Everyone, thank you for coming and welcome to our Health Equity round table with mayor Pete Buttigieg. Wed like to welcome everyone to Nicholtown Baptist church and were so happy that all of you are here today. As we all know, leading up to saturdays primary, that Health Equity and health care is a major issue throughout South Carolina, but predominantly in our africanamerican communities. And we have gathered together an esteemed panel to come here today and discuss this with mayor Pete Buttigieg. It has his plans and vision regarding Health Equity for the africanamerican community, if he and when he becomes president of the united states. So again, were very thankful for you to be here. We are going to go around our panel and have everyone take 30 seconds to a minute to introduce themselves, who they are, what they do and why they are here. So we would like to start with the young lady at the end and we will work our way around. My name is alicia edmund. Im a 15year health care professional. I was a health care executive. I have lived in various areas of the country and as i relocated here to greenville and this area, its undergoing a lot of change. I have a strong interest as i built my family here and grow within my career here as to how the politics will affect the community that i will live and work in. My name is javetis. Im here on behalf of the Community Group. We are a community of young africanamerican male professionals who give back to lowincome communities by mentorship and a lot of that focuses around Health Care Initiatives as far as obesity, exercise, things of that nature. So im super excited to have a seat at the table to see whats going to be done for our youth to make sure that were able to have part in Health Care Equity that were talking about and discussing today. Happy thursday, everybody. My name is stephanie. I always like to say, im the face and the voice out here in the community trying to help, to educate our people. Im very excited to be a part of this Health Equality round table discussion to really bring some of those questions to the forefront that do affect us in our black and brown communities. Im a radio personality. People always ask me all the time what i do. I say i do business. Thats a plethora of different things. Im honored to be here today. Hi, everyone. My name is alicia. I serve on the laurence city council and chair of the laurence democratic party. Also c. E. O. Of Sullivan Health care which is a Health Care Contracting service specifically to thank contracts that contracts to Different Health care facilities. Im here as well to see how we can talk more about creating more Health Equity in the community. Hello. I am tracy. I am the owner of blue realty and associates, as well as coowner of hssb home care. Im excited as well to be here as a Small Business owner and entrepreneur and health professional. Today i want to hear more specifically the things you plan to address during this election. Hey, good afternoon. My name is jessica. I work at the ymca but i also have a Consulting Company where i work primarily with educators and i teach folks about the impact of poverty and trauma on the brain. And i work with a variety of young people who are experiencing poverty and trauma and so im excited to talk more about how we can support them. Good afternoon. My name is dr. Frank clark. I am a psychiatrist who practices in greenville, South Carolina. Decided to be excited to be here to advocate not only for our profession but also our patients, as Mental Health disparities are something that i see day in and day out. Thank you for being here. Hi, my name is caroline. I am the c. E. O. And executive director of new mind health and care. Which is a Behavioral Health program that specifically deals with people who are returning from incarceration or families that have been affected by the criminal justice system. There are a lot of trauma, theres a lot of need for juvenile Mental Health. Theres a lot of need for reentry Mental Health and behavior modification that is not covered by any expanded medicaid. I am also the Vice President of upstate pride, where i advocate for lgbtqplus folks. We are two very narge nalized populations that are in need marginalized populations that are need of health equities. Im very interested to hear how the plan will address those. Jalen thank you for being here. I am the first vice chair of the greenville democratic party. I have the blessing of being here, able to moderate this great discussion. Like for the mayor to open up with a few words and get right to it. Pete sounds good. Thank you for moderating and thanks to everybody for being part of this event. I think this is a really excellent combination of insights and experiences to bring to bear. Ill try to be fairly brief in presenting what we envision as part of the campaign because i think this would also be a Good Opportunity to get a sense of your stories, those you serve, the priorities that you have seen emerge and since weve brought a few friends along with cameras, its a chance, i think, very literally to shine a light on some of the struggles, but also some of the solutions that you have seen and that you have pursued. My hope is that well be able to illuminate how different and better president ial leadership would be supportive of the work that youre doing. One of the themes that youll see across all of our policy work, but especially when it comes to Health Equity, is the belief that not all of the answers have to come from washington. But more of the funding should. Because we see a lot of work that is happening at the