Racial Equity in Health Series: Efforts to Expand Access to Healthcare in the United States

The New York Foreign Press Center (Virtually)

MODERATOR:  Hi, good morning, and welcome to today’s New York Foreign Press Center briefing on Racial Equity in Health.  The theme is Efforts to Expand Access to Healthcare in the United States.  My name is Mahvash Siddiqui, and I’m today’s moderator.  Just a reminder:  This briefing is on the record. 

It’s a pleasure to introduce our speakers.  Our first speaker is Dr. Omekongo Dibinga.  Dr. Dibinga is a professor of intercultural communication at American University who focuses on health and wellness issues for underserved communities.  Our second speaker is Anton Gunn.  Mr. Gunn is a healthcare consultant and a former politician.  Mr. Gunn served as a senior advisor and regional director of Health and Human Services during the Obama administration.  Mr. Gunn played a pivotal role in implementing the Affordable Care Act, also known as Obamacare. 

I will go over a few ground rules.  This briefing is on the record.  The views expressed by the briefers are their own.  Our briefers are not affiliated with the Department of State or the U.S. Government and do not reflect the views of the Department of State or U.S. Government.  Following our speakers’ opening remarks, I will open the floor for questions.  And if you have a question, go to the participant field and raise your virtual hand and wait for me to call on you.  When called on, please enable both your audio and your video and identify yourself by your full name and your outlet.  Could I also please request the journalists to have your cameras off until the question-and-answer session.  Thank you so much.  

And with that, it’s my great pleasure to introduce Dr. Dibinga as our first speaker.  Dr. Dibinga, please take it away. 

MR DIBINGA:  Good morning, everybody.  I hope that you’re doing well and that you’re doing better than good and better than most were, and sometimes even better than that, wherever you are.  I’m very happy to kick off this conversation about health disparities, particularly as it relates to race.  And what I want to do is I just want to paint a little bit of a context historically, particularly as it relates to why BlackBlack people in this country have faced the health disparities that they have.  And I’m so much looking forward to Anton, who’s really going to just hit so much of the nuts and bolts of today and the specifics because of – because he’s just an expert at it.   

And so I wanted to just drop some of the things historically so we can kind of be on the same page, and so I’m going to share my screen here because there are just some bullet points that I want to speak to here.  So if you can just give me a second to get that, which I have right now. Awesome.  Let me go from here.  

So there’s a couple of things that we need to keep in mind, right?  A lot of research that’s come out about the COVID pandemic, it talked about how it disproportionately affected poor Black and Brown communities in America.  And many people were surprised about that, right, but the challenge that we have here is that in 2020, even though it was reported that Black and Brown people were more likely or twice as likely to die from COVID, that’s not where the history of the health disparities started.

America didn’t just wake up and all of a sudden there was a disease that was only affecting Black and Brown people more than any other group.  We have to understand that the COVID pandemic exacerbated a system of racial discrimination that had already existed in the United States for centuries.  And if you read some of the reports about how COVID has affected different communities across the globe, you would actually see that the countries that did the worst as it relates to its response to COVID were the countries that had the worst issues as it relates to income inequality, which, primarily in places like the United States, primarily has broken down to issues of race. 

And so when we talk about specifically Black Americans, we can talk about the systems of health disparities going all the way back to our experiences with enslavement in the United States.  Now, many people will say that that’s kind of, like, far off, but if you really look at it – if you think about the countries that you come from, I can guarantee that all of the challenges and the successes that you have had in your countries can date back to different things, whether you’re going back to the time you got your independence maybe, to the time you had your first experience with the West or the Eastern countries as it relates to Arab enslavement or European enslavement.  The trajectory continues.  Nothing stops on a particular date, right?  Freedom is not a journey, it’s a – it’s not a destination; it’s a process.  Well, it’s the same thing when we’re talking about issues relating to health disparities. 

We have to remember that Black people were brought to America as slave labor, to serve as labor.  Stereotypes about people – Black people being barbaric and savage, that was used to justify their enslavement.  This idea that Black people were savages, they did not know the one true God, they were animalistic, the Black woman was sexually deviant, the Black male – this idea of what we called the Black buck, right, the big, strong, husky Black men who could handle anything – that was part of the reasons that were used to justify enslavement, to make us look as people who were worthy of being enslaved.  And with that mentality came the idea that Black people can experience more pain with less care – again, the idea that Black people can experience more pain with less care.   

