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from? Well, Mitch on this is our various your health's for pain patients Workshop. I have Doctor Sonia Fonzo to Barris here to tell us more about various to health for this workshop. Thank you so much for joining us, and I'll hand over to you. Thank you. And thanks for inviting me to cover and speak about this topic. Um, so I think without further ado, I'll tell you a little bit more about myself on dmard idea activities. Um, which are essentially that I started as, um, a nurse. I trained as a nurse before, because in acute medicine, doctor and I have quite a lot of interested in medical medication. Um, and that's part of my interest in medical education. And I developed, um, a broader in class in EDI activity. So I'm part off steering groups run traces on to racist curriculum strategic advisory groups for advanced a GI. I'm also be a mentor, unfashionable mentor within the medical school on dive developed, active by certain intervention workshops for the undergraduate program. But hopefully we can rule out for, um stuff a swell on. Go Also seeing a tutor for wellbeing within university, and I have a research interest in unconscious bias. Um, that reason I tell you all my activities is because when it comes to social determines of health and a lot off, these things have impact into how we do in terms of our health. Um, so we look at things like access to healthcare, education, economics, ability, our social contacts on, obviously the environment that we're in on day because over it came. It's sort of an eye opener in the MS of the Pandemic. We realize that, actually, a lot of communities were being affected more than others on dissuades know, obviously clear from the start. Um, but then researchers showed that actually, when you look at things like mortality in this graph, um, the liver complicated for those who are not statistically driven. But what you can see here is that you have, um, some name, community, so black, Bangladeshi, Pakistani, other Indian, mixed Chinese, and ah, line at the sort of the graph actually is the line where if you go towards the left, will be that their mortality is bigger. Um, so the white mortality is bigger than back mortality, for example, in the first line. So you can see there in the first milb black columns. That's, um, black mill. People are have three times almost the rate of mortality compared to white counterparts. When it comes to Cove, it, um and the green bar is a just it. The blue bar is fully adjusted and fully adjusted. Just means that we done consider things like population density, the area that you live in any social deprivation, um, household composition. And yet a socioeconomic factors essentially, that might affect the mortality, like education. Um, uneven occupation. A swell. So you can see that even taking everything into account if you put, um, a baby in person, um, within the same social economic contacts of white counterparts days to they're still have a higher mortality compared to a white person. Um, and so obviously we wanted to look at these things. And so for public health for interview we came across is that things like social inequity. So, um, Grace, class, gender, sexual orientation ability was playing a part, um, within the health on day, well, being institution, knowing in equity. So things like distribution of resources, wealth, um, power. So people in positions of power and earn Mawr, um, have better quality of life. So and spent a health, Um, and then things like living conditions. So their physical environment, um, they're economic unworkable iron mint there, ah, service environment. So health care, access, education, social services and so on. But we didn't live in living conditions. You have the social environment, which is kind of the experience of prejudice, isolation, immigration, culture, a swell. And any have factors that are personal, like risk factors, disease, an injury on your mortality risk, which give you your life expectancy. And so, looking at all these, you can see that for a baby perspective, you have race, um, playing a part, obviously. But also there's quite a lot of discrepancy off people off a more normal people being positions of power and having a wealth compared to their white counterparts. Of course, they suffer a lot more from prejudice, isolation, immigration, culture issues as well. So that plays a part as well. So going back to cove it as being an eye opener. Um, we think about the definition off ethnicity and race, for example, and we looking at this definition, we can see that ethnicity itself. It's a broader construct. And it looks at things I culture, tradition, religion, any shared air. It'd that a group of people might have whilst race itself. It's a social political construct, so it's essentially a classification that we've come towards that is based on a person's ancestry. Geographical origin. So, for example, I'm black. Most of my ancestors are from Africa. If Ralph classify as black African, essentially, um, but at NIST A is really broad on is very non specific, as you can imagine on braces, a social constructs. So neither of them really correlate very well with biology and so biological differences, even though at the start of Corbett were saying, Your black people this have higher incidence, of course of it and they fair worse. But there is no gene that that's kind of, um, uh, you know, supports that argument. So biological differences are very unlikely to underpinned these healthy inequalities. Um, but nonetheless, what it did bring was recognition. That's the risk for being populations was bigger, um, and things, for example, like working in healthcare setting such as nursing homes, for example. So blame groups, then Teo have more positions off the worker and occupational groups, and they have higher