local level or at the regional level where solutions are being developed. Especially when it comes to Health Inequities that need to have more of a wind at your back in the form of resources. But that we need to really tailer in a way thats going to make sense on the ground. I was reviewing some of the statistics of the challenges that you all are dealing with specific to South Carolina. A state that has the ninth highest mortality rate for women and that is something that we know here and also across the country is three times as likely to occur for black women as for white patients. Here in South Carolina, the seventh in the nation for adults with diabetes. It is now the case of approximately one in six africanamericans residing in the state are living with diabetes. We know from hivaids data that the majority of new diagnoses are in the africanamerican community. Many of these issues, i know, are very close to home here. As in different ways theyve been close to home for us in the community that i served as mayor for two terms. A community where we saw the effects of violence and trauma and the need for care that is informed by understanding adverse childhood experiences. Where a lot of these challenges of reentry were at stake. Where also there are a lot of Creative Solutions like the partnership with 100 black men that had nurses in barbershops finding men a little more willing there to, for example, be part of screening for diabetes than they were in a clinical environment. These were exactly the kind of local collaborations i think that we need to do a better job of supporting. And funding. At the federal level. So part of what weve proposed in the context of the Frederick Douglass plan, to dismantle the effects of systemic racial inequality in the country, is a real focus on intentionally dismantling the Health Inequities. That means within the first 100 days steak a national Health Equity task force that will specifically map out where these inequities are sharpest. It also means creating and investing in what were calling Health Equity zones. Again, this is an example of where that will be defined and decided by local partnerships. Local government, nonprofits, community leaders. But should have federal funding to help design a strategy and then make sure that strategy can develop with support from the department of health and human services. I believe that we can act to end the h. I. V. Aids epidemic by 2030. That we can tackle a diabetes epidemic that has been heading in the wrong direction in many ways in many communities. And that we can end this crisis of Maternal Mortality in a country that is lagging behind almost all developed nations, especially for the experience of black and other minority women. We also need to make sure, excuse me, i have my own Health Moment here. We also need to make sure that were investing in the profession. Part of whats driving, we know, the issues around Health Equity, things like the Maternal Mortality gap, is that theres often a lack of cultural competency. And there is bias. Explicit and implicit in the system. That means training our Health Work Force to be antiracist and to combat these kinds of bias in the clinical environment. It also means simply recruiting and empowering more clinical professions professionals who come from the very communities that have been excluded. So when we talk in other areas of the douglas plan about things like investing in hbcus, for example, its not just out of a regard for hbcus and the work that they do, but also out of the knowledge that a next generation of africanamerican doctors, nurses and researchers need to be supported so that we can close the disparities in who is represented among the Decision Makers and the practitioners. Knowing that that builtin cultural competency will lead to Better Outcomes at the clinical level. I also think that we need to recognize that health is not only the job of the department of health and human services. That, for example, when we look criminal Justice Reform and deincarceration, that influences health. For those dealing with Substance Abuse or Mental Health challenges, which is a huge proportion of those who are incarcerated, that that makes it that much harder to get continuity of care. When were talking about housing. Housing is ininseparable from concerns of health. We saw it in our community, for example, with the challenge of lead poisoning. Im pleased to say that the water is not the problem where i live. I was the mayor, i was in charge of the water, we saw to it that the water was good. But we had terrible problems with lead poisoning because the houses themselves, in lowincome families and older neighbors neighborhoods, where houses were built before the ban on lead paint, were the most likely to show up to high exposure to lead. These, of course, were also the neighborhoods where people were disproportionately red lined into. And so if were talking about things like housing desegregation, that is also a Public Health issue. So my point is that there will need to be an office of Health Equity injustice, not only in health and human services, but this needs to be in the considerations of d. O. J. , this needs to be in the considerations of h. U. D. And every department that is working on things that e. P. A. That ultimately reflect on Public Health. Coverage is important. I think that coverage is probably dominated the debate a little bit disproportionately so i dont want to dwell on it too long. But i do believe it is necessary to ensure that everybody can get covered. Thats the idea of the medicare for all strategy that we favor. That everybody would have access to a quality public plan. If its lowincome folks, then it will be subsidized so they dont pay anything out of pocket. As your income rises, we still make sure that its never more than 8. 