And by the Robert Wood Johnson foundation, working with diverse partners to build a natural culture of health, so that everyone in america can live productive and healthy lives. The california endowment. Health happens in neighborhoods. Learn more and by contributions to your pbs station from viewers like you. Everyone deserves an opportunity to live a healthy life. Disparities in health and health care are huge obstacles to improving the nations overall health. Dr. Karen smith is director of the department of Public Health and the states top Public Health official. She joins us. Dr. Smith, good to have you on the program. Thank you for the opportunity. What do we know . Is it too soon to tell whether or not we are seeing a leveling of the Playing Field in terms of Health Equity because of obama care or too soon to tell . I think its a little too soon to tell. Overall, there are areas we have made improvements. Many more people have Health Insurance, especially people in vulnerable communities. That means they have doctors that see them overtime. Their health is better, and we overall save money in the system. And thats a win win for everybody. Health coverage to my mind, is not the same as Health Equity. Whats the relationship between the two . Health equity. Let me start with Health Coverage, right . Without Health Coverage and access to really Good Health Care theyre not the same access and coverage. Even when you have both thats really important. Its essential but it isnt enough. We have to be able to live in environments that make it possible that offer the opportunities to be truly healthy. And that you cant get in a doctors office. You have to get that by living in a Healthy Community where you have opportunities to get a good education, eat good food, be active, all the things we know go into especially for children, being able to learn and grow and be healthy in the long term. Also for adults. Since we cant just up and move, do i take your comment to mean that we are never going to achieve Health Equity in this country . I think its a pretty big climb. But i dont think we cant do very real things in the areas they live. By really taking a serious look at violence and what violence does to kids and communities. All the other sort of issues that are barriers to people being healthy. The way we plan communities. When we make changes, instead of building in the way weve always built. We need to be thoughtful about what we do. In california, we have a task force thats at the Administration Level called the health and all Policies Task force what that does is look at every Public Policy were putting forward and say, does this has a positive impact on health or negative impact on health. Everything that we do, particularly those of us who work in the public sector. When we make policy decisions. Were making Health Decisions even if we dont recognize it. Why should i believe that the folks in washington care about Health Equity if theyre fighting a front line battle now against health care . I dont think they perceive what theyre doing as fighting a battle against health care. I think what they have are certain values that speak to smaller government, more investment in private Sector Health care. Theyre trying to change the system so its Less Government and more private sector. I think its a difficult transition, one of the characteristics of the private sector is its not many entities, its multiple entities. For a lot of people i dont believe in blanket statements, but for a lot of people privatization is the enemy . Yes. Is privatization the enemy of Health Equity . No i dont think it is. I think that unrestrained privatization where the only goal is to make money for the investor, thats a very difficult thing to bring into balance, actually being good for the people who are being served theres a challenge to working in the private sector and providing really good services, but also serving the people who are investing in you, its harder for the private sector to do that. Because of the constraints of government. And frankly, we are spending the taxpayer dollars, we have to spend a lot of attention and time thinking about, is everything were doing working. We create large bureaucracies to kind of monitor that, thats its own challenge. When i think of this conversation about Health Equity, i think of the same kind of conversation were having in the education arena, which is this notion of how you get to Educational Equity if youre barely achieving educational quality. And i think of the same thing when i think of health. Its one thing to have as a goal, everyone deserves equal access to healthy you have to meet people where they are, some people are going to need more because their condition is more catastrophic, that sometimes seems antiamericans that some would get more because of their need how do you get equity if you cant tackle equality . I agree with you in particular about the equity piece its about giving people what they need. If im in a wheelchair, im not going to be able to do the same things if youre in one of those neighborhoods you spoke of earlier. Its not equality, its equity. Im just trying to see where the political will is to talk about and advance a notion of Health Equity, if were not serious about equality. Thats a really interesting question, im not sure i have an answer for it, i do think theres a tension there. Were all equal. Its written in the constitution, i think that an absolute definition of equal, which you said, is everybody gets exactly the same thing is never going to get us to true equity. Everybody has the same opportunity. That from my perspective thats what the original documents were intended to say. We should all have the same opportunity. Yes, theres a role for personal Decision Making and choices, and for personal responsibility. If youre starting from a huge deficit of resources and access