►
From YouTube: Commission on Race and Access to Opportunity (10-27-22)
Description
No description was provided for this meeting.
If this is YOUR meeting, an easy way to fix this is to add a description to your video, wherever mtngs.io found it (probably YouTube).
A
Commission
on
race
and
access
to
opportunity,
our
October
meeting
will
come
to
order.
I
appreciate
all
of
you
being
here
today
to
to
join
us
in
the
conversation
as
we
continue
moving
forward
on
discussions
around
race
and
access
to
opportunity,
I
will
encourage
all
of
you.
Please
silence
your
cell
phones
if
you
would,
as
I'm
gonna
try
to
do
mine
right
here
in
the
same
moment,
and
we
will
ask
our
staff
to
please
call
the
roll.
B
Senator
Westerfield
representative
Brown
representative
cool
Carney,
representative
timony
Mr
Davis,
Miss,
Drake,
Mr,
Jones,
Dr
olaika,
here
Mr
Roberts,
chairman
Gibbons,
president
in
the
room
chair,
Hebron
present.
A
A
Let
the
record
reflect
also
the
attendance
of
our
esteemed
esteemed
esteemed
colleague,
Senator
Neal
Senator.
We're
glad
to
have
you
here
with
us,
so
today's
topic
is
going
to
be
health
and
health
outcomes.
We
do
have
a
robust
agenda
of
four
presenters
and
we'll
hear
from
several
several
several
Representatives
about
issues
related
to
the
topic
of
health
and
health
outcomes.
A
We
also
will
be
hearing
from
Senator
Westerfield
on
an
important
piece
of
legislation
directly
related
to
the
mission
of
this
Commission,
and
so
we
will
try
aggressively.
We
will
try
productively
but
aggressively
to
stay
on
a
30-minute
schedule
for
30
minutes
or
less
for
each
of
these
presenters,
and
so
with
that
we
are
proud
to
Welcome
to
the
table.
Norton
Health
CARES
Institute
for
Health
Equity.
A
C
Thank
you
for
Mr
Roberts
Irwin
over
there
and
Senator
Neil
for
just
giving
me
the
opportunity
to
to
not
only
talk
about
what
Norton
Healthcare
is
doing,
but
talk
about
health
care
disparities
and
what
it
looks
like
in
Louisville.
So
with
that
I'll
get
started,
and
this
is
this
is
my
first
disclaimer
slide
and
I
use
this
as
a
disclaimer,
because
the
language
is
a
little
bit
straightforward,
but
this
is
the
language
of
Dr
King
from
the
1960s,
but
I
think
this
language
sets
the
stage
for
for
what
we
need
to
address.
C
C
They
never
go
on
to
say
that
the
criminal
responses
are
environmental
and
not
racial
poverty,
ignorance,
economic
deprivation
and
social
isolation
is
what
what
we're
really
dealing
with
and
so
Louisville
is,
is
unique
and
you've
heard
this
before.
But
when
we
start
talking
about
health
care
disparities
in
life
expectancy,
you
can't
do
that
without
speaking
about
redlining
and
so
Louisville,
unfortunately,
is
one
of
the
most
segregated
cities
in
the
United
States.
C
This
language
is
also
a
little
bit
rough,
but
again
it
sets
the
stage
redlining
was
introduced
in
the
1910,
so
this
is
for
the
students
in
the
room.
This
is
not
a
policy
specific
to
Louisville.
This
is
a
policy
that
came
out
of
Baltimore
in
the
1910s.
You
can
read
the
language
very
quickly,
but
I'll
I'll
move
beyond
that,
and
why
is
this
important?
C
This
is
these
are
things
that
we
all
know,
but
let's
keep
it
front
and
center,
as
we
think
about
opportunities
to
move
the
needle
these
zoning
decisions
decisions
permitted
a
lot
of
what
we
see
in
terms
of
liquor
stores,
nightclubs
in
certain
houses
in
these
areas,
which
you
don't
see
when
you
cross
to
the
east
side
of
9th
Street
in
Louisville
when
we
think
about
other
cities
again,
this
is
not
not
unique
to
Louisville.
There
was
a
certain
city,
architect
and
planner
by
the
name
of
Harlan
Bartholomew.
C
That
was
instrumental
in
doing
this
in
almost
every
major
city
in
the
Southeast,
and
so
that's
why
Memphis
looks
like
Louisville.
That's
why
Nashville
that's?
Why
Savannah
and
some
of
the
other
areas
that
are
heavily
populated
by
African
Americans
when
I
say
heavily
populated,
20
percent
or
more?
That's
why
the
disparities
look
the
same,
and
so
I
wanted
to
take
a
point
to
to
set
the
stage
for
what
we're
dealing
with,
and
this
is
a
picture
of
Mr
Bartholomew,
so
in
Louisville
Louisville
is
called
a
sister
City
to
New
Orleans.
C
For
a
reason,
this
is
a
redlining
map
on
the
left
of
the
city
of
Louisville
and
on
the
right
is
New
Orleans,
and
these
are
mirror
images
of
each
other.
One
has
the
Ohio
river
that
creates
the
crest
and
the
other
has
the
Mississippi,
the
fact
Still
Remains
in
both
Louisville
and
New
Orleans,
86
percent
of
all
African
Americans,
live
within
two
to
three
miles
of
downtown,
and
so
this
was
also
a
city
designed
by
that
same
city
planner.
C
The
1930s
was
an
interesting
period
where
redlining
was
at
its
peak,
but
it
was
also
the
period
where
the
president
President
Roosevelt,
supplied
over
three
billion
dollars
in
support
for
over
a
million
mortgages.
Remember.
The
the
point
is
is
that
health
care
and
wealth
is
tied
to
housing.
Well,
40
percent
of
the
U.S
population
was
able
to
benefit
from
this
support.
Less
than
one
percent
of
African
Americans
benefited
from
this
particular
support.
C
It
didn't
matter
if
you
were
a
returning
GI
if
you,
even
though
you
had
the
opportunity
to
benefit
from
the
GI
Bill,
the
the
policies
and
the
administration
of
these
loans
was
done
at
a
local
level,
and
so,
if
you
happen
to
live
in
an
area
that
was
high
in
redlining
or
banking
opportunities
were
not
available.
C
Even
though
you
were
a
veteran,
you
still
didn't
get
the
benefit
and
we're
in
a
room
full
of
policy
makers,
policies
that
were
put
in
place
we're
still
in
the
still
feeling
the
effect
from
redlining
almost
a
hundred
years
later.
And
so,
while
it
was
a
successful
policy
on
one
hand,
it
is
still
the
number
one
policy
for
creating
Health
Care
disparities
across
the
United
States.
C
Let's
talk
a
little
bit
about
Green,
Space
and
tree
canopy,
because
you
can't
speak
about
it
without
understanding
redlining.
When
you
look
at
these
communities,
there's
no
green
space,
and
why
is
this
important?
So,
when
you
cross
over
9th
Street
in
Louisville,
less
than
one
percent
of
the
land
is
Green
Space.
C
When
we
were
kids,
we
understood
that
photosynthesis
was
important,
and
so,
if
you
look
at
this
slide,
pay
attention
to
what's
in
the
middle,
in
that
population,
where
86
percent
of
all
African
Americans
live,
there's
an
inverse
relationship
between
vegetation
and
air
pollution,
and
you
see
this
rampant
throughout
a
lot
of
the
cities
in
the
United
States
Green
Space
less
than
one
percent
in
the
California
neighborhood
commercial
and
Industry
50.
You
don't
see
that
when
you
move
Eastward.
C
So
you
lose
about
12
years
of
life
in
Louisville.
If
you
drive
four
miles
so
you
we
may
want
to
be
careful
how
we,
which
way
we
drive,
because
if
you
drive
toward
the
west
end
and
you're
in
the
communities
or
the
neighborhoods
of
Russell,
California
and
Portland,
you
just
lost
12
years
of
Life
by
moving
Westward
there's
other
challenges
and
the
challenges
are
pretty
pretty
clear.
And
so
this
is
a
excerpt
from
our
Health
Equity
report
and
what
you
see
here.
These
are
the
nine
neighborhoods
of
Louisville
and
they
have
the
same
challenges.
C
And
if
you
look
at
that
heat
map,
the
challenges
are
education,
income,
Transportation
crime.
Anything
that
you
can
measure
is
worse
in
these
communities.
We
talk
about
redlining
and
Home
Ownership
70
percent
of
renters.
The
most
alarming
statistic
for
me
is
that
60
percent
of
the
folks
in
these
communities
are
females
as
the
head
of
the
household.
C
And
so,
when
you
talk
about
women's
health,
which
I
know
we
will
in
just
a
little
bit
if
you
have
a
female
as
the
head
of
the
household
in
this
disparate
environment,
who
has
to
work
and
hold
two
jobs,
talking
about
health
care
becomes
a
little
bit
challenging,
and
so
just
to
make
the
point.
I
don't
like
to
pick
on
Louisville.
C
Here's
the
unique
part
this
slide
is
a
little
bit
busy.
This
is
not
Louisville's
Health
Equity
report.
This
is
hersus
Equity
report
and
you
see
that
there's
a
direct
correlation
between
cardiovascular
disease,
Workforce
and
unemployment
level,
and
you
look
at
which
population
is
leading.
C
This
is
not
a
category
that
you
want
to
be
leading,
but
as
I
go
to
the
next
slide,
those
bar
graphs,
you
can
almost
superimpose
and
that
slide
looks
at
homicide
and
so
now
there's
a
correlation
between
homicide,
Workforce,
cardiovascular
disease
and
unemployment
level,
and
this
data
is
from
hersa.
So
you
can
Google
this
data
when
we're
done
or
keep
these
slides,
but
it's
very
impressive
to
see
that
correlation
there.
So
I
want
to
spend
the
next
few
minutes
if
I
have
them
talking
about
the
importance
of
social
capital.
C
C
If
you
don't
have
the
following,
if
you
don't
have
individual
upward
empowerment,
if
you
don't
have
that
social
capital
and
if
you're
experiencing
environmental
behaviors
that
end
in
stress
discrimination,
substance,
use
and
nutritional
issues-
and
you
see
that
racial
residential
segregation
on
the
left
side
is
tied
directly
to
health
outcomes
on
the
right
side,
when
we
start
looking
at
punishing
and
toxic
neighborhood
environments
as
it
relates
to
intergenerational
social
Mobility,
when
you
look
at
this
particular
graph
here,
there's
a
bimodal
distribution.
So
at
the
top
you
have
a
majority
white
population
at
the
bottom.
C
You
have
a
majority
black
population
completely
separate.
When
we
start
thinking
about
social
Mobility
for
both
black
and
white
children,
this
one's
a
little
bit
busy.
But
let
me
call
your
attention
to
the
bottom
half
when
we
start
thinking
about
environmental
racism
and
we
start
tying
in
healthcare
disparities,
and
we
tie
into
everything
that
a
community
can
suffer
from.
C
There
is
a
standardized
coefficient
and
if
you
look
at
the
p-values
for
lead
exposure,
violent
crime,
incarceration
rate
and,
of
course,
infant
mortality,
it
all
ties
together,
and
so
these
communities
almost
have
a
double
triple
or
quadruple
Whammy
all
right.
So
let's
get
to
Norton
Healthcare.
So
why
is
why
am
I
here
and
why
is
Norton
Healthcare,
leading
in
Health
Equity?
We
understand
that
as
a
large
Health
Care
system
and
economic
engine
that
we
need
to
use
our
resources
to
bring
about
change,
particularly
in
Louisville.
C
If
you
look
at
anybody's
Community
needs
assessment,
any
non-for-profit
organization,
as
a
part
of
the
Affordable
Care
Act,
has
to
do
every
three
years.
A
community
needs
assessment.
I'll
save
you
some
time
from
Reading
everybody's.
They
all
look.
The
same
access
to
care
is
number
one,
and
so
for
this
committee,
no
pun
intended,
but
access
is
crucial
in
everything
that
these
communities
suffer.
But
if
you
don't
have
hospitals,
if
you
don't
have
clinics
in
these
areas,
you
you
can
forget
about
making
change
because
you
didn't
give
them
access.
C
So
access
to
care
access
to
Primary
Care
is
important,
Transportation
but,
more
importantly,
lack
of
specialty
providers.
We're
always
talking
about
Primary
Care,
but
no
cardiologists,
no
endocrinologists.
You
can
forget
about
seeing
an
expert
in
maternal
field
medicine
because
they're,
just
not
there
in
that
community,
so
I'll
move
quickly.
The
data
also
suggests
that
we
should
build
a
hospital
in
Louisville's
West
End.
If
you
look
at
the
demographics
here
in
terms
of
utilization
of
resources,
I
tie
your
attention
to
the
West,
the
Western
demographic
higher,
inpatient
admissions,
higher
ER
visits
higher
outpatient
surgeries.
C
C
These
are
the
disease
states
that
always
rank
at
the
top
of
the
list
in
these
communities:
cancer,
heart
disease
and
stroke,
as
well
as
hypertension
and
heart
failure,
but
mental
health
is
huge
and
to
think
that
any
one
system
has
an
answer
to
mental
health
is
a
bit
of
a
of
a
challenge.
You
know
for
mental
health,
we
cannot
operate
in
silos,
but
the
mental
health
burden
in
these
communities
is
extremely
high
just
to
zoom
in
a
little
bit.
C
This
is
that
bump
that
we
saw
on
the
Ohio
top
neighborhood
is
our
Portland
neighborhood
middle
is
Russell
and
bottom
is
California.