So when we talk about the beatings and the lynchings that took place during slavery, that led to the experiences of police brutality that we experienced post-slavery.  The belief that Black people can handle pain – can handle more pain, it leads to things like police officers believing that they need to use more force to subdue us.   

So when you see some of these videos that you may have seen of an African American teenager or a 35-year-old Black woman getting shot, unarmed, 20 to 30 times literally, it’s this idea that we can handle more pain, and therefore it takes more force to put us down.  And that is – that is a carryover from the legacy of slavery in this country. 

Some of the other things we have to talk about.  The inability to receive adequate health care during slavery led to Black people not being allowed in the same hospitals as White people going into the Jim Crow era of the early 1900s.  This idea that we have to be separate, this mentality that came up in the United States of separate but equal – the “equal” part never existed.  The idea that Black people could be separated from White people – have your own neighborhoods, your own schools, your own facilities – and get the same equal treatment, that never happened in the United States.  And we kept everything separate to such an extent that we even had separate funeral graveyards for Black and White people.  During World War II, when people were looking at needing – soldiers needing blood transfusions, they had to make sure that they had the Black blood for Black soldiers and the White blood for White soldiers.  That’s how deep the notions of inferiority and superiority went. 

So when we see this, even as it relates to the diet, enslaved people were fed the worst parts of animals on the plantation, the leftover parts of the pig, the leftover parts of the hog.  All of those things that had the worst health benefits was what was given to them.  This was the experience of poorer health standards for Black people.  So as Black people emerged from slavery, too many were marginalized into communities where there was no access to healthy foods or health services.   

Furthermore, Black people have often been the subject of actual medical experiments to further American medical growth and progress at our own expense.  I’ll give you just two examples.  The father of American gynecology, who had a statue built for him in New York which was recently taken down because this history was exposed, he grew to prominence by conducting procedures on Black women without anesthesia – without anesthesia – and it’s not that it didn’t exist, but it wasn’t deemed necessary to use on Black women.  Between 1932 and 1972, the U.S. Government failed to treat Black men who developed the disease of syphilis in order to track the progress of the disease.  Now, this is not to say that the government gave these men syphilis, but they didn’t track their – they didn’t treat it with Black men in order to see what would happen. 

These are the types of issues that have been prominent within the Black community in its relationship with the United States since our arrival here, and so this is what I mean when I say it starts with slavery but the practices that people thought may have stopped with slavery continued on in many other ways, shapes, and forms.   

So today – and Anton will get more into these types of things – Black people are the number one leaders in most health issues: asthma, diabetes, prostate cancer, and the like.  So while some argue that it comes simply from conditions of Black people not taking care of themselves, the fact of the matter is the disparities existed in the Black community – it derives from either neglect of Black people in the form of health practices or intentional denial of services that are provided to other communities in the form of quality health care and health care access, leading to the types of discrepancies that we’ve seen with the pandemic today.   

And so when I talk about some of these things historically, we have to understand that when it comes to how the Black community has dealt with issues in the United States, there is a multi-decades, a centuries-year history of us being disparaged, targeted, and discriminated against, and that has led to the challenges that we have today.   

MODERATOR:  Thank you so much, Dr. Dibinga.  We really appreciate your remarks.   

Over to Anton.  Take it away, Anton.   

MR GUNN:  Oh, thank you so very much for this opportunity, and I’m excited about being with you all here today, and I thank Dr. Dibinga for giving that great context around the challenges of the American health care system.  But to ground it into a modern context, I want to use a quote from Dr. Martin Luther King, Jr., that he delivered in 1966, when he was speaking at a medical conference in Chicago.  And the – some of the quote is:  “Of all…forms of inequality, the injustice in health care is the most shocking and inhumane.”   

Now, I want to contextualize that we know that the American Civil Rights Movement was around equity, around justice, and opportunity for African Americans, particularly in housing, in education, in employment, in accommodation of services.  And so Dr. King faced attack dogs, water hoses, was beaten on the Edmund Pettus Bridge.  I mean, so much violence took place during the Civil Rights Movement.  But for him to state in 1966, just two years before his death, “Of all [the] forms of inequality” in America at the time, the “injustice in health care is the most shocking and inhumane.”   

And Dr. Dibinga gave you evidentiary framework of how the system has been used to distribute inequitable outcomes in health care, inequitable services.  So this is where we are, and this is where we have been for the better part of 40 years. 

Now, let me give you some additional context about solutions and how we drive to making this system better, making America better when it comes to health equity and reducing disparities for persons of color. 