to decent wages and housing that doesnt make you sick, and transportation to good jobs and an educational system that provides you what you need to learn, then youre going to need a whole lot more to have the same opportunity. What is to your mind the link between equity and not opportunity but equity and responsibility, choice, the choices we make. Peoples choices are constrained by their circumstances you dont have the same choices, if youre a single mom whose husband is gone, not in the picture. You cant get a job, because you cant get child care, you have to take care of your child. Youre being demonized by members of your community because youre a single mom. And often because youre a person of color. You cant get there. You dont have the same choices. If you live in a rural community. If youre somebody whose white and you live in a distant place, and you have to travel 5, 6 miles to get to a Grocery Store. You dont have the same opportunity to buy healthy food, if that Grocery Store sells that healthy foot at a premium. Youre not going to have even if you can get there, youre not going to have the same opportunity. Youve been reading california is doing better than most states at adopting the challenge accepting the challenge of obama care to make sure that californians are healthy. What is it you want to brag about what is it that california is doing that the rest of the country could learn from and do better. One of the things california did was to expand medical, our medicaid. Earlier than many states did, that was intentional. It required a lot of investment of state money along with the federal money. It provided access to folks who would not otherwise have gotten access sooner. We also adopted a model with the Health Exchange we created our own exchange that gave us flexibility in what we did. That looks like the massachusetts model that romney put in place when he was governor there. We have a balance of yes we have expanded medicaid for the poor. We also have an exchange for those folks who dont qualify as poor, but we have supplements that we give to folks who arent quite there but arent actually able to afford Health Insurance itself. We make coverage possible for a much broader spectrum of people. The other thing california has done is take advantage of the opportunities provided to us for what are called the medicaid waivers. We negotiate with the federal government saying we want to try these models and see if we can get Better Health for less cost. The barriers that people face are really very high. And physicians dont necessarily or Nurse Practitioners dont necessarily know what those are bringing them closer together, were going to get Better Health outcomes and were going to save 347b in the long term the challenge of Health Equity. Its this segment we do called road to health. Thanks for your work. Good to have you on the program. Thank you. Up next, a conversation with director amma asante. Stay with us. Please welcome, amma asante back to this program. Her latest project is called a united kingdom, based on the true story of the interracial marriage of an african prince to an english woman who became his queen and the real life ramifications of their marriage on the Political Landscape of post colonial africa. A clip from a united kingdom. This is the im pleased to meet you, sir. Refreshments will be provided. Over two decades of preparing you to be our king and this is how you face me. A white woman by your side. Are you trying to tear us apart . I am my lady. Please dont. Why would you do this to us . To yourself, be somewhere, something that makes no sense to you. Look at them. They are fighting because of you. I mean you no harm. Do you understand what mother, mother of our nation mean means . I whispered to amma during the clip, i said this wasnt no joke. You said to me, he reminded you of your father in what way . Well, you know he gave me that look all the time first of all. But also, there was the sense that we were talking about this the other day, there are certain african family members that you dont play with and i wanted that feeling with this uncle. I wanted him to be a man, who when you saw him and you saw threats walking toward him, you knew this was not going to be easy. There are two parts to this story, at least two parts to this story. Im curious how you married these two things together which is the story of the political ramifications that this marriage had and the love affair. Is it a love story here . And serious political ramifications. How did you weave those things. When i came on to the project, there had been lots of conversation about how this story should be told in the balance of those two things, i think that everyone had come down on what the side of it should be a love story. I felt really differently about it, mainly because of the important period of time where the story was taking place, which is when india had formed its independence and africans there was a feeling in africa that this could be a possibility for many of the african countries too. We needed to have the politics, the african politics. We also needed to understand the power of this couples love, to understand exactly what that love was up against. If you didnt understand what they were up against, you didnt understand the strength of that love. For me, it was important to know what the stakes were in terms of britain being just post war. Needing cheap gold from south africa to underline its economy. Britains atomic bomb program, the Prime Minister of the u. K. At that time, had been given a mandate to take care of britains future, on the other hand you had this couple who fell in love at a very uncomfortable time as long as we saw everything through the prism of the love story, we saw all of the politicslways through the prism of the love story, we would be okay. You needed one to emphasize the other. Ive