Following the murder of George Floyd in the context of the pandemic, communities across the country rushed to recognize the public health scourge of racism — a clear, but long ignored public health crisis. But if we declare racism a public health crisis, what do we do about it? Abdul reflects on the consequences of hollow words and speaks to Dr. Matías Valenzuela, Director of the Office of Equity and Community Partnership at the Seattle & King County Public Health Department about their work tackling the public health crisis of racism.

TRANSCRIPT

Dr. Abdul El-Sayed, narrating: A new Omicron sub variant is slowly spreading, as data from abroad suggests another surge may soon be on its way. A rare strain of Ebola is spreading in Uganda. President Biden pardons all federal marijuana possession charges and moves to declassify it as a Schedule one drug. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] Two years ago, the murders of George Floyd and Breonna Taylor at the hands of police created a moment that forced the world to pay attention to the crisis of racism in America. Estimates suggest that the uprising following their murders were the single biggest social movement in American history. The Kaiser Family Foundation estimates that up to 10%, one in every ten people in America participated in a rally. The backdrop, of course, was the worst pandemic anyone alive had ever lived through. One that by that point had taken nearly 100,000 lives and would go on to take more than ten times as many. What felt like the whole world was locked down, spending more time at home and behind computer screens than we ever had before. The contrast was brutal. After all, if we could band together to tackle this pandemic, why hadn’t we done so to tackle racism, a scourge upon humanity that had been around far longer than COVID? After all, racism does kill. It kills when police shoot an unarmed woman sleeping in her bed or pin a man’s neck to the ground for 9 minutes and 29 seconds. But it also kills Black babies at two times the rate of white ones and their mothers at 3 to 4 times the rate. It kills by way of heart disease and stroke and diabetes. It kills in hospitals that are systematically underfunded and clinics where Black patients are more likely to be turned away for lack of health insurance coverage. It kills in car accidents in communities where basic traffic infrastructure has been missing for years. And at the ends of smokestacks and factories that are far more likely to be situated in majority Black neighborhoods. And it kills tens of thousands a year. In 2005, Dr. David Satcher, America’s first Black surgeon general who served under President Bill Clinton, asked a basic question about Black lives. What if Black people were to die at just the same rate as white folks? How many Black lives would we save every single year? 83,000. That’s how many Black lives we would save if the Black mortality rate were the same as the white mortality rate. Those 83,000 lives are lost to the racism that accounts for the difference. Structural, institutional and individual racism. Racism is a public health issue. Period. Whether or not a given authority declares it. But after the uprisings, state and local governments around the country began to recognize that they could no longer stay silent. State and local governments finally began to declare that racism was, in fact, a public health crisis. And today, that’s what we’re talking about. After all, we’ve seen what we can do when something’s a public health crisis, we invest tens of billions of dollars in researching and developing the treatment. We slow whole societies to reduce the risk of transmission. We do everything we can to get the word out about the risks. Which is why declaring that racism is a public health crisis isn’t the end. It’s the beginning. What we do about that crisis is where the real work is. But there’s more. If we declare something a public health crisis and then fail to mount the kind of resources that the crisis requires, then what we’re really saying is that this is a second class crisis. And what’s racism except telling a whole class of people that they don’t warrant the same dignity, respect and support as others. If we fail to tackle the public health crisis of racism, we risk reifying the exact same dynamics that drive it. Today, we’re talking to a leader from one of the first communities to make this declaration. After learning about some of the work that the Seattle King County Health Department is doing to tackle their public health crisis. I wanted to reach out to the person leading that effort. Dr. Matías Valenzuela directs the Office of Health Equity at the Seattle King County Health Department. He joined me to talk about what it means to declare racism a public health crisis, to check in two years after our reckoning and break down how far we’ve come and how much further we need to go. Here’s my conversation with Dr. Matías Valenzuela: 

Dr. Abdul El-Sayed: Can you introduce yourself for the tape? 

Dr. Matías Valenzuela: Matías Valenzuela with Public Health Seattle King County. I’m the Director of the Office of Equity and Community Partnerships. 

Dr. Abdul El-Sayed: Dr. Valenzuela, thank you so much for taking the time to join us. The hope today is to talk about uh how we in public health make a rigorous investment on the notion that we are tackling racism as a public health issue. And it’s been on vogue and you see it in a number of different communities. To declare racism a public health issue. And then the question becomes, all right, so what do you do about it there. Right? And I I’m always dubious of rhetorical fixes to a problem um versus actual fixes to the problem. And I think in this day and age, it’s easy to get a lot of headlines by making a rhetorical fix to the problem rather than an actual uh nuts and bolts redistributionary fix to the problem. And I think what’s unique about what you guys are doing in King County is that you guys haven’t just declared racism as a public health issue. Um. You’ve thought really rigorously about how you um rebuild the bones of your interventions uh to take it on. So, you know, thank you for joining us and thank you for the work. And I’m looking forward to [?].