The first is you have to understand that our system was never designed to provide health care to all people.  The fundamental reason why this is the case is because our nation made a decision to attach health care access and health insurance coverage to employment.  If you do not have a job, you’re not entitled to health care.  That was the context in most of America’s history, that if you did not have a job, you are not entitled to health care.  It’s not a right unless you’re employed.  And then it is not the government’s responsibility to even provide that health care to you, that the responsibility of health care was on the company that employed you or the organization that employed you.  So if you work for a large corporation like a bank, an insurance company, a utility company, any kind of large business, as a condition of your employment, that employer would provide health insurance coverage. 

But the challenge is, given the history of Black and Brown people in the United States, they were systemically and structurally prohibited from getting jobs in certain companies.  And if you did get a job, that job was not a full-time position, but just a part-time position, which kept you from the opportunity of accessing health insurance coverage which gives you access to doctors, hospitals, and other medical services. 

So as you can see, in the building of the American health care system, we made a specific decision to not provide coverage for all Americans, but only provide it to those who have jobs or employment. 

It was sometime later that you saw benefit programs like Medicare, which provides health insurance coverage for adult Americans over the age of 65, and then you saw Medicaid come into existence around the same time that provided coverage for poor and disabled persons, persons who may have a severe disability or may be at extreme poverty that they need access.  But that level of poverty was deemed to be so low, millions of Americans and millions of people of color were left out, locked out, priced out, and shut out of access in the American health care system. 

In my 25-year career, I started doing this work in 1996, seeing how so many people were locked out.  But it wasn’t until 2009, after the election of Barack Obama for president, that we made a significant, positive impact in reducing the number of African Americans and other people of color who didn’t have health insurance coverage.  And that is known as the Affordable Care Act, also called Obamacare. 

So let me explain to you the biggest focus of Obamacare and the biggest focus of the Affordable Care Act.  It was for people who did not get health insurance coverage through their employer or through a public program.  And they didn’t get it because they either couldn’t afford it or it did not exist.  So the Affordable Care Act created a mechanism for individual citizens to be able to buy health insurance coverage even though they may not have had a large employer to provide that coverage. 

Now, I can tell you – hindsight from today – that the Affordable Care Act reduced the number of African Americans that didn’t have access to health insurance coverage by more than 30 percent.  So 30 percent more African Americans today have health insurance coverage than they did in 2008.  This created an incredible opportunity for more people to improve their health outcomes.  It gives them access to coverage.  

Now, access to coverage is a big part, but it is not all that’s necessary.  Because you can have access to coverage, but the question is:  Can you get in to see a doctor?  And when you get in to see that doctor, does that doctor provide care to you in an equitable and just way?  Do they value you as a person or a human being? 

So there’s still some hurdles to overcome, but I can tell you unequivocally that the Affordable Care Act did great opportunity for millions of people, particularly persons of color – African Americans specifically – to get something that they desperately wanted but did not have in any way, shape, or form.  There were 50 million people in the United States of America who did not have health insurance coverage before the Affordable Care Act.  Well, since its passage and enactment, now 30 million people have access to health insurance coverage.  A large percentage of them, a growing percentage of them, are persons of color who can now buy and purchase coverage.  This is a win for America. 

There are also other things that have happened more recently.  As a matter of fact, just a few days ago this week, President Joe Biden and President Barack Obama were at the White House signing an executive order – President Biden signed an executive order that strengthened pieces of the Affordable Care Act – or when I say “pieces,” segments and provisions in the Affordable Care Act.  It addressed something called the family glitch.   

Now, the family glitch – and I’m going to touch on this very briefly and leave time for Q&A – the family glitch happens when you are a married person with children, and you have a job that provides health insurance coverage, but your employer requires you to pay money to access that coverage for your family.  Sometimes your payment portion for your family to access your employer-based coverage could be nearly 30 percent of your income.  That made it a burden for many families who wanted family coverage but didn’t have that 30 percent to pay to be a part of their spouse’s or partner’s health insurance plan at work.  So they chose not to get coverage.  So you would have a husband who had health insurance coverage at work, but the wife that did not work and the children that did not work would not be able to access the health insurance coverage.  That is the family glitch. 

But this week, President Biden signed an executive order basically making it so that that wife and children could get financial aid or financial subsidies from the federal government to help them to be able to afford to join that employer-based coverage that’s held by that family member.  They believe – the administration said in their press briefing – they believe that immediately some 200,000 Americans who did not have access to coverage would get coverage beginning in 2023.  Additionally, another 1 million Americans will have the opportunity to access that option and get more affordable coverage on their spouse’s health insurance plan. 

