Host while he just told the secretary of Homeland Security not to deport people. Whats the difference. Guest he has the executive power but he didnt write out the power and issue it. He just basically told the cabinet secretary to cut down on the removal, so the number of removal dropped. Actually an Office President obama had removed aliens from the country more than any president before because congress had more resources in it and now those have dropped enormously and he is basically also said to people who could be removed you are safe. We are not going to come after you. Host the one group is the children who were brought here by parents and brought across the border than the other, the parents come here illegally and have a child is now the parents are illegal and the child is american. Guest these are millions and millions of people. Its hard to get a firm count but it sounds like there might be ten to 12 illegal aliens in the country and this is a huge portion of them, millions and millions that fall into these categories. The problem is the statute written by congress dont make any exceptions for any class of people. I wish people in both classes were able to stay through the process that is set up by congress isnt the president s job to decide who gets to stay in the country and who doesnt. Host when i was talking about crisis and command i ended up saying what are you going to write about obama ten years from now you were pretty pricey and at this time. Guest i was so pleased. You said im concerned about his expansion of domestic powers and then you said. Theyve done a better mark in even more than the electronic surveillance in the approval over the courts. What worries me is in the crisis had commanded to the point that the presidency was to act vigorously and decisively with speed in the face of the foreign threats and things Like Congress and legislators could not anticipate thats why you would have a president. That purpose is it important for Domestic Affairs because then congress can write things, the states are there, you can write the law to anticipate and if things arise you can rewrite the law. There is no harm in acting deliberately and slowly thats why you need the legislature and not one person. To me now at the end of the obama administration, that of the general framework of the framers set up this kind of been turned upside down. In a Foreign Affairs you see the president withdrawn even more in the constitutional powers for leading the country he is deferring to court, congress and the decision not to go to serious and Even International agencies and the un when he can. But in Domestic Affairs he is using all of that power that we want the president of National Security is using it on domestic matters and the administration is pursuing a whole piece people where common sense should take care of the matter is that he would rather have a permanent large regulatory state. I dont know though this may be the question of how that ever gets turned around because it seems host that is your next book. Come back. Guest it will be a few years. Thank you. They bring you offer after author after author and spot like the work of fascinating people. I love booktv love book tv in miami cspan fan. [inaudible conversations] good evening, everyone. I would like to start by thanking everyone for being here at the very first event at the supplies and poets collaboration politics and prose as we embark on the first of the wonderful ratings. I would like to remind everyone to turn off your cell phone and devices before we get started. And like many of you have feel free to order food and drinks and after two nights reading there will be a question and answer session. Raise your hand and i will come in to give you a microphone and after the question and answer session will have a signing right over here. Welcome you here on behalf of the coowners of politics and prose bookstore and the owner of both boys and poets and on behalf of the amazing staff. There is a 500 events a year at politics and prose and bus boys and poets locations like this one, tacoma and the store in connecticut avenue and venues across the city. In addition we have book groups, classes, trips and Children Programming yearround. We have cspan tonight, so if you would like to see events like these Going Forward feel free to subscribe to the channel. But on with tonights purpose i want to begin by saying that i am pleased to welcome dana as she discusses her book that is then a cure for racial inequality in American Health care. Professor university of Colorado Law School and the school of Public Health she serves on the faculty at the University Center for bioethics and humanities and is the cofounder of the Colorado HealthEquity Project a medical Legal PartnershipWhose Mission is to remove barriers for those who are very low income clients into the first book she draws on the experience and expertise to illustrate the bias that is present in the Health System and results in the loss of 84,000 lives annually. The disparities entrenched in the Health Care System are the premise of the argument for the solutions not just Training Programs and cultural sensitivity. They celebrate her for having presented a thorough picture of the problems facing minorities and Healthcare System and proposing reform on specific sections of the Civil Rights Act of 1964 when she claims to provide a legal and moral basis to hold liable those who discriminate and would hope to establish a new standard of care and medicine. And Michele Goodwin