Dr. Matías Valenzuela: Well, thanks for having me. Appreciate it. 

Dr. Abdul El-Sayed: Just so for some context, how did you get into public health? What was it for you that led you down uh this career path? 

Dr. Matías Valenzuela: Oh, it’s interesting. I’ve been in public health for about 20 years, my graduate work and PhD are in communications and more uh international development issues. But I quickly became more and more um engaged with the importance of health work and part of it, I do have a background uh and just a history. I’m an immigrant from Chile. I came and I left Chile during the seventies with my family during a time of political strife. So I think there’s been a social justice bent to just  the things that I’ve been interested in my whole life. And uh early in my career, I was a journalist. I, I worked in Nicaragua for three years um uh as the revolution there was ending um and then went back to school, grad school, studying communications, but then also quickly became attracted to the field of public health. Just given the approach, given um the population based approach, the mission driven qualities of the field. And I think there is it’s fundamentally around uh social justice principles, too. So all those things um really called me to the field.

Dr. Abdul El-Sayed: Mmm. I wanted to ask actually about your preparation as a, as a journalist because you know, it strikes me as someone who uh sort of engages in in journalistic activities around public health quite a bit. There’s there’s really a lot of value that uh we can pick up by thinking about the tools of journalism, particularly around um listening for stories and being able to uh engage people, how they situate themselves. Um. How did your time as a journalist prepare you for public health? What are the parallels there that uh that that you feel like you use uh in your day to day work at King County’s Health Department? 

Dr. Matías Valenzuela: Yeah. Well, especially I think early on and the work that I was doing, I think, I mean, public health does a really good job around the quantitative, the, the data, the numbers. I think what we don’t do as well is what you are referring to is sometimes the listening, the qualitative um analysis and approach. I think there’s been growing appreciation of uh community voice and even what we’re going to be talking about today, which is the anti-racism work. Uh. How do we really begin to value um uh human experience, the voices and the experiences of those communities who’ve been most left behind uh and raise those up? So I actually think a lot of the skills that I have learned in communications and in journalism early on became very useful in terms of both uh listening, highlighting and then understanding community perspective, but also how to, framing of the issues is extremely important. Right? So how do we actually move away from like the more individualistic frameworks? I mean, those are all communications [?], right? About, um you know, lift yourself up by your bootstraps. And then when we think at health, it’s really is driven by broader factors, the social determinants of health and equity and some of the root causes that are really the main drivers or people’s outcomes you know by race and by place. So I think some of the the perspectives and and things that I did, both as a journalist, as a initial communications scholar, have also uh helped me and come in handy as I do both the public health work and the equity work. 

Dr. Abdul El-Sayed: Mmm. And what I always find interesting is that public health uh has often taken its authority as an implicit platform. And I feel like one of the challenges that we’ve had, particularly in the midst of the pandemic and then more generally communicating in the context of a very crowded media ecosystem, is how to tell a story that’s compelling to listen to on its own, but then also reframes the content that we’re talking about and engages with the fact that we’re just in a very different space around the amount of crosstalk that you’re going to get for any piece of content. And I guess I’m wondering, this is sort of an aside, but it’s something that’s of particular interest to me and the through line through a lot of the show. How should public health professionals and public health as a set of institutions be communicating right now versus maybe the way that public health is traditionally communicated to the public? 

Dr. Matías Valenzuela: Yeah, I mean, I think there are uh a lot of learnings even that we’ve had from the uh pandemic, and I think there are is a lot of trust that has been eroded. Um. I do think that we and having said that, there are a lot of things that have worked really well. I think at the local level where we are at, um even though sometimes I think maybe at certain levels there’s a distrust of institutions. I actually think through the COVID pandemic, we’ve been able to become much more closer to our communities, become better listeners to our communities. And we’ve actually built a lot of trust with folks. Then when the when the pandemic started, they were very hesitant. They were um it had had some um a lot of negative experiences that were rooted in in history and also some recent um you know practices. So I, I actually think that there’s a lot that can be done around kind of taking control of the narrative on the one hand. But kind of going back to what you talked about before, it can’t be just empty words, right? This has to be very much linked to actions and there has to be um things that are being done different uh and there have to be systems of accountability and there has to be results that we are doing things different and this is not business as usual. So uh I also think that the historical moment that we’re having now and with even some of the declarations of racism as public health crises, that’s what makes it different for me. Even though I’ve been doing equity work and um health disparities work for, um I’ll say, you know two decades um in the public health world, this does seem different. It does seem that it’s more um focused, it’s more clear that there um it’s about Black and Indigenous communities in particular, and Black and Brown communities. Um. And our communities are also um uh feel uh hugely empowered, as they should be, to be really guiding us um and demanding that we actually pay attention to uh things that have been ignored for a very long time. Um. So I think we are at a at a different moment right now when there is a lot of distrust in systems like and and public health. But it’s also an opportunity, uh I think. And when we react in the right way, I’ve been able to see some some results right um in that work. 