levels of exposure. So, for example, this could be an indicator that they were at high risk of infection rather than just, um, they're they're race or ethnicity. Get a thing that we started thinking about was that being family stand to have more extended family and be more interconnected with them? So there's a lot of contacts becoming, uh, surrounding overcrowding and called it obviously. And it's not very easy to social distance. If you're living in an over crowded environment, and if you have extended family living with you, that becomes even more difficult. Um, so the contacts became key when having these conversations. Essentially, Yeah. The thing is that immigrants, for example, are very high risk group when it comes to health qualities, as you can imagine. So some groups of international migrants in the UK and to avoid any chest altogether because of their current um, status they don't want to be charged on. Also, they have the fear of off their data being shared with home office. I'm sorry, um, for irrigation enforcement purposes. So, um, migrant groups also have different complex care needs. Oh, for example, refugees can have lots of psychological impact from there lived experience on, but, um, they might have different health seeking behavior from their own experience. Um, and all this needs to be taken into account when you're thinking about inequalities and care for them during cold weather has been a call about removing charges for this particular group of people so that there was no delay in healthcare seeking and reducing the risk of death. But that didn't really improve the tensile together, and they still remained high. Lt group. Unfortunately, Now, um, we looked at all this and actually, um, the conclusion was that to achieve health and mental health equity at every level on have, ah, overall healthy society, no matter what your background and misty baseball's, what you need to do is have a healthy environment, healthy community, so you can have healthy people. And to do that, you have to have prevention, good mental health services. You have to be culturally, linguistically, a poor periods on behalf, competent services that address that you have to have income security, good housing, good neighborhoods, good environment. Um, obviously your health care and you have teo have access to healthcare. Um, but also, education and literacy played a part. Nutrition and food on the environment that you live in and also discrimination and minority stressors. So you can see how this all plays a part when it comes to bein essentially. But it could because we already said that they are a group that suffers quite a lot of discrimination and minority stressors. Well, so if we know what we need to do, why isn't it happening? Essentially. And so obviously, this is a Nimmo, surely charged subjects When it comes to race ethnicity, it becomes kind of personal. So you have a resistant population not only from the same population, but the the wider population in terms of are these issues relevant? Really? Um, and then you have resistant and caters resistant care providers. And sometimes even this institutional climates are unsupportive and aware of these barriers so they don't get dressed, Which lives this in a position of what to do. Essentially, Um, which takes me back. Teo, Why? I told you about all my activities and what I do. Um, because I'm not here to tell you how to address all best, because I'm no expert. By all means, But just from a personal experience going to view, I can tell you what um I am trying to do on go, please. Sharing this will empower you to do something similar or something different and that, um so from joining old curriculum steering groups and inclusion groups and action groups. What I'm trying to do, really is tackle the structural, racism and institutional racism that we know exists. So you can't really do much about individual races because, you know, if someone is racist, I guess that's their own personal bias. Um, really, You can't necessarily change it, Um, and it stems from their own personal experience and so on. But when it comes to structural races, and so the history and the reality of institutional racism across institutions, both in the health care setting under educational setting um, then that's something that we can perhaps stretch your address because it does negatively impacts communities of color and then off course institutional racism. So all the policies practices procedures that's tend to work better for, um, white people rather than people of color and often an intentionally. And so bring that's to the four light. It's part of the work that I do. Um, the other point is my interest in that medication Unconscious bias on distance because from research, medical training could be an effective intervention, actually, to reduce implicit biases on back chew a li reduce so mitigate physician driven healthcare disparities just by being cultural competent. And so I developed an interest in unconscious bias on golf course if taken that into my medical medication as well to see if we can try to mitigate those health disparities which our physician driven. So I'm at the point of medical school and, um, particularly, um, the other thing is, being a big mentor and professional mentors when I'm trying to do really is create a little bit of visibility and be sort of a role model off sorts. Andi. Because essentially, there's a shocking lack of diversity and being representation. Um, particularly it any chest stress, ports and executive levels. So there was a report in 2019 called um W R yes, report rest respond port. So that report found that, um, is getting It's getting a bit better. So there's about 8.4% off board, um, bein board members on the NHS and this is a marginal increase from kind of 7.4% in 2000 and 18 and 7% in 2017. But