professor at california irving held just medicine inequality in American Health care as a captivating narrative that is so well written one cannot stop reading claiming nonsense. Washingtons page turning and awardwinning book medical apartheid has there ever been a book that makes medical discourse so captivating. Please try me in welcoming ms. Matthew. [applause] [cheering] that was an awesome introduction i would like to package it and take it home to my kids. [laughter] i want to get right into the matter and talk about unconscious racism as it affects the health of populations in the United States. I want to pick up on the number that chris spoke about, et 4,000 people because that is the number of people that die Surgeon General of the United States estimates by annually because of Health Disparities in the United States. Its a very big number, 84,000 people. Let that sink in and we will talk about why he and a minute. My objective tonight is to leave you with some food for thought so ive developed a sort of acronym i want to leave you with the five and sql. I want to talk about unconscious racism in healthcare being morally unattainable, medically unattainable, monetarily, manageable and just massively urgent. So those are like you to take away and i will try to trace them out in about 20 minutes and take this to the conversation level. I had an experience when i was 9yearsold i remember clearly because it was my First Experience with explicit racism. The expression that i was an inferior person to the speaker because of the color of my skin. I was on a playground and 89yearold girl a 9yearold girl i was nine at the time also made it very clear by using the nword why she wouldnt play with me on the playground and she made it clear to everybody else on the monkey bars by the wouldnt be playing with me either. I have no doubt about her motives, i had no doubt whatsoever about my relative position and reminder to myself worth. That is called explicit racism. I remember it well. Was my first time experiencing it and that isnt what this book is about. However, in unscientific study, i have three kids all in their 20s i checked with them and i said do you remember your First Experience with explicit racism clacks every single one of them does which tells us the generation between the two of us hasnt changed the existence and presence in the experience of people of color in the nation today. I want to make that clear because that isnt what im talking about. Im talking about implicit racism. All of those terms i will use interchangeably and let me start by defining them. Unconscious racism is what happens when your stored social knowledge. The information you take from the music that you hear on the radio, the movie is presented to you, the Television Stories if youve been watching the political debates and conversations, all of this is social knowledge into the stores in the unconscious part of your mind. It is triggered when you encounter a person of another race involuntarily, not you have encountered in voluntarily. You call up that knowledge and it informs your conduct and interaction with people of a Different Group on intentionally now lets be clear the difference between explicit preferences and an implicit preferences is important because studies show us most people in the United States today are not going to identify themselves, that was before the president ial election cycle that we are in. [laughter] more than we thought would identify them as explicit but most people its kind of out of style. Its not what we do or how we identify ourselves and not pr as the people but here is the rest. This is what the book is about. Its about finding out by just reams and reams of data that even if your preferences are egalitarian even if your preferences are to be a fair non prejudice a gala terri in person, youre implicit bias trumps your preferences. Youre implicit bias is what is stored in your social knowledge and will do more to inform and protect your conduct they had your preferences. Why is this important . Its important in healthcare and why i came to write this book is because is killing people of color it is causing people of color to live sicker and die quicker because of the color of their skin. So if i were so inclined i could spend the rest of the evening of running running the data on just that fact. In 2003 the institute of medicine published an important seminal work called unequal treatment and a catalog of 25 years of data. The fact that infant mortality in the africanamerican population is twice that of white populations and the fact that you are 75 more likely to die if youve are diagnosed with coronary Artery Disease than if you are a person of were a person of color then if you are white. And these are the kinds of data, the kind of statistics that will be replicated no matter what the leading cause is. Its true for stroke and diabetes and i will pause at cancer as i want to make a point. With respect to cancer, whites and blacks diagnosed at the same time have a 33 difference gap in their fiveyear survivability rate. This is not true however if they received similarly intensive treatment, education, screening. If these treatment disparities are eliminated, then the difference in survival rates disappears. The fact that that is true is morally untenable. That is my first m. Come a morally untenable in the United States. Its morally untenable in the United States because the medical profession not only agrees to first do no harm but if you read closely, the hippocratic oath talks