Red
dots,
African-Americans,
blue
dots
are
non-african-americans,
so
at
first
I
said
this
was
about
poverty
and
Geographic
segregation,
but
in
certain
communities
certain
populations
still
coalesce
together.
C
C
So
time
for
changes.
Now
we
started
out
with
the
institute
for
Health
Equity,
led
by
myself,
and
the
vision
of
our
CEO
Russ
Cox,
and
our
leadership
team
said
we're
going
to
improve
Health
Equity.
We
need
to
have
a
site-based
investment
in
the
West
End,
and
so
this
is
a
forty
thousand
square
foot
building.
We
have
two
soon
to
be
three
units
in
this
building,
but
our
job
is
to
be
in
the
community
where
the
health
care
disparities
are
instead
of
trying
to
affect
it
from
outside
the
community
in
that
building.
C
I
won't
spend
a
lot
of
time
here,
but
everything
that
affects
the
social
determinant
of
Health
cycle
happens
in
that
building
from
banking
opportunities
to
amped,
which
is
a
business
incubator
to
Head
Start
programs
all
situated
in
that
building,
and
it
is
the
flagship
building
for
Health
Equity
as
it
relates
to
Norton
Health
Care,
not
just
that
building
Norton
has
made
some
significant
strides
well
before
the
racial
Injustice
that
has
happened
in
Louisville,
our
location
at
18th
and
Broadway.
C
The
sports
and
learning
complex,
our
relationship
with
the
African-American
churches,
and
so
we
have
supported
medical
programming
in
both
churches,
Bates
and
Saint.
Stevens
to
the
tune
of
1.4
million
dollars
around
medical
programming,
we
will
have
a
student
health
clinic
at
Simmons
that
will
open
in
the
spring.
C
Just
a
quote
and
I'm
almost
done
Health
Equity
is
not
about
treating
all
patients
the
same
okay.
We
lost
the
ability
for
sameness
back
in
King's
day
now
it's
about
treating
people
different,
because
people
have
different
challenges
that
get
in
the
way
of
them
reaching
their
desired
outcome.
So
we
don't
want
to
walk
away
thinking
that
Equity
means
the
same.
Equity
actually
means
treating
people
differently.
C
C
The
Institute
for
Health
Equity
looks
outside
the
organization
and
how
that
organization
interacts
with
the
community
almost
done
so
we're
building
the
first
hospital
in
150
years.
I
started
this
presentation
talking
about
1930s
and
FDR
and
redlining
in
the
the
homeowner
loan
corporation.
C
About
the
same
time,
the
only
Hospital
in
the
West
End
closed
in
the
1930s
as
well,
and
so
it
shouldn't
take
150
years
for
anyone
to
to
have
access
to
health
care,
but
Norton
wants
to
be
leaders
in
this
area
and
so
we're
building
a
campus
in
conjunction
with
Goodwill
Industries
of
Kentucky
I'm
on
28th
and
Broadway.
This
slide
says
a
70
million
dollar
investment.
C
Let's
just
say
we
blew
by
that
a
little
bit
pretty
close
to
100
million
dollars
now,
but
this
is
a
fully
functioning
Hospital
20,
inpatient
beds,
ER
beds,
adult
pediatric
primary
care
and
what
I'm
most
excited
about
is
Specialty
Care
and
just
in
in
terms
of
wrapping
up.
We
want
to
set
the
blueprint
for
how
large
Healthcare
organizations
ought
to
interact
with
the
community
regarding
health
care
disparities,
so
our
laws
for
questions
now.
Thank
you.
A
Nice
work:
you
did
that
in
about
I'm,
told
46,
slides
in
about
20
minutes.
A
Done
really
well
done
and
I'm
encouraging
members
to
gather
questions
run
through
our
staff.
Let
me
see
some
names
appear
on
the
list.
I'll
be
glad
to
call
on
you
I'd
like
to
ask
you
if
you
would
pull
your
presentation
back
up,
though,
and
back
up
to
a
slide
I'd
like
for
you
to
spend
a
little
more
time
on,
because
this
was
significant.
This
is
the
slide
with
your
chart.
C
This
is
interesting
and
the
the
data
is
represented
from
the
the
bottom
here
and
a
lot
of
times.
We
talk
about
economic
investment,
but
you
can
imagine
and
I'll
give
you
my
interpretation,
then
we'll
walk
through
some
of
this.
You
can
imagine
if
you're
in
the
on
the
east
side
of
Kentucky
or,
let's
just
look
at
the
folks
here
in
this
room.
Your
conversations
are
much
different
than
the
conversations
that
are
happening
at
the
community
level
in
West,
Louisville
you're.
C
Hopefully
talking
about
stock
options,
you're
talking
about
kids
and
going
to
college
you're
talking
about
different
relationships,
you're
talking
about
vacations
that
you
want
to
go
on.
Those
conversations
are
not
happening
at
the
same
level
in
those
communities,
it's
more
about
Economic
Opportunity,
which
sometimes
translates
into
negative
behavior
and
and
so
a
lot
of
times.
We
don't
spend
a
lot
of
time
addressing
the
social
construct
that
exists
in
these
communities,
but
they
need
to
see
a
senator
Neil.
They
need
to
see
a
Dr
mckins.
D
Thank
you,
I
want
to
continue
on
this
topic.
Social
capital
is
what
my
dissertation
was
in.
So
this.
This
is
something
I
understand
really
well.
Let
me
ask
this
question
and
it
it's
going
to
sound
like
a
controversial
one.
It's
not
meant
to
be.
It's
meant
to
be
a
straightforward
one.
I
think:
where
do
you
think
these
negative
reinforcements
come
from
is
in
if
I'm,
a
black
student
I
go
to
Jefferson
County
Public
Schools
I'm
in
ninth
grade,
you
can
pick
any
High
School,
where
am
I
most
likely
to
hear
these
negative
reinforcements.
D
This
few
part
questions
that
first,
one
where
am
I
most
likely
to
hear
positive
reinforcement
and
then
the
third
one,
because
obviously
a
big
part
of
social
capital
is
what
is
the
institutional
response.
Norton
Healthcare
is
an
institution.
I
think
is
trying
to
do
the
right
thing.
What
is
what
should
be
the
institutional
response
from
the
school
district
and
from
the
city,
so
you
heard
them,
but
I'll
repeat
them
for
everybody
else.
D
If
I'm
a
ninth
grade,
black
student
from
West,
Louisville
and
I,
am
in
Jefferson
County
Public
Schools,
where
is
the
negative
reinforcement
coming
from
about
what
my
opportunities
are,
whereas
the
positive
reinforcement
coming
from
what
is
the
responsibility
of
the
school
district
and
of
the
city
government
to
do
better?
For
me,
powerful.
E
C
You
know
I'll
go
back
to
when
when
I
was
a
kid,
I
did
some
things
that
probably
I
shouldn't
have,
but
guess
who
was
next
to
me
doing
those
same
things,
my
peers
and
it
wasn't
and
I'm
answering
question
number
two.
The
influence
from
outside
my
community
gave
me
that
positive
Direction,
most
of
my
mentors,
were
not
African-American
right.
These
were
people
that
were
white
females
who
happened
to
be
teachers.
C
These
were
Indian
professors.
That
saw
something
in
me
that
thought
I
should
go
forward,
and
so
most
of
the
the
mentorship
was
from
outside
and
I'm,
not
denigrating.
C
What's
inside
the
community,
but
I
made
a
point
here
to
say
that
60
percent
of
the
population
are
women
in
that
community,
and
so
the
male
leadership
is
not
there
and
when
the
male
leadership
is
there
it's
coming
from
a
peer
level,
and
so
that
answers
question
number
one
and
two
large
institutions
have
to
understand
this
first
right,
and
so
one
of
the
things
that
I
think
my
opinion
adds
value
as
it
relates
to
Norton
Healthcare
is
to
bring
awareness
and
say,
look
as
we're
designing
this
Hospital.
C
C
All
right,
I
need
you
to
allow
for
people
to
be
people
until
it
gets
Beyond
a
certain
a
certain
level,
because
the
social
interaction
is
different
and
we
need
to
account
for
that
and
so
I
hope
that
answers
your
question
but
understanding
the
social
context
that
you
provide
whatever
service
it
is
you
provide
powerful.
F
F
G
F
The
health
outcomes
that
their
families
are
facing
and
why
did
you
all
decide
to
build
now
and
then
my
second
question,
if
you
want
to
just
answer
that
one
and
then
I
have
a
follow-up
chairman.
C
So
that
that's
a
powerful
question,
why
and
the
the
the
answer
to
that
is
shame
on
us.
We
should
have
a
long
time
ago
and
and
that
responsibility
doesn't
just
follow
Norton
Healthcare.
There
are
three
other
health
care
providers
for
the
city
of
Louisville,
but
Norton
Healthcare
touches
one
in
two
African
Americans
in
the
city
of
Louisville,
and
with
that
comes
a
lot
of
accountability
and
our
CEO
and
our
leadership
team.
They
understand
that
and
initially
our
investment
was
supposed
to
be
20
million
dollars
over
a
two-year
period.
F
Thank
you
and
quick
follow-up.
My
second
question
has
to
do
with
the
care
that
will
be
provided
at
this
facility
in
a
couple
of
slides,
I.
Think
you
had
the
words
mental
health
and
substance
use
in
bold
I.
Don't
see
that
in
the
list
that's
provided
now.
Is
that
something
that
you're,
anticipating,
mainly
because
back
in
one
of
these
other
slides?
Where
you
had
you
know,
70
of
these
areas
of
renter
60
are
women.
Female
head
of
households
there's
an
87
percent
AA
population
is
that
African.
F
African-Americans,
there's
a
utility
utility
disconnection
rates,
one
Banker
for
every
1200
people.
F
So
my
question
is:
how
are
you
going
to
get
people
the
access
to
the
care
right,
I
have
Norton
like
my
chart,
everything
is
online.
Appointments
are
made
online.
So
if
you
have
no
internet,
you
know
that
kind
of
thing.
How
are
you
going
to
access
this
care
and
then
the
other
part
was.
Were
you
planning
on
adding
mental
health
and
substance.
C
Use
sure
so
we're
very
cautious
in
how
we
approach
Mental
Health
and
the
reason
why
is
there
are
some
organizations
community-based
organizations
in
Louisville
and
West
Louisville
doing
some
phenomenal
work?
C
You
try
to
find
a
psychiatrist
right
now,
almost
impossible,
and-
and
so
we
know,
we
can't
do
it
alone
and
I.
Think
your
other
question.
We
brought
up
some
of
the
the
utility
disconnection
rates
and
digital
access.
C
We
thought
that
Wi-Fi
was
going
to
be
a
huge
deal,
but
when
we
we
do,
our
community
needs
assessment
in
our
survey
of
6
000
people
that
fell
down
on
the
list
quite
a
bit
and
so
I'm
not
saying
that
it's
not
an
issue,
but
here's
what
the
issue
is.
Even
when
Wi-Fi
is
available,
African-Americans
and
Hispanics,
don't
trust
technology,
and
this
isn't
me
saying
it.
I
took
that
slide
out.
C
J
Thank
you,
Dr
mccance,
for
your
presentation,
I
I
came
in
late
and
sometimes
I
do
that
when
I
come
to
church
and
you
you
preach
the
sermon.
Yes,
sir
and
I
think
you're
faxing.
Your
figures
speak
to
the
issues
that
we
have
not
just
in
Louisville,
West,
End
of
Louisville
or
Savannah
or
or
New,
Orleans
or
anywhere
else.
J
I
think
it
speaks
to
the
issues
that
we
have
in
America
and
I
would
like
Mr
chairman
for
us
to
miss
chairman
to
to
to
to
to
to
make
this
a
somewhat
white
paper
for
for
what
what
we
see
as
the
issues
and
concerns
in
the
Commonwealth
of
Kentucky
and
when
you
finished
it
was
like
a
drop
the
mic
moment.
I
appreciate
what
you
said,
I
appreciate
the
presentation.
Thank
you
very
much.
Thank.
C
You,
sir
one
other
comment:
you
you
brought
up
Kentucky
and
so
what
we
see
in
the
African-American
population,
you
can
apply
to
rural
Kentucky
as
well
and
I.
I
said
segregation
and
most
people
heard
racial,
but
I'm
also
talking
about
geographic
segregation,
and
so
you
look
at
rural
Kentucky
and
some
of
the
areas
that
border
West
Virginia,
the
healthcare
disparities
are
just
the
same.
A
B
I
Thank
you.
What
a
great
presentation,
very
eye-opening,
you're,
very
direct,
and
to
the
point
and
I
appreciate
that
when
we're
hearing
information
I
think
it's
very
strong
and
it
sends
a
strong
message.
I
have
two
questions
for
you.
First
I
guess:
I
want
to
make
a
comment.
First,
I
think
representative
Kulkarni
brought
up
a
good
point
of.
Why
is
it
taking
so
long
to
build
a
hospital
in
the
West
End
of
Louisville,
but
thanks
for
doing
it
now,
thanks
for
making
it
a
focus
now
and
I
think
July
of
2020?
C
I
You
know
whether
that
was
a
an
indicator
of
that
yay
or
nay,
but
I'm
glad
that
it's
happening
now,
because
it
is
and
and
I
think
my
first
question:
I
read
in
The
Courier
Journal
the
other
day.