5 of anybodys income to pay for premiums to get on an excellent plan. And i believe that we need to establish monthly outofpocket caps on how much somebody can have to spend on prescription drugs. The reason it has to be monthly is right now, even if you have insurance, a lot of times you have a yearly cap. And you see people delaying coverage or delaying filling in a prescription or getting a procedure so that they hit it in the right month. Which makes no sense medically. Of course most of us dont experience the economy on a yearly basis. The bills come in every month. So i think the outofpocket caps should be monthly too. I want to make a conings mention a couple other things that i think are impacting south carolinians in tick and need to be addressed through an equity lens. One is environmental justice. So 56 of africanamerican residents in South Carolina are in the same census tract as a superfund site. This points to the need, first of all toirnings crease the funding to clean up superfund sites, but also to look at how housing segregation has played a role in sending families into areas where they are made vulnerable to Health Issues simply by where they live. And then you layer on issues of contamination with things like food deserts, even exercise deserts. If theres not a place where a parent knows they can take a child to play that is safe. This too is a question of Public Health. The other thing i would point to is the need to support small water utilities. I know what the community of denmark has been up against and not the only one. Where there havent been the resources for lower income communities to be certain of access to clean, safe drinking water. So im proposing as part of our trilliondollar vision for Infrastructure Investment that there be a dedicated fund for supporting communities that are trying to enhance their Water Infrastructure to deal with these issues. So i could go on but im going to stop here because hopefully that gives you a flavor for the kind of interventions that i believe we can undertake. Its all based on this philosophy that weve got to start thinking about politics and government first and foremost in terms how it affects everyday life. The biggest impacts on everyday life are for those who have often been most directly excluded by policy in the past. And now is our chance to get it right. So having laid down some of those markers, im very eager to get into a conversation and learn more about what is impacting the people you serve, answer any questions i can about our vision and gather any input on how we can make it more tailored than ever to the work that youre doing. [indiscernible] [laughter] jalen i like the eagerness. What i was going to say was, everyone on the panel, i probably have the least amount of health care background. So im really interested to hear how the conversation is going to go and to learn what everyone has to say to really hear about everyones experiences and hear their questions. Since you seem very eager to ask the first one, were definitely going to throw it to you first. [laughter] i thought about it because for a years years i served as a marketer director for new Horizons Community health services. We talk about making these medicare for all that would want it. But my concern would really be, we can make it available for them and even make it free, but them having access to get there is a concern. So i really want to know how can that piece intertwine with the plan for the medicare for all or even if its free, i mean, you know, how can we, feern you being a president , say this could be inclusive with making sure were going to have this available for them, how do we make sure they can get there to make those appointments . Pete its a great point. Theres so much in the sizzle of the debate of getting everybody insured, but what good does it do you if you cant get to a provider . If you dont have the transportation to travel to a provider. Or if the providers in your area are closing. Whether were talking about the federally qualified Health Centers which are doing such a remarkable job but are clearly underresourced. Whether were talking about the closure of rural he is talking about the closure of rural facilities. By the way, one thing that rural facilities that have closed have in common, its in states that refuse to fully expand medicaid. So its something that deserves to be raised at a time when you have a president who i think claims to be caring about Rural America and were not really seeing that. The provider shortage, i think, theres two things. Theres a shortage of providers and theres this transportation issue. The provider shortage is why its not enough to just create medicare for all who want. It we also have to set reimbursement rates that encourage people to go into underserved areas and encourage people to go into areas of practice where theres not enough people to do it and in particular i think thats true of Mental Health. Where we are seeing another great thing is they have done often a remarkable job of having primary care and Mental Health care right alongside each other. Its not just about physically locating them next to each other. But that sure helps when youre trying to integrate them. I also believe that Health Funding has to include transportation funding because we have to make it possible for people to actually access