. And I'll kick off the conversation by asking you a couple questions so that our audience can get to know you better. Does that sound good?

>> It's my honor to be here. Thank you.

>> Thank you. So, let's get started. So, as someone who has devoted much of their career in the field of public health, can you share your career path, and the inspiration for your pivotal career choices, including addressing health equity?

>> Yeah, so thank you. And let me, if it's okay, just say a couple words. And maybe that's one of our questions. But, you know, I just want to say, being a part of this seminar, and recognizing the legacy of Bill Jenkins, is kind of overwhelming. And Diane in her comments mentioned some of my collaboration with Bill. We used to have this, we used to have this joke that he said people will listen to you, so I'm going to plant the idea. You go out and be the front person, and I'll be back there making sure you keep moving on. So, we had this wonderful good cop, bad cop relationship that I think allowed us to do things that neither one of us could have done together. And I, you know, also, before I ask, answer your question, you know, several times people have referred to Bill as the late Dr. Bill Jenkins. And obviously we know he is no longer physically with us. But Bill was always early. He was never late. He was always at the tip of the spear and leading all of us in so many important ways. So, anyway, just an homage to Bill and all that he did for me, for public health more broadly. But, let me, you know, just to say, for me, you know, I grew up at a time and in a family where giving back was really all about, you know, the ecos around us. I grew up at a time of, I think of it as the movement time. It was the Civil Rights Movement, it's a women's movement, antiapartheid movement, all of these issues that were going on that [inaudible] of wanting to be part of something bigger than ourselves. And so, for me, I knew that I wanted to have a career that allowed me to give back, and particularly give back from the standpoint of equity and social justice. And, you know, I guess I was practical enough to decide that medicine was a tangible way to do that. But as I was going through my training, and focusing primarily on the skills of being an individual practitioner, you know, I realized that if I wanted to have an impact on being able to actually address issues of inequity at a population level, that public health was really the way of kind of marrying my political, my social aspirations with my chosen profession as a position. And so that, after finishing my pediatric training, led me to the CDC to do the epidemic intelligence service, and ultimately the preventive medicine program, and, you know, I kind of, I laugh and say I came to CDC thinking that I would do a two year epidemiology training program, and maybe return to clinical medicine, and I stayed for 20 years. So, that was kind of the beginning of, you know, my career that really I think helped me to actualize and realize, you know, why I started on my path to begin with.

>> Thank you. Thank you, Dr. Gayle. And so you mentioned, you know, being able to address or how you started addressing health equity. And since you worked so closely with Dr. Jenkins, and reflecting on Dr. Jenkins' dedication to, you know, mentorship, public health ethics, and health equity, how have you introduced some of those aspects into your work as a public health development and business leader?

>> So, you know, I think that throughout, when I look at, you know, the threads of my career, having, you know, gone from individual, political training, to public health, then to economic development on a global level, and now here where I am with the Chicago community trust, looking at economic development at a local level, you know, all of those issues are so intertwined. And, you know, we always talked about how the lived experience and everyday life of people is probably more important in many ways to their health outcomes than, you know, how many times they go to the doctor, or how many times they access healthcare. And so for me, this notion that we didn't call the social determinants of health until, you know, a decade or so ago, has always been front and center. Recognizing that, you know, we do have a fragmented health system here in this country. And there's a lot more that we could do to get a more equitable health system in terms of people's access to clinical health. But we now know that 60 to 80% of what determines one's outcome, one's health outcome, is about the neighborhood you live in, the food you eat, how, whether or not you have stable housing, whether or not you have stable employment, what level of education you've been able to attain. And all these things are really the things that are more predictive of one's health outcomes. So, I tried to infuse that in all of the different arenas that I'm in, because I believe it is always through integrating health issues with the rest of how people live their lives on a daily basis where we're going to get the kind of outcomes that we want in terms of health equity.

>> I absolutely agree. Thank you for that. And I'm sure it wasn't always easy juggling those different characteristics, because we know with any career choice there will always be obstacles in one way or another, which leads me to my last question, reflecting on your career to date, what challenges did you experience in advancing health equity? And what opportunities did you leverage to navigate through those challenges?

>> The biggest challenge, we may talk about this more, is that those of us who are concerned about health outcomes often work in a narrow health box. And maybe, you know, clinical health, or it may be public health, but oftentimes the tools that we have available to us may or may not be the levers that we need to pull to be able to have the impact. And I think this challenge of how do we better integrate our systems so that the things that impact health beyond the health and public health system are able to talk to each other, are able to think about how we create seamless systems for individuals and communities to be able to do that, I also think the other factor that I'm so pleased that CDC is now talking about is systemic racism. We know that we have a system in this nation that has robbed individuals from realizing their full potential. And until we attack systemic racism, and realize its impact on health, and particularly housing black and brown citizens in this country, indigenous populations, we are not going to be able to have the impact on health. And so, you know, a lot of what we need to do is to think about how do we change policies, how do we look at systems differently, so that we're going beyond thinking about individual and short term fixes, to thinking about the [inaudible] sustainable fixes that we need to do at a systemic level.

>> Thank you, Dr. Gayle. So, we've made it to the end of our interview. And we truly thank you for sharing your insights with us. But most importantly, we want to thank you for your ongoing commitment to health equity. I'll now turn it back over to Dr. McCree. Thank you.

>> Thank you, Ati. And thank you for that interview. And now I'd like to invite your special guest, Dr. Helene Gayle, and the Director of the National Center for HIV, Viral Hepatitis, STD, and TB prevention, Dr. Jonathan Mermin, to the conversation. In the interest of time, and so we can have a very robust discussion, my colleague has pasted a link to the complete bios for our guests in the chat box. So, please feel free to click that link if you'd like to view the complete bios of all of our guests and our speakers today. All right, so I have this question I'd like to first pose to Dr. Gayle. And that would be while people are thinking of questions they'd like to ask, I think it might be good for you to tell us a little bit more about your work at Chicago Trust, and how your focus on economic development helped to advance health equity in Chicago.