How
therefore
Walgreens
shutting
down
in
Louisville
and
two
of
those
would
be
in
Beechmont
and
Taylor
Berry
neighborhoods,
which
the
one
on
Broadway
by
the
hospital
I
think
is
still
would
be
considered,
probably
use
by
the
West
End.
I
C
West
End,
so
we
we
will
have
a
pharmacy
at
our
location.
Several
of
the
federal
qualified
Health
Care
Centers
that
have
been
providing
great
work,
have
pharmacies
associated
with
them
also.
But
when
you
look
at
the
and.
C
C
Does
access
it
does,
but
when
you
look
at
the
investment,
that's
coming
between
Norton
and
Goodwill
I
think
you'll
see
more
industry
pouring
into
that
area,
so
not
really
worried
about
who's.
Leaving
once
that
hospital
opens
and
once
Goodwill
Goodwill's
opportunity,
campus
is
erected,
you'll
see
a
lot
of
investment
coming
back
into
that
area.
Good.
I
I
But
I
really
think
that
you
know
I
wanted
when
I
ran
I
wanted
young
girls
and
young
people
to
recognize
they
have
a
voice
in
government
and
I.
Think
that's
very
important,
and
so
to
me
this
is
an
awesome
opportunity
for
you
all
to
come
into
the
community
and
say
hey.
These
are
opportunities
you
can
be
when
you
get
older,
but
what
is
like
when
you
all
are
hiring.
Do
you
think
you'll
focus
on
hiring
minority
people
for
the
hospital
at
the
West
End
like
what
you
know
kind
of?
C
Very
very
good
and
important
question:
we
want
the
right
attitude.
We
want
the
right
service
attitude
first
and
we
hope
that
comes
in
a
color
that
mirrors
the
community,
but
it
doesn't
have
to
be.
But
our
other
interest
is,
you
know:
I
sit
here
as
a
cardiologist,
but
less
than
five
percent
of
the
medical
Workforce,
our
African-American
cardiologists,
and
so
we
have
to
work
on
our
pipeline
programs
notice
that
I
mentioned
Simmons
College
as
an
HBCU,
we're
working
with
Meharry,
Medical,
College
and
Morehouse
also
to
make
sure
that
we
have
good
representation.
I
I
think
too,
to
that
point
you
trust
what
you
know.
That's.
G
I
You
know,
and
that's
not
I
just
I
feel
like
that.
Just
is
what
it
is
and
I
found
it
very
interesting
when
you
were
sharing
how
your
your
white
teachers
are
the
ones
that
influence
you
the
most
that's.
G
I
You
know
and
I
think
that
there's
I
don't
know
thanks
for
sharing
that
it's
given
me
a
lot
to
think
about.
So
thank
you
for
that.
Thank
you,
Mr
chair,
thank.
L
L
What
impresses
me
about
this
is
at
Norton's,
with
its
intentionality
instead
of
just
plopping
in
is
doing
its
research
and
moving
into
a
space
that
can
make
a
huge
difference
in
a
critical
area,
and
it
said
intentionality
and
the
the
value
that
you
bring
to
that
space.
That
is
highly
impressive
and
I
just
want
to
say
that
I
think
this
is
a
game,
changer
and
I.
Think
if
more.
L
Corporate
entities
I
just
use
corporate
with
capacity
and
intentionality
move
into
spaces
with
the
intelligent
and
research
that
you
guys
are
doing
and
you're
going
to
learn
as
you
go,
you
don't
know
everything
yet.
Yes,
sir
I
think
that's
going
to
be
that's
going
to
be
a
really
big
deal.
Reason
I'm
saying
this
is
because
we
can
talk
about
how
bad
things
are,
but
the
fact
of
the
matter
is
that
this
was
not
done
by
happenstance.
L
This
was
done
by
Design.
It
was
done
by
intentional
policy.
The
reference
to
redlining
specifically
speaks
to
that,
but
there
are
multiple
things
that
have
done
that
now.
The
legacy
of
the
racism
and
so
forth
that
not
only
brought
us
to
this
day
still
exists
today
and
overcoming
that's
going
to
take
some
strong
intentionality
now
I
know
those
are
words.
A
lot
of
people
don't
like
to
talk
about
no
more,
but
it's
the
reality
and
you
can't
deal
with
reality
unless
you
understand
what
is
real
and
you
work
from
that.
L
So
I
want
to
congratulate
your
leadership.
What
they
may
not
know,
and
what
I
do
know
about,
is
your
leadership
in
this
and
the
intentionality
that
you
have
applied.
You
are
leaders
in
making
the
changes
that
we're
talking
about
on
this
commission
right
here
about
creating
opportunity
and
dealing
with
it
in
a
real
and
concrete
way
and
not
in
a
superficial,
dress,
up
sort
of
way.
Congratulations
on
that
and
any
support
that
I
and
others
I'm
sure
on
this
commission
can
give
I
think
you're
going
to
get
it.
Thank
you.
Thank
you.
K
Thank
you,
sir.
This
was
an
awesome,
awesome
presentation.
My
question
was
brought
up
by
representative
hevron
a
little
bit.
We
have
data
that
shows
that
if,
if
black
children
have
a
black
teacher
in
school,
they
do
better.
K
C
C
African-American
patients
are
more
compliant
when
they
have
an
African-American
provider.
Hispanic
patients
are
more
compliant
when
they
have
an
Hispanic
provider,
and
we
have
to
accept
that
Embrace
that
number
one.
So
my
answer
would
be
to
those
that
are
not
African-American
or
not
Hispanic,
just
because
that
patient
or
student
does
better
with
that
person.
C
That's
not
a
bad
thing,
encourage
that,
because
we
need
those
students
to
be
better
so
that
they
end
up
at
the
top
of
their
skill
set,
but
I
don't
have
the
answer
for
for
what
we
need
to
do.
I
just
know
that
we
have
to
build
our
Workforce
and
everybody
has
to
get
the
same
message.
One
of
the
things
Dr
Miller
and
I
were
talking
about.
Is
that
often
we
operate
in
silos?
Everybody
is
doing
good
work.
C
Everybody
is
well
intended
to
still
Senator
Neil's
term,
but
we
operate
in
silos
and
you
can't
do
that
in
health
care.
You
can't
do
that
in
any
service
industry,
where
the
people
or
the
population
depends
on
you,
and
so
that's.
Our
first
thing
is
Norton
has
to
work
with
uofl,
and
we
have
to
be
intentional
about
how
we
do
things,
because
the
workforce
needs
to
see
that
again
long
way
around,
but
I
wanted
to
make
a
few
points.
K
A
A
Our
next
presenter
on
the
agenda
today
is
going
to
be
Dr
Dana
Quisenberry
from
the
University
of
Kentucky
Department
of
Health
Management
and
policy
Dr
Quisenberry
we're
honored
to
have
you
please
introduce
yourself
for
the
record
and
your
topic
based
on
our
agenda
and
I'm.
Confident
your
presentation
is
going
to
be
overdose
mortality
rates
among
black
kentuckians.
H
Yes,
thank
you
so
much.
My
name
is
Dana
Quisenberry
I
am
an
assistant
professor
in
the
Department
of
Health
Management
and
policy
at
the
College
of
Public
Health
at
the
University
of
Kentucky
I'm,
also
a
faculty
associate
at
the
Kentucky
injury
prevention
and
Research
Center.
We
are
currently
funded
by
the
CDC.
H
If
I
will
I'll
go
ahead
and
get
this
started
so
that
we
can,
we
are
currently
funded
by
the
CDC
to
conduct
drug
overdose
surveillance,
Public,
Health
surveillance
I
actually
lead
the
team
in
the
and
the
principal
investigator
on
that
CDC
funding.
My
colleague,
Dr
Terry
Bunn,
is
the
principal
investigator
for
the
prevention
side
of
that
house.
H
We've
been
doing
this
work
at
kippwick
since
2014
when
I
first
started
there,
and
I
would
like
to
tell
you
that
I'm
coming
with
good
news,
but
I
wouldn't
be
here
if
I
was
coming
with
good
news.
So
this
is
not
I
have
got
toughened
up
and
have
gotten
broader
shoulders
could
I,
because
I
am
very
rarely
appearing
with
good
news.
H
I
want
to
share
with
you
some
observations
from
our
last
annual
drug
overdose,
death
report
or
mortality
report.
It
actually
covers
a
five-year
period,
but
with
the
most
recent
data
we
have
some
concerning
findings.
H
We
know
that
in
2020
we
had
a
50
percent
increase
in
drug
overdose
deaths
in
this
state.
It
was
alarming
it
was
concerning.
We
were
stressed,
we've
been
doing
this
prevention
work
and
others
in
our
state
have
been
doing
prevention
and
intervention
work
for
a
number
of
years.
This
was
very
unexpected,
as
you
can
see,
from
2017
to
18
to
19
we
were
declining,
we
thought
we
were.
We
were
finally
getting
ahead
of
the
opioid
epidemic
in
this
state.
H
H
In
the
world
of
epidemiology,
we
try
to
convert
these
numbers
into
numbers
that
we
can
compare
to
others,
and
that's
why
we
have
why
we
calculate
age-adjusted
rates,
because
I
can
now
take
these
rates
and
go
and
compare
to
any
state
in
in
this
country
and
be
able
to
say.
Are
we
in
a
better
or
worse
position
than
some
of
these
other
states?
H
Where
several
things
that
we
do
with
this
information,
one
of
them
is
we
look
at
geography
and
what's
the
distribution
across
our
state
with
this
mortality
and
as
you
can
see,
the
age-adjusted
rates
for
the
counties
that
we're
allowed
to
report
on
it's
pretty
distressing
and
I
will
tell
you
the
we
haven't
been
this
dark
in
color
on
this
map
and
from
in
some
time,
I
live
in
northeastern
Kentucky
and,
as
you
can
see,
that
I-64
Corridor
looks
pretty
distressing.
H
We
also
look
based
on
gender
and
we
still
maintain
that
for
every
single
female
who
dies
from
drug
overdose,
we
have
at
least
two
males.
H
Foreign,
this
applies
to
all
Kentuckian
Kentucky
resident
deaths.
This
is
the
drug
types
that
are
involved
in
these
deaths,
and
these
are
counts.
These
are
not
rates
and
if
you'll
see
what
has
happened
with
the
introduction
of
fentanyl
in
our
drug
Supply
in
2020
and
2021,
that
seems
to
be
driving
nearly
well,
it
doesn't
seem
to
be.
We
know
it
is
driving
more
than
70
percent
of
our
mortality.
H
H
H
So
we
have
to
take
the
information
from
their
deaths
and
try
to
prevent
other
overdoses,
particularly
fatal
overdoses,
and
we
know
that
there
is
a
large
proportion
of
our
nearly
90
percent
of
our
overdose
decedents,
who
have
had
a
non-fatal
overdose,
at
least
one
non-fatal
overdose
prior
to
their
death.
H
A
A
The
presentation-
that's
perfectly
fine,
and
no
no
humor,
no
laughter,
no
smile
on
my
face.
None
on
yours,
because
these
are
depressing
numbers.
Yes,
sir,
the
broader
category
and
correct
me
if
I'm
wrong,
but
we
we've
I've,
heard
this
phrased
as
deaths
of
Despair
This
falls
into
that
scope
and
space
of
deaths
of
Despair,
so
speak
for
just
a
moment
about
prior
to
covid.
You
say
we
saw
this
coming.
H
Didn't
bring
the
slide
with
me
today,
but
we
also
have
a
way
of
representing
this
data
in
a
monthly
breakdown
and
prior
to
the
pandemic.
We
were
looking
at
an
average
of
100
to
125
deaths
per
month,
which
is
astronomical
by
itself.
You
know,
that's
a
small
plane
crash.
Every
month
we
started
seeing
increases
in
September
of
2019.
H
H
May
of
20
20
honey
was,
by
all
accounts
the
worst
month
we
have
ever
had.
We
had
nearly
250
drug
overdose
deaths.
We
also
saw
a
proportionally
similar
increase
in
non-fatal
overdoses.
It
was
on
record
our
worst
month,
however,
after
the
pandemic
after
we
started
to
get
a
handle
on
that
issue,
we
are
seeing
a
new
what
we
are
calling
a
new
endemic
level
of
Overdose
mortality.
H
So,
instead
of
returning
to
that
100
125
per
month,
we
are
are
now
about
150
to
175
per
month
and
that
that
seems
to
be
the
level
that
we're
going
to
be
maintaining
for
some
time.
We've
been
at
that
level
for
about
15
months
now
now
there's
variations
based
on
months,
but
that's
the
average
so
we're
a
larger
aircraft
crashing
every
month.
A
H
Well,
we
know
that
first
of
all,
I
have
to
tell
you
that
none
of
these
answers
lie
in
the
data
that
I
I
gave
you
now
and
I
have
colleagues
that
are
doing
great
work,
doing
qualitative
work
and
doing
additional
work
in
this
area.
This
is
simply
Public
Health
surveillance,
but
I'm
glad
you
asked
me
to
somewhat
go
off
record.
H
We
disrupted
People's
Health,
we
just
disrupted
people's
Financial
stability
and
we
isolated
people
with
there's
data
that
I
have
and
some
service
study
that
we
have
done
on
case
fatality
rate
borrowing
from
infectious
disease,
and
that
is
where
you
take
the
number
of
deaths
over
the
number
of
cases
of
infection,
and
we
did
a
similar
type
of
analysis
with
drug
overdose
and
believe
it
or
not.
Our
case,
fatality
rate
has
not
dramatically
increased.
