Good morning. This is the house health care committee again meeting on February 10th we are continuing our work this morning on issues of health disparities and between now and noon we will be focusing our attention on a house bill that has house bill 210 which was just introduced on the floor yesterday and and what we'll be doing this morning is first hearing from representative Gina member of our committee who's also the lead sponsor for the bill. After representative Gina sets some context for the bill and introduces the bill. We'll turn to our legislative council Katie McLinn. We will not be going through everything line by line. But we'll and we'll come back to the findings at another time to look more closely. But some of our witnesses will also be speaking to the findings. But Katie I would hope that you can give us a general introduction to the the key areas of the bill. But not necessarily a line by line description at that point if we can do that. So that we understand what the components of the bill are. And then most importantly today we have a number of witnesses who have made themselves available to speak to the development of the bill and the importance and issues in the bill. So my inclination is for us to hear our witnesses before we take questions because I think the priority is to hear from our witnesses this morning. So with that again I'm looking around looking around my screen and I think we're set to go. So with that represent Gina Brian I welcome you to as the sponsor of House Bill 210 to begin our testimony this afternoon. Thanks. If we were in person I would be saying for the record this is Brian Gina state representative from Burlington but everyone knows that now because it's on Zoom on YouTube. So thanks everyone for giving us a chance to present this bill today to the committee. So I'd just like to start by saying and thanks to our witnesses for making times out of your lives to come here today without compensation. It's much appreciated. And I think it's important to acknowledge all of the labor that's done by black and brown people that they're not compensated for in our society and haven't been compensated for for 400 years. But thank you all for making time today to come here. So the the public health emergency of the COVID-19 pandemic over the past year has amplified the inequities of our health care system. Hold on I'm hearing some feedback so I'm just that is I think can everyone else mute themselves. Maybe that's what it was. If someone's using two devices that sometimes creates a feedback loop and that's maybe what we're hearing. I don't know if anyone is on two devices but if you are you could somehow arrange to be on one device that would be helpful. Thank you. I think it's better now whatever it was. So I'm going to start over because that was distracting for me. Sorry. Um, so the public health emergency of the COVID-19 pandemic over the past year has amplified the inequities of our health care system associated with the public health emergency of racism, which has gone on for 400 years. Although the ethic of medicine traditionally stated primam non nocere to first do no harm the health care system has created harm and reinforced the suffering that many people have faced in our society who are black indigenous or other people of color lesbian, gay, bisexual, transgender questioning of queer and people with disabilities. For hundreds of years many of us have had to learn to take care of ourselves and each other when the system failed us. In the context of this pandemic we've taken a long hard look at the inequities and disparities that exist and we ask ourselves can we make the system better? The wellness committee of the racial justice alliance of which I am a member started meeting last summer to explore ways to meet the health and wellness needs of BIPOC especially black people differently from both within the existing health care system and from outside of the systems of our government. This work has included discussion about different approaches to training providers so that they could serve patients better. We also looked at access to all kinds of resources and the role that social determinants of health play in the lives of black indigenous and other people of color. We considered ways to provide support through BIPOC led wellness centers which would be grounded in traditional cultural methods of healing and collective liberation While considering the need for alternatives, we also acknowledged the need to provide better care for people within the existing health care system. We recognized that there were fundamental systemic problems with the structure of our health care system that could be improved from within. So we began working on this bill h 210 as one way to address health care equity. The bill was created by combining our concerns and our research over the summer and fall with pieces of a federal level bill that has not yet passed called the health equity and accountability act of 2020 And you can feel free to look that up and compare our bill to that bill In our bill So there's pieces of that that we took and there's pieces of that that we left behind because we felt that they were unrealistic or um that they reinforced systemic oppression versus versus um undoing it So we took the pieces that we thought worked and we combined them with our ideas to create the bill That's before you today in the end this bill seeks to establish the office of health equity It seeks to establish the health equity advisory commission It issues grants for the promotion of health equity Collect seeks to collect data to better understand health disparities in vermont and requires additional education on cultural competence in the practice