Dr. Abdul El-Sayed: You know, it’s interesting because um I think the point that you made earlier about uh the role that public health has traditionally had around number crunching and quantitative uh information has sometimes gotten in the way of our ability to think dialectically with the communities that we say we want to serve. And, you know, any good journalism starts with listening um and not saying. And I think the mistake that we’ve often made is that we sort of think about our sciences as coming from on high. And, you know, we’ve crunched the numbers and this is what we know. And here you go. Uh. Rather than asking to engage with the communities that we are serving in a conversation about what they’re experiencing, offering and engaging the science around their experience, situating that within the stories that they tell and they want told, and then being able to offer that back um into communities as we listen for the next iteration. And I think that humility uh to start with listening to the public that you are that you are measuring and offering numbers about should seem pretty obvious. But it does run contrary to a lot of the, the fundamental strains in our um teaching uh in public health where um we sort of only think about every story as just one of the data points. Um. And then the only thing that that’s valuable is what comes out after you’ve run some statistical test on your data points uh to understand what the real issue is when, when fundamentally for most people, they know what the real issue is. You know, they can tell you um and I think there’s an opportunity to to to sort of combine streams of information uh management and listening in to a far richer understanding and a far more compelling delivery. I want to move to the to the central topic of our episode today, which is about what it means to turn racism um or to turn uh public health against racism. And, you know, in King County, you all were one of the first to declare racism a public health issue. And I just stepping back, in your uh words, what does that mean to you? 

Dr. Matías Valenzuela: You know, first it was the work that we did. And when we did a declaration in June of uh 2020, um it was built on a lot of years of work that we had done. And we had frameworks and we had tools, equity tools. Uh. We had um developed a even a community engagement continuum and other things that that really were telling us we had to move away from some of these more dominant um white supremacy types of ways of doing business to actually be more driven by community co-creating. Um. And I think we had laid out the great good groundwork and, and, and that had actually achieved a lot and achieved some uh changes in policies. We’ve had some really significant um even uh new like levies and initiatives like we have Best Starts for Kids, which is a whole uh new um local tax that we have in King County that is focused on early childhood development and place based initiatives to try to address um health outcomes. So we’ve been doing a lot, but I think the the fact of declaring this uh racism, the public health crisis when we did it was also um extremely important, the sense that we were early in the pandemic. There was um people were seeing images of uh Black bodies and in particular one that got of course a lot of the national and international attention was the killing of George Floyd. Um. And there were uh a lot of demands that were placed on us locally, for example, from especially Black led organizations. And part of the questions that I think were also um coming up for us was one, is that we definitely had um you know systems that were causing a lot of harm. But beyond that, I think we got, were having questions about, um you know, and this is around calling something a crisis, is why had we declared a COVID-19 a crisis, a global pandemic uh and we’re putting attention to um this public health issue um with an all hands on board approach, um putting uh attention, putting resources um in a way that we hadn’t done with something like racism, where we began to see the harms, um the chronic uh illnesses of disease, um not just, you know, sometimes the shooting or the violence, but the slow killing that happens with our Black and Brown communities every single day. It should be a crisis. It should have been declared a crisis. So I think just the historical moment and when it happened that we were in a pandemic, that we showed that we can mobilize resources so that we can um rally around certain issues. And for example, in King County, we have been um we have done a lot around the pandemic and been able to get very high rates of vaccinations, for example, for communities of color, uh at least on some of the initial doses. Um. It shows that we can do it with resources, with efforts, we can do it. And it was time to do something similar with with racism and with um treating it as a crisis. And uh I think learning at least from the sense of urgency that we were having with a pandemic was um really significant for us. So then to really begin to say hey we’re going to take on these two um crises at the same time, which really should have been been taken care of. Uh. You know, uh racism as a crisis um for a long time, there have been leaders, of course, in the field who’ve been um pushing for this, um namely people like Imara Jones um for many years already. 

[AD BREAK]

Dr. Abdul El-Sayed: One of the things that strikes me about uh this moment is that it took us this long to see it. You know, COVID didn’t exist before 2019. Racism existed long before 2019. And part of the challenge with the way that we’re thinking of talking about it now is that it can tend to undercut the history of this thing and the ways that it has wound itself around every institution, around every structure of our society. And um the one of the things that I worry about sometimes is that because of the nature of of the moment in which we as a set of institutions, declared racism a public health issue, is that is that I worry that people are going to move on. Right. Just like people are moving on off COVID. Right. COVID is still here. Nearly 400 people a day are dying of COVID, um and yet uh it’s still here. The sort of story has has passed um and folks want to move on. And I worry right about when we point to something declared a crisis in a moment when we’re forced to see it. Are we just as quickly going to move off of it when it’s out of the zeitgeist and out of the public conversation? How do you think about institutionalizing the responsibility to be fighting racism uh in everywhere in every way that we take it on? 