It's
basically
increasing
a
little
over
a
percentage
point
every
year
from
2017
until
the
summer
of
2021.
H
What
we
did
see
is
a
seasonality
in
the
case,
fatality
rate.
So
how
do
we
then
get
if
the
case,
if,
if
it's
not
more
lethal,
if
the
disease
is
not
more
lethal?
What
is
going
on
in
in
the
beginning
of
the
pandemic,
and
what
we
are
seeing
is
far
more
incidences
of
overdose,
so
the
increase
in
death
and
the
increase
in
non-fatal
overdoses
were
increasing
in
similar
proportions
because
the
case
fatality
rate
pretty
much
stayed
stable.
H
H
A
L
Of
all,
thank
you
for
the
presentation
and
the
information
that
you
provided.
So
you
just
blew
a
hole
in
the
information.
I've
told
me
as
a
negative.
It's.
H
H
L
Even
methamphetamine,
yes,
and
that
those
who
produce
that
and
those
who
carry
that
Target
certain
communities,
poor
communities,
black
and
white,
yes,.
B
L
Particularly
for
targeting
in
Black
communities,
and
that
the
mixing
of
this
now
is
done
in
such
a
way,
this
I
don't
know
the
correct
word
to
use,
but
in
ways
that
those
who
are
users
it's
more
lethal-
and
you
just
said
that
you,
you
have
information,
suggested
it's
not
more
lethal.
H
We
have
a
population
that
was
not
necessarily
opioid
using
that
may
have
been
introduced
to
fentanyl
over
the
last
couple
of
years
and
that's
why
the
rates
for
that
Community
looks
different
than
the
other
community.
We
are.
We
have
known
since
the
beginning
of
the
epidemic
that
white
kentuckians
have
have
been
not
well
as
we
call
they're,
not
opioid
naive
I
suspect
that
there
is
a
population
in
the
the
black
community
that
were,
in
fact,
opioid
naive
prior
to
the
time.
L
Looking
for
me
so
correct
me
if
I'm
wrong,
so
because
if
you
look
at
in
Indiana
and
non-black
populations,
you
find
a
very
high
mortality
rate
happening
in
certain
communities
as
well,
that's
being
reported,
but
what
I
think
I
heard
you
say
is
that
it
seems
like
there's
an
introduction
of
usage
of
a
particular
type
of
drug,
that
there
was
not
a
history
of
in
the
community
and
but
still
you're,
not
in
a
position.
I
understand
that
you're
not
in
a
position
and
then
it's
probably
unfair
question
I'm.
L
Just
probing
yes,
you're,
not
in
a
position
to
or
you
have
no
information
or
knowledge
in
terms
of
those
who
put
Fentanyl
fentanyl
in
the
community
are
mixing
or
using
it
in
a
different
way.
That
makes
it
more
lethal.
H
We
don't
have
that
information
here.
Yes
in
this,
it's
not
available
or
discernible
from
this
data
here,
but
I
do
we
do
know
from
the
toxicology
that
there
was
a
point
in
which
Fentanyl
became
part
of
the
substance
use
of
those
individuals,
and
that
is
different
than
what
it
had
been
in
the
past.
You
know
we
cannot
discern
from
people
who
are
not
living
whether
they
are
are
looking
for
a
combined
product
of
of
a
stimulant
and
an
opioid
methamphetamine
and
Fentanyl.
We
can't
discern
that.
They
can't
tell
us
that
information.
H
We
don't
know
that
question
either,
because
people
who
are
deceased
can't
tell
us
that
we
have
been
starting
to
do
more
work
around
non-fatal
overdoses
and
trying
to
discern
from
living
individuals
more
information
about
the
how
those
use
patterns
happen
and
I
have
colleagues
that
are
doing
great
work
in
that,
and
it
is
something
that
needs
to
be
understood
so
that
we
can
do
the
type
of
harm
reduction
services
that
are
effective
for
the
for
those
specific
issues.
Thank.
H
E
You
so
much
thank
you
for
your
presentation
and
you
may
or
may
not
have
the
answer
to
this.
Just
going
off
of
the
the
slides
you
presented
and
I
believe
you
said
that
there's
like
at
least
one
non-fatal
overdose
before
an
actual
overdose
that
results
in
death
and
I
was
curious
about
for
those
that
are
non-fatal.
H
E
You
look
at
who's
in
rehab
who
gets
the
help
and
I
don't
know
if
you
all
have
done
that,
like
how
many
white
people
are
offered
rehab
right
versus
black
people
being
offered
going
to
jail
or
being
able
to
get
more
access
to
drugs,
and
even
if
they
are
arrested,
they
can
certainly,
we
know
access
drugs
while
they're
behind
bars,
so
I
don't
know
if
you've
done
that
and
then.
Secondly,
if
I
could
ask.
K
E
And
you
may
not
know,
but
you
did
mention
May
of
2020
and
an
increase
in
Despair
and
you
mentioned
covet.
Have
you
all
looked
at
racial
Injustice
and
what
happened
in
Kentucky
in
May
of
2020.
H
To
answer
your
first
question:
you're
right
I
can't
provide
you
from
this
data.
An
answer
to
that
and
I
wish
that
I
could
and
I
think
it
is
an
important
question
that
needs
to
be
studied.
There
are
communities
in
this
state
that
are
starting
to
stand
up
response
teams
that
will
go.
Do
a
a
hand-to-hand
touch
with
people
who
have
survived
a
non-fatal
overdose,
I,
think
there's
now
17
or
18
of
those
teams.
Now,
whether
or
not
there
is
one
of
these
teams
doing
work
in
this
particular
Community,
I
am
not
aware
of
one.
H
So
that
would
be
a
great
place
to
start
of
being
able
to
offer
that
as
a
service
to
be
able
to
do
that.
Work
with
that
Community
Access
to
treatment
is
a
significant
problem
in
this
state,
even
as
we
continue
to
develop
providers
that
are
licensed
to
do
buprenorphine,
as
we
include
continue
to
increase
the
methadone
clinic
footprints
access
is
a
real
issue
and
I
don't
expect
it
to
be
different
than
regular
Health
Care
in
a
matter
of
from
the
standpoint
of
being
a
problem,
but
I
do
think
it's
probably
more
significant
of
an
issue.
H
H
But
this
data
doesn't
speak
to
that.
But
if
you
are
interested
in
some
more
information
about
that,
I
can
try
to
get
that
for
you
and
your
second
question
about
racial
Injustice.
Once
again,
this
data
doesn't
speak
to
that,
but
you
are
absolutely
right
that
we
will
be
unpacking
the
events
and
of
2020
as
researchers
for
probably
the
next
decade
to
being
able
to
understand
the
effect
of
covid
the
effect
of
racial
Injustice.
H
You
know
even
the
the
fact
that
the
people
had
fear
of
of
even
going
to
a
medical
facility
during
that
time
and
that
whether
or
not
that
delayed
care
for
other
conditions,
we
have
a
tremendous
amount
of
work
to
understand
so
that
we
can
potentially
prevent
this.
This
cluster
of
events
from
happening
again
and
having
the
effect
not
just
over
on
overdose
mortality,
but
other
mortality
in
the
excess
mortality.
During
this
time.
A
N
Programs
in
our
jurisdictions
been
very
successful
for
those
who
aren't
familiar
with
those
they're
they're
dockets
that
encourage
steer
and
sometimes
direct
folks
are
involved
in
the
criminal
justice
system,
usually
at
lower
level
offenses
into
treatment
versus
into
custody,
jail
or
prison,
and
one
of
the
things
that
I
know
that
we've
seen
is
is
our
issues
with
access
to
treatment,
kind
of
along
the
lines
of
what
Dr
mccance
was
talking
about
access
for
addicts
to
treatment?
Can
you
speak
about
that
and
where
we
are
at
all?
N
As
far
as
in
the
Commonwealth,
do
we
have
enough
treatment
facilities
for
the
ones
that
we
do
and
I
follow
up
on
that
one
for
the
ones
that
we
do
have?
Are
they
private?
Are
they
non-profit?
Are
they
government
funded?
Are
they
government
operated
just
to
kind
of
get
a
feel
for
what
the
treatment
Spectrum
looks
like
well,.
H
When
you
go
to
that
page
to
the
the
site
you
can
actually
put
in
the
parameters
of
what
you're
looking
for,
and
it
will
only
deliver
to
you
in
results,
facilities
that
have
an
opening
right,
then
and
I'm
going
to
share
with
you
Mr,
commissioner
Roberts
I
was
a
practicing
attorney
for
15
years
and
I
have
had
the
horrific
experience
of
having
to
tell
someone's
mother.
We
have
to
charge
your
son
with
the
checks
that
he
stole
so
that
we
can
get
him
into
treatment.
H
But
that's
why
the
tool
to
find
help
now
KY
of
being
able
to
give
you
an
open,
available
treatment.
Slot
is
so
important
and
that's
it's
now
been
active
for
three
years
and
we're
very
excited
about
what
we
see.
So
we
have
built
into
that
every
level
of
Provider,
including
buprenorphine
providers,
and
we
we
only
let
them
stay
on
the
website
if
they
will
update
their
availability
so
that
we
don't
have
an
opportunity
where
you
know
result
will
show
up
and
that
bed's
not
really
available,
because
that's
discouraging
and
it's
available
publicly.
H
Anyone
can
use
it
matter
of
fact,
it'd
be
great
tool
for
you
all
to
be
able
to
use
in
your
program,
but
you
know:
I
was
and
we're
doing
community
work
about
15
years
ago,
when
the
Appalachian
Regional
Commission
issued
a
report
saying
that
Kentucky
was
doing
substance
use
treatment.
The
best
of
any
state
in
the
region
and
I
was
like
what
I
know.
I
saw
your
reaction,
too.
My
same
reaction.
H
N
I
ask
one
other
quick
follow-up.
Thank
you.
That's
very
helpful
and
I
I
noted
that
I'll
make
sure
our
folks
have
access
to
that.
If
they
don't
already
for
the
folks
that
you
know
that
you're
we're
tracking
for
the
overdoses
and
over
the
over
the
time
period
here,
do
we
have
any
data
on
how
many
of
those
folks
actually
had
any
treatment
before.
H
We
actually
do
have
some
of
that
information.
There
are
some
of
the
parameters
we're
catching
of
whether
they
have
been
incarcerated
prior
to
their
death,
whether
because
there
are
some
substance
use
programs
in
our
our
Corrections
facilities,
whether
they
are
recently
have
been
in
treatment,
one
of
the
things
that
we
will
be
doing
now
that
we
have
enough
years
of
data
to
be
able
to
do
some
trending
and
understand,
what's
really
been
going
on
in
those
those
opportunities
to
intervene,
we're
going
to
be
doing
some
more
work
with
that.
N
H
Thank
you
and
I.
Also,
let
you
know
there's
another
tool
find
recovery
housing.
Now
that
may
be
helpful
for
you
that
we've
stood
up
as
as
an
ancillary
site
to
that,
so
that
transition
in
providing
sound
housing
for
individuals
early
in
their
recovery.
That
site
will
help.
You
find
that
as
well.
A
A
Secondly,
I've
long
had
an
interest
in
trying
to
discern
those
treatment
programs
that
are
successful
versus
those
are
that
are
not
so
that
we
can
build
a
performance
rewards
model
to
move
forward,
those
that
are
successful
and
maybe
incentivize
those
that
are
just
collecting
money
on
a
fee
for
service
model
and
not
producing
outcomes.
So
if
you
could
put
something
together
for
me
for
a
future
reference,
I
would
appreciate
it.
Dr,
olaika
you're
next
to
be
followed
by
Senator
Berg.
Thank.
D
You
Mr
chairman
earlier
the
chair,
mentioned
the
term
death
of
Despair.
This
is
not
my
area
of
research,
so.
F
D
D
Between
the
ages
of
we'll
say,
18
to
50,
to
give
a
very
broad
range
I'm
going
to
ask
you
a
few
questions
about
variables
and
whether
or
not
you
all
have
looked
at
these
in
terms
of
how
they
could
relate
to
substance,
abuse,
related
deaths,
marriage,
education
and
then
income,
slash
employment
again
based
on
things
that
I've
read:
anecdotally,
I,
I,
hate,
saying
things
as
facts
without
being
able
to
set
the
research
behind
them.
But
from
what
I
understand
for
men,
these
things
are
particularly
beneficial
work,
marriage
being
educated.
D
H
Have
collected
that
data,
whether
you're
married
at
the
time
of
your
death,
is
on
the
death
certificate
uniform
death
certificate.
So
we
have
that
information
as
well
as
the
education
level
is
also
on
there.
There
are
their
unemployment
status
is
sometimes
captured
on
there,
because
the
death
certificate
specifically
asks
last
known
occupation,
and
we
have
noticed
there's
some
inconsistencies
in
that
particular
field
of
the
death
certificate.
H
We
are
in
the
middle
of
doing
a
study
about
the
pandemic
effect
on
unemployment
of
the
study
on
the
changes
in
employment
during
covid
by
industry
and
we'll
hopefully
have
that
paper
out
in
the
next
little
bit.
We
do
know
that
our
service
industry
took
a
pretty
significant
hit
and
there
are
a
population-
that's
by
large
stays
employed,
but
has
some
significant
substance
issues
in
it,
and
so
we're
we're.
Hopefully
we'll
have
the
data
on
that
very
very
soon,
for
you
and
I
can
make
sure
that
that
gets
to
you.
