WEBVTT 00:00:06.373 --> 00:00:16.373 As we Public Health practitioners work to improve health outcomes throughout the public sphere, we need to be mindful of power and how it can work for or against us. 00:00:17.066 --> 00:00:25.066 Many ideas, like ensuring safe and affordable housing, paid sick leave and expanded access to Health Care can benefit everyone. 00:00:26.239 --> 00:00:30.239 But they will especially benefit marginalized communities. 00:00:30.661 --> 00:00:34.470 Sometimes these ideas come to fruition, sometimes not. 00:00:34.510 --> 00:00:38.453 It depends on who has power, and how they choose to use it. 00:00:38.493 --> 00:00:49.493 Corporations, businesses, government and wealthier white communities hold power over marginalized ones and maintain that power through laws, policies and harmful narratives. 00:00:50.878 --> 00:00:54.878 These become structural determinants of Public Health. 00:00:55.861 --> 00:00:59.861 We have power too, but often we do not know how to use it. 00:01:00.774 --> 00:01:06.774 This leads to damaging scenarios like this one: 00:01:06.077 --> 00:01:13.077 Your Public Health Department is rolling out a new vaccine for a pandemic virus and determining who gets the first of a limited supply. 00:01:14.222 --> 00:01:20.222 Power and resources to deliver the vaccine and combat the virus are being unequally distributed across the community. 00:01:21.491 --> 00:01:25.491 Leading to more deaths in marginalized communities. 00:01:26.011 --> 00:01:33.011 Powerful government officials, plus local leaders and campaign donors are pressuring the leadership of the department to vaccinate them first. 00:01:34.164 --> 00:01:37.582 Everyone else should have access to the vaccine later. 00:01:37.622 --> 00:01:40.521 Should the department defer to the powerful and connected? 00:01:40.561 --> 00:01:44.561 Or should they be more equitable with how they distribute the vaccine? 00:01:45.140 --> 00:01:49.140 If it defers to the powerful, what happens to the marginalized? 00:01:49.520 --> 00:01:53.520 Despite misgivings, the department caves to this constituency. 00:01:53.849 --> 00:01:57.633 It sets aide shots for VIPs and limits the supply. 00:01:57.673 --> 00:02:02.673 Crucially, the department also restricts who can talk about the availability of the vaccine, and to whom. 00:02:03.819 --> 00:02:05.627 Thereby limiting access. 00:02:05.667 --> 00:02:10.667 The results of these decisions mean more people get sick and or pass away. 00:02:11.190 --> 00:02:19.190 People lose jobs, some even their homes and the virus spreads across the community. 00:02:20.157 --> 00:02:27.157 Consider another scenario: your department is prioritizing access to healthy food in two marginalized zip codes. 00:02:28.151 --> 00:02:37.151 The department meets a number of groups that already have relationships with, like local businesses, Hospital, School leaders and a coalition of community elites. 00:02:38.202 --> 00:02:44.202 Everyone is excited about creating Community Gardens to feed folks, though it will only serve the community in one ZIP code. 00:02:45.420 --> 00:02:51.420 The department then reaches out to individual Community folks who like to garden and they are excited about the idea as well. 00:02:52.558 --> 00:02:57.558 However, a local group in the community has been organizing for zoning changes for years. 00:02:58.520 --> 00:03:02.520 This would allow a grocery store into the area that serves both zip codes. 00:03:02.758 --> 00:03:09.758 This group includes representation from both zip codes and especially those in the most marginalized neighborhoods. 00:03:10.475 --> 00:03:22.475 As an organized collective, they know that folks in the area need affordable and healthy food options that are easy for everyone to access all year round, not just during harvest season. 00:03:23.812 --> 00:03:27.812 The department has to choose between promoting only one of the two scenarios. 00:03:28.435 --> 00:03:29.904 Which is the best? 00:03:29.944 --> 00:03:37.944 You might be surprised to learn the department chose not to work on bringing in the grocery store and instead prioritize the Community Gardens. 00:03:38.268 --> 00:03:41.304 Is this action the best outcome for the community? 00:03:41.344 --> 00:03:45.344 How is power being misused here? 00:03:45.878 --> 00:03:48.305 Now consider this final scenario: 00:03:48.345 --> 00:03:55.345 The state legislature is considering expanding Medicaid to those with slightly higher incomes, but who still desperately need it. 00:03:56.013 --> 00:04:02.013 Medicaid is easily obtained with Federal funding being offered to the state, but legislators object to expanding this funding. 00:04:03.659 --> 00:04:09.659 They stoke fear and spin the narrative that it is a handout to the poor while leading to higher taxes for the rich. 00:04:10.734 --> 00:04:16.734 Despite strong public support and the data to back it up, the legislature refuses to expand funding. 00:04:17.982 --> 00:04:21.105 This fight drags on for years. 00:04:21.145 --> 00:04:29.145 What can local public health departments, like yours, do to ensure better, affordable access to high quality care while this fight continues? 00:04:30.019 --> 00:04:33.738 Are there ways to reach into the community to provide care? 00:04:33.778 --> 00:04:36.006 Is there a funding workaround? 00:04:36.046 --> 00:04:40.640 What types of power does public health have to impact these important issues?