Dr. Matías Valenzuela: Yeah, that’s a a great point. And you know, when and I’ll just say initially, because our our declaration was our executive and our public health director uh making that declaration, um I was of two minds. One is I was concerned that once again, we’re going to make a declaration that wasn’t going to have any actions uh behind it. At the same time and then even as the smoke cleared, that often what happens is, you know, BIPOC communities and within public health, the employees of color are going to be left holding the bag, so to speak, and having to do this without the political will and support to um carry it through. At the same time, right. It was an historical moment. And I, I did feel and actually still think that the um gains that we were able to do at that moment were extremely uh I hadn’t seen it in my my years working in government uh and in public health. So it was something that we actually had to um embrace, even though it was, in a way a double edged sword I that we knew I knew at some point this window was going to start to close and it has been closing. You know, I have to say it has been closing. And we see it around some of the movements now um in terms of uh like for defund the police, for example, and disinvesting for the criminal legal system. Those things now have there have been shifts, important shifts um in the other direction from where we were in 2020 and um those things have also played out locally um uh in King County. But I do think that the um opportunity that has existed and by uh getting on board with that has now for us as a public health [?] King County, actually, our department has been changed forever. It really has been. We have been able to bring people in through some very vocal leaders like our Pandemic and Racism Community Advisory Group and some other um groups and the ways that we work with community and integrated them into our policymaking, our decision making, our um public health orders, our um [?] King County orders as well, in a way that also showed for, um you know, elected officials and for others that it was actually the right way of doing things. That when you listen to community and you bring them into a process, you adjust, um you know, and do equity analysis and adjust to their needs. Then when it’s time to make the announcements, then it’s when it’s time to do, um you know, act and make the policies and make some of the things that you’re aiming to do. And you have the um the support of communities, they are going to be vocal supporters of what what we want to do and there’s going to be the buy in. I think now when we think about creating a policy when we think about doing, um you know, some significant actions as a department, as a county where front and center is to think about, okay, how are we going to work with community on this? How is this going to affect Black and Brown communities? Um. How can we make this, you know, a significant process with our um community leaders so um they uh are heard, we incorporate um you know their input and then have a better um you know policy. And we have a lot of different examples that I could cover about how we have actually done that um and then developed tools to report back. We’ve done a lot now to make this like very clear that it’s not just about, you know, having a process and listening. It’s actually showing some results. And we are moving in a way to also be able to report back to them and say, this is the things that we’ve been able to do and this is what we have and in being accountable and transparent in a way that we um you know haven’t been uh before. So I do think even though I had those early um trepidations or just being a bit hesitant about, you know, where this may all end up I actually think the the gains that we’ve been able to make and what the opportunities that we were able to take advantage of have been really uh, really significant. At the same time, I am very concerned. I am concerned that some of the things and some of the openings and some of the real backlash has been very significant, um you know, nationally and locally. And we’re having to deal with that. 

Dr. Abdul El-Sayed: I want to ask you, can you walk us through uh maybe three or four programs or policies um that you’ve enacted uh because racism is a public health issue? 

Dr. Matías Valenzuela: Sure. So when we we declared racism a public health crisis, uh we had we received tons of letters um from community, from Black led organizations, our local Black Lives Matter uh movement and other um groups, our community health care coalition really being very specific about what they wanted to see from us. And uh also, many employees actually internally, there was a surge of uh of demands. What we did um that summer was we developed a a anti-racist and racism public crisis uh policy and budget um agenda, that is for 21, 2021 and 2022. And it included really the main framework around that was shifting uh investments away from the criminal legal system um and into uh more community investments in public health and community development. So there had been efforts um to, uh for example, deintensify the jail we had in any given day. We had about 1900 before COVID, 1900 uh adults in the in the jail. Uh. With COVID, we reduced that to about 1300 individuals just because we wanted to reduce the number of people who are uh incarcerated and then wanted to also then continue to push those numbers and keep them down based on our declaration of racism as a public health crisis. So that’s one. So did a lot of um work around policy um working with, of course, our executive and the prosecutor attorney’s office to do really address some of the um some of the sentencing and some of the policies that were really driving the higher rates of uh incarceration that we were seeing pre-pandemic. We um also did things such as like shifting um funds. Uh. You know, we had revenues that had actually were coming in from uh marijuana tax revenues that were going to the sheriff’s office. So we started we did divest like um in those funds uh to community uh programs. Also, um there was the the commitment that our executive made at the time to, to actually close children or the the the youth portion of uh our incarceration or the jail for for youth by 2025. So we have a Children and Family Justice Center um that we have had a lot of demands from community for a long time, basically telling us that that uh center should be um closed. Actually, it was rebuilt and there was a lot of opposition to us building that. So really the executive, you know, parts of the courts and other parts um the plan is to keep keep those more long term. But reduce the um detention sections of that really uh there is a commitment within the next few years to actually uh close that. And then there are some other elements in uh that budget, uh including a $25 million dollar uh community fund that was created to really uh address uh the especially economic development issues in our county for Black and Brown um individuals. The other thing and that started off a whole other effort now too that is um trying to um with a couple of community leaders to really begin to um uh really shift the the funding that we have uh for um and the way we use the the county budget in a way that we can focus it more on community and public health types of programs when out out of our general fund, which are our most flexible funds. Three quarters go to the criminal legal system. So most of the funds, you know go, it’s the jails, it’s the sheriff, it’s the courts, it’s a public defense, prosecuting attorneys. So it’s an extremely costly system. So really our our budget that we did two years ago, right, for 21′, 22′ was really focused on [?] policy things and then investments that would get us on track to moving towards um systems that were more based on community programs, community development, public health, uh and less focused on systems that cause harm. 