>> Thanks so much for that. And, you know, as I look back over my five years here, and, you know, in the midst of a transition to my new role, it's wonderful to reflect on how we have really tried to shape our priorities here at the Chicago Community Trust. And when I came, the Chicago Community Trust, which is the community foundation for the Chicago region, did not necessarily have a unifying focus. And, you know, like so many foundations, we had an arts and culture section. We had an education section. We had a health section, et cetera. But there wasn't this kind of sense of, you know, what could we do that could have the longest term impact. And, you know, while I came in as a health professional, and many people may have thought that I would have taken on a specific health issue, or, you know, the issue of public safety and violence that is so front and center in so many of our urban areas, but when we stepped back and thought about how could we have the most sustained impact, in a way that touched on health and education and violence prevention and so many of the other issues, we recognize that underneath all of this, one of the most important causes was the economic inequity that's based here in our region, and so many other urban areas. You know, we're in a region where two thirds of our population are black and brown. You can't expect that the Chicago region, or any region that is, you know, like so many cities, the majority, the minority can move forward if you're holding back two thirds of the potential of our citizens. And so we said that we would put our energy against the focus on closing the racial and ethnic wealth gap, because we felt it would be the most sustainable way of having an impact more broadly on issues like the life expectancy gap, like the access to quality education gap, like the issues of gun violence and public safety. Chicago has one of the largest life expectancy gaps in the country. Thirty years difference between people who live in rich neighborhoods in the north side in our downtown area to those who live five miles away in our black and brown communities, 30 years difference in one city. And if you look at that 30 year gap, so much of it is linked to the broader social determinants of health. So, we felt this is where we could have our greatest impact. And so as a health person, I came in, and have learned a lot about economic development and how do you really think about closing this gap that has always been linked to the racial and ethnic segregation that we also face in this country.

>> Yeah. Thank you, thank you for that. All right, so this question is for both of you. So, looking back on the past few decades of work, are there any key policy strategies that you wish had been put into place early on that would have advanced health equity and HIV, Viral Hepatitis, CSIs, or TB in the United States? And I'll start with you, Dr. Mermin.

>> Thanks very much. And I wanted to also just thank you, Dr. McCree, for inviting me to participate on the panel. And for Dr. Gayle, a great friend, mentor, and founding, you know, Director of NCHHSTP, who really left her legacy of doing good out of the pain of, that comes from, you know, poor public health. And so we have spent a lot of time trying to do the kinds of things that she is so good at. So, I appreciate that, Dr. Gayle. I, what comes to mind are three policies that were important, but put in place later than I wish they had been, and one that has not yet been implemented. First would be marriage equality. Like racism, homophobia and transphobia are integrated into society and affect us in our daily lives. And if we had addressed the discrimination inherent in marriage inequality sooner, I think we would have prevented more STIs and HIV and supported the humanity and dignity of everyone in the nation. But second is healthcare reform. In addition to Medicaid expansion, requiring the coverage of preventive health services with no co pay changed the cost of preventive services. And we still need to see it fully implemented. But having prep in STI testing, Hepatitis A and B vaccines, screening for HIV, Viral Hepatitis, STIs, and LTBI, all covered with no co pay makes staying healthier a great deal easier. And it, it puts a dent into the massive disparities that we see because of societal racism, xenophobia, and homophobia. The third is [inaudible] services programs. Appropriations law prevented the use of federal funds to support SSPs for many years. And there was only a two year break about a decade ago. But recently that restriction was changed. And certain service programs have proliferated. It was a conscious effort by CDC and partners to do this. And having Congress and the administration make a powerful statement set the groundwork for changes in many states and local jurisdictions. And I think support of the efforts to normalize certain service programs, that they're seen as an integrated part of the public health system, just like we would for a community health center, or an STI clinic, or a TB clinic. And then the fourth I hope can be in place, would be the implementation of a new approach to mental health. Entangled with all of the diseases, conditions, and behaviors we address at NCHHSTP, is our collective failure to effectively prevent and ameliorate the effects of mental illness. Mental health and substance use are public health issues, as well as medical ones. And yet policies currently in place from an inability to prevent adverse childhood experiences to limited mental health insurance coverage from physical and sexual violence to approaching drug use as a crime rather than a health issue, all leave our nation less well off than we would want it to be.

>> Thank you. Dr. Gayle?

>> I meant to also say how wonderful it is to be with you, Donna. And I will also say, you know, you have the hard, you have a lot of hard jobs, but having added an additional H to what was already a [inaudible] we all use the, when we were naming the center, we already thought HSTP, NCHSTP, and now you have a second H. But, anyway, great to be with you. So, you know, I will say, you know, ditto to the things that John [inaudible]. I maybe talk perhaps less specifically about particular policies, and more perhaps a bit more generally [inaudible]. First of all, from a public health standpoint, I just think we need to have a commitment to public health that this nation has ever really seen. And as we saw and witnessed during the start of the COVID pandemic, there was a lot of scrambling. And there was a lot of scrambling because, you know, we do not fund public health like we do other urgent issues. And so although I don't like to make military comparisons, you know, we would never underfund our military in between wars. You know, we are trying to hopefully never have to have major warfare. But we would never say let's underfund the people who will protect us if we need it. But we do that to public health all the time. And we do not, you know, funding goes up when there's a crisis. Funding goes down when we think that that crisis is over. And so first and foremost, I think a commitment to public health in a way that sustains the workforce, sustains our surveillance systems, sustains all the efforts our laboratories, and better knits them together so that we actually have a public health, a national public health system, and that that is linked with our health system, because we have a huge disconnect between clinical and individual health and public health. And we just definitely need to think about those as much more integrated and much more essential. And, you know, and that linked to, you know, what we have as an incredible biomedical research industry. But we see those as separate pieces. They're not as integrated. And particularly public health does not get the support it needs. So that, you know, first and foremost, when we think about what could we do differently, I would add to that that we need to continue to remember that we're part of the global world, and that more and more the issues that we're dealing with are global public health issues, and, you know, again, we go back and forth between are we part of this [inaudible] or are we an island onto ourselves, every time we do that, you know, we pay the price. Secondly, I think that we should think about what are the kinds of safety net guarantees that really address some of the social determinants of health? You know, we saw during the COVID pandemic a huge expansion of things like the child tax credit, taking young children out of poverty, best health intervention we could have. So, why can't we put some of those things into place on a more permanent basis? We gave people cash to pay their bills so that they were not homeless. Huge health impact with that. Why can't we think of things like a guaranteed income for individuals? So, I think that there's a lot of things that we should be thinking about that look at how do we make sure that the richest nation in the world is providing some basic ability to live a life with dignity, and a life that allows for the basic needs in ways that we haven't? And, again, you know, thirdly, I think addressing this issue of race and racism, which is clearly such an important part of our unfortunate history of health disparities, and we, you know, we saw that during the COVID pandemic, you know, clearly the impact that it had on communities of color, and I think until we start addressing bold solutions, to redress some of the inequities and some of the obstacles that have been placed in front of people, you know, we're not going to have the health outcomes we want. So, I think we have to address all of these issues if we're serious about, you know, how we move forward as a nation.

