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    "text": " Hi, everyone. My name is Zina Ahmed. I have a Master's in Translational Medicine, and I'm currently an MPH student at the Yale School of Public Health, with a focus in health policy. So today, I'm going to be discussing sort of equity and health equity in the gist of it. So does equity mean equitable on a global scale? And oftentimes, when we think of equity, we often associate that with social mission, with health equity, you know, things along those lines. But oftentimes, you know, health professionals, unfortunately, tend to negate, you know, the concerns of patients from what the patients are going through. We talk about it from like the institutional and structural aspect of it, but the end goal seems to always be redefining. So who exactly am I? And what have I done in order to talk about, you know, equity as a whole? So to give you guys a little background as to who I am, like I said, I've had a first Master's degree in Translational Medicine at City College, where I've worked extensively with, you know, amazing colleagues and mentors, where we were able to create sort of like a biomedical device that was geared towards patients, first being, you know, osteoarthritis and looking at that, you know, sort of in this innovative to from like patients, from patient's bedside, to, you know, the bench, the bench side. And then with the pandemic and everything else, I started to look more so into policy or specifically health policy, being that I was born and raised in New York. And so a lot of it, and a lot of my expertise currently has been more so like advocacy, activism, policymaking, emphasizing COVID. I've worked on several projects with public citizen in regards to COVID-19, the mortality rates in the United States, looking at Latin America, looking at things in Africa, you know, in regards to like regulatory information and, and those sorts of stuff. So, again, that's me in a nutshell. My email is provided at the end, if anyone has any questions or comments or anything like that. So to begin, I'm sort of going to show you guys the structure of today's sort of table of contents or, you know, what we're going to talk about today. And again, the objective of it all is how does sort of health equity look like on a global scale, right? And we're looking at sort of these three tenets of drugs, COVID-19 and abortion, specifically, because those three, I think, are sort of the importance of what's going on in today's world. Again, these are things that I personally have touched on, and I have expertise on. And we're looking at it from a graphical standpoint. So looking at it, obviously, in the United States, but also in Africa and Latin America. And then with those sort of groundworks, right, we're looking at the implementation of sort of like the global policies surrounding drugs, COVID-19 and abortion, and whether or not that can be sort of addressed, can it be modified, can it be codified, you know, into things that is international and sort of standard? Or primarily, right, is it not? And do we have to sort of break down or decolonize the current standing, you know, laws and policies for healthcare services in those parts of the region? And again, in conclusion, sort of to wrap things up, I'm going to sort of show amazing call to action organizations that are doing groundwork. And you guys can take a look at that, or, you know, Google the name. So I hope that helps. Hope we can sort of talk about health equity in a larger standpoint. So in regards to the United States, and again, I'm currently at the Yale School of Public Health. So the American Public Health Association has defined health equity as ensuring that everyone has equal opportunity, right, to achieve this sort of goal. And the goal is to have the highest level of health. Now, that's sort of broad in and of itself, right, it doesn't talk about, you know, racial, sort of like racial injustices, or, you know, individuals who are who are at like underserved communities or under resourced or underrepresented. And I know, and again, I know this personally, because born and raised in the Bronx, I know how underserved, the Bronx is when it comes to health care, in comparison to like, you know, other private hospitals, for example, in New York City. And so that in and of itself requires, you know, more attention should be brought. And so this is why I'm saying we're looking at it from a US health care standpoint, right? And what exactly is the US doing? And again, this is a very broad, generic definition. Now, obviously, there are tons of flaws with this, in my opinion, right? And sort of the flaws is, again, it's talking about, like, everyone has that equal upfooting, equal standard, but it's not, we're not talking about how can it be equitable, you know, for everyone to achieve, we're not talking about communities that, for example, have been displaced, or, you know, how can we best aid, it's just a very basic generic definition. So the path to equity, and again, this is