D
H
K
Thank
you
ma'am
again,
very,
very
interesting
and
I.
Don't
necessarily
expect
an
answer
to
this
today,
but
I
would
like
to
know.
Has
Casper
worked?
Has
you
know
I
mean
initially?
What
I
thought
I
saw
is
once
we
sort
of
closed
the
pipeline
to
legal
drugs
that
were
being
abused,
that
opened
more
of
a
pipeline
for
illegal
drugs
to
be
abused
and
unregulated
drugs
and
then
I
sort
of
thought.
Well,
that's
all
steadying
itself
out,
but
it
looks
like
it
hasn't
studied
out
that
it's
actually
getting
worse
so
am
I.
Reading
this
wrong.
H
H
H
H
I
try
to
characterize
in
my
own
mind
is
that
we
have
a
population
that
is
opioid
dependent
and
there
could
be
some
conversation
around
this
concept
that
when
there's
a
in
the
whole
economic
Supply
demand
type
of
thing
until
the
last
few
years,
the
the
demand
side
has
been
kind
of
light
on
the
intervention,
and
now
that
we
have
more
Treatment
available
more
opportunities
to
address
the
demand,
it's
just
going
to
substitute
one
after
the
other.
So
it's
it's
not
really
a
true
transition
from
one
substance
to
the
other.
H
As
long
as
we
have
a
population
that
is
opioid
seeking
because,
as
you
can
see,
I
put
back
up
on
the
screen,
we
still
have
218
deaths
in
2021
that
involved
a
prescription
opioid.
You
know
that
was
you
know.
We
had
2256
deaths,
so
I'm
don't
want
to
you
know
they
say:
don't
speak
in
public.
You
also
shouldn't
do
math
in
public,
so
someone
else
is
going
to
have
to
do
that.
Math.
H
It's
still,
you
know
present
in
a
lot
of
overdoses.
Now
to
let
you
know
these
and
I
should
have
said
this.
When
we
talked
about
this.
These
are
not
exclusive
categories.
H
Until
you
know,
the
last
couple
of
years
heroin
would
have
could
have
also
been
present,
because
individuals
who
are
in
substance,
active
substance,
use,
it's
kind
of
addiction
is
a
disease
of
opportunity,
and
so
it
has
to
you
know
that
has
to
be
fed.
So
whatever
is
available
is
what's
going
to
be
consumed.
H
H
F
Thank
you
chairman.
Thank
you
for
your
presentation.
I
had
a
question
about
this
slide
in
particular,
and
I
think
you
might
have
touched
on
it.
My
question
was
just
looking
at
the
the
graphs
right:
you're
you've
got
an
increase
in
fentanyl.
You've
got
an
increase
in
methamphetamine
prescription
opioids,
look
like
they're,
fairly
steady
in
terms
of
use.
Heroin
has
gone
down
in
the
same
time
period.
I
wondered
if
you
had
a
breakdown
in
terms
of
race
and
usage.
K
F
Each
drug
you
just
mentioned
in
answer
to
Senator
Berg's
question
that
there
may
be
multiple
substances
involved,
so
my
question
was:
is
it
possible
to
get
that
breakdown
and
are
there
any
highlights
like?
Have
you
seen
anything
in
the
data
in
terms
of
drug
usage
by
race?
Specifically
and
then?
My
second
question
has
to
do
with
the
site:
I
went
to
find
helpnow.org,
which
is
I,
guess
a
University
of
Kentucky
initiative,
and
there
are
several
Partners
listed
on
that
site,
including
chfs
Kentucky
public
health.
F
My
question
was
in
terms
of
this
site,
which
is
very
helpful
because
it
goes
by
your
location,
right
so
it'll
say:
there's
a
treatment
center,
half
a
mile
down
the
road,
yes
ma'am.
What
is
your
budget
or
scope
for
outreach
for
this
particular
site
and
the
information
in
it?
Thank
you.
H
Let
me
deal
with
the
toxicology
piece
first,
because
that's
really
my
bailiwick
of
the
the
grant.
We
do
know
that
and
that
I
made
reference
to
the
little
bit
of
that.
With
my
response
to
Dr
to
Senator
O'neill,
we
have
seen
a
transition
from
a
primarily
stimulus
stimulant
using
population
to
more
of
a
combined
a
stimulant
and
some
type
of
opioid,
usually
fentanyl
in
the
black
community,
and
that's
that
whole
conversation
around.
H
They
may
have
been
opioid
naive
and
that's
why
we've
seen
a
more
dramatic
increase
of
Overdose
amongst
that
population,
but
I
can
get
you
more
specifics
by
race.
Now
we
did
a
paper
in
2020
that
is
in
Jama.
That
has
some
of
that
information
and
I
can
send
that
paper
to
you
I'm,
going
to
make
a
note
of
that.
So
I
actually
remember
to
do
it.
Okay,.
H
When
we
first
started
with
od2a
the
prevention
side,
we
stood
up
the
the
find
help.
Now
we
heavily
invested
in
Media
and
we
still
have
that
same
marketing
firm.
That
is
helping
us
with
it.
What
we
are
finding
it
doesn't
matter
how
many
messages
we
push
out?
How
many
ads
we
run,
whether
we
buy
social
media
ads
I
I
come
to
a
you
know
like
a
hearing
like
this
and
there's
still,
maybe
one
or
two
people
that
have
heard
about
it
and
I.
H
Our
od2a
funding
ends
August
of
2023.
We
will
be
riding
competitively
for
that
again
in
the
spring
and
this
will
remain
one
of
our
initiatives.
But
if
it
you
know
we,
it
could
be
more
heavily
resourced,
as
any
good
message
going
out.
You
need
at
least
you
know,
15
good
messages
to
outweigh
the
one
bad
message
and
Public
Health
in
particular:
we're
not
resourced
to
do
15
messages
to
to
one.
A
H
A
Thank
you.
We're
gonna
go
a
little
bit
about
out
of
order
in
order
to
continue
building
on
our
conversation
around
Trends
data
and
health
outcomes,
Dr
Berg.
If
you
would
like
to
introduce
our
next
guest
and
invite
them
to
the
table,
remember
to
tell
them
to
turn
their
microphone
on
and
introduce
themselves
for
the
record.
K
All
right
put
me
on
the
spot
guys
this
is
Dr
Miller,
who
is
here
at
my
request,
because
he
is
one
of
the
perhaps
the
leading
African-American
Authority
on
maternal
mortality
and
Obstetrics
and
Gynecology
in
this
state,
chair
of
the
Department
of
obstetrics
Gynecology
at
University
of
Louisville
school
of
medicine,
where
we
train
our
OB
GYN
physicians
in
this
state
and
sir
I
personally.
Thank
you
very
very
much
for
being
here
and
sharing
your
knowledge
with
this
committee.
Thank.
O
You
so
much
for
having
me.
Can
everyone
hear
me?
Okay,
perfect!
Thank
you
for
that
introduction.
I'm
Edward,
Miller
I
am
a
fetal
surgeon
and
Maternal
Fetal
Medicine
doctor.
It's
been
fantastic
to
be
able
to
sit
here
and
listen
to
these
presentations.
I
hope
to
build
on
these
and
really
approach
them
from
the
lens
of
maternal
health
and
pregnancy.
O
So,
as
we've
talked
about
today
and
as
Dr
McCann's
mentioned
before,
Health
outcomes
are
multifactorial.
So
when
we
look
at
things
like
maternal
mortality,
maternal
morbidity,
we
can't
look
at
the
end
outcome,
maternal
death
and
pregnancy,
maternal
near
misses
during
pregnancy.
We
have
to
think
about
everything
that
led
to
those
outcomes.
I
asked
my
residents
quite
frequently
when
a
patient
comes
to
their
office,
is
how
did
this
patient
get
to
you
and
when
their
interns,
the
first
responses
they
took
the
bus
they
took,
they
walked,
but
it's
bigger
than
that.
O
How
did
they
get
here
and
then,
once
they
answer
that
question?
How
did
this
Health
Care
system
that
we've
created
that
we're
working
in
today
contribute
to
the
disparities
that
these
patients
are
facing?
So
when
we
have
near
misses
at
uofl,
when
we
have
adverse
outcomes,
we
use
this
model.
We
look
at
the
social,
social
and
economic
factors,
the
clinical
care
that
we
provide
patient
and
provider
behaviors
and
the
physical
environment
that
the
patients
are
growing
up
in
to
determine
what
led
to
those
adverse
outcomes.
O
So
I
don't
need
to
go
back
here
because
Dr
McCann's
talked
about
this
beautifully.
I
have
been
in
Kentucky
about
two
and
a
half
years
moved
here
from
California
and
I
was
immediately
struck
by
how
sick
our
young
people
are
here
in
Kentucky.
You
know
at
the
University
of
Louisville
we're
we
have
a
very
unique
patient
population.
We
serve
the
urban
Louisville
population,
but
we
also
as
a
referral
center,
get
patients
from
the
rural
counties
of
Kentucky.
O
So
we
see
hypertension,
we
see
diabetes,
but
we
see
it
from
an
urban
perspective
and
we
see
it
from
a
rural
perspective
and
it's
amazing
how
the
same
disease
entity
presents
quite
differently
but
ultimately
leads
to
the
same
adverse
outcomes
that
we're
seeing
and
where
you
live
is
critical,
as
Dr
mccance
mentioned
in
Louisville.
If
you
live
in
West
Louisville,
your
life
expectancy
is
12
years
shorter
than
those
of
your
neighbors,
but
life
expectancy
is
one
thing,
but
what
about
on
the
flip
side?
What
about
how
your
life
gets
off
to
you?
O
The
start
that
your
life
gets
off
to
we'll
talk
about
the
rates
of
pre-term
birth,
but
all
of
these
are
linked
with
almost
any
chart
that
you
look
at
for
preterm,
birth,
adverse,
fetal
outcomes,
NICU
admissions.
You
can
overlay
that
same
chart
onto
this
one
and
would
match
almost
exactly
so
Healthcare
disparities
that
we're
talking
about
globally,
not
just
in
women,
not
just
in
pregnancy.
So
this
2019
data
looked
at
all
the
states
and
found
that
Kentucky
ranked
number
one
in
terms
of
cancer,
death
and
performance
of
disparities.
O
Number
three
in
terms
of
obesity,
number
four
in
terms
of
drug
overdoses,
nine
and
heart
disease,
you
can
see
the
list
goes
on
and
I
want
you
to
think
about
which
of
those
affect
women
of
reproductive
age.
So
we're
looking
at
minimally.
Cancer
deaths,
definitely
obesity,
definitely
drug
overdoses
as
we'll
go
into
later
and
we'll
be
amazed
to
see
at
the
rates
of
heart
disease
and
diabetes
and
organ
damage
in
young
people
that
are
pregnant
of
childbearing
age
in
Kentucky.
Today,.
O
So
numerous
medical
conditions
short
black
lives.
This
is
just
just
the
fact
that
we're
living
in
kidney
disease
disproportionately
affects
African
Americans,
stroke.
Cancer.
Heart
disease
literally
takes
away
on
average
13.4
years
from
the
black
lives.
Now
this
disproportionately
affects
black
men,
but
it
affects
black
women
as
well.
O
So
as
we
enter,
this
talk
some
key
terms.
So
when
we
talk
about
pregnancy
or
maternal
mortality,
there's
numerous
steps
in
the
lead
up
to
it.
So
we
have
pregnancy,
Associated,
death,
that's
death,
while
pregnant
or
within
one
year,
at
the
end
of
pregnancy,
irrespective
of
the
cause,
so
it
may
be
a
car
accident,
that's
not
related
to
pregnancy.
It
may
be
a
some
other
sort
of
accident.
Those
are
all
reported
in
pregnancy,
Associated,
death.
You
have
pregnancy
related
death,
which
is
next.
O
This
is
death
during
pregnancy
or
within
one
year
at
the
end
of
pregnancy,
from
a
pregnancy
complication.
So
this
is
where
we
need
to
focus
our
efforts:
a
pregnancy
complication,
whether
that
be
hypertensive
disorders,
a
blood
clot,
a
bleeding
disorder
and
finally,
it
all
ends
up
in
maternal
mortality,
death,
while
pregnant
or
within
42
days
of
the
end
of
pregnancy,
irrespective
of
the
duration
and
side
of
the
pregnancy,
from
any
cause
related
to
or
aggregate
aggravated
by,
the
pregnancy
or
its
management,
but
not
from
accidental
or
incidental
causes.
O
Now
I'd
like
us
to
think
about
about
maternal
mortality,
which
we
hear
quoted
quite
frequently
and
pregnancy-related
death
I
would
hypothesize
that
both
of
those
are
just
as
impactful
for
the
patient
for
the
family
for
the
individual,
but
we
oftentimes
quote
maternal
mortality
as
opposed
to
pregnancy,
related
death.
There's
reasons
for
that,
and
it's
all
in
that
number
42
days
seven
weeks
after
delivery
is
when
we
stop
quoting
maternal
mortality
and
seven
weeks
after
delivery.
O
Many
women
who
are
uninsured,
who
have
the
highest
risk
of
Baseline
complications
who
obtain
Insurance
during
pregnancy,
then
lose
it
and
are
uninsured
and
whether
or
not
they
had
congestive
heart
failure
that
they
developed
during
pregnancy,
whether
or
not
they
had
poorly
controlled
diabetes,
they
lose
that
insurance
and
as
a
result,
rather
than
keeping
track
and
Reporting
pregnancy
related
death.