>> Yes, that's great. And thank you. And I think the comments that both of you made actually relate to the next question, which is there's an increasing openness now in the country to really discuss some of the social determinants of health that you just talked about in your responses. And many of the drivers such as inequitable distribution of wealth, racism, and homophobia, are outside sort of the day to day influence of public health institutions. So, what can people at CDC do to influence the main causes of health inequity? And this time I'll start with you, Dr. Gayle.

>> Well, I think, first of all, talk about it. You know, I think there's just an openness to talk about these issues differently. And also reaching outside of our health boxes that we are, that we're in to talk to our colleagues in education, in housing, you know, in economic development, et cetera, you know, and I think by helping to break down some of these silos, we can really create solutions that are very, very different. You know, as an example, here we have a program that we funded called Housing Plus. And it's a program that, you know, is based on the premise that if people have stable housing, you know, they will be able to take their medications, they'll be able to get more stable nutrition, you know, there's so much that goes into what does it mean to have an address, what does it mean to have a stable place to live, so I think the more we can start thinking about these kinds of integrated programs and actually look at this, and understand that, you know, we get funded in different silos and different buckets, we can break through some of those by just really thinking creatively about how do we integrate these programs, and talk across. So, you know, I just think the more we can talk about these issues, the more public health becomes central to discussions at other tables, at the education table, at the housing table, at the economic development table. I think bringing public health into everything, you know, is an important aspect of how we can, you know, how we can better, and learn from each other.

>> Yeah, great. Dr. Mermin?

>> I agree with everything Dr. Gayle said. And I would say that also, you know, Dr. Berton will be also citing some of how we've kind of taken a dual road both ensuring there's equity within our center, both with, you know, workforce demographics and workforce experience, as well as working in kind of public health equity in the world around us. And those are, and so that will kind of set the stage for both parts. But I do think this is one of those situations where sound science, you know, a strong commitment and an open discussion can move mountains. One of the obligations of those of us at CDC is to collect and analyze data that allow us to measure social determinants of health rather than the markers of their influence, which is what most disease surveillance systems and studies do. And share that information with agencies and communities and institutions about the power to change the underlying drivers that Helene had mentioned. Another is to conduct studies and evaluations that not only identify the most important social determinants of health, but what policies have resulted in changes in health outcomes, ideally for the better. And then this often takes complex multilevel models and creativity, but I think it can provide really meaningful results. And another is to think about policy and law as a public health tool, and to support their inclusion in our work, and that of our partners, especially federal, state, and local governments, and use that approach to disseminate guidance on the policies and strategies that will increase equity.

>> Okay, great.

>> Just to add one other thing, and, you know, I think about my days when we worked on HIV/AIDS, and, you know, developed, you know, something that was very new to CDC, which was directly engaging with community and community organizations. And I think so often when we talk about solutions, we forget about the voices of community and including the voices of community. And we are not going to have solutions that matter to people's lives unless we have them at the table helping us to think through what [inaudible] me, what are the most practical solutions for their lives. And so I just want to add to all of this, making sure that we are having opportunities to listen to voices of the communities that we serve.

>> Outstanding. Of course. Thank you for that. And I also see that we have a number of questions in the Q&A. And I'm going to say to our audience, please continue to submit your questions using the Q&A feature. And I also would like to take this time to acknowledge and expand the special invitation to any of our past and present CDC club students or Ferguson fellows who are joining us. We really like to see questions from our students who are participating. And programs like at Morehouse, Columbia, University of Michigan, UCLA, and the Kennedy Krieger Institute. So, please feel free to submit your questions. And also when you do that, let us know what program you're in. All right, so I'm going to start with a question from our Q&A section here. This says thanks for the presentation and the discussion. And this is for both of our presenters. Based on your experience, what can you tell young professionals at CDC to pursue in order to see our agency embrace health equality and DEI as an important part of our future? What can the next generation focus on to move us forward? Who would like to begin with that one? That's a wonderful question.

>> So, [inaudible], since you're at CDC, I'll let you start.

>> There you go.

>> Thanks, [inaudible]. You know, a lot of it we touched on is thinking about how you can make the biggest difference. And I think what that raises for us is how do we incorporate doing a good job in this arena into our day to day work? A lot of that is our responsibility. Wherever we are, you know, when you're thinking about the studies that you are designing, think about this. When you're devising, revising your surveillance systems, or you're analyzing data, what are you analyzing it for? And what are you going to use the results for? And how are you going to use it? When you're implementing a program, how are you engaging with the communities most involved? How are you designing that program? And how are you, you know, helping it to flourish? Who is implementing it? All of these questions I think we are empowered to work with. And we don't know all the answers as individuals. We won't. But that's part of the benefit of working in public health, is, you know, more than academia, sorry, Helene, they are, actually we work together as a team often. And we are able to kind of come together and help each other move forward to make the differences that we want to see.