sort of my vision, you know, my sort of opinion, this is my bias, this is my just strictly, you know, professional opinion on the matter. And so what I think, and sort of on the basis of my expertise, is in order to achieve equity, and equity on sort of a global aspect, we need to look at it as to how do we assess the inequities of the underserved communities first, we analyze it, and we look at sort of the statistical analysis or the data provided in these underserved communities, then we can determine, okay, there's all the health burdens, right, that communities are facing. And then from there, we look at it from, okay, who are partnering or who are doing the groundwork. So if we have individuals who are partnering up with non-profit organizations, right, that are, again, providing the resources that are helping uplift individuals, helping, you know, with screening processes, you know, checking for diabetes, like biometric screenings, things along those lines, right, that can, again, uplift these communities that are part of the underserved. Then we're looking at it from, you know, partnering to improving residents' quality of life. And if we can improve it, right, then we can lessen the burden of comorbidities. So again, things like biometric screenings, you know, looking at cholesterol, looking at glucose, right, those primarily can, we know, can decrease, like, comorbidities. Then analyzing all of that, right, so we have the analysis, we have the research, we have the data. Now let's talk about policies. So establishing an international guideline of treatment and care that meets global health standards. So again, we have to look at it from a standpoint of, this is not just U.S. based, this is not just U.S. healthcare, but overall, right, we go to different continents of the world, and we can see that in different regions, depending on their GDP, right, their gross domestic product, how these countries are surviving, right. If they're within the low, middle, and income countries, right, they may not, there is a difference between those that have, who belong in sort of social classes, those that are on the higher end of the social classes have better care, right, versus those that are on the low end spectrum of things. So how can we establish sort of these guidelines and treatments to sort of meet that equal standard of care, right, no matter the skin color, no matter what the individual looks like, right, whether or not that they have disabilities, or they're part of the LGBTQ plus community, irrespective of it all, right, that there is sort of the standard ideal guideline for treatment and care. And lastly, if all of these things are followed correctly, right, path to equity, then we have equity for all. And that's sort of where I'm trying to, you know, bring this all together. So again, looking at it from the perspective of the United States, I want to talk about communities that have been overlooked. And the reason why I want to talk about it is in order to move forward, we need to address communities that are currently suffering, they're currently overlooked, especially in the United States, you know, we can't be a superpower without addressing our flaws. So indigenous communities have lower life expectancy, right? Typically, they tend to live, I want to say the average lifespan is about 71, where in comparison to others, Hispanics, for example, average lifespan is like in the 80s, right? And then moving forward, it's like, much more higher. So again, there's a lower life expectancy, there is a disproportionate disease burden by cardiovascular diseases, we know that indigenous communities suffer from alcoholism, they suffer from addiction, they suffer from diabetes, they suffer from etc, etc, etc, you get my point. We need to stop that, right? There has to be sort of a line of addressing the burden, but also addressing what it is that we're doing. Are we not detecting? Are we not screening? Are we not providing care? Are we not, you know, giving the medications and whatever treatment that is necessary for these individuals? So we have to adjust to the discrimination of healthcare services and the cultural stigma that comes with indigenous communities. And a lot of it too can be pure ignorance, right? A lot of it can be not understanding, you know, cultural intelligence when it comes to, you know, indigenous communities. For one, again, I'm not literate whatsoever, but I'm just saying, when it comes to certain communities, right, I can't speak on those type of communities. However, if I notice that something is wrong, then it's time to speak up, right, on those communities and advocate and push for change. That's essentially what I'm trying to do here, right? In order for us to receive equity as human beings, right, because we all bleed the same, we need to look at those that aren't doing so well and provide the attention on them so that way they can be uplifted and move forward. So same thing too with disabled communities. Now, disabled communities obviously have been overlooked for far