So these are things that are designed to close the gap of the disparities in care, the most unjust and unfair layout of health insurance coverage.  And the ACA is doing a great job of it, but it is not the end-all, the be-all.  We still see massive disparities.  Dr. Dibinga laid out diabetes, heart disease, cancer, HIV, and AIDS still disproportionately have a negative impact on persons of color.  And the main reason this is the case is because it took us a long time to recognize the value of Black and Brown skin.  As a nation, still into the 2000s, the value on a life of color was not seen as the same as the value of a person who’s White.  And because of those disparities and because of that mindset, these disparities persist.  So the Affordable Care Act and Obamacare is closing the gap, but we still have a long way to go.   

And I would be happy to entertain questions and dialogue about where we go from here. 

MODERATOR:  Thank you so much, Mr. Anton Gunn and Dr. Dibinga for both your opening remarks.  Let’s open the floor for questions.  If you have a question, raise your virtual hand and wait for me to call on you. You’re also welcome to type your question in the main chat room. 

We received a few questions in advance, so I’m going to go ahead and ask those questions on behalf of the journalists.  We have a question from Pearl Matibe from South Africa, Power 90.7* (correction 98.7) FM channel.  She asks:  “What lessons about the Affordable Health Care Act could African countries learn, improving access to health care or health care reform for African populations – like in South Africa, Eswatini, or Zimbabwe – not only to eliminate TB, malaria, or HIV, but in preventative care?” 

MR GUNN:  That’s a phenomenal question, and I’m so glad to hear it and so glad to answer it.  So I think the greatest lessons are actually tied into the COVID-19 pandemic.  As we saw this global pandemic impact the entire world, it brought into clear focus that a public health infrastructure is incredibly important for people to get preventive care and be able to get access to life-saving treatment when they need it.  And so I will say that the biggest lesson that any nation could take away from the Affordable Care Act and from health care in general in the United States of America is to build your public health infrastructure before you reach a crisis point.  So whether it’s TB or malaria, these are immunizations that people need.  And having a robust immunization program in any nation is the greatest opportunity to prevent the disease.   

One of the things that the Affordable Care Act put in as a part of the law is that every health insurance plan and every insurance plan that you could consume under the ACA must have preventive services attached to the insurance plan.  So what am I saying specifically?  A lot of people use health insurance coverage when they get ill or when they get sick.  So if you have a heart attack, you go to the doctor, and then the insurance pays for your treatment under your heart attack.  You break your ankle or you break your arm, you go to the hospital, they reset your arm, they put it in a cast, and then the insurance pays the doctors for setting the cast.  That’s all reactive healthcare.  But preventive healthcare is not waiting for anything to be wrong with you, but to go to the doctor routinely to get a checkup, to get screenings, to get immunizations, to understand what you can do to keep yourself healthy.   

And one of the most important things that the Affordable Care Act made as a part of its requirements is that now every American who gets coverage under the Affordable Care Act gets free screenings before anything is wrong.  So you can get screened for prostate cancer, you can get screened for depression, you can get screened for diabetes – it’s called a wellness visit, and that is to make sure people can access coverage long before they’re sick.  And so a public health system and also screenings and preventive care is something that every nation should be doing for all of its citizens.  Don’t wait for people to get sick; give them access early while they’re still healthy. 

MR DIBINGA:  And I would add to that, if you go back to the beginning of Anton’s presentation, he talked about the fact that health care has not been a guarantee or promise for everybody in the United States, and we’ve suffered greatly for that.  The best example is the crack epidemic and the heroin epidemic.  So in the ‘90s, the United States, we had an issue with crack cocaine, and it was primarily an issue facing Black and Brown communities.  Rather than look at it as a disease worth treating, government, mayors, governors, they looked at it as a criminal issue.  So they focused on arresting Black people and Brown people who were addicts –and of course dealers as well, but people who were addicts who needed treatment.  And it was the idea of lock them up and throw away the key.   

You fast forward to the last decade with the opioid epidemic, which has primarily affected White communities, you see across the country in these White and rural communities they have said we don’t have the infrastructure to treat these people.  So you saw people dying on the streets and getting high in their cars.  If we had set up the infrastructure to treat crack cocaine in the ‘90s, we would have the infrastructure in place now to treat the opioid epidemic, to not put us in a situation, as Anton just said, of having reactive health care. 

MODERATOR:  Thank you both for your responses.  I’m going to turn it over to Alex.  Alex, why don’t we start with you?  Please introduce yourself and your outlet.  Thank you so much. 