what they need. So part of the funding were proposing in rural health in particular is to address that issue. Otherwise youre right. You might be insured but it doesnt mean anything if youre ot able to get the care. Piggingbacking off of her question, one of the things we are being a part of the Community Group and even in my personal just daily professional life, like i work with a lot of physicians and medical professionals. One of the things that i think we dont talk about enough in our communities is that a lot of the issues arent, you know, you mentioned prison reentry. We have high population of prison reentry, diabetes, all of these things. But at the end of the day, theres i think all of these issues come back to economics. Theyre economic on two ends. On one end, when you think about the new horizons and the regenesis. I volunteered with both of those organizations. When you think about those organizations, the care givers there, the physicians there, the people that are serving there are forced to say, hey, if i want to do good to my community, i have to make half of what my contemporaries are making in a larger facility, a larger hospital space. So that is financial on one side. On the other side, we do have the transportation issues. When you talk about Health Care Equity, what does that really mean and how do we get to the bottom line issue from my perspective of there being a real economic and financial gap thats caught in this disparity . Its on both sides. From a provider standpoint and im sure youve heard a ton of it. A lot of people think your plan will quoteunquote cripple the Health Care System so to speak or get us to this place where we have one governMental Health care system. Like how do we combat that . Whats your response to that . Pete youre right. One of the things ive found, especially when were talking about racial inequities, everywhere from criminal justice to health, is it comes back to Economic Empowerment too. To the first side of the coin youre talking about, the side of those who go into the profession, its one of the reasons why i believe we need to true up these reimbursement rates and have a system that can tell the difference if youre providing for an underserved community. I also think when we do Public Service loan forgiveness, we should do that with you in mind. You work in Public Service, you get your Student Loans for given. But almost impossible to take advantage of. Most of the loans dont qualify, have to do 10 years straight before you get any benefit at all. So what i would do is make it more user friendly, more generous. And have a bigger sense of what counts as Public Service. If youre a Mental Health provider to an underserved community, i consider that Public Service, service, whether youre technically in the Public Sector or not, and i think that should qualify. Thats the first side of the coin your talking about. The other is the biggest youre talking about. The other is the Biggest Issue of all. I think we can learn a lot. Youll see that reflected in a lot of whats in the doug plass plan on the economics side. Its everything from big business, making sure that when were talking about fund management, for example, for pension funds, federal oversight, where billions of dollars are moving, can more of that be in minorityowned business . All the way through to the medium sized enterprise where im proposing we set a 25 goal for federal purchasing to reflect the communities that have been underserved or you might say underestimated in terms of their amount too ability to do business with the federal government. All the way through to recognizing that, ok, thats great, but not everybodys going to go start a business. So just the basics of wages. What could be worse for your health than poverty . And raising the minimum wage, for example. Extending access to union rights, to categories that have been historically ex cluesed excluded. Whether were talking about domestic workers, direct care workers, which were going to need a lot more of, as the population is aging. Gig workers. If youre doing a gig, you are doing work, that makes you a worker and you have to have labor protections. Fast food workers. We were in charleston marching with workers there, trying to get 15 in a union there. And weve got to make sure, and we know this disproportionately affects black and other minority workers. So all through the spectrum. Weve got to be intentional about this. And the way i explained this to majority audiences is that this is not about doing anybody a favor. This is about fixing something that was broken on purpose and wont be fixed without intention. Because if you save 1, that counts over time, right . Compounds over time, right . On into your descendents and through the generations. So if thats true of the value of a dollar that is saved, then thats true of the value of a dollar that is stolen. What were seeing today in Health Outcomes is the effect of generational theft that has to be put right and thats why we have to have not just intentions of dollars going into remedy it. I have a question. Im going to piggyback again off of the access. Although your thought process, i guess, is to increase reimbursement and the monthly check. For hospitals, doctors offices, medical facilities that are not in a rural area, how are we to or how will you help us with maintaining the quality, right, and knowing that access is a huge portion of how we get paid in our reimbursements now . How is that going to help us while maintaining equality . And currently commit cal providers within the area clinical providers within