to put it into context, um, there's about 20% of names stuff working in the NHS altogether, So 8% is, um, quite low in comparison. Um, so I guess what I'm trying to say is that I'm trying to achieve some sort of role modeling and increasing visibility on goes with when my favorite sayings, which is you can't be what you can't see. So putting myself out there hopefully is giving, um, people Ah, you know the visibility and creating some, um mawr, um, tackling the inequities essentially, um and then my research and unconscious bias. So a little bit off the same. So I was trying to sort of mitigate the bicep's toe towards social minorities, and I found that everyone has unconscious biases on some of these on overt but implicit. So creating awareness to help to address this and might try Teo to mitigate stools, inequities a swell. Um, this is a map. It's called the war mark of stereotypes and ignorance. And essentially, um, it's just ah parody essentially on, um, what the Westernized view off people from elsewhere in the world have. Um, but you can see that. Ah, the western area. So you're a pessary. And America, as in us A. Is seen as a civilized world on des everywhere else, not on Ben, they, you know, places like South America related to drugs and that football apparently and Africa related to poverty and HIV and so on. So these are obviously biases and preconceptions. It's just a next MPA lof, you know. Oh, over address. She'll discrimination. But it's just to say that how we view others will affect our interactions with them. So when it comes to care and care providing, um, it will also affect their care and how they fear in health. Um, the other thing is obviously the important off being aware of cultural context and well, and we'll be in health. Um, well being, um, so thinking about cultural practices, it's very important on thinking about the way some cultures react to religious beliefs, their approach, death, the illness and health. Um, I haven't example. So my mother always opt. It's for natural methods. So no matter what she has, um she has quite bad asthma, for example. She always opt. It's from natural methods rather than, um, Western medicine. Eso. Once everything is failed on, all the alternative remedies have failed. Then perhaps she will try to go to the doctors, but it tends to be that she goes to the doctor's when she's in a dire situation and just like her a lot off my cousins. And, um, do you take the same approach? Um, so it's just taking that into consideration how different cultures take their health and their healthcare differently. Onda It's sort of this optimism bias that, um, my mom and particularly has that no matter how bad her condition is, we'll probably get better by itself, essentially on DNA thing used to be done about it. So, um, she then presents in a dire situation which obviously it's tends to have a words health outcome. So think about things like that. Um, obviously, things like food and diet, um, affect your health. Um, and migration affects your health. So, um, populations move all the time. It's just understanding how that impacts their health as well. Um, just off the top, my had, like um, for example, malaria. Uh, so if you've come from a malaria prevalent area on, do you come and live in a numb prevalence area? Um, when you go back, you're immunity is actually decreased. So or or back to, um, you don't have the sort of immunity that the people from those problems areas have. And if you don't take that into consideration, you can become quite ill. So is recognizing that that's a possibility. For example. So essentially, what I'm trying to say is that people need to be culturally competent Onda clothes specific needs of specific, um, groups, Essentially, and and, of course, language in communication is a biggie, because I'm not just that different. You know, people from from different countries can have foreign languages, but we're talking about things I dialect accents, use of jargon and slang Z in medicine. Um ah, work choice. When we're talking to patients, you know some ambiguity and what we're saying on deviously taking it to a car Gilotrif see of the patients and even things like normal verbal communication, for example. So, um, some cultures don't, um, particularly have direct I contact when talking to senior people or um, you know, different gender rules. So if in a consultation the doctor is perhaps trying to maintain eye contact throughout, that can be very intimidating. And that can, um, affect the the in traction, for example, um, so it's just taking older things into consideration. Um, good thing is, obviously, we've after post covered. We've come through sort of attack revolution where a lot of things have been put in place, which are technology driven. So you now have mine appointments. You have, ah, texts. Um ah, bookings and things I doubt for for your GP and your healthcare in general. So just remembering that those in society who do not have regular access to a computer or handheld device or indeed I till a true enough to use some of these systems, um, that have been rock Italy implemented. So, um, it's really to know how this is gonna affect, um, in terms of ethnic minorities. But it's an area that I guess we should keep an eye on. I'm sure that there is safe and equitable access is Well, so the thing is, where do we go from here? So, um, from my example, I was thinking about things like accessibility to learning and services. So starting at university and thereafter, Um, think about the interactions we have with people and patients. Students think about expectations that patients have from awesome. We have off them swell confirmation biases in medicine. There's a lot of, um, obviously pattern recognition, but also, um, thinking, Oh, this person might have this based on how the present. So we just need to