QUESTION:  Hi, thank you so much for doing this.  This is Alex Raufoglu from Turan News Agency of Azerbaijan.  I really appreciate compelling – very compelling presentations.  I have a very specific question about my region, but let me first follow up on Pearl’s question, and – so I understand the core of the problem in the case of COVID and vaccine allocation.  There are racial disparities with COVID that have been articulated in a few reports that I have seen so far, and the truth is that the risk of death for minorities is far greater than the rest of the country.  And again, they are often from African American and Latino communities.  So discussing racial equality in health isn’t a conversation about affirmative action, right, it’s also about understanding who gets sick, who dies.  Do you think a rather stronger case can be made for a age-based triage of vaccine allocation moving forward? 

And now back to my region, this is a wonderful opportunity for me to ask about the minorities, including those refugees and dissidents from Africa who are currently fleeing Europe to escape the war in Ukraine.  As the administration is in the process of developing a refugee acceptance program, what would you like to see to be done in terms of this particular group of minorities, including their access to health care?  Thank you so much. 

MR GUNN:  That’s a great question.  So I will tell you that it is my personal belief and perspective – I really do believe that you should do what is right at all times and for all reasons.  And so I take a very specific lens around justice and around equity.  So to answer the question specifically for your region, when you have conflict and war, everyone should have the opportunity to be free of that conflict and war.  So if refugees are leaving a region and fleeing conflict, regardless of what their race, ethnicity, background, or age, they should have the opportunity to be safe, secure, healthy, and whole.   

And so for those nations who are setting up a program, they shouldn’t prioritize one group or another.  By prioritizing one group or another, you’re doing the same thing that the United States of America did for many years during the transatlantic slave trade and the hundred years after the transatlantic slave trade, which is prioritize people who are White over people who are of African descent.  They made a decision that one was more worthy and another was less worthy. 

So when it comes to setting up any kind of system, you have to not focus on who is more worthy or less worthy in the context of race, but who is more worthy in terms of need.  That’s the context of equity, is to meet the needs of people where they are and the way that they need them.  And so a big challenge for all of us – all governing nations and all leaders – is to understand and have a equity lens to delivering outcomes, and that’s a justice lens.   

So I fundamentally believe that that’s what they should be doing is provide those services to people in need.  If people come to your border and they don’t have immunizations and they are not in good health and they’re sick, then immediately provide access to services and treatment and do it in a culturally appropriate way.  What is valuable to them is not always what’s valuable to you. 

So that would be my strongest answer in response to that. 

MR DIBINGA:  And I would – to the first part of your question about age and disparities with the vaccines and things like that and like kind of an age-based approach, there was a point where we were looking at the vaccines that there was a targeting of people who were older because they were more likely to suffer from COVID.  But one of the things we have to understand, that with COVID there was one point during the beginning phases of this where the majority of people who were dying in the White community were older and White, and the majority of Black people who were dying were more middle-aged.   

And so what was happening was people who were like in their 40s, their 50s and 60s, who – what we would call the sandwich generation, people who have their own kids but are also taking care of their parents as well – that portion of our community was being ripped from us more quickly than the White community because of COVID, because of those pre-existing health disparities.  And so when you bring up the issue of the age issue, there’s a good point to be made there, but you’re also going, as Anton was saying, dealing with situations where they are.  If you see that there’s a group that is pivotal to a community that is also disappearing rapidly, you also need to develop the services at the same time to treat them as well. 

I live in Washington, D.C. in a poor – in the poorest area of Washington, D.C., Southeast, Anacostia, D.C.  When the vaccine started to be rolled out, I’d go to my – and this was happening all across the country – I was going to my neighborhood grocery store, majority Black people, and I was seeing all of these older White people there who I knew didn’t live there.  And I’m like why are they here, and people were saying they were here for the vaccine.  And my question was, how come they got to know the vaccine was available before people who live in that own community got access?   

And so local governments had to go back and realize how they were distributing information, and they were doing it mostly technologically as opposed to going into churches, going into schools, going into community centers, and letting people with less technological access know that that was available.  And once they started making that change, those things started to change.  So yes, we can make the argument about the age-based issue, but there are also some basic disparities from jump that we also have to deal with as it relates to how we roll out these programs. 

QUESTION:  Makes sense.  Thank you both. 