We
choose
to
report
maternal
mortality
because
our
numbers
look
better.
O
So
this
is
all
cause.
Maternal
mortality
related
maternal
mortality
rates
in
the
United
States,
so
these
are
55.3,
and
if
you
look
at
this
African-American
rate
in
2020,
that's
per
100
000.,
as
you
can
see
from
2018
to
2020
the
rates
of
pregnant
maternal
mortality
Rose
across
almost
all
demographics.
But
if
you
look,
the
rates
amongst
African
Americans
are
highly
discrepant
compared
to
other
groups,
and
it's
important
to
recognize
that
this
is
not
new
data.
This
has
been
around
for
years.
O
We've
known
this
for
years
and
as
we
talk
about
the
impact
of
covid
with
some
new
data,
that's
come
up,
the
rates
are
only
Rising,
so
how
are
we
doing
in
Kentucky?
So
when
we
look
at
women
in
Kentucky
and
as
we
all
do,
our
our
research
and
look
into
the
topic
of
maternal
mortality,
as
you
do
research,
as
you
read
articles
you'll
oftentimes,
see
them
entitled
papers,
women
and
child
health
Women
and
Children's
Health,
so
we
lump
them
together.
O
I've,
never
seen
an
article
about
men
and
Children's
Health
before
right,
because
there's
a
reason
for
that,
because
when
you
love
it
Women
and
Children's
Health
were
then
forced
to
choose.
What
is
the
outcome
and
the
outcome
that
we've
chosen
is
children?
Is
babies,
so
we
focus
on
things
like
Howard.
How
are
prenatal
outcomes?
What
happens
to
the
babies?
There
was
the
years
ago,
one
of
the
most
Landmark
changes
in
obstetrical
care
that
changed.
How
babies
do
is
the
administration
of
steroids
when
babies
are
at
risk
of
delivering
early.
O
We
found
that
when
babies
are
delivered
early
around
24
weeks
and
they
get
steroids,
their
survival
rate
goes
from
50
to
75
percent.
It
literally
changed
the
game.
The
person
that
came
up
with
this
won
a
Nobel
Peace
Prize,
but
one
of
the
things
we
don't
talk
about
is
there's
been
this
study
this.
You
know
the
steroids
took
years
and
years
of
data,
but
if
we
had
actually
looked
at
the
data,
we
would
have
seen
that
steroids
and
knowing
the
benefit
of
steroids
should
have
been
seen
much
earlier.
O
So
whenever
we're
stressed,
whenever
we
have
a
stressful
environment,
our
body
releases
steroids.
It
is
one
of
the
things
that
contributes
to
the
fight
or
flight
technique.
What
we
know
from
looking
at
NICU
data
from
years
back
is:
do
you
know
which
babies
if
you're
taking
babies
born
at
20
weeks,
24
weeks
of
gestation?
Do
you
know
which
babies
are
more
most
likely
to
survive
black
females?
O
This
chart
right
here
looks
at
Social
and
economic
factors
and
how
Kentucky
rates
against
other
states
in
the
country
when
it
comes
to
Social
and
economic
factors.
Kentucky
ranks
42nd
in
the
nation,
and
it's
because
of
areas
right
here.
So
when
we
look
at
they
have
high
rates.
Women
have
high
rates
of
intimate
partner,
violence
before
pregnancy,
High
rates
of
food
insecurity,
a
large
gender
pay,
Gap
High
rates
of
poverty.
And
then,
if
you
look
at
other
aspects,
Health
outcomes,
we
have
high
rates
of
tobacco
use
compared
to
other
countries.
O
There
are
high
rates
of
health
of
High
Health
status,
so
presence
of
diabetes,
hypertension,
heart
disease,
chronic,
multiple,
chronic
medical,
comorbidities
and
obesity.
So
all
of
these
factors
lead
to
the
fact
that
when
women
come
to
my
office
they
are
sicker
now
the
thing
is
they
don't
feel
sick,
because
what
I
always
say
is
no
one
says
that
their
diabetes
hurts.
No
one
says
that
their
high
blood
pressure
hurts
it's
a
silent
killer.
Women
come
to
my
office
at
18,
19,
20
years
of
age,
but
not
every
year
is
the
same
for
every
individual
woman.
O
So
when
we
look
at
causes
of
maternal
death
in
Kentucky
and
again,
this
is
maternal
mortality.
The
most
common
cause
of
is
accidental.
So
we're
pointing
that
to
things
like
substance
use
disorders,
heart
attacks,
those
kinds
of
or
not
car
accidents,
those
kinds
of
things,
then
you
have
natural
disorders,
which
are
things
like
chronic
structural
disease
suicides
and
homicide.
O
When
we
look
at
Kentucky,
we
know
that
most
recent
data
from
2020
show
that
overdose
is
now
the
leading
cause
of
maternal
mortality
in
Kentucky.
It
used
to
be
things
like
heart,
disease,
renal
disease
or
or
Strokes
bleeding
disorders.
But
now
it's
overdose.
Opioids
are
the
main
cause
and
methamphetamines.
So
our
last
speaker
talked
a
lot
about
resources
to
people
during
pregnancy
or
during
that
are
have
substance,
use
disorder,
but
during
pregnancy
those
resources
are
slashed
dramatically
during
pregnancy.
O
If
you
live
in
a
rural
County,
you
may
have
to
drive
over
45
minutes
to
a
provider
that
will
prescribe
medication-assisted
treatment,
methadone
or
Suboxone
to
you
during
pregnancy.
The
amount
of
providers
or
the
access
you
have
during
pregnancy
is
slashed
dramatically.
Now
that
provider
may
not
May
prescribe
you
that
medication,
but
they
may
not
be
an
OB
GYN.
They
may
not
be
able
to
take
care
of
you
during
your
pregnancy.
O
O
And
to
go
back,
we
talked
about
so
what
are
barriers
to
getting
these
moms
in
for
medication,
assisted
treatment,
methadone
or
Suboxone?
So
we
know
that
there
are
disparities
in
things
like
CPS,
so
many
pregnant
women
are
afraid
to
come
into
the
doctor,
because
the
first
question
they
ask
you
is:
will
my
baby
get
taken
away?
And
you
can't
answer
that
question.
But
we
know
there
are
disparities
in
how
frequently
CPS
gets
called
for
black
women
versus
other
ethnicities.
O
So
this
is
relatively
new
data
that
looks
at
2018
through
2021,
and
it
shows
that
covid-19
the
covet
epidemic
has
significantly
exacerbated
the
rates
of
maternal
mortality.
We
see
that
in
2021
there
was
a
significant
increase
in
the
levels
of
maternal
mortality
and
400
of
the
1178
deaths
that
occurred
in
the
United
States
in
2021
401
of
those
were
secondary
to
covid-19
and
that
far
outpaces
the
non-obstetric
population.
O
The
study
that
looked
at
these
covid-19
deaths
during
the
pandemic
found
that
the
maternal
death
rate
for
black
or
African-American
women
was
44
per
100
000
live
births
in
2019
and
then
increased
to
55.3
and
2020,
the
beginning
of
covid
and
finally
68.9
in
2021,
and
that
far
outpace
is
the
48.7
that
was
found
earlier
or
55.3.
That
was
found
in
African
Americans
earlier,
and
it's
not
just
maternal
mortality.
O
As
we
talked
about
it's
about
getting
off
to
the
best
start
in
life
and
pre-term
birth
rates
in
Kentucky,
every
state
is
given
a
grade
by
the
March
of
Dimes,
with
a
gold
pre-term
birth
rate
of
six
percent.
The
significance
of
preterm
birth
is
immense.
So
it's
not
just
about
admission
to
the
NICU.
These
babies
are
more
likely
to
have
chronic
medical
conditions,
COPD
asthma,
high
blood
pressure,
failure
to
thrive
and
that
those
comorbidities,
both
in
the
early
neonatal
period
and
later
in
life,
Place
significant
stressors
on
families.
O
The
preterm
birth
rate
for
African-Americans
in
the
from
2016
to
21,
has
risen
linearly.
It's
the
highest
that
it's
ever
been
it's
upwards
of
14,
total
pre-term
birth
rate,
the
most
important
slide,
this
early
preterm
birth
rate,
so
these
are
the
babies
that
are
at
highest
risk
of
these
adverse
outcomes.
Early
pre-term
birth
means
birth
before
34
weeks.
O
That
is
somewhat
Rising.
It's
somewhat
steady,
but
still
the
early
pre-term
birth
rate
is
at
the
goal
in
African
Americans
before
they
want
the
overall
preterm
birth
rate
to
be
so
overall.
Looking
at
it,
Kentucky
from
the
March
of
Dimes
gets
a
grade
of
D
in
terms
of
preterm
birth,
so
takeaways
from
this
because
I
hope
to
have
a
really
nice
discussion
today,
black
and
white
maternal
mortality
disparity
is
the
largest
among
all
conventional
perinatal.
O
Health
disparities,
it's
the
largest
that
it's
ever
been
black
women
consistently
experience
four
times
greater
risk
of
pregnancy-related
death
than
white
women.
This
is
independent
of
age,
Purity
or
education,
so,
in
short,
nothing
protects
black
women
from
dying
in
pregnancy,
not
education,
not
economics,
not
being
an
expert
on
maternal
mortality.
That's
what
the
studies
show.
O
Black
women
are
more
likely
to
die
from
complications
of
hemorrhage
hypertensive
disorders
and
cardiobiopathy
and
National
data
sets
reveal
that
black
women
did
not
have
statistically
significant
greater
prevalence
of
common
disorders
during
pregnancy,
like
preeclampsia
eclampsia,
but
than
white
women
do,
but
they
were
two
to
three
times
more
likely
to
die
from
these
conditions,
so
they
occur
at
the
same
rate,
but
they're
two
to
three
times
more
likely
to
die
from
them
and
there's
a
fantastic
new
article
out,
then
kind
of
the
obstetric
world
is
really
taking
over
and
it's
the
the
takeaway
is
that
the
causes
of
these
disparities
is
not
race.
O
A
O
We
do
worse
when
it
comes
to
disorders
that
are
more
common,
so
diabetes
and
hypertension.
We
do
worse.
We
do
worse
when
it
comes
to
conditions
like
lupus
so
I'll
use
the
example
in
Louisville
in
Louisville.
We
have
not
one
rheumatologist
that
sees
pregnant
women,
so
the
closest
doctor
for
a
woman,
a
black
woman
with
lupus
to
go
to
is
in
Lexington
and
that's
what
they
have
to
do
so
what
happens
without
that
is.
O
If
they
cannot
go
to
Lexington,
you
have
internal
medicine
providers,
not
trained
or
as
trained
to
treat
women
with
lupus
doing
their
best
to
treat
them.
So
in
states
where
there
are
concentrations
where
hypertension
and
diabetes,
for
instance,
has
higher
proportions
in
Kentucky
than
in
other
areas.
Our
providers
are
overwhelmed.
A
O
An
axis
standpoint,
I'll
speak
from
my
personal
experience.
I
am
the
only
Maternal
Fetal
Medicine
physician
at
the
University
of
Louisville.
They
have
four
a
Norton
Health
Care
so
and
one
at
Baptist.
So
in
a
city
that
delivers
14
000
babies,
there
are
six
of
us
that
are
taking
care
of
every
high-risk
woman
that
are
taking
care
and
reading
and
interpreting
every
ultrasound.
So
there
are
six
of
us
for
14
000
women,
so
I
am
booked
out
for
two
and
a
half
months
for
new
patients.
O
So
you
don't
have
two
and
a
half
months
during
pregnancy,
but
that's
all
you
can
do
when
it
comes
to
other
aspects
of
care.
So
there's
the
distrust
of
the
Health
Care
system.
I
mean
that's
its
own
separate
talk,
but
what
is
it
we?
It
comes
back
to
what
does
it
take
for
this
patient
to
get
into
your
office
right?
O
So
if
I
have
a
mom
who
has
black
women
are
more
likely
to
have
to
be
pregnant
with
a
young
child
if
I
have
a
mom
that
has
to
take
city
transportation
to
get
to
my
office,
and
then
she
gets
to
my
office
and
she's
10
minutes
late
and
the
Healthcare
System
shames
her
for
being
10
minutes
late
and
then
says
you're
not
supposed
to
bring
a
young
child
to
the
office,
and
then
she
has
to
say:
I
don't
have
money
to
take
an
Uber
back
How
likely.
Is
she
to
come
back
to
my
office?
O
A
Wow
well
said
all
right:
we
have
a
number
of
questioners
and
we
have
limited
time,
but
we
are
going
to
spend
as
much
time
as
we
need
here
and
then
we
will
continue
to
do
all
we
can
do
to
get
this.
This
fine
agenda
finished
representative,
Cole,
Carney
you're
first,
but
to
be
followed
by
commissioner
Drake.
F
A
F
Is
that
and
then
my
second
question
was
near
the
end
of
your
presentation.
You
had
I
think
three
points.
The
second
one
like
black
women
are
less
likely
to
enter
prenatal
care
in
the
first
trimester
and
the
second
point
is
they're
less
likely
to
receive
adequate
care.
Why
is
that?
Is
that,
and
does
that
have
anything
to
do
with
them
not
being
listened
to
in
terms
of
they
think
something
is
wrong,
but
their
physician
is
not.
F
O
Attention
this
is
my
opinion
for
why
I
think
we
report
preg.
We
don't
report
pregnancy,
related
death,
I,
think
that
if
we,
if
maternal
mortality
has
reached
such
a
level
of
public
Consciousness
and
we've
recognized
that
there's
disparities
are
here.