about justice. It talks about being a provider and h. Reader of an entire patient, a whole patient in context. And when that is not the case, then an implicit biases change the way that people are treated. Let me turn now to the content of the book that institute of medicine study that was done in 2003, positive that its possible that the physician bias may have a causal relationship with Health Disparities that because physicians themselves as individuals were bias on race, ethnicity, socioeconomic, gender, Sexual Orientation and other grounds that might actually influence their treatment decisions but at the same time, the institute of medicine said we dont know how those mechanisms work. The plaintiff by both was to come up with in understanding how it is the physician bias translates into Poor Health Outcomes for people of color as compared to whites. So i looked at the empirical literature, it looked at a look at the studies into your copious with respect to implicit bias in health care, and i organized them into i called six mechanisms. I will only talk about one tonight but i organized them in a way that suggests there are six different pathways or mechanisms by which physician bias translates into Health Disparities. One of the most important contributions i hope my book will make is not only is organized set of this organized set of mechanisms for others to discuss and research but also the fact that one of those mechanisms, dirty little secret, includes implicit biases that patients hold. So if the fact of the matter is we get to the to the spy or social knowledge all of us living here in the United States we are going to get the same social knowledge into the literature tells us that patients as well as providers so one mechanism for tonight if you are interested in the others we can talk about them during the qanda but the study was about mechanism number five is the implicit bias actually changes the treatment pattern. This is a very direct link or mechanisms between the bias and disparities and Poor Health Outcomes. The studies that are in the treatment space status, and im thinking of one by Alexander Graham especially. They say that if a patient has a coronary Artery Disease and we present that the Patient First as a black woman, then as a white woman and next as a black man then as a white man, that we use a script, we use a predetermined set of data that tells us about the medical indicators. He is a predetermined we use a predetermined set of facts about their history and personal background and their family connections so that all of these individuals are identical to the physician but for their race and gender. If we do that, then we can see that race and gender informed the quality of the treatment decision. The second step of the study and probably the most troubling for my work and the reason i went to do this work if we also measure the implicit bias of the physician making the diagnostic treatment decision there is an inverse relationship between the level of implicit bias and the quality of the treatment decision. That is to say that moore implicitly biased a physician is, the high higher on the Implicit Association test and if you like i can talk about that test to hire the higher the Implicit Association test scores that position, the more likely they are to provide an inferior treatment modality to patients of color as compared to patients who are white. The reverse is true. The lower their implicit bias measures, the more likely they are. This is a study of coronary Artery Disease patients that needed the treatment of choice for their disease. But more likely the physician score was to prescribe the treatment of choice. That tells us there is an evidenced relationship between the bias and quality of treatment a patient will receive that results in different Health Outcomes because different treatments will be afforded to people based on the color of their skin. So, the other mechanisms have to do with a conversation or communication between physician and patient, particularly interested in the fact that there is a feedback loop. Maybe youve had this experience un counter someone and about they are not looking you in the eye. You know they are not giving you the kind of information you might have caught him if he were not a person of color and even though the interview is short and the body language puts distance between you and them. They are verbally dominant not asking and accrediting your opinion. These are the kind of signals patients pickup when they pick up their biases kick in also and so they say i know what that is. Since i know what that is, i no longer am satisfied in this experience and we have a lot of data that is us no satisfaction equals Poor Health Outcomes. What i found in this book is a series of interviews and that its not just low Patient Satisfaction equals Poor Health Outcomes it is that it means i am not coming back to you anymore. That is an introduction in my continuity of care. It means if you tell me i need to exercise, i am not listening to you because you have insulted me and that that means my adherence and compliance is love which translates into low or relatively Poor Health Outcomes. So all of these mechanisms work together. Now it is often the case that you write a book, ive been told to come and view finish a book and write another book, at different about at the conclusion of that conversation that for me just means now i have a second book project. But let me share a couple things. I am going to read one thing out of the book and