of medicine The bill was fast tracked because the committee was going to take it up so soon So there's a few changes that didn't make it into the draft that i would advocate the committee make if we were to act on this bill, which um Quickly are that there's a supposed supposed to be a piece about the professional education of other health care professions That didn't doesn't seem to have made it in um that needs to be there and also There's been some workout in california on anti racist training for health care providers So I think we should look at that and and consider that in the piece around training for providers So next we will have katey mclinn from lech council walk us through the bill to explain the mechanics of how this bill takes some steps towards our goal of addressing equity in the health care system And after katey, I will introduce some other witnesses each with us um each who are going to um share their perspectives on why we need this bill um And like chair lippard said earlier Katie mclinn is not going to give a detailed walkthrough of the findings Some of our guests will refer to the findings and talk about the data And we will make time in the future hopefully to dig into the findings and look more at the body of evidence supporting the need for this bill So at this time, I'd like to turn it over to katey and just say thank you so much for your hard work Trying to get this bill together quickly because we had been working on it at the usual pace and then we had to step it up So thank you for your diligence and effort to get this done by today. So thank you and take it away katey Thank you, katey mclinn office of legislative council. It's nice to see everyone this morning Before I pull up the document and share my screen I always think it's helpful to take a step back and kind of get the big picture view of what we're about to look at When we look at the words um, so as representative chena Already indicated this bill that we're about to look at creates an office of health equity within the department of health And there's a director position that's created within that office The bill also establishes the health equity advisory council to provide advice to the commissioner to the general assembly and state government there's language about Issuing grants for the promotion of health equity and the criteria That somebody who's applying for one of those grants would have to meet to receive a grant There's also language about how to collect data in a way that would help us as a state better understand health disparities in vermont And lastly, there's language that has to do with continuing medical education and cultural competence Um, and then one last point. Um this morning. We've focused a lot of our time I'm hearing about race and ethnicity and this bill when we talk about um disparity and establishing health equity Takes an even broader view than race and ethnicity. It focuses on the lgbt community as well and also persons with disabilities So that's something to keep in mind as we turn to the language So I will attempt to share my screen now How did I do? Do you see the document? We do all right um, so there are um There's quite a lengthy finding section. So I'm going to scroll past it for the time being um, and the finding section is followed up by a section on legislative intent And purpose and I'm also going to skip over that for today Um, I would encourage legislative intent and purpose as as katie scrolling I would encourage members to take time to read through the findings and the legislative intent If you haven't had a chance to do so as well, but we're not going to focus there this morning as katie said Great, thank you So that brings us to chapter excuse me section three which creates a whole new chapter in title 18 the health title on health equity And the first section is a definition section. I won't go through each definition but um, there are a lot of terms that come up repeatedly throughout this chapter cultural competency in the practice of medicine is defined health disparity and health equity come up again and again throughout this chapter health equity data Non-white who are we referring to when referred to non-white? Race and ethnicity is defined and also social determinants of health So i'm happy to come back and look at those in a little more detail with the committee So the second section of the bill has to do with establishing an office of health equity So as I said earlier, it's established within the department of health And the role of this office is to advise the commissioner of health governor the general assembly on matters affecting health equity And the office is to serve in a coordinating educating and capacity building role for the state and local public health programs and community based organizations that promote health equity By implementing strategies tailored to address varying complex causes of health disparities Then we go on to say that the health The office shall work collaboratively with the department and affected stakeholders to set priorities collect and disseminate data and Align resources within the department and across state agencies And then in subsection b1, we start listing the powers and functions of the office And I think this is important. So i'll spend a little time here So the office is to lead and coordinate the department's health equity efforts The office is to publish data reports documenting health disparities Provide education to the public on health equity health disparities and social determinants of health Build capacity within communities to offer expand public programs to better meet the needs of individuals who are black indigenous and persons of color individuals who are lgbtq and