the area, especially in the state, theres a lack of diversity. The Patient Panel within greenville is high minority. How do we or how do you plan to help build that cultural competence, because most of the providers who are teaching our up and coming students now are teaching from their current education state and not with how we would want them to treat our true population for the quality we want and they may have some biases. So how do we attack that thats currently happening within our area . Pete so ive got some thoughts and id welcome other ideas you might have too. Part of it, i think, is and this reaches back to the first half of your dwee in a way. How do we train the next generation of providers . If were going to increase reimbursements and maintain quality, were going to have to expand the profession. That means making sure we invest in more institutions being certified and qualified to train more professionals. And it means making sure that whether its through title ii or other offices that its done with a specific intent toward greater representation of racial minorities. The question of how bias gets passed down i think is a really important one. I think its become even more urgent now as technology plays more of a role because the other question is how bias tends to go automated. Theres a lot of evidence that without intention, in other words, without being intentional about reversing bias, the more things get automated, the more it can perpetuate those biases. Ill give you a simple example that was explained to me recently that i think is revealing. If you go into going translate and you type in the sentence Google Translate and type in a sentence, he is a d she is a nurse, and you doctor, she is a nurse, and you translate it into turkish that doesnt have any gender pronounce and you do the opposite, it comes back, he is a doctor, she is a nurse. At least it used to. Its not because somist programmer at google was some sexist programmer at google was saying only men should be doctors, the algorithm hailed whatever bias wauth was out there in language across the internet. And then reproduced it. So when we think about the different facts that are could be contributing to either detection gaps or inadequate service for black patients in clinical environments on everything from Mental Health to maternal health, can we use those same technologies to actually identify and exposes the biass . Because part of what we also have to do, i think, is in a way that doesnt arouse the defenseness that will happen when people defensiveness that will happen when people who are established in a certain profession are forced to call into question a certain way of doing things. We need to gagget ar body of evidence about gather a body of evidence about how these biases are working. Thats the kind of things the federal government should be doing. In addition to making sure that the next generation of clinical staff are just plain more diverse themselves. Thats where weve got to partner with hbcus. We have to partner with training programs. To look at the ways where underrepresentation of staff almost automatically means that there will be continued lamb of cultural competency lack of cultural competency. Those are things we think we can get a handle on. If there are other things you think will work, were eager to hear about that too. Mayor pete, 2020. [laughter] so i work with two marginalized populations. I work with people who have been previously incarcerated. And i work with the lgbtqplus community. So now im going speak to equity in both of those instances. With people who have been previously incarcerated, there is little to no medical health care provided. There is little to no Mental Health care provided. So when these men and women are coming out, and lets understand that 65 of the incarcerated population are brown people. So when theyre coming out to these communities, theyre coming out with diabetes and no medication, hypertension and no medication. Ill tell you about a client whose family was in my office yesterday, lost his leg while in prison to diabetes. Because of a lack of medication, while in prison. And hes being released with no cheel chair and wheelchair and no prosthetic. And so thats what were doing to our citizens and to our human beings. So when you talk about a lack of Health Equity, were talking far beyond what i think we really consider is there. We have a Mental Health care system here in South Carolina that is completely stressed. I know they just merged all of our centers but there was a sixmonth waiting list to see a sychiatrist. There need to be policies and legislation that cause a different flow. So as my president , how will you address that issue . Pete thats where weve got to look to the federal government to set a floor. What youre describing, i think, would be characterized in the International Environment as a Health Human Rights violation. Absolutely. Pete when were talking about the state assuming responsibility for somebody while incarcerated, theres a responsibility to make sure Something Like that cant happen. Let alone making sure when we have returning citizens, that we are lifting them up and making it possible for them to integrate and contribute as they would seek to do. This is why, again, things like the medicaid exclusion, while incarcerated, i believe, have to end. Then you have people who are living at the intersection of different vulnerabilities. Lgbtqplus, people of color who are also incarcerated, are among the most vulnerable people. And that means we have to have intention and policy specificity