been to 16 or 17 african countries. The gnaean people are the nicest folk on the planet. Ive been to the country so many times, i wonder ed given my respect for the couple and ghana being the first country to get its independence. How on a personal level, that increased your willingness or interest or the way you saw this story about this particular country. It was so important to me, when i came to the project, threats that had no inner story, no inner journey toward his decisions to give up his kinship and become a leader in a different way if his country would vote for him. And to hopefully take his country to independence my dad stood in Independence Square in 1957 and he saw the gold coast become ghana and waived that flag. I was raised able to resite some of the sweeps my father believed in a United States of africa, and so he was a political man, and i understood on a very personal level what independence meant to my parents. I understood what it meant to them for their country to become the master of its own fate. You know thats injected into the movie. And the first time we hear that phrase in the story, its in a small moment, the personal moment between the couple and the final time you hear it in the movie, its in the end and it has a bigger world meaning to it, it was important for me to be able to tell one african countrys stories journey toward independence. I am that daughter of africa. David oyelowo was here not too bit ago. I want to get your take on this, whether or not something has changed or is changing amongst moviegoers where we are now more at peace seeing this interracial love on screen. There are a number of movies out around this season. You guys are making movies, you dont know whats coming out when, you are doing your project. It seems to me there is this i dont want to overstate it, there is this onness i hope. I think were in a better place than we have been. Were not there yet, its not im not sure what david said. Certainly from my point of riou, i dont think were there yet. In my world the relevance of an interracial story is in terms of film making, is only for the sake of being able to show characters of color that are isolated, have to find a way of asserting their identity in a world where they dont see that identity happen that often. And in those times, there is an interracial element to a relation ship they might have. Its difficult, were getting to a better place, but were not there yet, i dont think anybodys completely comfortable. Whos more progressive on this question. The u. K. Or the u. S. . Probably the u. K. I think that has everything to do with the history of how African People came to each of the continents really, and to a certain extent it matters that people of color in large part came to the u. K. In recent history, because they wanted to. As opposed to being taken and i think that makes a huge difference. I love bail, one of my favorite movies ever now. Since the theme of race is present in both films, two different pieces, both beautifully done by you. Since race is present in the story line of both pieces, what did you learn from the journey of bail that helped you on a united kingdom. I learned to be more sub versive. In the way i tell my stories. You know, its on the one hand, you get a bit of a love story in bail. The main love story you walk away with is a woman a womans love for herself. And understanding her own value and the importance of that value. I learned to do that in hopefully subtle ways that engage accordions, here the love story is so important important in a united kingdom, its the driving force of the narrative in many ways, what i hope you walk away with big time is an understanding that africa was countries in africa were functioning before they became colonies. Democracy was not something that was introduced from outside. Democracy existed. Our traditions have always been important to us, and we hold on to them for really important reasons. I hope there is a real understanding, a better understanding for people who havent been to africa, dont know very much about africa, dont know much about people of color who have resided or have emerged from africa, that we that africa has a relevance to it that we dont often get to see on screen. How did you develop this courage to take these risks in your story telling. I could think of any number of other routes you could take. Youve chosen to tell stories that have not just in the story itself, but to tell the story means you have to take some risk. Yeah. Why take the risk . You know im a broke filmmaker, i dont make any money out of this. I tell the stories that are important to me and its usually those elements im being subversive about that are important to me. I think we all have to have a purpose in life, thats what keeps us going. And my purpose is to connect with my fellow human being on issues that mat ter on anything that allows us to connect over a common humanity. We talk about this a lot. On the films i work on how being culturally specific is really important but understanding that universal humanity that is supposed to connect us all really matters to me, i have no idea how i became to be born like this, i know i was born this way and im compelled to tell these stories, because i think theres a greater good attached to them. Thank you. United kingdom is a powerful story. Its a beautiful film you will not be disappointed in it thank you for coming to see us, and thank you for the film. Thats our show tonight and thanks for watching, as always, keep the faith. For more information on todays show, visit tavis smiley at pbs. Org. Join me next time as we take a deep dive into whats happening around the country. Thats next time, well see you then. And by the Robert Wood Johnson foundation, working with diverse partners to build a natural culture of health so everyone in america can live productive and health