MR GUNN:  Let me add one other thing.  I really appreciate the question and Dr. Dibinga’s commentary on that.  So I know we have multiple journalists on here who probably speak multiple languages, okay?  And I want you to understand – imagine if you did not speak English at all and all of the information to tell you where to go to get the COVID vaccine was only in English.  How easily and accessible would it be for you to get a vaccine if the language that you were most comfortable in, the communication methods that you were most comfortable in were not the methods that were used to tell you where to go to get life-saving treatment and prevention to keep you from dying from a deadly virus?   

That is a challenge that we have always had in America, is that many times, the government or agencies or even organizations would communicate in ways that did not reach the people who needed the information, who were dying disproportionately from a disease, who didn’t have the same access to information.  And you would think that you’re reaching people by sending emails when a large portion of the community don’t even have a computer at home to check an email.  They – even if they have a smartphone, they don’t know how to use a smartphone in the smart way, so they’re not getting the information.  And that is how disparities persist and grow over time because of how you choose to communicate information and to what demographics you choose to communicate that information.  

MODERATOR:  Thank you so much for both your responses.  I’m going to turn it – I guess we don’t have any additional questions.  Oh, actually, there’s a question from Mamadou Niang.  Mamadou, please, go ahead and introduce yourself and your outlet and go ahead and ask your question.  Thank you.  

QUESTION:  Yes, good morning, everyone.  I want to thank you for hosting this platform.  NextMedia is my television news agency for service for West African television networks and  France Télévisions 2. 

So I would like – I mean, it would be interesting to discuss an issue that just came up Monday in Congress, where it is regrettable that they dropped the funding package intended for helping nations abroad, actually, especially Africa, combat the pandemic.  Of $22 billion that the President requested, 10 billion were slashed.  So how do you see the lack of sensibility to the reality of the global pandemic?  I mean, you all know that when it hits one place, it will very rapidly and massively engulf the entire world.   

So is there a reason, maybe, for a massive surge on the part of citizens to explain to Congress that probably they do not understand that this disease is global?   

MR DIBINGA:  You’re muted, Anton.  I thought you were going. 

MR GUNN:  Yeah, I was.  I am going, no.  So —  

MR DIBINGA:  Yeah.  So go for it. 

MR GUNN:  So I really want to thank you for framing of that issue in such a very focal area to talk about right now.   

Unfortunately – and I don’t think I’m going to say anything revolutionary to all of these journalists on here – that America has – and when I say “America,” the United States of America has always been self-centered and centric in its view around global issues; that even when we know that there is a global pandemic, we only get involved and take action when it impacts us, and we focus on what is going to best benefit or serve America.  And it’s a very short-sighted and un-altruistic way of seeing – meeting the needs of challenges around the world, because the world is more global.  Where we think about global travel, we think about globalization in general, goods and services, that we are actually more reliant on the entire world today than we ever have been at any point in history.  And so we have a greater responsibility to think about how do we help stop the global pandemic in the world because it does impact us.   

But I think the decision that you saw Monday around reducing the funding for combating disease really is the short-sightedness of some elected officials and individuals to really only focus on self-preservation and not on world preservation.  And it’s an unfortunate byproduct of the American political system and I definitely wish it was different.  As an international traveler, I know that I will not be able to get to Burkina Faso anytime soon until there is a herd immunity from COVID-19, because, I mean, it’s all of these things.  If we think about the entire world, it makes it difficult.   

So I agree with your premises that we need to have more concern and more outrage in America around how this is impacting the world, but we don’t have it at this point.   

MR DIBINGA:  Yeah.  Mamadou, hope that you’re doing well.   

QUESTION:  Yes. 

MR DIBINGA:  (Laughter.)  So for me, everything Anton said for sure.  One of the things that we also have to be mindful of is – yeah, like Anton said, we’re just being honest here.  That’s what we were asked to do.  So there’s also been this history of, sure, we might get affected, but not as much as the other group.  In the United States we have this thing called a Southern strategy, this idea that politicians were using that as long as they change racial-coded language – instead of saying things like “Black,” say things like “school bussing” or “forced bussing” or “states’ rights” – the idea is that with policies that are created, White people – poor White people may get hurt, but Black people will get hurt more, and therefore it’s okay.   