individuals with disabilities Conducting state level strategic planning to eliminate health inequities Provide technical assistance to the department of health and carrying out its programming And coordinating and staffing the health equity advisory council, which we'll look at a little further in the bill Building collaborative partnerships with communities To identify and promote health equity strategies Providing grants to community-based organizations and this is something again that there's a whole standalone section on providing grants So we'll look at that in more detail later on Developing a statewide plan for increasing the number of individuals for black indigenous and persons of color individuals who are lgbtq and individuals With disabilities in the health care profession including recommendations for financing mechanisms and recruitment strategies necessary to carry out the plan Working collaboratively with uvm's college of medicine and other health care professional trading programs to develop courses That are designed to address the problem of disparities And then The last item is subdivision l developing curricula and the provision of continuing Education courses to teach cultural competency in the practice of medicine So those were the responsibilities and functions of the office and then we get to this list online To which are things that the office may do They're not required to do it. They may do it. So the Office may hire personnel as the director of health equity. We're going to hear more about in a minute deems necessary In consultation with the commissioner the office may apply for and accept any grant of money from the federal government Private foundations or other sources that could be available to programs related to the office's function The office may serve as a designated state agency for a seat of federal funds specifically designated for programs and The office may enter into contracts with individuals organizations and institutions necessary for the performance of its duties So next we get to the part about Who is running the office? So the office is run by the director of health equity This person is appointed by the commissioner of health and is serving at the pleasure of the commissioner until the appointment of the director's successor And the director of health equity is to have specific experiences. So this is Who is eligible for this position? It's a list of eligibility In subdivision 2a the person has to have a lived experience of oppression Or discrimination or both based on race ethnicity perceived mental condition or lgbtq or disability status or any combination thereof Demonstrated experience addressing inequities and a range of political and professional environments Experience and equity advocacy or systems change efforts Experiencing measuring and monitoring program evaluation activities and working in multidisciplinary partnerships Demonstrated success and the administration of community education or social programs Their focus and part on the elimination of structural racism Including at least two years in a managerial supervisory or program administration capacity Strong understanding of the root causes of inequities and social determinants of health and a strong understanding of health inequities and disparities in Vermont Next in subsection d This is language about a report that every year the office is to submit a report to the governor and to various committees of the general assembly The report is to address projects and services developed and funded by the office and include recommendations for administrative or legislative action And lastly the authorize excuse me The office is authorized to seek assistance and avail itself Of the services of employees of any state agency department board bureau or commission as it may require And as may be available for its purposes and all State entities are authorized and directed to cooperate with the office of health equity to the extent consistent with law So next we move away from the office and turn to the advisory commission that Was mentioned earlier So this language creates a health equity advisory commission to monitor health equity throughout brumat and provide The office of health equity with recommendations and guidance and then we have a list Of members of the advisory commission. It's a very long list. Um, and in the interest of time, I'm not going to go particular member So section two I would just encourage members to take a look because it's a it's a list that's important to understand But let's not take the time right now Thank you Great. Okay. The next subdivision Talks about how members are appointed and the length of their terms. There's a staggered term So members um terms wouldn't all expire at the same date The language talks about how vacancies are filled and it also mentions that members are eligible for reappointment And then most importantly the duties of the advisory commission The advisory commission is to review and make recommendations to the office of health equity And any rules or policies proposed by the office conduct statewide hearings on issues of concern to the health interests of individuals who are black Indigenous persons of colors individuals who are lgbtq individuals with a disability review monitor and advise all state agencies regarding the impact current and emerging state policies procedures practice practices laws and rules on the health of individuals and the affected population Identify and examine the limitations and problems associated with existing laws rules programs and services related to health Advise the office On award on the awarding of grants and the development of programs and services required under the chapter Advising