so long. And there are definitions too that have varied in regards to labeling someone as, quote unquote, disabled. So what I suggest and what I'm going to emphasize is that we need to reach a consensus on the expansion of the definition of disabled, right, the definition of disability within the federal and state legislative. So the reason why I'm saying that is if we look at, you know, government entities like Medicare, Medicaid, Social Security, right, Social Security benefits, and if there are, you know, disagreements or arguments made on the basis of whether or not these government entity, you know, whether or not that someone is disabled or not, it should be irrespective, right? We should understand that if someone, you know, may visibly look disabled or may not visibly look disabled, right, there are visible signs and then hidden signs. And so how can we address that as a whole, right, in order to push forward as human beings are receiving treatment and care. Looking at it too, we have to address the environmental, structural, institutional barriers that can obstruct the disabled person's ability to receive adequate care. COVID-19 did not just exacerbate, you know, the healthcare system in the process. It also harmed these communities. Disabled communities specifically did not receive screening for individuals who were not, like, mobile. And so when it came to mammograms, when it came to pap smears, when it came to all these things, unfortunately, individuals who needed, you know, assistance in, like, wheelchair or, you know, in other aspects, unfortunately, the stats when it came to those numbers were relatively low. And so this is why I'm saying, or this is why I'm emphasizing again, you know, the need to address these barriers. So let's look at healthcare on a global perspective. Equity is the absence of unfair, avoidable, or remedial differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically, or by other dimensions of inequality. Health equity is achieved when everyone can attain their full potential for health and well-being. So this is a little bit more detailed than what we would normally ask for, right, or in the first definition that I provided to you guys. And this is sort of from the World Health Organization. And again, it's a little bit more detailed, right? It's giving us more of... it's sort of giving us more and sort of what we would imagine equity to be, right? Just fair game. Everyone is sort of on the same, like, playing level, leveling field. And so that's sort of what we want. But on the contrary, right, we assume that everyone is equal, everyone is receiving equal treatment. But what if I said that it's not the case? What if I said that NGOs are sort of the checks and balances when it comes to global health equity? You may be puzzled. You're like, wait, hold on. I thought NGOs help out these, you know, these, like, regions and, and they're providing everything for them, you know, and I'm not labeling them. I'm not labeling, like, large NGOs as the black sheep. On the contrary, like, they're necessary for, you know, growth and funding and whatever else. But what I'm trying to... what I'm arguing is the fact that these NGOs are sort of the third party when it comes to funding, when it comes to grants, when it comes to research, when it comes to resources. And obviously, it's a lot of money that's being funneled. As you can see here, sort of, it's quite a bit. These NGOs, unfortunately, have a lot of say in where the resources are being funneled to. And that's, to me, that's an issue, right? We've seen that with COVID-19. UNICEF was in COVAX. Sort of, they played a hand in the donations and where the donations of the vaccine should go to. And if things were sitting there, then we know what happens to expired vaccines. And, you know, it sort of becomes a waste of money. So, again, what I'm sort of emphasizing is that, you know, we see the amount of money that's being funneled into these NGOs, right? But again, they're sort of the checkpoint for a lot of these low-middle-income countries. You know, especially when it comes to emergency humanitarian aid. And we've seen that, you know, firsthand, you know, in certain parts of Africa, in certain parts of South America. You know, we've seen that recently with Ukraine and Russia. And so, a lot of these checks and balances, right? And at the end, a lot of people sort of on the ground have complained that they haven't seen the funds or the resources or the aid and the help and the medical assistance needed to help them sort of overcome these burdens. So, when we're talking about, you know, global policy or we're talking about things like aid... Sorry, when we're talking about things like aid and and assisting in sort of, like, looking at it from these different perspectives. Remember I said in the beginning, I'm going to talk about, like, the drug world. I'm going to be talking about COVID. I'm going to be talking about abortion because those, you know, those topics are sort of what's being discussed quite frequently. But