What
would
we
have
to
do
if
these
numbers
were
doubled,
because
we
know
that
moms
that
there's
a
higher
level
of
death
that
occurs,
and
especially
in
women
with
chronic
conditions
if
we
were
to
go
out
a
year
and
follow
them?
O
So
if
we
stop
it
at
that
42
days,
what
we're
saying
is
we're
catching
the
sickest
we're
catching
the
ones
that
were
probably
most
likely
due
to
acute
pregnancy
events.
But
pregnancy
is
extremely
hard
on
the
body.
It's
extremely
hard
on
the
heart,
it's
extremely
hard
on
the
kidneys
and
to
think
that
you
know,
ask
a
pregnant
woman
who
had
a
C-section.
Are
they
back
to
their
normal
self
in
42
days?
No,
but
we
don't
follow
them
out,
because
we
don't
want
that
data.
O
We
don't
I,
don't
believe
that
we
want
to
report
on
numbers
that
high,
because
it
would
force
much
more
outrage
and
much
more
focus
on
having
to
put
resources
into
this,
and
it's
a
really
hard.
The
answer
to
that
is
really
really
difficult.
It's
going
to
take
a
firm
commitment
in
terms
of
access
to
care
that
I,
don't
think
a
lot
of
people
really
want
to
have
that
conversation
about
so
evolving
yet
and
when
it
comes
to
why
women
come
to
the
doctor
later,
there's
multiple
reasons
for
this:
it's
distrust
of
the
Health
Care
System.
O
It's
many
women
who
have
many
women
who
African-American
women
in
particular,
have
irregular
Cycles
because
of
things
like
fibroids
or
chronic
conditions,
and
don't
know
that
they're
pregnant,
it's
you
know,
fear
of
especially
for
young
women.
Fear
of
what
parents
are
going
to
say.
It's
there's
so
many
reasons
behind
it,
but
ultimately
what
we
do
know
and
what
data
has
shown
is
that
all
those
disparities,
while
still
present
or
improved
when
the
obstetrician
gynecologist
looks
like
the
patients
that
they're
serving
so
we
mentioned
that
before,
but
those
outcomes
are
improved
significantly.
E
Thank
you,
Dr
Miller,
for
your
presentation,
and
especially
thank
you
for
saying
it's
not
race.
It
is
racism.
I
do
appreciate
that
I
wanted
to
ask
you
in
your
professional
opinion,
that
would
you
say,
supporting
a
pregnant
woman
with
resources
like
access
to
health
care
and
food
stamps,
and
things
like
that
would
help
them
or
would
cutting
food
stamps,
hinder
them
and
their
children
later
so.
O
Not
only
would
it
help
them,
but
we
uofl
are
piloting
a
program,
that's
entitled
her
best
life
and
it's
all
about
what.
If
we
Supply
these
resources
before
something
bad
happened.
What
if
we
didn't
wait
to
find
out
that
a
woman
was
food
insecure?
So
we've
done
things
like
partnered
with
dare
to
care
a
local
organization,
and
we
now
have
a
food
pantry
in
our
Clinic.
O
We
now
screen
everyone
for
food
insecurity
when
they
leave
so
that
they
can
not
only
come
to
get
their
prenatal
care,
but
they
can
leave
with
groceries
as
well
if
they
need
it.
I
think
that
the
Not
only
would
it
improve
pregnancy
outcomes.
It
would
enforce
more
trust
in
the
system
and
ultimately
improve
long-term
Health
Care
outcomes.
Thank.
I
Thank
you,
I
appreciate
this
is
a
great
presentation,
and
this
is
something
near
and
dear
to
my
heart.
One
of
the
first
set
of
bills-
I
passed,
was
a
bill
over
for
the
child
and
maternal
fatality
annual
report
to
include
demographic
information,
so
race,
income
and
geography,
because
I
feel
like
if
we
I
think
we
need
data
right,
I
mean
that's
what
we
need
Data
before
we
can
make
good
policy,
and
so
until
we
really
know
where
these
are
happening-
and
you
know
I
had
some
pushback
from
the
cabinet
too.
I
You
know
they
don't
want
to
do
income
I
might
go.
Are
they
Medicaid
or
not?
You
know,
I
mean
that's
a
pretty.
That's
a
pretty
significant
income
acknowledgment
right
there
because
it
shows
that
this
is
this
effect
socioeconomic
backgrounds,
which
you
know.
What
do
we
need
to
do
more
of,
or
is
this
everybody
you
know
and
so
I
think
you're?
This
has
been
a
very.
We
all
thought
out.
Presentation,
I,
appreciate
you
taking
your
time
of.
F
I
And
I
just
think
about
you
know
I'm
from
Litchfield
Kentucky
Grayson
County,
which
is
about
an
hour
and
15
minutes
from
Louisville,
and
if
we
have
pregnancies
that
are
high
risk,
we
come
to
Louisville
so
you're,
not
only
serving
you
know,
the
six
doctors
aren't
only
serving
you
know:
14
000
people
in
Louisville.
It's
also
the
rural
areas
around
it,
because
we
don't
have
access
to
care
like
that,
and
so
that
really
gives
a
good
perspective
on
how
we
can
partner
with
the
hospitals
at
so
many
levels.
I
B
I
Thank
you
for
for
that
that
acknowledgment,
but
I
do
I
would
like
to
ask
you
to
follow
up
as
time
goes
on.
You
know
with
this
data
that
we're
getting
with
the
demographic
data.
If
there's
you
know
strategic
things,
we
can
do
as
a
general
assembly
to
help
with
that
in
areas.
We
want
to
do
that,
and
that
was
the
point
of
getting
the
data,
so
we
can
really
dive
into
that
and
saying.
A
F
I
D
You
Mr
chair,
thank
you
for
the
presentation.
I've
got
a
definitional
question
and
then
a
question
that
might
sound
naive,
but
I
think
it's
important
that
we're
all
on
the
same
page.
Here
you
mentioned
this
last
report.
That's
popular
among
Obstetricians!
Now
you
said
the
quote:
it's
not
race!
It's
racism!
D
Can
you
define
racism
as
you
understand
it
from
a
health
care
perspective?
That's
the
first
definitional
question
and
then
two:
how
might
that
be
actualized
in
a
way
that
would
be
demonstrably
harmful
to
patients
and
again
that
that
one
might
sound
naive,
I
think
it's
important
that
you
as
somebody
who
does
this
kind
of
work
every
day
my
sister's,
a
pediatric
gynecologist,
so
she'll
often
see
the
women
and
sometimes
the
kids
about
five
ten
years
after
you
do.
D
O
I,
you
know
I
think
racism
is
is
a
term
that
seems
like
it
has
such
an
easy
definition,
but
it's
so
hard
to
Define
so
from
a
Health
Care
system.
I.
Think
racism
is
the
system
that
hospitals,
employees,
decision
makers,
insurance
companies,
everyone
that
touches
and
supports
the
system.
It
is
the
system
that
is
promoted
that
leads
to
adverse
inequitable
or
unequal
Health.
Care
outcomes
amongst
groups
I
think
that
there
are
so
many
examples
of
how
racism
plays.
So
if
you
look
at
like
I
can
go
on.
O
If
you
look
like
on
a
big
picture,
let's
look
at
for
a
long
time.
We
actually
had
racism
ingrained
into
our
everyday
every
day-to-day
work.
So
if
I
ordered
a
lab
and
if
I
ordered
a
lab
on
you
versus
Senator,
Berg
and
I
was
looking
at
your
kidney
function.
We
know
that
African
Americans
are
at
increased
risk
of
having
elevated
certain
elevated
kidney
markers.
So
rather
than
identify
those
African-Americans
with
elevated
kidney
markers
and
simply
say,
we
need
to
watch
them
more
carefully.
O
That
would
have
led
to
Too
Much
influx
in
the
Health
Care
system.
So
instead
we
said
your
numbers
are
one
set
was
normal,
but
for
you
we're
going
to
raise
the
threshold
so
that
we
don't
have
to
see
as
many
of
you
back
so
we're
going
to
catch
you
at
stage
one
and
we're
going
to
catch
you
at
stage
three
kidney
disease.
Instead,
those
are
systemic
levels
of
racism.
We
have
things
like
when
a
woman
has
a
C-section
before
and
she
wants
to
have
a
vaginal
delivery.
O
We
have
a
calculator
that
determines
what
her
success
rate
will
be
for
a
vaginal
delivery.
Race
is
a
part
of
that
calculator.
For
years,
black
women
don't
have
different
pelvises
than
white
women.
Black
women
don't
push
differently
than
white
women,
but
it
literally
went
in
and
it
was
a
negative
marker.
So
black
women
had
more
cesarean
sections.
It's
that's
like
systemic
in
what
we
do
day
to
day,
but
it's
everywhere.
It's
who
answers
the
phone.
A
A
A
lot
of
what
we're
going
to
be
doing
in
November
is
going
to
be
built
around
the
sort
of
conversation
that
Senator
Westerfield
is
going
to
be
leading
us
through
here
regarding
the
crown
act
and
Senator
Westerfield
we're
honored
to
have
you
at
the
table.
If
you
and
Terence
Sullivan
would
both
introduce
yourselves
for
the
record
Terence
great
to
see
you
again
here
appreciate
your
work
with
me.
Yesterday
we
had
a
good
debate
and
discussion
and
a
fine
presentation
there
at
the
summit,
so
Center
Westerfield.
G
Mr
chairman,
thank
you,
madam
chairman.
Thank
you
both
and
I.
Appreciate
you
all
making
time
for
this
bill
on
the
agenda
today
and
I
realize
it's
we're
we're
maxed
out
on
time,
but
I
first
I
want
to
commend
you
both
on
a
fantastic
agenda
and
for
the
presenters
that
we've
heard
from
so
far.
I
agree
completely.
This
has
been
a
fantastic
meeting
and
an
eye-opening
meeting
a
lot
of
really
rich
information
to
dig
into
and
to
hear
so
I'm
thankful
for
that
I'm
glad
bad
cleanup
here.
G
G
This
is
a
pretty
straightforward
bill
that
makes
very
modest
changes
to
two
chapters
in
our
statutes:
our
Civil
Rights
Act,
chapter
344
and
chapter
158
of
KRS,
which
relates
to
the
conduct
of
schools
and,
very
simply,
it
protects
the
hairstyles
that
are
culturally
important
to
the
children
that
have
them
now.
G
I'm
white-
that's
not
breaking
news,
but
my
kids
aren't
and
before
I
had
my
two
precious
babies.
This
wasn't
an
issue
I
thought
about
or
considered
it
wasn't
something
that
I.
It
wasn't
something
on
my
mind
or
my
radar.
G
It's
very
much
on
my
mind
and
my
radar
today,
I've
heard
from
the
young
people
that
are
sitting
behind
me
I'm,
so
glad
that
the
young
prodigies
are
here
by
the
way,
I'll
remind
you,
you
got
an
email
with
a
link
to
the
last
time
that
we,
this
bill
was
before
a
legislative
committee.
G
I
encourage
you
to
go
back
and
watch
that,
if
you
haven't
already
and
if
you
haven't
watched
it
at
all,
go
see
it,
but
these
young
folks,
these
young
folks,
were
here
and
have
testified
and
I'd
be
remiss
Mr
chairman
if
I
didn't
also
give
credit
where
it
certainly
is
due
to
representative
Attica
Scott,
who
I
believe
is
also
behind
me.
Who
was
the
first
person
to
bring
this
up?
She's
filed
this
in
the
house
a
number
of
times
and,
and
she
deserves
the
credit
for
having
done
that.
G
I'm
glad
she's
here
with
us
today
again
others
just
like
a
lot
of
things
that
that
I
and
you
and
other
legislators
have
done.
There
are
a
lot
of
people
who
carried
water
on
issues
long
before
I
came
around,
and
this
is
one
of
them.
I'm
honored,
to
be
the
sponsor
of
this
in
the
coming
session
in
the
Senate
I
hope
that
there
will
be
a
house
sponsor
to
bring
the
bill
forward.
It's
actually
made
it
out
of
a
committee
in
the
house,
but
you
know
the
bill.
G
It's
my
hope
that
this
bill
can
can
have
passage
in
2023
and
land
on
the
governor's
desk,
to
create
Protections
in
our
Civil
Rights
Act
and
in
our
schools
for
children
like
the
children
behind
me,
to
protect
culturally
important
things
about
who
they
are,
including
their
hair
and
the
hairstyles
that
they
wear
I
wish
I
could
have
that
hair,
but
that's
not
ever
going
to
happen.
There's
no,
nothing!
Fancy
I
can
do
with
this.
G
What
little
of
it
I've
got,
but
I
think
this
is
a
simple
fix
that
we
can
do
to
address
and
you've
heard
them
talk
about
real
stories.
Real
things
and
circumstances
and
situations
that
have
happened
not
just
in
Kentucky
but
around
the
country
where
children
with
various
hairstyles
that
are
culturally
important
to
them,
have
had
just
terrifying
things
done
to
them
without
mom
and
dad
being
there
without
any
explanation.
Just
because
it
didn't
meet
some
code
or
some
standard
or
some
expectation.
M
And
then
good
afternoon,
I'm
Taryn
Sullivan
I'm,
the
executive
director
for
the
Kentucky
Commission
on
human
rights
and
just
to
speak
a
little
bit
more
about
the
crown
Act
and
why
it's
important
to
our
agency.