the office on the needs priorities programs and policies relating to the office um relating to the health of individuals within the population Identified in this bill and also providing any other assistance to the office of health equity as may be requested by the director So we have that the advisory commission Receives assistance from the office of health equity The advisory commission is to submit an annual report um to various committees of the general assembly And subsection f sets up how the meetings are to run The director of health equity calls the first meeting by september of this year And then annually the advisory commission is to select a chair and vice chair from among its membership um The advisory council is to meet by monthly And there's some circumstances as to who can call a meeting if one is not being called um All meetings are open to the public There's language and subsection g about the acceptance of grants and contributions and there's all so excuse me also language and subsection h about Per diem compensation reimbursement for members participating in the meeting and you'll see online seven that that's limited to six meetings annually So moving away from the advisory council now our next section deals with um grants um So there's intent language It's the intent of the general assembly to provide grants that stimulate the development and community based and neighborhood based projects that improve health outcomes For individuals who are black indigenous persons of color individuals for lgbtq and individuals with disability So the grants um are administered by the office of health equity You'll see there's a cross reference to that subsection or excuse me that's up that section And then there's a list of um what the office's responsibilities are with regard to this grants program So the office is responsible for publicizing the availability of grants and established an application process Provide technical assistance and training Including convening meetings for grant recipients Developing uniform data reporting requirements For the purpose of evaluating performance of grant recipients measuring outcomes Developing and monitoring a process to evaluate progress and meeting grant objectives In coordinating with existing community based programs in the state and local level to avoid duplication of effort Um next there's language um the any individual entity or organization within the state can apply for a grant um as long as it That um comports with the different criteria set forth in this section um And then Let's see the applications the applicants are to submit their grant to the office A grant proposal is to include the following elements um So try to hit this as a high level. Um, but the purpose and objective for the grant And then there are certain um goals that the grant would have to address Decreasing health disparities for certain populations improving social determinants of health for um The population identified in the bill identifying um And relevance to the target community methods for obtaining baseline health status data mechanisms for mobilizing community resources mechanisms and strategies for evaluating project objectives proposed work plans um and Based on this information that Applicant would submit to the office the office is to give priority and awarding proposals um, excuse me awarding grants to proposals that demonstrate broad-based local support and commitment from individuals for black indigenous and persons of color individuals for lgbtq and individuals with a disability um priority to um grants that propose multi-dimensional ways Individuals who are black indigenous persons of color individuals for lgbtq and individuals with disability experience disabilities Uh that demonstrate a commitment to quality in all aspects of project administration and implementation and priority to grants to incorporate approaches to achieve sustainable reductions and disparities So that is the grant section and then the next section of this chapter has to do with data collection This section says that each state agency department board commission that collects any health related data um Individual data shall include its data collection health equity data disaggregated by race ethnicity gender identity age primary language socioeconomic status disability and sexual orientation And that data related to race and ethnicity shall use separate data collection categories and tabulations in accordance with the recommendations of the director of health equity and in consultation with the advisory committee And in subsection b we move into a language about how it should be analyzed So the department is to systemic systematically analyze such health equity data using the smallest appropriate units of analysis Feasible to detect racial and ethnic disparities as well as disparities along the lines of the categories that we just looked at in subsection a So it says to do this periodically but not less than by annually And the data is to be available to the public in accordance with state and federal law In addition to this There's to be a report every year by the department of health containing the results of the analysis conducted pursuing to this Subsection and that report is to go to various committees of the general assembly The last substantive Section that we have of this bill I should say that's the end of the chapter that's being created on health equity and then this last section Is an amendment to existing law that governs continuing medical education requirements So the board of medicine Is currently required to have a minimum Of 10 hours of continuing medical education by rule. So this expands this to be The current requirement to be 12 hours