And this idea has been the case with COVID.  When COVID first hit the United States, there was this mentality of we’re all in this together.  Then-President Trump declared a national state of emergency.  Like, all of that.  Once the racial data started to come out and it realized that we were affected more as Black and Brown people, the mentality changed.  There were protests for governors in Michigan to open up the country and free America, because this idea of White people are going to get hurt less made it okay.  Just let everything happen and kind of let the pieces fall where they may.  And that is also the case as it relates to the African continent.  So the idea that, well, yes, Africans may suffer from this, but they’ll suffer more than we would.  So even if somebody may catch COVID in Senegal and it might spread from Dakar or wherever, and they come here and it spreads, the effects are not going to be that great.  You may lose a hundred to the thousand that they lose, and it’s not that big a deal.  And it’s unfortunate, but that has always been the case. 

Look, we have all of these work that’s going on relating to the Ukraine, and all of us here support the Ukraine and what’s happening.  We support the Ukrainian people and their fights.  But at the same time, there’s no attention in the United States to what’s happening in Cameroon in terms of what’s happening with the war that’s going on there.  And we could talk about different geostrategic things, but my point is there has not been the same level of response or care in the United States historically to Black people dying inside the United States or outside of the United States.   

MR GUNN:  Let me – let me add one last piece to that.  Let me contrast another health crisis that happened some years ago.  Everybody remembers the Ebola crisis.  Okay.  Ebola crisis started in West Africa, and nobody in the United States really cared about it until the first patient showed up in the United States of America.  I mean, when I say they didn’t care, there were people in the public health agencies, CDC, who did care because they do global health and they focus on that.  But it became a personified crisis when patient zero was in the United States of America, and then there was a response. 

And so again, that speaks to the self-centric nature of we don’t really care until it starts to hurt us, and then we’ll respond; but if we start to see that hurting us means that it’s hurting people of color more than it is White people, then we care less.  I mean, it’s such a, I don’t know, schizophrenic nature of doing global public health or doing health care work in general, and we need to change.   

MR DIBINGA:  And you’re not going to see a large groundswell from the American people that you asked about because many of them don’t know much about the continent either or care much for it either.   

MODERATOR:  Thank you so much for both your remarks.  I’m going to turn it over to Alain Chagnon.  Alain, please, go ahead and introduce yourself and your outlet and please ask your question.  Alain, we cannot hear you.   

I’m going to turn it over to Kobby Gomez.  Kobby, please, go ahead and ask your question.  Introduce yourself and your outlet.  Thank you.   

QUESTION:  So my name is Kobby Gomez-Mensah.  I am a Ghanaian journalist, currently freelancer, and also a human rights professional.  A few comments.  The first comment I’d like to make is that I would have expected to see some data when it was mentioned that with the introduction of the ACA, and there were 30 million people who have had access to health care.  I mean, I would love to see data and see which groups of people are in the majority in terms of those who benefit from the ACA.   

The next thing that I find quite interesting is the statements from both presenters about the extent to which the Black population probably do not have access to information, or even if there was information available, they could not use modern tools to access such information.  And I ask that question because from my travels and my learnings, it looks as though those of us of the Black race tend to hammer on the negatives much more than the positives, and also providing ourselves an actual (inaudible) to give people the chance to advance from wherever they find themselves.  Because otherwise, then all you do is pity party, often discussing your weaknesses much more than taking advantage of the opportunity that exists within every continent, as to whether that is in Africa, whether it is in Europe, whether it is America.  How do Black people begin to look at (inaudible) differently rather than bask in the difficulties that (inaudible)?  Thank you.   

MR DIBINGA:  So Anton and I, outside – we were asked to come here to speak about the disparities, to speak about the history and where we are.  If – outside of our work here, we’re on the front lines of everything that you just said, working with communities who are doing the work, who are making the change.  I mean, there were Black people – Kizzmekia Corbett – who were a part of the creation of the COVID vaccine.  There have been Black communities and churches and organizations and individuals who have been on the forefront of making sure that the resources we talked about were lacking get provided, to make sure that the education – that’s the main reason that numbers of Black people who are vaccinated went up, was because of the work of more Black people in the community. 

So it’s not about the idea of having a pity party or anything like that.  The fact of the matter is you have to – if you don’t recognize what’s there, you can’t deal with it.  The great James Baldwin said:  If you don’t understand what happened behind you, you’re not going to understand what’s happening around you.  So we understand the idea about being proactive and the like.  But it’s one thing to move forward with dealing with the situation, but you can’t ignore the history.  You can’t ignore Ghana’s colonial history.  You can’t ignore Ghana’s experiences as it relates to slavery and the like.  Is it an excuse for the Ghanaian people not to do anything?  Of course not.  But you have to acknowledge something as being there before you move forward productively, which is what we’re doing every day.  But we’re here to talk about the context.  If it was to talk about what Black people are doing and the responses and all of that, many of the things we talked about here would have been different. 