I'm not going to dive too much into it only because of time. And, you know, I wish I can just talk about drugs and equity all the time, but I, unfortunately, I can't. But I do want to note sort of the contrast and very similar aspects of looking at it from, like, here are two different parts of the world that are both working on sort of the same issue. And the issue is drugs, right? Now, when I talk about drugs, I'm not talking about it in a negative sense. I'm not talking about it in a way of, like, it's condemned or anything like that. I'm talking about it from the perspective of drug users who are seeking aid, right? Programs for methadone maintenance treatments or, you know, methadone clinics or, you know, things like that. Like, how are they seeking aid? How is it being treated? So, surprisingly, in Iran, right, they're doing quite well when it comes to the methadone maintenance treatments. When it comes to the Middle East, surprisingly, to my... surprisingly to me, I should say that because I, being Middle Eastern, I didn't know much about Iran and much about the Middle East world when it came to drugs because it's very taboo. But I was surprised to find out that Iran actually has a phenomenal drug program over there. So, drug users receive care, right, through MMTs. And surprisingly, again, surprisingly on my behalf, right, they receive support rather than being condemned, right, or feeling ashamed of participating, right? And Iran knows that if they take care of their nationals or their citizens, then they increase their labor workforce, right? And so that's sort of what they're doing. They're noticing that if we take care of our citizens, then they have a place to work and we can do well as a country overall. Now, like, in comparison to that, let's look at the United States. So, we know, like, we have these methadone clinics, you know, throughout America, mostly in the East Coast and the West Coast. But if we're looking at them, right, a lot of drug users unfortunately don't feel very comfortable using these clinics. Yes, they can receive aid. Yes, people have shown up. Yes, people have done things. But there's medical mistrust within the community, right? Law enforcement shows up. And, you know, they often feel like they can't receive treatment because, you know, law enforcement may arrest them for partaking in drugs or whatever the case is. And so it doesn't create a safe site. And so, again, it's avoiding the medical aid, right, where something is supervised with health professionals, as opposed to doing it on your own, where, you know, an individual may use, like, you know, may reuse needles and may cause hepatitis C. They may cause infections. They may cause, you know, the list goes on. And so we want to avoid all of that. And so this is why I'm saying it's important to look at the policies and how the countries are sort of applying the same issue at hand, which is drugs, and using, like, methadone clinics, for example, and how they treat their citizens. Obviously, again, you know, I'm touching it from the surface level. So, again, it's not to say that this is exactly how it's going in Iran. It's not to say that this is exactly how it's going in the United States. On the contrary, I'm taking very two different hypothetical scenarios that's often backed by research. And I'm saying that this is what's going on. These are the policies currently, right? Unfortunately, these are, again, the negative aspects and here are the positive. So, let's look at COVID-19. So, I mentioned COVID-19 very briefly, but let's look at it from the U.S., Africa, and Latin America. Let me just move this over to Latin America. So, the United States, when it initially started, right, we had mass mandates. Once the vaccine was sort of approved by the FDA, right, then we saw, like, vaccine requirements. And we also noticed, you know, the CDC tend to release, like, guidance documents for health care professionals, for schools, for employers, for, you know, a number of things, right, in order to make us safe, to, you know, minimize the number of incidents, to minimize the incident rate and the number of infections within the country. Now, these documents or these guidance documents were also shared, you know, in Africa. There's the Africa CDC, in Latin America, same thing, right, we have all of these, like, Ministry of Health, like, entities that, again, take COVID-19 really seriously. However, the issue with that is we tend to see that there are some regulations and there are some issues that go about it. So, in Africa, instead of, you know, that, like, instead of them creating the vaccine, or self-supplying themselves, they had to rely on donations, unfortunately. There were mass mandates, but again, it's quite difficult to uphold if you have some countries that, you know, have individuals who are not upholding it. So, you know, I was in Egypt, and I'm half Egyptian, so I've seen people who would walk around without any mask, and I was there in 2021. So, very early 2021, no one was wearing masks, everyone was