>> I guess I would just add to that, and this is not just CDC, this is more broadly, I think that understanding that internal in our organizations, you know, we have people who have a range of lived experiences. And if we don't allow for a workforce that is truly inclusive and lets the voices of the range of people that we have, it doesn't matter how diverse we may look, but how are we making sure that we are giving voice to, and giving support to people who want to raise these issues? And so I think there's a large role not only in terms of how an organization like CDC or other organizations that are focused on positions of health equity and academia more broadly, you know, how we engage with our external partners, but how do we actually do that hard work internally as well so that the voices, you know, of people who want to raise tough issues are supported? And I think about that in the context of this lecture named, in honor of Bill, you know, as Diane said, in the very early days, it was really tough to raise some of these issues and be supportive and not feel like, you know, your career was at risk, or, you know, you had consequences, or, you know, you were made to feel less than. And so I think there's internal work for every organization to do as well as we're thinking about the external focus that we want to have.

>> Great. Thanks. And because we have so many questions, I'm going to continue to get some from the audience. Here's a great one. How has the concept of trust come into play in your work?

>> I'll just say this quick, and then turn it over to you, [inaudible]. We saw this with the COVID vaccine 10 times over, you know, we were very involved in trying to increase rates of COVID vaccination in the communities that were most hard hit. And we did several, to your point about the importance of data. You know, we did surveys that looked at why were the rates different, what was it that made some populations willing and others not? And in the beginning, you know, communities of color were not accessing vaccines at the same rate as the majority population. And when we looked at the surveys, you know, particularly later on, in the beginning it was lack of access to the technology to make appointments, or, you know, lack of access to vaccine sites, you know, they were not understanding or not knowing where they would go to get vaccines, you know, they were more like informational and access gaps. After, you know, working hard in our department of [inaudible] here really did a great job of, you know, improving access in a variety of different ways, and getting the information out there. But what remained the barrier, and we saw this particularly in black populations, was the sense of trust, you know, people did not trust the vaccine, did not, you know, trust something that came from, quote came from the government. And we know we have this longstanding issue of how people have been treated in our health system, you know, we talk about the TB. Yes, that's a metaphor, if you will, for the broader issue of this trust. But it's not Tuskegee. It's people's everyday experience with the health system. And so, you know, we've got to be trustworthy if we want people to trust. And I think building that sense of trust is something that we all need to think about as, you know, job number one if we want to have an impact on, you know, people's ability to access the services that will make a difference in their lives.

>> Great. Thank you [inaudible]. Dr. Mermin.

>> Thanks. I think, you know, your question of how do we, how do we assume good intentions in an environment of structural racism and homophobia, I mean, that's hard, because we have facts that show that it is, we would live in an unequal society. And I think as Dr. Gayle had mentioned, that, you know, what happened with COVID, in terms of increased incidence of infection and mortality, as well as decreased access to vaccination or use of vaccination, it wasn't an active effort by the public health system to cause disparities. It was that in an unequal society, disparities will naturally occur and get worse in infectious disease if you don't do something very specifically to prevent them from occurring. And so I think we need to talk about it, and we need to win trust when it's necessary by documenting that things are working or changing things that aren't working. And I also think something that Dr. Gayle mentioned earlier on, which is we have a very robust community engagement activity in our center. We fund community based organizations. We fund programs that are ensconced in the community with engagement with others. But to try to do the best. It's participatory program implementation, like participatory research. And those kind of things can also help, because people are part of the solution, and realize that, you know, we're working on this as a team together. But I also would just want to acknowledge that I think the question is real. It's hard in this society, and it's hard when we don't control communications in any way like we might have in the past. And so what it means is you may be doing great work, and people still don't trust you.

>> Yeah, very good. I'm just going to continue to answer some of these questions, because they're just very thought provoking, and I think then we'll come back to some others. So, there are several questions, Dr. Gayle, about you becoming the next president of Spelman. And a lot of congratulations around that. And some questions around public health loans and the cost of higher education. And we're going to give you time to answer some of those questions. You can also type your answers there. There are some others too around here's one, black folks, black women in particular, seek information about experiences with bias, racism, sexism, et cetera, at hospitals. How can we begin together and share that information? So, and I guess I'll leave it up to guess which one of you want to start with that question.

>> Go ahead, John.

>> No, I think you have  I was going to defer to you.

>> I'm not sure I quite understand the question. So, and this is my interpretation saying that black folks, black women in particular, seek information about experiences with bias, racism, sexism, at hospitals; i.e., there are data that talk about the experiences that black women have at hospitals related to bias, racism, and sexism. How can we as an institution I'm thinking begin to gather some of that information and share it? What would be a way that we could share about black women's, black folks' experiences at hospital with bias, racism, and sexism?

>> Yeah, so I guess I'm not sure that, and maybe it is true that black women get more of their information from hospitals, you know, I think these days we get information from everywhere, including, you know, unfortunately from websites that actually probably [inaudible], and so I think that in general we need to figure out what are bright unbiased evidence based sources of information, the CDC being one, but there's a variety of them, and I think the more we have messengers that people can trust, back to our issue of trust, and, you know, how do we work through, you know, whatever the organizations are that people are most trusting of, you know, whether it's your church, whether it's your sorority, whether it's, you know, your civic organization, I think we, you know, again to the message of how do we use public health into the major [inaudible] of our society, so that people are hearing messages in different ways? Because we all know that everyone needs different messages, different messengers, and that we need to hear things several times. I still think of the times when I interact with the health system myself personally. And I'm a trained physician. Somebody mumbled some information to me about, you know, [inaudible], and then I get home and I'm like scratching my head saying, now, what did they say? And if I have that experience of, now, did they say I'll go through this two times, and they say I'll go through it three times, exactly how was I supposed to? If I have that confusion, you know that people who are untrained and don't understand biology are having that ultimately. So, if the question is that our health systems are doing a bad job of health education, I would wholeheartedly agree. And, again, I think that's where, you know, some of the community based organizations, and other can be so important. I just think, again, our experience with HIV/AIDS, and how important it was that, you know, messages were given in barber and beauty supply shops, you know, places that people work, we educated those people to be health educators so that the only interaction that you get around your health and wellness was not at a place that only had two minutes to give you instructions.