be a little bit careful as to know attributes certain diagnosis to people because of our unconscious biases rather than actual factual evidence on drink about the impact of what you do and how you pass on to those cultures Got me. See, if you treat someone within that culture and they don't speak to someone else within their their group and the cycle me repeat itself, and so your interaction might not be a singular in traction. It might be a community in traction as well. And how you come across by the next the whole community. So, um, I'm quite guilty off having some unconscious biases and on having, um, you know, some some, I guess, um, barrier stores. Um, some of these care, um, practices so for example, in my in my consultation, if I see a picture that needs ah, translator, I'm automatically think, Oh, this is going to take a lot more time is gonna be so difficult. I'm guilty of drink Seeing that patient as it turned TK rare. Essentially. So I think we just need to work better on strategies to the stigmatized these needs and see. It's like, I don't know, in hearing aid or visual aid rather than a burden. Um, so I think starting with health education. So thinking about accessibility off being people into health education, but also, um, whitening participation strategies at my work and seven ating the contacts and content decolorize in the curriculum is essentially so thinking about what we're teaching, how we're teaching, who who were teaching and who's visible during the teaching, for example are important parts of It's a swell, um, and thinking about the hidden curriculum sort of things, the things that we passed that we don't tend to pass on to students. So I'm the higher key how we, um, deal with different patients from different backgrounds the jokes, the innuendoes, the stereotypes. They're all kind of very pervasive in health medications. Still, we need to be careful When When we're doing that, then, of course, the use of additional era. And it can be actually Ah, good thing it can perhaps improve learning outcomes rather than allowed to perpetuate this sort of inequity gap. Eso I'm partition well being. And so a lot of students from bein backgrounds come to shin Well, being with issues that may present as kind of, um, lack of understanding off their own issues, you know, other people not necessarily understanding how their particular position is affected. They tell me about the lack of visibility, the feeling of other ring by others and just essentially family ostracised for being different. Um, I guess this is something that we need to work on this well, so hopefully, if we look at all those things, we can achieve the quality never seen clue shin and reduce the inequities in health. And, um, obviously being visible on role modeling and to sure good practice is a life alli ship is very important and key. So it's not just for the pain people to do the work, but obviously, um, number being people to also be involved on you know, be allies and everything we do Sinus part of that. That's how I went on to create the active by center intervention training Because a lot of times it wasn't actually, um, the perpetrator. That was the the key factor in the victim, Um, feeling off, being ostracized. It was everyone else that was around that didn't do or say anything. Essentially. And we do know that Mrs um, bleeding any inappropriate behavior contributes to toxic culture and impacts people on in a very detriment away. So they have really poor mental health outcomes restaurants, I it and so on. And so this type of training hopefully provides, um skills to challenge those unacceptable behaviors. And some of them have bean become normalized over time, like my progressions and things that people need to recognize an address. So I talked to lots, but some final thoughts on guys have a lot of final for all the speakers. There's a lot to be said on this topics I could go on forever, but just essentially skiing Behm as not a hoe marginalis group off course. They, um we use here as a term, but not everyone even like that term, and it's definitely know on all inclusive term. So, um, there's a lot of diversity within the that umbrella on just acknowledging it is important. Um and then implementing community ladder raise awareness. So in crude, increasing those discussions around racism and acknowledging that there is racism that needs to be tackled and want to improve occupational risks and hazards, particularly for those who do work in, um, you know, health and healthcare, um provide adequate income protection. So it's a lot easier for people who are on your hours on day known contract, too. Just say, Actually, I'll get on with this and I want lose time going to the doctors because it's a paycheck that I'm not going to get. So, um, insuring that they have, um, income protection and they can attend without the fear off. Um, having fascial costs added on to is, Well, um, we need to be more culturally linguistic, appropriates when we're having communications with different communities and being cultural competent, essentially not necessarily seeing Westernize healthcare as ah end off. Actually engaging with those communities and seeing what they're doing might actually improved their endurance when he comes to and health outcomes. And I think effective equality never see inclusion. Training is waas unconscious Bias training can help in doing this, um, and actually having data about being population and healthy holiday factors. But taking into account the complexities off all the social moment factors that play a part. So essentially, intersectionality are not just rate or ethnicity, because that doesn't explain the full picture. Um, and actually having, um, minority groups and underrepresented groups be part of those steering groups on do have their voices heard when it comes