sort of walking around as if it wasn't, again, if it, as if it wasn't, like, corona, you know, COVID-19 was not a thing. And then lastly, dependency on NGOs to provide resources and relief, like the CHIPS waiver. So, the CHIPS waiver is basically sort of a compulsory licensing, right, that the world was trying to come to an agreement with. Unfortunately, it fell through in recent times, and again, NGOs like UNICEF, COVAX, were sort of providing the resources of these vaccine donations to Africa, to places like Egypt, to, you know, Uganda, to Kenya, to Rwanda, like, you know, a number of places. And again, they're still doing these things where they're still holding, like, they're still providing donations. But again, the COVID relief from the United States is not as much as we would like it to be. And so, there are issues, again, with the number of vaccinated, with those that are being infected, you know, obviously, space and distance, the ability to work as well, right, we know how traumatic it was in the beginning, especially for those that couldn't work or couldn't go in, the economy level. So, again, a number of things. I came on so much detail, but for time's sake, let's move on. In Latin America, it's sort of the same situation. I may echo the same thing, but that's because that's exactly what's going on. So, there's very few vaccination donations being made. And then currently, and as a result of sort of the lack of enforcement of mass mandates, sorry, the lack of enforcement of mass mandates, we see currently that, you know, there's a high rise or high mortality rate in Latin America currently due to COVID-19. So, again, we want to emphasize, right, that if we're looking at health equity, we have to address the continents that are under-resourced and we have to address continents that don't have enough, right? We can't move forward as a society or as a whole if the other person is sort of lacking behind. We have to move forward together. Abortion policies, again, we're talking about it from the US, Africa, and Latin America. There's a lot going on right now, especially with Roe v. Wade being overturned. Reproductive rights are currently being questioned. We know with apps, like, period trackers can criminalize women, can, you know, do a whole bunch of things. And so, we're fighting for that, right? We're fighting to get those rights back. I wish I can say more. I think that the country itself, you know, we can't, we cannot have equity if we don't have reproductive rights. And so, this is why I'm emphasizing this as sort of my last, one of my last points, because women should have a right to choose. Women should have a right to their own bodies. Women, you know, and trans men as well should have a right to say, hey, this is my, you know, this is my consent. I need to, you know, emphasize on certain things. And unfortunately, in a governing world, people don't have that. You know, in Africa, an estimated 90% of women who are childbearing live in countries with restrictive abortion laws. Same thing in Latin America, right? There are barriers to reproductive rights, right? And so, again, if we're looking at as a world and sort of as a whole, if we're holding back on reproductive rights, then we don't have rights, you know, we don't have sort of these health equity rights. And then we sort of regress, and we're not moving forward. And so, again, I wish I can go deep into this. But I just want to emphasize one thing. If we don't have sort of these basic human rights, then, you know, about our bodies and about reproductive health, then health equity does not work. This whole concept of health equity does not work. So, in conclusion, health equity continues to be a moving target because of racial bias within the healthcare professionals globally. Health equity can be achieved when patients receive non-discriminatory healthcare services with anti-racist policies. What must be addressed are the frameworks that continue to plague overlooked populations, which starts with decolonizing and dismantling the current healthcare system. And the current healthcare system is not just here in the United States. It's all over the world. You know, we have to think back to the sort of checks and balance of the healthcare system and NGOs sort of play at hand at that. So, again, I want to say, like, look at it from that perspective. I gave you guys sort of a gist of certain things, certain puzzles to certain pieces. If we connect them together, you can see the bigger picture. And then I said that I'd be showing you sort of these call to action, like, organizations that are doing amazing, amazing, amazing groundwork. I'm going to pause for a second so that way you guys can take a look to see, you know, the organization. You can Google it. But, again, amazing, amazing work. Thank you so much. And, again, I want to thank the Biohacking Village. Oh, my God, you guys are great. Thank you for the opportunity to talk. And if you have any questions, feel free to reach me at zina.amed at Yale.edu. Thank you so much. Bye."
}