>> All right, great. Thank you. Dr. Mermin, did you want to add anything?

>> Only that I hope that the knowledge and kind of, can be tied with action, so that if we do identify these problems, we fix them. And we've had some successes, some of our programs in funding, where we actually allow and even encourage those kind of changes so that you know either, you know, you know of a friendly clinic or a friendly place where you will be welcomed. And a provider who is, you know, positively engaging to all communities. And I think that can be very helpful too.

>> Great. Okay, I'm going to take one more from the audience, and then we'll come back. This is, how can we intentionally integrate and incorporate health equity and other DEI initiatives into health programs and organizations? And the question is what I've seen over the last few years, especially with social justice reckoning since George Floyd, has become a checkbox for some organization when it comes to DEI work. The DEI health equity should be what we do as a community organization and an individual. So, understanding that tools, resources, investments, training and time are some ways we best integrate these efforts. So, the question was how can we intentionally integrate and incorporate health equity and other DEI initiatives into health programs and organizations? And I guess I'll start with you, Dr. Mermin.

>> I think we have to treat it seriously. Once you realize that part of getting the public health job done is reducing inequity, then you pull in all the, all the knowledge, science, you know, program, procedures, change your administrative procedures, do what you need to do, because that's the goal, just like it used to be to prevent COVID, or to prevent salmonella infections, or in our case to prevent STDs, you are actually, you have to use your, all the skills, all the teamwork, and focus on that and an important outcome. The other is something that I think you have led Dr. McCree with Captain Burton is in the center is really embedding this conceptual framework into how we work on a day to day basis, and incorporating, what I think the question incorporated DEI, which is like my workforce, how am I, how are we treating people, how are we creating a supportive and inclusive environment that is allowing all of us to flourish, that's tied in with how well we do externally. And I think if we do both of those things, we can, we can succeed. But it also is having leaders who care. If you're going to hit your head against a wall if you don't have someone who cares, and you can have someone else hold them accountable, make sure that we have measures that monitor whether we're successful, whether it's public health measures or other kind of internal workforce measures. You know, I think in this society, we will never be perfect, just like any country I've lived in, they're never going to be perfect. There's going to be discriminatory practices, and there's going to be injustice. But we want to lesson it as absolutely much as possible. That's our goal.

>> Great. Dr. Gayle, did you want to add anything?

>> Not to add. I would just say ditto. And I do think, you know, the importance of measuring and holding ourselves accountable, you know, what gets measured gets done, as people say. And so, you know, to the questioner's point, it is about intentionality. And if you're intentional, just like anything else, you can get it done. So  

>> Okay, yeah. And, you know, building on that, and I'll just answer this, and this is from a former Ferguson fellow, talking about the current environment that's resulted in this renewed focus on health equity, and those of us that have been doing this a long time knows that, you know, there's the ebb and flow where you don't necessarily. How do we keep the momentum going to keep health equity as a priority once we return to a normal environment? And that's how it's described in the question. How do we, how do we keep this momentum going, keep health equity as a priority?

>> Well, you know, I would just say, think of it as analogous to how the business community is thinking about sustainability, DEI, social issues, health professionals, and public health professionals. If we want to impact our bottom line, if you will, which is making sure that, you know, we have improved health outcomes in this nation, we can't do it without addressing these issues, you know, we just will not. The reason that we have one of the highest maternal mortality rates in the industrialized world is because of our wide gaps and the disparity. So, if we want to improve any of our health outcomes, we've got to address, you know, the issue of health disparities. And, therefore, we put into place all the things that, you know, Dr. Mermin talked about that are critical if we're going to have an impact on health disparities.

>> Right. Dr. Mermin, did you want to add anything to that?

>> I'm with her.

>> Okay. All right. What key partnerships do you think we need to advance equity when we talk about policy programs and economic development? What are the key partnerships that we need to really advance equity? And I'll go with you, Dr. Mermin.

>> You know, I think we've touched on some of them. You know, it's thinking carefully about which partnerships are going to lead us to the outcomes that we want. And sometimes they're not always the easiest or the ones you immediately think about. So, one, I mean, you need federal agencies to do the right stuff. Congress needs to be a partner. You know, we need to be able to engage at the highest levels. Not just to convince people about things, but to tactically figure out what's going to be the most effective ways of moving forward. We need our health departments, and, you know, state legislatures and local health departments and legislatures. And we need communities. I mean, whatever that is, and communities vary and intersect and everything, but we need those organizations need communications. And I think it's been a big gap for us in public health and CDC is that we haven't been able to stay on top of the use of digital media and communications and microinfluencing and large scale influencing in a way that industry has. And that's left us behind. And, you know, I was struck by the example that during a certain period of the COVID epidemic, someone did an analysis of Facebook and found that 50% of the misinformation related to COVID was coming from 14 Facebook accounts. So, you're assuming, well, what about reversing that and making it positive? Can we, as public health, essentially use this as a way of reaching people and improving public health and decreasing inequities? And I would say that the monkey pox response that's been happening now has been in many ways a success story in terms of getting information out through the digital streams and methods that people who are currently at risk for monkey pox are using.

>> Great. Dr. Gayle, did you want to add?

>> You know, I just think we have to keep thinking about the fact that, you know, so many of the solutions are not necessarily within one agency. And I think, you know, both, as Dr. Mermin said, federal to local, you know, some vertical as well as horizontal, if you will, you know, thinking about all these systems, how do they interact, and I think, you know, continuing to think about what are the key other drivers, you know, housing, education, et cetera, that could also have an impact in making sure we have those kinds of partnerships as well?