Dr. Abdul El-Sayed: So I wanna, I want to dig in on the, on the public health piece because I, I um, I certainly lauded the effort to rethink uh the way we think about public safety in King County. But then, you know, the degree to which racism imbues itself in institutions um is is bigger than that. Right. Um. You know, you think about the the massive difference in uh risk of dying in a hospital if you’re either a mother of a new baby or a new baby, um you think about uh differences in access to basic services and resources in schools. Um. You think about the difference in the probability of being exposed to lead or uh or breathing un— unclean and unsafe air. Um. How have you thought about some of these other uh engagements, I you know, around beyond the the question of the singular moment that animated um a lot of this conversation, the engagement of the legal system with Black and Brown bodies. But how do you think, you know, beyond even that uh in terms of turning racism or turning public health against racism? 

Dr. Matías Valenzuela: Yeah, that’s where the you know, I and I covered some of the things that we did early as part of like um, you know, off the bat and to make some remarks and really say and show that we’re really serious around this. And I think that the next phase and what we’re doing now is really integrating this into the fabric of the work that we do. So whether it’s you’re talking about lead or whether it’s environmental health or like community health services or public health clinics or prevention work or the work that we’re doing around uh the pandemic and COVID is really having um this be, you know, kind of front and center in terms of where we’re putting our resources, where we’re putting our uh our attention. So, you know, that’s one of the things that we have, we did even like with with COVID, for example, around vaccination, we’ve developed principles of equitable vaccine delivery, which really were things that were guiding. Um. And we worked with community on these that were in our Pandemic and Racism community advisory group uh informed these that really laid out how we’re going to use community voice, how we’re going to use data to drive our resources and any um you know, we had a lot of vaccination sites ourselves, we had community vaccination events, and then we also contracted and worked with a lot of partners that were part of the whole King County system. We even had like there was Kaiser Permanente. We had Microsoft actually running our biggest site out on the east side of King County. For them to um work with us, they, we and as part of the agreements that we made with them and be part of the um King County Vaccination Partnership, um they needed to agree and to work with some of these um you know principles. And they had to be able to incorporate these so really thinking about the location of sites, thinking about how services are provided, uh thinking about providers that they should be hiring that reflect the communities that um that they serve. Making sure that there were some basic things that sometimes seem trivial, but just having, you know, translation and interpretation services, those kinds of things. So those were things that we laid out as must do’s uh and they agreed. I mean, those partners, significant health systems and other businesses really got on board with some of these um you know principles. So I think we’ve been able to move and create some of these big shifts, public health, working with our partners. And I think also now at the next level, it’s really thinking um and working with all our programs. So actually they like right now we have we have our maternity support services that is really thinking about and has been working very hard on how to not have community come to us and come into our public health centers. But how do we actually develop models in which we go and go to the places where community is at? Right. So visit them at their homes, visit them at community locations, those kinds of things. So looking at different models um of and how do we deliver work and how we work with communities. So I think these shifts are kind of big picture and I’ve been talking about some of the bigger kind of systems of policy issues, but they need to be reflected in the work that everybody uh is doing and what we do have working for us is that people that come to public health and also as we do the declaration, this is why they’re coming to work in public health. This is why they are committed to this work that they identify our workers and our frontline staff are the ones that most identified with what we’re trying to do and support it. So um I think we also have to um as we even like with the pandemic, we hired as a department, maybe 600, 700 new staff heavily from our communities of color. We are more racially diverse now than we have ever have been, and those employees are hugely racially diverse. How do we build and tap into the skills, the knowledge that they have as members of the community um and really be able to use and work with the the community insights that they bring and are able to incorporate into their work. So it’s not just about becoming more racially diverse as a workforce because that’s a nice thing to do. It’s actually it’s important because there are inequities there, but also uh it will allow us to better uh serve and work with our communities. So that’s part of the very hard work that happens uh even right now what we’re doing, it’s not very uh sexy or attractive, but we are working on um the next round of commitments at all division levels. What are they doing in the area of policy and racism as a public health crisis? What are they doing around workforce workplace equity? What are they doing around community partnerships? Each of our divisions has to have things that they said that they are doing and those areas we actually post those on our website and then they have to report on those things, too. So there’s a system of, you know, continuously digging deeper and uh and further uh and being very clear. There are things that we are measuring as well like so we are we know that generally, for example, our workforce is quite racially diverse. Um. But when you get into the leadership positions, we are very white. So we have goals and we are we are really tracking how our different divisions are doing, how they are, what are they doing in terms of uh promotion, retention, hiring, all those kinds of things. Um. So there, these are not just intentional, you know, or or good intentions without some action behind them. I mean, we we have been doing and this what again, what I think the racism in public health crisis now is different is that people want to see results. And so we need to look at those numbers and what is changing and what isn’t changing. We need to figure out you know what we do then differently and um, you know, try with new people or try with something else. But um I don’t think we have the same level of of patience now for things that aren’t changing. 