MR GUNN:  Yes.  I’ll add this would have been a totally different presentation if we were talking about all of the work that has been done and is being done.   

So let me give you a data point.  I know you asked for a data point.  Before the Affordable Care Act, the uninsured rate for non-elderly African Americans in the United States of America was about 18.9 percent of the population, but the ACA helped to reduce that down to 11.7 percent.  So that’s a significant reduction in the number of people that were uninsured.  However, there’s still a great need for improvement, because even with that reduction down to 11 percent, the uninsured rate for African Americans is still 7.5 percent higher than it is for White persons in the United States of America.  So as you can see, we provided access, we made health care more affordable, more people got coverage, but there is still a disparity of 7.5 percent, which means that there’s still more work to be done.  So there’s a lot that has been done, but there’s more work to be done.   

And in the context around the response to COVID-19, there are countless numbers.  I’m actually a part of a group of African American physicians who worked at all levels – some in policy, some in organizations, some in medical practices and hospitals – who literally have been doing daily education in communities to teach people around how they can access the vaccine, even opening up vaccine clinics on their own to help people to get access.  So a lot of work is being done to reduce the disparities.   

But to reinforce what Dr. Dibinga said, the context is this:  In order for you to solve a problem, you have to understand the problem.  And in order for you to understand a problem, you have to look at the problem from the beginning to where you are right now.  The moment you ignore the origins and the systemic nature about how you got to where you are is the moment you find a solution that is necessary but will be totally insufficient. 

And so a big part of the work is understanding how we got here, and it took us roughly 400 years to get to where we are.  And being honest about it, it might take us equally as long to get to a place of equity and justice.  And that’s what our work is about every day.  That’s the reason why I travel, the reason why I work with the organizations, the reason why we all are in the fight every day, because we recognize that the solution – we’re closer to it today than we were before, but we still have a mighty long ways to go.   

MODERATOR:  Thank you for both your responses.  I’m going to turn it over to Abdou Casset for the very last question.  Go ahead and please introduce yourself, Abdou, and introduce your outlet as well.  Thank you. 

QUESTION:  Thank you both.  My name is Mame Abdou Gaye Casset.  I work for E-Media Invest, a group in Senegal.  So I have two questions.  The first is:  What is the Biden administration’s current strategy in terms of universal health coverage?  And the last one is:  What is the future of Obamacare?  Thank you. 

MR GUNN:  That’s a great question because the answer is pretty much the same.  There’s a great intersection between them.  So President Biden – I was going to say President Obiden – but President Biden recognizes that the Affordable Care Act was not a total solution to our challenges around the American health care system.  It was a great foundation.  That foundation gave more access to coverage to millions of people.  But there’s still roughly 10 or 15 million Americans who still don’t have access to coverage.  Some of them are undocumented immigrants.  Some of them are people who are in particular career paths where they can access it, but they can’t really afford it.   

And so what President Biden has done thus far is to strengthen the ACA to make sure that over the last four years, when the Trump administration literally tried to roll back and undo most of the Affordable Care Act, the Biden administration set itself in a position to say:  How do we make the law stronger, make it more sustainable, make it more impactful, particularly for underserved communities and communities of color?  The family glitch is one example of that.  Strengthening Medicaid is another example. 

Now, the reason why Medicaid is important, Medicaid is a health insurance program that happens at the state level.  And let me be clear:  The overwhelming majority of states that have not expanded Medicaid under the Affordable Care Act are states in the south of the United States of America.  It’s also the same states where you have the largest population of Black and Brown people.  So in the place where the need is the greatest, in the south, given the number of people of color there, those states have made decisions to not create opportunities for African Americans and other people of color to get access.  So the Biden administration is doing everything in its power to make it easy for the people in those states to get coverage under the Affordable Care Act until their state government makes the decision to value those people the same way the national government, under the Affordable Care Act, is valuing people. 

So that’s the solution to get towards universal health care.  It’s to strengthen the Affordable Care Act, number one, and number two is to make sure that the Affordable Care Act becomes a big part of how we provide that coverage for everyone long-term.   

QUESTION:  Thank you so much. 

MODERATOR:  Well, thank you so much, all.  We are now out of time.  Thank you for – to both our speakers for participating in today’s briefing.  Thank you to our journalists for joining us today.  Today’s briefing was on the record.  I will share a transcript with everyone who is participating today, and it will also be posted on our website.  And with that, have a wonderful day.  Thank you.