>> Right. Okay, and, again, we have some really wonderful questions from our audience. And some of them I'll just share again. Dr. Gayle, congratulating you on being the president of Spelman College. Next [inaudible] we have a live individual source saying they're either, they're Spelman alum, and are looking forward to sort of having you onboard. There are some questions that, again, we'll share these with you about the costs of higher education, and the need to sort of thinking about public health loan forgiveness, and whether or not that's helpful to the public health workforce. And there are questions around medical schools and institutions that educate public health professionals preparing their students to be more productive contributors to the solution. There are several there. And research programs that motivate powerful people to really prioritize socially and economic environmental benefits and sharing some of the feedback. And then there's a question, I think this is a great one, about incorporating global policies into our current public health practice. And the bioethical implications of some of those studies that came from a former IMHOTEP student. And the need to really address early career professionals and assisting them with mentoring and meditating on long term goals, careers, and how do you kind of get through feeling sort of overwhelmed when you're doing those types of things, they're asking really questions about, you know, sort of being able to prioritize and move forward in your plans for the future in terms of your career. And I would like to ask this one live. When you move into these cross disciplinary, multiinstitutional collaborations, and you bring public health into an economic development and education, how do you set a baseline understanding and common language to achieve common goals through different approaches? So, how do you really work with all of these different institutions, different disciplines, you know, towards achieving health equity. How do you really set a baseline understanding and sort of common language? So, let's answer, ask that one.

>> Yeah, I don't know that there's, you know, one right answer. I think, you know, partnership and collaboration takes time. And I think we often think, you know, we throw around these buzzwords of collaboration and partnership and integration. And we do it with the same staff who have other things on their plate. I think that the only way that collaboration happens is that you resource it appropriately so that, in fact, people have the time to get to know each other, people have the time to discover what their shared values and shared objectives are. And without that, you know, you end up potentially going to a lot of meetings that are, that put a burden on your schedule but don't accomplish anything. So, I just think if we're going to think about doing things in a different way, in a more integrated way, we have to resource it appropriately and make sure that people have the time they need to actually make those partnerships a reality.

>> Dr. Mermin?

>> I agree completely. I think another kind of tactical tool is to bring people together and get the job done is to set a goal that forces people to do that. Like, you know, health in all strategies, for example. So, if you're the Department of Labor, or, you know, the housing of urban development, you're kind of forced to think about the influence on health. You have to think about how I can improve the health of the people receiving the services which I'm providing, or provide my services to people in a different way, or to different people, so that those can be implemented. And so in a way if at the top you come together, figure out one thing that you would like to get done, bring partners together, and then have assigned kind of very simple understandable tasks, I think that can be successful too.

>> Yeah, totally want to just emphasize, you know, the tangibility, because oftentimes you think of these things in these grand conceptual, and don't bring it down to like what's the two or three things we can all agree on, and set those goals and targets, and then set the metrics so that we're actually, you know, evaluating and holding ourselves accountable.

>> Great. I have two more questions. This one, since both of you are physicians, I think would be, is a great one. And this is from a student at the, on the Morehouse Project IMHOTEP Program. And he asked Dr. Gayle and Dr. Mermin as well, both of you are physicians, so what current barriers do you feel have been the most influential in the disconnect between public health and clinical care? Barriers that you see have been the most influential in sort of  and this is, there is the disconnect between public health and clinical care. Anyone want to go first there?

>> If it's okay, I'll put out two. I don't know which one. I haven't done a careful analysis. I've assigned a team to do that. And then they would come back with some great advice. But I would say there are a couple things. So, one is the hodgepodge of insurance and coverage and lack thereof, it still exists in this country, makes it hard for us to provide preventive care and good, you know, equitable care as clinicians. It's just, it's harder to access things. We, I was presenting earlier today to a group of state legislators, and one of the topics that really came up for them as particularly painful from health and justice standpoint was Hepatitis C treatment. Hepatitis C treatment, which is, it's curative in 8 to 12 weeks. All oral therapy. Yet there are restrictions in place from insurers that range from requiring GI docs or infectious disease docs to treat you, saying that you, that you have to have severe disease before you can get treated, even though it's shown that that hurts people, and leads to higher rates of severe disease and mortality, all of that is put into place, and so we have to remove those systems, even in the hodgepodge, that create an environment of injustice. And I think that's hard. The other, I would say, just as a physician, is that it's really hard to be a doctor right now. There's extraordinary pressures of the healthcare industry to see patients very quickly, and to essentially save money. And so what happens is doctors don't have the time to set the relationships with the patients to be able to get that extra moment where you can find out something that the patient may be uncomfortable talking to you about, to do a sexual history, to really develop the relationship so that in the long run you are providing the public health, or, you know, the preventive care issues that you want, that doesn't happen. So, systems change I think is a lot of what could move us forward.

>> Yeah. Okay, great. Dr. Gayle?

>> Well, I would just, you know, echo, I think that the bridge of preventive health to public health is important. And because there's no financial incentives for preventive health in a clinical setting, you know, that bridge between individual medicine and population health never really seems to be made. I also think that public health could, needs to continue to do a better job of explaining the benefits of public health. You know, we do our jobs well, nothing helps, you know, we are the quintessential non event, if you will, if we're successful in public health. In individual medicine, you have somebody who's ill who is totally, you know, kind of incentivized to get treatment. And I think we need to do a better job of demonstrating why the absence of disease is as important to benefit as curing somebody when they have a disease. And so I think there's just a lot more we need to do. And if we can elevate public health in people's mind, I think we'll also have a better opportunity to integrate individual care with public health and public health system. And, again, I think, you know, the payment issues are incredibly important as well.

>> Right. Thank you. And here's a question from a Columbia club scholar, 2013, and a current DRPH candidate at Morgan State, focusing on HVC or black women's uptake on prep. And this question is for both of you, and it is as we think about sustainable solutions, and the need for increased diversity, equity, and inclusion, how can we continue to give those that look like the epidemics we are trying to address positions of leadership, change, and power. So, Dr. Mermin?