Dr. Abdul El-Sayed: So I one of the um ideas that you’ve uh raised in your um writing about this has been this idea of targeted universalism, which I found um really compelling. And you talked about a lot of the different programs and the ways of thinking uh that you’re engaging across the department. How do you think about targeted universalism? What does that mean to you and what does that mean for the kind of department, the kind of work that you guys do? 

Dr. Matías Valenzuela: Yeah. So in a very concrete way, one of the things that we have started out to my office now uh is what we’re doing is what’s called the priority population work. So we have teams working on the Latinx community, the Black community, the Black immigrant community, Asian, South Asian, Pacific Islander. So we use we work with people from our department who are working closely with each of those areas and then develop teams that are focused on those specific communities. So I [?] have to get one of our divisions, the Community Health Services Division is leading the work with the Black community and they are doing amazing work. One is they do things such as go out and do you know health fairs and those kinds of things. But more significantly too, they were equally significant and I’ll say is they’re working, for example, in our Skyway neighborhood, which is the area where we have our the highest numbers of um uh Black residents in the county, and they are um really establishing their presence for public health. We traditionally haven’t had a presence there. Now we have a presence an ongoing presence. There’s a resource center. There’s ways for people to have um uh and creating more opportunities for people to have the services and have their needs met and those communities that have been traditionally um you know underserved. So it’s about unapologetically saying, okay, we have this team working on the Black community, with the Black community, we have this other team that’s working for the Latinx community. We have um employees who are Pacific Islander, one in particular who’s leading the effort with the Pacific Islander community, working with our our on, also a new program that we have now started just in the last couple of years, which now we have community navigators working with our equity response team, which is a new area. We also have, as I’ve talked about, some different advisory groups. So we have systems in place, an understanding that um to get to where we want to be, um we need to have a system of of a of support in the first place. But then we need very specific strategies for each group. So what we need for the Black community is very different from the Latinx community than it is for what we need for the African Immigrant community. So I think this is just and we learned this also through the work that we did early on with with vaccination, too, that we couldn’t take one approach that would fit for everybody. We needed people from those communities working with leaders from those communities to be able to um get us where we needed to be. And with time, we were able to make um huge uh impacts in terms of getting, you know, over 80% across all racial groups and and ethnic groups and um geographic regions in our county to have to be vaccinated. Um. And that wasn’t done because we were doing things in  one way, we were doing things in very targeted, focused ways um that were specific to uh each community um and giving them time and I think giving them time to also, again, kind of where we started to build trust, right? To understand the issues and then hear things and work with people that look like them, that are from those communities. [AD BREAK]

Dr. Abdul El-Sayed: I want to um think a bit about uh some of the dynamics. You talked a lot about being community led and driven. That’s really awesome. Um. One of the ways sometimes that can work, though, is that you have um a group of folks who speak on behalf of community um but uh may not actually represent a lot of the folks whom they claim to claim to speak for. Um. And, you know, the sort of en vogue term for this now is elite capture. But, um you know, I want to ask, as you think about doing this work, right, my experience in Detroit was one where you really had to penetrate deeply um beyond many of the institutions and you engage with the institutions, no doubt. I mean, they’re extremely powerful and really important in terms of being able to move a message and and and and work with you. But you also had to go out of your way to engage with folks who don’t who don’t necessarily have the resources to be institutionally engaged. Right. Um. They may be working two, three jobs. They’re not thinking about what the health department can do for the city. They don’t even know that the health department exists. And if if they know that it does, um they don’t trust it. Um. And uh how have you guys thought about trying to get a um balanced view of what the community’s needs and wants are, to sort of penetrate past um that that advocacy space um where, uh you know, folks are um speaking on behalf of their communities, but sometimes in a way um that may not fully capture the nuance of the stories that you want to collect about people who may not be represented by them. Um. How have you gone about that at the department? 