around how theyre going to be supported, given the health needs we know the population faces. These kind of delays youre describing for Mental Health care are something were seeing all across the country. And often, especially when were talking about Substance Use disorder, someones life depends on whether somebody can see them in relatively short order. And so in addition to dealing with a provider shortage, i think we need to create ultimately a rights framework and a liability framework that establishes a responsibility for making sure nobody can fall through the cracks. The younger people are, the more we see these vulnerables vulnerabilities really surface. If we really want to break the school to prison pipeline, for example, this is a good example of where somewhere in between the education side of it and the criminal legal system side of it is the health nexus. Because a lot of times this is about disability, its about Mental Health, trauma. And we have to bring that perspective to bear on whats going on. Because the other two systems, frankly, without a Health Perspective are going to be incapable of handling it. What i envision is a rights framework that sets the floor. But also a partnership for the organizations that are serving those who are in such need. To make sure that the resources are going toward for example, in order to meet the goal that ive laid out in decars rating the country by half deincarcerating country by half. Well solve one problem, but creating a new pressure which will be more returning citizens. And that means we will be doing a disservice to everybody if were not prepared for that. We cant do that with Public Sector agencies alone. We will have to make sure that the funding is flowing and that the Technical Assistance is there. So that the organizations that are already set up to do this kind of work can scale and expand when we really need it. Jalen guys, i hate to be the bearer of bad news. Ms. Caldwell had to be our last question. For this panel. We definitely want to say, we want to thank all of our panelists for coming here today and really shining a light on this issue of Health Equity, especially among our africanamerican communities. Definitely want to thank mayor Pete Buttigieg for coming. Youre in the nicholtown community. Its one of our historically africanamerican neighborhoods that we have here in the city of greenville that has been neglected in a myriad of ways. The fact that we could have this discussion at Nicholtown Baptist church in this community and really give voice to the polite of those who live here though, who are plight of those who live here, those who are still in poverty, those being jentified, is very heartening to know that someone gentryified, its very heartening to know that someone who is running for the highest office in the land would come here and continue to speak out about their plans and their vision for bettering the community. So we want to thank you for coming. Want to thank all of our panelists for coming and we want to see if the mayor had any final words that he wanted to give . Pete again, i want to thank everyone who has participated here and since we always hit up against time when were sitting down, we hope we can remain in contact with you through jalen and our Campaign Staff to make sure were continuing to gather ideas and respond to questions. I know that you are living the things that president ial candidates talk about all the time. And so we want to make sure that we are resourced to you, but also just importantly that your experience informs what we have to say in the policy space. Because sometimes we talk about, whether its Economic Issues or Health Issues, sometimes i find theyre being talked about like theyre the result of these cosmic impersonal forces out there. When really theyre the result of decisions that were made in white buildings in washington, d. C. And i believe if we make different decisions we will experience different outcomes. And so much depends on us connecting the decisions that are made there to the lived experience of the people who you are serving. And who this Campaign Seeks to benefit. So im looking forward to continuing the dialogue as we go on and im very thankful for your time, for your participation and for your work. Jalen thank you, everyone. So much. Pete thanks so much. Wonderful. Thank you. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] [captions Copyright National cable satellite corp. 2020] thank you. Thank you. Pete thanks for your support. All right. [indiscernible] pete absolutely. Thank you so much. [indiscernible] indiscernible] [indiscernible] [laughter] i mean, really. [indiscernible] yes. I dont want a picture. [indiscernible] ill see you. Adios. Give me a second. Ok. Mayor pete, can we have a few words over here . Indiscernible] President Trump so this november were going to take back the house, were going to hold the senate and we are going to keep the white house. [cheers and applause] President Trump speaks at a rally in South Carolina friday ahead of the primary. Watch our campaign 2020 coverage live friday at 7 00 p. M. Eastern on cspan. Watch ondemand at cspan. Org. Or listen on the go with the free cspan radio app. The South Carolina primary is saturday. Join us to hear the candidates reaction to the results. Live coverage saturday evening starting at 8 00 p. M. Eastern on cspan, on demand at cspan. Org, or listen live on the free cspan radio app. Washington jo. Host welcome to the table, congressman Warren Davidson of ohio, member of the freedom caucus. Lets begin with the coronavirus and pfizer c