>> Well, I think, Dr. McCree, as you know, that's been a strong effort within our center. And we've had some success. We just did an analysis internally that looked at our workforce. And as Dr. Gayle mentioned, what gets measured gets done. So, we've shown a 20% increase in racial and ethnic minority staff over the past decade. We already are over 50% of our staff are racial and ethnic minorities. And we've seen that that's, you know, we have increased the proportion and the higher GS levels, but we have not reached the levels that we would like, particularly at the GS 15 level. But then we also did a survey of, with staff about sexual orientation and gender identity, and we found that 18% of our staff are LGBTQ and that, and that it is completely even across GS levels, so people are being, you know, either promoted or hired through what appears to be, you know, a method that is non discriminatory. So, I think continuing to, for that particular factor, but I think continuing to look at these data, to improve where you need to improve, and there is one, you know, large gap we have, which is with Hispanic and Latino employees, where it's about 4%, which is well below where we should be. And to try to change the system in human resources and outreach and recruitment and selection and all the processes that needs to happen so that we can do that over time, and treat it as urgently as it really is. It's an urgent issue. And so I think we've had some success, not enough, and maybe that honesty also comes into play. But I think that it's really important that that becomes a priority, and that people use their creativity to think about how we can get this done. And I also think that relates to one of the other questions about, about increasing racial and ethnic minority physicians in America, and how do we, how do we get that, how do we do that, well, that's been a long, long understood as an issue that would benefit the nation's health if we could fix, but hasn't happened. And so I think hopefully the same kind of approaches can be made with regard to that. And understanding some of the factors that Dr. Gayle has highlighted, which is, a lot of is economic and the structures of higher education, and what does it mean to be able to access all of the education, and other kind of social and economic determinants from childhood, so that we don't have these disparities when we, when we measure them at the, you know, the physician level.

>> Great. Dr. Gayle, anything you want to add?

>> We've got lots of questions. Yeah.

>> And we won't get to the 47 questions that we have in our Q&A, which is wonderful to have such an engaged audience, but let us close out with just this one in terms of the fact that we're living in a world shaped by all of our collective experiences with COVID 19. And we know, we know that it has changed, or exacerbated, or shone a light on the disparities that we see. And I guess I'm going to ask, what are some of the similarities and differences between the COVID 19 response and the HIV response, as you both were a part of that, and some of the lessons you learned in terms of lessons learned for advancing equity when you think about those similarities, those differences, and some of the lessons that we learned?

>> COVID 19 resulted in a whole government and whole society response within weeks. HIV took years. But misinformation, fear, and politicization of public health occurred for both epidemics. In the beginning of each, we were unaware of exactly how each pathogen was transmitted. And we made errors. However, with COVID 19, public health communications tried to avoid stigmatizing persons who had COVID 19. And I think that was generally effective. That was not the case for HIV. So, our response to monkey pox has been more similar to COVID 19. And I think we've learned from that experience. It's generally careful and informed. And I think that's a sign that the public health and this agency are thinking carefully about those facts. But we are still dealing with the ramifications and current stigma and discrimination related to HIV that I don't, I don't think we've seen with COVID 19. And I think learning about that, and how we can both do the things we did with COVID 19 wrong better next time, but also the things we did with HIV, not repeat the mistakes, and to repeat the good things.

>> Yeah. Dr. Gayle.

>> Yeah, I would agree with that. We responded a lot more rapidly. And I think we learned some of the lessons from HIV, and addressing the HIV pandemic, and perhaps we're more attuned to some of the disparities earlier on. But I also think, you know, there are differences, you know, there is a difference between a sexually transmitted disease and a respiratory transmitted disease. And so, you know, I think it says to us, you know, we've got to think about health in an unbiased way. It doesn't matter how one contracts a disease. We are dedicated to reducing the health burden on populations across the board, particularly populations that are oftentimes the most impacted. So, I just think, you know, how do we think about health in a broader context? How do we think about it in a non stigmatizing way so that everyone gets the help that they need? And, you know, I just think there's lots of lessons, both in terms of the similarities, but also in terms of differences. I would just, one other, if you allow me, I saw one of the questions around the issue of reparations, and I just wanted to address that, because I think, you know, it's an ongoing topic. And as I think about these broader ways in which we think about society, you know, I think we have to start having bold conversations about how do we think about the biggest barriers to people's health and well being, and are there ways of addressing it? I just did an op ed on reparations, and talked about reparations as an investment in our future. And not thinking about it as, you know, are we advantaging one group over the other. We know that we cannot, without bold action, address some of these disparities that have existed for not just decades, but centuries now. And that if you compound the disadvantages and obstacles that have been put in the path of groups within our society, we cannot get to an equal society without thinking creatively about big, broad solutions. So, while, you know, I don't think anybody has the exact answer, I think we have to push ourselves to be bolder if we're going to have the kind of impact that we want. And just finally, I want to say thanks to everybody who has congratulated me on my next step. And I look forward to rejoining the Atlanta community before very long.

>> Yes. And thanks to both of you for a wonderful discussion. Very thought provoking. We learned a lot about what needs to be done in order to advance equity. We talked a lot about making sure that we focus on the drivers rather than the markers. And that the approach will take multidisciplinary partnerships. And we'll need to involve the communities that we serve and need to engage and hear the voices of the communities that we serve. And we need to create efforts that are going to be sustainable. Whatever we do now during this time where health equity is a focus area, we can plant those seeds that will grow into a sustainable effort. Policies, programs, strategies, to help us achieve health equity in the work that we do. And thank you for your more than 40 years of service in this area. And I think that the fact that we have these 50 questions here is a testimony to how important it is for us to continue this conversation. So, want to thank both of you for just an outstanding discussion. We will do our best, audience, to sort of answer some of these questions, typing them, and to get back on to thank those who joined us here, as well as those on Facebook Live. And now we, next slide to have a very special presentation, if we could do that, Dr. Gayle, we had a wonderful gift for you. It did arrive. It should have arrived. Which is a clock that's nicely engraved on behalf of our team here. And just to recognize and thank you for spending this time with us. And because your service is timeless. So, I know your assistants should have the gift.