Our
agency
is
the
agency,
the
state
agency
that
enforces
krs-344,
so
it
sense
to
have
some
discussion
on
what
it
would
do
and
why
it's
important,
and
not
even
speaking,
specifically,
to
the
impact
on
children
and
students,
because
that's
very
important
and
that's
something
that
I
personally
care
a
lot
about,
and
especially
the
tie-in
from
having
negative
consequences
at
school.
M
That
eventually
can
lead
to
negative
consequences
within
the
justice
system
because
a
lot
of
times.
The
first
touch
point
you
have
with
the
justice
system
starts
in
school,
and
so
we
need
to
make
sure
that
we
keep
children
out
of
that
system
because
of
the
way
that
their
that
their
hair
grows,
because
our
hair
grows
differently
and
thinking
about
this
Commission
and
the
purpose
and
the
access
to
opportunity.
That's
another
important
part
that
I
wanted
to
discuss.
Just
briefly,
just
looking
at
the
commission
right
now,
there
are
two
people
that
I
can
see
that.
M
Looking
at
some
of
the
policies
that
we
get
in
our
office,
they
would
not
be
able
to
have
a
job
there
and
that's
not
fair.
We
had
two
cases
just
last
week
where
there
were
policies
that
were
put
in
specifically
to
weed
out
certain
populations
from
the
job
force,
and
they
would
change
their
policies
and
the
dress
code
just
to
make
sure
that
they
had
a
specific
look
and
that's
not
right.
M
M
For
as
long
as
the
numbers
were
tracked,
our
highest
percentage
of
cases
were
brought
because
of
employment,
disability
discrimination,
but
after
2016
that
changed
and
so
now
we
have
a
higher
level
of
race,
related
discrimination
and
a
lot
of
times.
They
do
it
by
using
hair
as
a
proxy
for
race,
and
that's
not
okay,
and
so
hair
policies
have
no
bearing
on
the
functions
or
the
ability
to
do
a
job
or
the
skill.
That's
needed,
it's
simply
a
way
that
they
can
discriminate,
and
so
that's
something
I
wanted
to
discuss.
M
The
way
that
you
do
your
hair
is
still
a
choice
and
it's
not
a
choice
that
everyone
has
to
make
so,
and
it's
really
dangerous
when
that
choice
could
also
lead
to
uterine
cancer,
and
so
this
is
one
of
those
things
that
I
think
is
very
important
to
pass.
It's
a
simple
fix,
as
Senator
Westerfield
said,
and
it's
something
that
has
to
be
done.
A
I
You
very
much
thank
you
all
for
your
presentation.
I'm
sure.
If
you
remember
from
the
committee
I
was
very
supportive
of
this
and
I
voted
in
for
the
bill
for
rally
olaika
and
which
is
my
honorary
niece,
which
is
the
daughter
of
O.J
olaika.
Yes,.
A
K
A
I
Would
support
it
for
his
other
daughter
Rhys
as
well.
I
want
them
to
live
a
life
where
this
isn't
a
concern.
So
thank
you
all
go
back
and
watch
the
community.
You
can
see
my
other
longer
comments
and
thanking
representative
Scott
as
well
for
her
work
on
this.
It
is
very
much
appreciated,
much
needed
and
unfortunately
she
will
not
be
here
next
session,
but
I
hope
that
we
can
get
that
passed
and
worked
on
and
she
can
celebrate
with
us
in
that
Joy.
I
My
question
is,
you
know,
last
last
year,
when
we
were
talking
about
it,
there
was
some
concern
being
brought
up
about.
This
would
be
a
mandate
on
businesses.
I
disagree
with
that,
but
I
wanted
to
see
if
you
could
maybe
take
the
time
to
clear
that
up
just
for
the
record
what
your
all's
thoughts
were
sure.
M
So
it's
not
a
mandate
on
businesses
for
multiple
reasons,
but
the
main
reason
being
we
really
shouldn't
have
to
tell
people
not
to
discriminate
because
of
race.
That
should
be
the
first
point,
but
as
far
as
businesses
are
concerned,
this
is
something
that
in
theory
can
happen
now,
but
it's
harder
because
we
don't
have
the
specific
statute,
courts
and
HR
Executives.
Actually
Human.
M
There
are
already
protections
for
all
for
employers
and
for
employees
in
businesses
that
are
50
to
more
people
and
that's
really
where
our
Authority
and
employment
kicks
in,
and
so,
if
this,
not
if,
when
this
passes,
this
will
be
something
that,
when
it's,
if
it
is
brought
up
to
our
office
for
investigation,
we'd,
have
to
look
at
the
application
across
the
board.
M
If
it's
something
that
is
consistent
with
everyone,
if
there's
a
rule
that
is
put
in
place
in
your
policy
or
whatever
your
dress
code
is
if
it's
something
that
doesn't
isolate
one
group
and
it's
applied
equally
to
everyone,
then
it's
okay,
but
it's
really
just
to
make
sure
we're
not
doing
what
some
of
these
businesses
that
have
been
brought
to.
Our
attention
have
done
where
they
specifically
write
their
policies.
That
would
exclude
certain
people
from
being
able
to
have
a
job.
G
I
I
would
Echo
everything
you
just
said:
I,
don't
think
it's
a
burden
on
on
companies.
Many
size
to
not
discriminate
on
the
basis
of
someone's
hairstyle
and
holding
them
accountable
to
that
I
think
is,
is
pretty
modest
and
pretty
slight,
but
immeasurably
profound
to
the
to
the
human
being
who's
positively
impacted
by
that.
I
Thank
you
I
appreciate
that
you
know
I
think
sometimes
in
the
general.
Simply,
we
just
think
need
things
on
record
of
why
and
then
answer
some
questions
that
get
brought
up
at
the
very
end.
So,
thank
you
all
very
much.
Thank
you
for
your
presentation.
I
apologize
having
to
leave
I
have
to
get
back
to
the
18th
District
and,
as
you
all
know,
it's
a
long
drive.
So
thank.
A
If
under
safety
regulations
in
my
manufacturing
plant,
I,
don't
permit
anyone
to
have
hair
longer
than
15
inches
right,
some
amount
for
safety
reasons.
Then
what
I'm
hearing
you
say
is
that
that
is
not
a
discriminatory
statement
that
that
still
stands
as
a
safety
requirement
for
anyone
that
may
seek
employment
with
me.
Clarify.
A
E
You
and
I
will
be
brief
and,
with
all
due
respect
to
the
chair,
I
want
to
say
in
2022,
I
find
it
as
a
black
woman
with
braids
and
underneath
these
braids
is
natural
hair,
insulting
that
this
is
the
hair
that
grows
out
of
my
head
and
the
heads
of
the
young
people
that
are
sitting
behind
Senator
Westerfield
has
to
be
legislated.
I.
E
Insulting
in
2022.,
only
19
states
have
passed
the
crown
act,
so
we
still
have
a
long
way
to
go.
My
daughter
has
natural
hair,
my
mother,
my
sister,
my
Aunt,
so
this
is
I
tell
them
all
the
time.
This
is
not
an
issue
about
hair.
We
know
what
this
issue
is
about.
This
is
an
issue
about
racism.
Everything
we've
talked
about
today
has
been
about
racism.
Yes,.
G
E
My
daughter
shaved
off
all
her
hair
when
she
was
a
ninth
grader
at
Ballard,
High
School
and
was
relentlessly
bullied
to
the
point
where
she
wanted
to
commit
suicide.
Now
she
has
a
big
afro
and
help
those
young
people
behind
you
pass
the
crown
act
in
Louisville
as
a
Legislative
Assistant
for
jagori
Arthur.
So
this
is
an
issue
that's
near
and
dear
to
my
heart.
E
E
Could
go
on
and
on
and
on
as
an
author
of
11
books,
and
none
of
it
had
to
do
with
the
hair
that
grows
out
of
my
head.
But
what
growing
this
hair
out
of
my
head
did
do
and
seeing
other
people
that
looked
like
me,
it
made
me
see:
oh
I
could
be
a
judge,
katanji
Brown
Jackson
that
has
braids
in
her
hair
or
to
see
former
First
Lady
Michelle
Obama
with
braids
in
her
hair.
E
This
is
where
it
starts,
and
if
we
are
going
to
be
about
the
business
of
race
and
access
to
somebody
on
the
house,
side
needs
to
sponsor
this
with
Senator
Westerfield,
because
this
is
where
it
starts
for
young
people
to
say
it
is
okay
for
me
to
be
in
this
space
with
my
hair
for
these
young
people
to
see
me
up
here.
It
is
okay.
So
thank
you
for
this
and
thank
you.
Mr
Sullivan
and
thank
you
chair
I
know.
I
went
on
a
little
bit,
but
thank
you.
D
O
D
So
I
want
to
make
sure
I
could
speak.
Let
me
just
actually
speak
to
you,
young
folks
behind
them.
Thank
you
for
what
you're
doing
it
is
incredibly
powerful
and
gives
me
Pride
to
hear
the
conversation
that
we've
been
having
all
day
about
the
challenges
and
difficulties
that
exist
in
Kentucky,
mainly
for
black
folks,
and
to
see
you
young
people
here
getting
involved
in
the
policy
conversation
and
the
political
discussion,
because
you
simply
want
to
make
sure
that
everybody
can
value
you
for
the
way
that
God
made
you
the
way
that
you
value
yourself.
D
This
is
incredible
what
you're
doing
and
imagine,
because
you
all
are
young
now
not
old,
like
we
are
on
this
side,
but
eventually,
five
years,
10
years,
20
years
from
now,
you
will
have
even
more
experience
even
more
credibility
for
the
leadership
that
you
can
provide.
Imagine
what
you
can
do
the
very
challenges
that
we're
talking
about
now.
You
can
help
solve
them,
not
the
crown
Act,
only
not
the
value
of
who
you
are
as
human
beings.
Because
of
your
hair
and
again,
my
daughter
has
very
similar
hair,
like
what
you've
got
a
little
one.
D
Seven
months
old,
you
have
a
whole
lot
of
hair.
Yet,
but
it'll
probably
look
like
that
too.
Imagine
what
you
all
can
do
on
the
issues
of
Health
Care
long
term,
the
issues
of
housing,
long
term,
the
issues
of
job
opportunities,
long
term,
all
because
you
get
this
experience
right
now,
seeing
success
and
doing
what
is
right
and
necessary
for
your
community.
Dr
mccance
earlier
said
that
it
was
peers
that
you
all
listen
to
people
should
listen
to
you
all.
Your
peers
should
listen
to
you,
the
adults
in
your
lives.
We
should
listen
to
you.
D
N
B
N
We
can
do
it
here
with
what
we're
trying
to
do
here
today.
So
I
just
wanted
to
make
that
comment,
and
then
I
want
to
follow
up
on
Dr
olika's
comments
to
these
young
folks.
I.
Tell
you
what
first
of
all
you
look
great
and
at
risk
of
being
too
cool,
I
mean
your
style
fire
right.
J
Thank
you,
Mr
chairman.
Thank
you
for
indulging
me
I,
don't
I,
don't
I,
don't
have
a
question.
I've
got
a
comment
and
and
I
want
to
comment
the
chairs
of
this
committee
and
staff
for
for
putting
together
today.
J
What
I
think
is
the
essence
of
what
this
Commission
on
race
and
access
to
opportunity
is
about
from
the
beginning,
to
the
very
end
Senator
Neil
left
out,
and
he
came
back
because
it
was
so
good.
J
He
didn't
tell
me
that,
but
I
know
he
did,
but
but
but
I'd
like
to
congratulate
also
the
young
people
and
and
and
the
fact
the
young
man
held
the
door
for
me
when
I
went
out
a
little
while
ago,
and
it
is
very,
very
important
and-
and
you
all
stayed
and
you
were
patient,
you
didn't
fidget,
you
didn't,
you
didn't
go
through
anything,
but
in
in
10
to
20
years.
J
You
all
will
be
the
people
that
are
making
the
decisions,
and
this
is
very,
very
important
for
you
all
to
remember,
put
a
pin
in
this
one,
because
it's
very
very
important
that
that
that
you
be
the
leaders
in
your
community
and
in
our
state
that
are
about
doing
the
things
that
are
necessary
for
the
Improvement
and
the
uplift
of
our
state.
All
these
issues
today.
Hopefully
they
can
get
a
copy
of
the
the
the
the
the
agenda
and
the
information
that
was
discussed.
Senator
Westerfield,
thank
you
for
for
pushing
this
forward
with
Mr
Sullivan.
J
Thank
you.
I
want
to
get
with
you
as
early
as
possible
to
co-sponsor
the
crown
act
and
in
in
the
absence
of
my
dear
friends,
representative,
attic
Scott,
we're
going
to
make
this
happen
this
time.
With
your
help
in
the
Senate
and
mine
in
the
house,
we're
gonna
make
this
happen.
Thank
you
all.
Thank
you.
Mr
chair,
thank.
A
You
all
I'm
building
on
representative
Brown's
comments.
All
the
materials
are
online,
so
I
encourage
especially
the
four
young
people
in
the
front
that
have
been
so
talked
about,
and
so
appropriately
recognized
get
your
friends
to
sit
through
some
of
this
with
you.
This
is
all
available
online
proceedings,
everything's
been
videoed.
All
the
materials
are
available
online
help
build
the
narrative
that
we
all
want
to
live
into
thanks
to
everyone's
presence,
be
aware
of
the
next
meeting,
and
this
meeting
is
adjourned.