Dr. Matías Valenzuela: Yeah, so that’s a that’s a great question. And I think we have different approaches in the sense of if I think about our pandemic and racism community advisory group, it tends to be uh folks who you would think and are um from smaller and grassroots organizations and then from larger organizations, larger Black led organizations or uh coalitions like our Community Health Coalition that represent um a lot of um a lot of people uh and a lot of communities. But we also then have some very specific like with our community navigators, those are from small communities. So with that program, we have people from um different Black communities. We have multiple if you take a community like the Indigenous community, we have U.S. or Native Americans in there and U.S. Indigenous. But also we have, for example, working with a a [?] Indigenous from Mexico and we’re working with a [?] we’re working with the [?] now, which are black Honduran Indigenous communities. Um. You know. We’re getting very specific into the particular groups and communities. Some of these are work as part of very small um organizations or that are just acknowledged leaders within their community that don’t even have any kind of, you know, nonprofit status. So I think we’ve been very and we have 27 navigators, so we’re being very careful and very intentional about lifting up those voices. And we’ve um, you know, with that group, for example, we’ve taken um some of our budget proposals for our um that we want to uh you know, we’ve asked them where do we should we be putting our budget, what are the things that we should be funding? So we’re bringing some, when we did our vaccine verification policy, you know, we got input from, um you know, these groups. So there’s  things like like uh like that. And at the same time, also thinking about um in terms of, for example, RFP and funding opportunities being very um clear that they’re um we want to fund organizations and we’re doing this in a current um uh process that we’re about to uh release that being we want to prioritize organizations that haven’t been funded by the county, that are small organizations. Um. So then we are able to uh fund and support those who we have tended not to fund, because it is true there are the usual suspects or the usual organizations are the ones that tend to get the funding from the county. Uh. And some of that will continue because actually they have the capacity and sometimes the other systems to be able to continue to do this, but we have to be really thoughtful and intentional about making sure that resources are coming to some emerging groups uh and to other um organizations that are really addressing and working with community uh at a in a very close way and also meeting the needs of community in a very authentic way that nobody else is being able to to do in the same way. So really, we are trying to build those systems in right. Funding opportunities, for example. So we very intentionally go to some of those small organizations. 

Dr. Abdul El-Sayed: I really appreciate that um perspective. And just as we wrap here, I want to ask you um, why does this effort succeed um and what are the obstacles toward that success? 

Dr. Matías Valenzuela: Um. That’s a great question. They they uh you know, the more I do this work, the more I am uh convinced that, you know, and where I get my energy too is around community, listening to community and keeping it real with with community and hearing some very um clear and unfiltered feedback on, you know, sometimes people say, like, we’ve been doing this for so long and what do we need to do? It’s like, just take some minutes and be in a community space where you’re going to be um sometimes yelled out, going to be talked at, at and you’ll hear all the issues that you know that we need to uh be addressing. So there’s there’s so many although we’ve made progress, I think there’s just we’re still very early. I would just say, we have no way gotten to the point of um kind of arriving. And then we have a long we have a very long way to go. At the same time, and what you need too is so those connections to community and keeping it real. And at the same time, you do need the political will to be able to do this, what we’re able to do. I mean, I talk to to colleagues in other parts of the country some time and there’s some places where you can’t even say the word equity, for example, or you can’t really do the things that we’ve been able and fortunate to do sometimes in Seattle and King County. So even though I have plenty of frustrations and think that we could go so much farther and quicker, especially given the resources that we have in our region uh and the amount of wealth that we have. At the same time, since we are so wealthy, we have some of the biggest um inequities because because some people are doing so well and our communities of color do very similar to how they’re doing in other parts of the country. So I really, um you know, think that we do have a lot of political will that makes it here, you know, possible and then showing successes where you need to be able to show successes. Uh. Talk about those. So then they, uh you know, then they get the support and then people say, hey, this is the right um approach. And at the end, you know, what I’ve been um convinced about and I’ve seen it is that we do when we focus on our anti-racism work and to integrate it into policies, into the systems, we actually get better results. That’s better work. We’re getting more impact. Um. So it’s not a a feel good thing. It’s actually about doing our work as public servants uh much better. 