to putting, um, new things in place for this, that needs to be more research. To understand why these groups are at greater risk on do we need to be able to measure this is set success and failure is off the stretches, and we do put in place Andi do need senior leadership to to, um, have a by in and help us have a unified response to say that this is, um, crucial thing that needs to happen on Ben. Develop things that are being specific, like therapies articles, while being services s so that people can feel that sense of belonging that sometimes it's lacking. Um, and with that mentoring programs for Bemis? Well, creating a sort of all round inclusive croup curriculum. Um, so that's pretty much what I had to say about the topic. Um, just conclude, I guess just to say that obviously, a lot of being groups face barriers in accessing high quality healthcare, and the NHS needs to kind of try to remove these barriers when working with people understanding their particular issues. Um, I guess a key unanswered question is to understand why these mortality risks differ between ethnic groups. And, um, it could be that it's just the risk of developing infection because of their social conditions, which leads the worst. Prognosis is worse care or combination of the above. Essentially. But what's important to conduct these reports and things? I think we need to take immediate action to mitigate these circumstances. Um um, and make sure that people don't find as a deterrent to access healthcare. Um, and we don't kind of instigate this context off year and strokes. Um, that it's it's, um, just going to make things worse. And then so just, you know, like I said, become, um cultural competent, better communication. Try to have better engagement communities develop things that are Taylor and specific to there challenges and address kind of bold cultural specific things. But also doesn't the this information? Um, that word yes, on And that they might have about the health care practices? Um a swell, um, and have data, but have that data into context. Essentially, eso not disaggregated from the sex and social a prevision occupation and things because it's true that back, um uh, groups, for example, are represented in carrying and leisure industries. Wells groups like Pakistani Bangladeshi groups are overrepresented in sales and consumer services. Well, so having, um, that insight into remission and actual addressing it has all helped determines resident concentrating on biological differences. I think it's very important. And I'll stop there. Yes, um, for reading, um that I have there. If people want to have a look and I'll take any questions if there's any at this point, Thank you so much for your talk. I have a question myself, actually, perfectly. Just ask. So I wanted to ask if you have any advice for us as medical students and future doctors', but what we can do to try and recognize the's unconscious biases in ourselves and how we can try to be more inclusive towards colleagues as well as patients in the future. Yeah, absolutely. No, that's a really good question. And it's wondered, I don't particularly haven't answer to. But what I can advise is, um, engaging and cultural competent activities. So, you know, dissipating and active by standard training. Um, any training that's will make you a bit more cultural competent will definitely make you a better practitioner out, say, And, um, just by doing so, you create an awareness off other cultures and how you're behaving and how and your own unconscious bias is, um, you know, you have towards other people come across a swell, and then you become more aware, and then you can address them. If that makes sense. Yes, thank you very much. Um, I think that yeah, that would be good to do. Like, as he said, some active bystander training and to just be more aware off cultural differences and, yes, just evil. Be more knowledgeable. I also just wanted to ask. So for people who are going to watch this recording later, do you have any resource is that you could recommend on anything else that we could look into if we wanted to be more involved in working against these prejudices? Yes. So we didn't. University of Adam read. There's lots of communities that's are tackling kind of inequality. So, um, just I guess joining those groups would be a good thing to do because then you you know what the challenges are. And also you can have conversations in terms of literature. I mean, there's quite a lot out. There is difficult to tell you where to start, but I think just being aware that these inequalities exists and, um perhaps doing research yourself into, um what are the barriers and what else is being done? Um is a good starting point. Essentially, um, be I mean, gone to the university website on D. Just type in EDI and you get up the rajah things that you can have a look at. A lot of societies A so well. So I know there's being met eggs, but is Erin and and there's lots of good work being done in terms of my progressions and, um, different, um, language to be used, Um, in that it's more inclusive, a swell, um, and obviously active by senator training and cultural competency trading and things like that. So all of that, hopefully will create a better, um, outcome in infusion, make us better professionals, but also create that outcomes for our patients. Yes, thank you so much for, uh and thank you so much for your talk. I If we don't have any more questions, I'll just let people know that our next talk off or the we have a panel for questions. If anyone has. And then we also have our poster presentations on that starting at half past, so you can just go and join the sessions there. But thank you so much, Doctor. Tomorrow for joining us. Thank you. Thank you for having a pleasure. It was you. Thank you. All just intercession here. Been okay, But by by