>> Oh, that's this box.

>> That's the box.

>> The box that she told me not to open until today.

>> That's the box that he told you not to open until today. We hope you'll share it with our audience. It is just to recognize your timeless service in this work, and the importance of what's done. And to tell you that the clock is still ticking, and there's still much to be done.

>> How beautiful.

>> Yeah.

>> Oh, thank you.

>> Thank you.

>> Thank you.

>> Thank you for being with us. That's on behalf of us here to thank you. And looking forward to having you back in Atlanta.

>> And so just to say to the audience, the Dr. William Bill Jenkins health equity lecture, a man worth remembering, work worth continuing.

>> Yes.

>> Couldn't be better said than that. So, thank you.

>> Thank you. Thank you. And now I have the pleasure to turn it over to Dr. Darren Burton, who's going to close us out on this history day. Dr. Burton.

>> Thank you, Dr. McCree, for that introduction. And thank you, Dr. Rowley, Dr. Gayle, and Admiral Mermin, for all of your insightful comments. This event has been a wonderful opportunity to reflect on the need for long term commitment to achieving equity, as exemplified by the life and work of Dr. Bill Jenkins and many others, including those represented here today. I would like to conclude with a few summary lessons from today's discussion, and a brief description of how CDC's National Center for HIV, Viral Hepatitis, STD and TB Prevention is putting these lessons into practice. Today, we've heard that achieving equity will require change at multiple levels. From individual decisions to learn about the history and current landscape of social and structural factors that drive health inequities, and to seek opportunities to oppose those forces in our daily lives at work. To community organizing, whether that be in neighborhoods or professional settings, to harness our collective wisdom, skills, and agency to drive equitable change. To the commitments of large and small organizations, to reexamine their operations from the perspective of equity, and to consciously implement strategies to infuse justice into their organizational DNA. And all the way to large scale policy changes to combat racism, stigma, and discrimination, and to achieve equitable distribution of health promoting social determinants. We've also heard that doing this work requires creativity and persistence, as the best path forward is not always obvious, and the road of progress is likely to include some setbacks along the way. And despite the scale of the challenges and the complexity of the endeavor to achieve health equity, we've also heard a strong message of hope today. Collectively, we have made a difference. And we will continue to bring just change to our communities, our workplaces, our nation, and the world. As one example, I'd like to describe efforts by our national center to foster equity within our organization. And to achieve health equity for the populations we serve through what we call the NCHHSTP equity initiative. In spring 2019, NCHHSTP began looking for ways to create a shared understanding and long term mission for advancing equity across our center. A small planning team explored strategies and trainings that could be offered to all staff on the root causes of health inequities, racism, and awareness of the experiences faced by sexual and gender minority populations. As part of this process, NCHHSTP also conducted site visits and consulted with state and local health departments, such as the New York City and Chicago Departments of Health, that had implemented their own equity initiatives, and we're seeing positive impacts on organizational change, and improved strategies for achieving health equity. These real world examples further inspired us to move toward a more wholistic, fundamental, organizational change, to address equity comprehensively within our organization, and to bake equity into all that we do. After two years of planning, our center formally launched the NCHHSTP equity initiative in February of 2021. This initiative connects our existing equity activities, supports the identification of additional opportunities to embed equity as a workplace operations, and public health programs, and includes a detailed implementation plan. The NCHHSTP equity initiative is a transformational, long term strategy, to help us achieve equity within our workplace, and eliminate health disparities by addressing racism and other systems of oppression that hinder our center's mission. Although our center has worked for many years to advance equity, this initiative is breaking new ground by intentionally and systematically integrating equity into everything we do, by focusing in three areas. First, ensuring the workplace culture that is inclusive, collaborative, and anti racist. And one that encourages all staff to engage in dialogue about racism and other systems of oppression. Second, establishing workplace practices and policies that further increase diversity, ensure fair and equitable opportunities for advancement, and eliminate discrimination. And third, refining our systems and processes for designing, funding, and evaluating research, programs, policy, and partnerships, to ensure they are intentionally, systematically, and consistently focused on addressing the social and structural causes of health inequities. Within each of these focus areas, the equity initiative implementation plan has goals that are supported by objectives and activities, each with responsible parties, target completion dates, and metrics of success. The equity initiative builds on decades of successful work by NCHHSTP staff, our partners, and advocates, gives us a strong foundation of proven strategies and bold ideas to advance equity and eliminate health disparities. The NCHHSTP equity initiative is, of course, just one example of organizational change efforts to advance equity. And I'm sure that there are many other examples represented among our participants and attendees at today's event. And I hope there will be more such efforts sparked by today's lecture. I personally take tremendous inspiration from today's discussions, and would like to exhort all of us who endeavor to achieve health equity. Be bold and innovative, aiming for systemic change. Be inclusive and build community for this work, which requires diverse perspectives and approaches, and the shared energy of a social movement. And be resilient, and commit to a posture of hope, knowing that the arc of the moral universe is long, but it bends toward justice. Let us all be part of that bend. In closing, I would like to thank the many participants and contributors to today's successful lecture event. Dr. Helene Gayle, Dr. Diane Rowley, Admiral Jonathan Mermin, Ms. Ati Kazari [phonetic], NCHHSTP's Office of Health Equity staff, including Dr. Donna Hubbard McCree, Dr. Renel Miles [phonetic], Dr. Merel Marlo [phonetic], Mr. Greg Batista, and Dr. Terica Barnum [phonetic]. And our [inaudible] colleagues, Robin Lobe and Reed Walton. And thank you to all who have listened and participated in today's event. We appreciate your engagement, your passion, your ideas, and your questions. Thank you again. This concludes our event.