Dr. Abdul El-Sayed: Matías, I really appreciate you uh taking the time to walk us through the way that you guys in um Seattle, King County, are thinking about operationalizing racism uh and public health’s fight against it. Um. You were one of the first to declare racism a public health issue. We really appreciate that leadership and we appreciate the leadership in showing uh how we take it on. Obviously, the fight against racism is something that is um existential and it’s also, um you know, bigger than any one agency, any one institution. Uh. But it takes all agencies and all institutions deciding to put their shoulder in the work. And uh we appreciate you sharing how you guys are doing that. So um that was uh Dr. Matías Valenzuela. He is uh the lead at the Seattle King County Public Health Department um in uh tackling racism as a public health issue. We really appreciate you joining us. 

Dr. Matías Valenzuela: Thank you so much. I appreciate it. 

Dr. Abdul El-Sayed, narrating: As usual. Here’s what I’m watching right now. COVID cases are spreading more rapidly across Europe, prompting some concern over a fall and winter surge here in the US. While BA.5 remains by far the most dominant variant, there’s a new kid on the block. That’s BA.4.6 It’s still an Omicron sub variant, by the BA, so it’s not likely to differ widely in terms of immune invasiveness or transmissibility, but it’s rising as a proportion of overall cases across the US. And to make matters worse, uptake of the new Bivalent COVID vaccines has been abysmal. Only 4%, 4% of eligible Americans have been boosted. In fact, a recent survey from the Kaiser Family Foundation found that two in three American adults have no plans to get their booster. Part of that is the obvious fact that only 40% have had their third booster to begin with, and only about two thirds have been vaccinated twice. I know if you’re listening to this podcast, you probably have already had your booster. You’re part of that 4%, but not everybody in your family has. So I hope that you’re willing to take this information, share it with them, talk to them about why you want them to be vaccinated, what you’re worried about, and make sure you tell them that you love them. But COVID isn’t the only virus folks are worried about. A rare strain of Ebola is spreading in Uganda. An outbreak of the quote “Sudan strain” was declared in Uganda’s Mubende district on September 20th. So far, 63 cases have been confirmed and 29 have died. That’s in itself awful. But there is good news that the outbreak has been relatively limited. But as we should know by now. When it comes to viral outbreaks, small numbers can become big numbers pretty quickly. The Sudan strain is particularly concerning because there are no approved vaccines for it, nor are there effective monoclonal antibodies which have drastically reduced mortality among people infected with other strains. For their part, the Biden administration is routing all travel from Uganda to one of five airports where screening can take place. But if we’ve learned anything about curbing global infectious disease outbreaks, it’s that it’s not enough to try to keep the virus out. We’ve got to put our resources into the fight against the outbreak on the ground where it’s occurring before the virus well goes viral. And right now, it’s not enough to screen people at airports. We’ve got to put our shoulder into supporting the Ugandan public health workers in stopping the spread of Ebola locally. In other big news. President Biden pardoned all federal marijuana possession charges, clearing the records for about 6500 Americans. And for these folks, that’s a huge deal for accessing everything from jobs to housing. We know that the white folks and Black folks use cannabis at similar rates. Overpolicing among Black communities means that they are about two times as likely to have marijuana related charges. This move, well, it helps to address the racial inequalities of the past and clears the way for the government to address them moving forward. But there’s something more, schedule one drugs are those that have no recognized medical value and have a high misuse potential. But we’ve long known that cannabis can be a very effective treatment for seizures, nausea and pain. But until now, because it’s been a schedule one substance, we haven’t been able to study it effectively to understand everything from the most effective administration pathway, dosing, or even other characteristics. A big limitation has been funding. The move to declassify marijuana as a schedule one substance would open the doors to that kind of research and improve our ability to use it to treat people who could benefit from it. I want to be clear. As we’ve discussed previously with Professor David Jernigan in our cannabis capitalism episode. Cannabis is still a substance and there are real risks using it, but the risks are far less serious than, say, alcohol, which is completely legal. And cannabis isn’t chemically addictive the way that alcohol or opioids are. So descheduling it is simply about asking honestly about whether or not it meets the criteria for schedule one, that it has, quote, “no agreed upon medical benefit and has high risk of abuse”. Clearly, that’s just not the case. So I applaud President Biden for making this move, but there is a lot more that we need to do. That’s it for today. On your way out. Don’t forget to rate and review. It goes a long way. Also, if you love the show and want to rep us, hope you’ll drop by the Crooked store for some America Dissected merch. [music break] America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producer is Tara Terpstra. Veronica Simonetti mixes and masters the show. Production support from Ari Schwartz and Ines Maza. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Sarah Geismer, Sandy Girard, Michael Martinez and me, Dr. Abdul El-Sayed, your host. Thanks for listening. [music break] This show is for general information and entertainment purposes only. It is not intended to provide specific health care or medical advice and should not be construed as providing specific health care or medical advice. Please consult your physician with any questions related to your own health.