and there's specific language that says two hours are to include cultural Competency in the practice of medicine component And then we have a definition of cultural competency It's the same definition that appears earlier in the bill in the definitions section Of the chapter we just looked at but because this is in a completely different title of the vsa We're repeating it here. So um, it's the same same statute just appearing in two different titles And that is it The effective date is july 1 of this year Thank you, katie Thank you And let's turn let's turn to hearing from our witnesses and represent china. Would you like to introduce the witnesses? Yes, so we have i'm looking at who's actually here right now and it's um unclear is Who is who is using the vermont racial justice alliance account right now? Is that mark and christine? Is it just mark or just christine? Thank you representative china and good afternoon, uh committee Uh, mrs. Sheehan, I was just checking who was there mark. Uh, so hold on So we've got what's that? I says i'm trying to tell you that mrs. Sheehan Oh my bad. Okay So, um, so we've got christine Hughes and mark Hughes we've got reverend christopher cockrow We've got mayumi cornell and we've got reverend roe v. Hill roe. I think you're a reverend too, right? People call me minister a minister roe v. Hill. So Um, so I think the order we're gonna go in um that we had established was going to be uh christine hughes Oh and pato attilio is here. Sorry the screen is scattered. So, um, I did see you move though Um, so I think the order we were going to go in was we were going to start off with christine hughes So are you ready to go christine? I am brian and i'm just going to say hi with my video and then turn it off because it's easier for me to just Have you hear what i'm saying and not be on video as long as that's okay with everybody? Just wanted to show you that i'm here and i'm a real person Thank you, and I think we'll ask everyone else to mute because I see some people have a might have unmuted. Um So everyone mute and then christine go go right ahead. Thank you. Thank you representative. Gina. Thank you all um that are here today, um I'm just going to read my testimony. It's kind of hard. I've been here before testifying for other racial justice legislation and um It actually takes a lot to show up aside from taking time away from Work. Um, it's just it's just difficult to do this. So thank you and bear with me um Happy black history month brave little state legislators I'm here today to testify in support of the racial justice alliances health care bill h210 I've lived in vermont since 1974 when I was a child. I survived the burlington school system and lots of other Racial aggressions um against me my family brothers and sisters children grandchildren I began standing up for racial justice in burlington when I was about 16 years old in 1982 when um at a rally on city hall steps to protest the kkk's plans to hold the gathering in southern vermont I was afraid then and in 2021 I'm even more afraid I don't feel safe in vermont. I'm often asked where are you from or what brings you to vermont? The translation is you don't belong here We all witness what happened to kaya morris and tavitha more And it's frightening our attorney general called The hate speech hate speech and racial harassment of a family with children freedom of speech He failed to protect kaya and her family I've been leading the racial justice alliance as wellness working group for about six months It has grown and i'm so honored to be part of that work a lot of people and a lot of work has gone Into the legislation that we're talking about today. Um, we've worked really hard Thank you representative china for your work and for all the other folks that have put in a lot of time and energy to this Um, this is a personal matter for me that has to be dealt with in a business forum That's difficult. Um, like I said, I took some time Away from work and I've done this many times basically to help you do your job And rather than bearing my soul to feed the white appetite for trauma tourism that plagues vermont social justice spaces where People have good intentions, but no real will to make change I have a few questions for you and you can answer them on your own time and as part of your internal process What have you done to learn about the unmet physical and mental health needs of black and brown vermonters? Do you understand the phrase policy violence? Are you equipped to look at existing policy or policy you create through a racial justice lens? Just like all americans, you've not only been taught and brainwashed You've been consciously you've consciously bought into the myth of white supremacy because it benefits you politically economically Culturally and even maybe genetically Vermont just like the rest of the world is browning I understand that not supporting this legislative legislation or whitewashing it benefits you I understand that doing nothing benefits you the status quo is your comfort zone Taking risks that may compromise your political aspirations with your base impacts your decisions I know it is fear that presents you from doing the new right thing instead of the old white thing I also know decisions made out of fear are based in cowardice selfishness and are sadly predictable in vermont Trump is assist is a symptom of a deeper problem that has come to light I believe there is little trump in all of you and I know many of you have trump type relatives All it took was a phone call to a police To the police over a $20 bill by a racist store owner To spur the televised murder of george floyd at the hands of police to put systemic racism into the national conversation The resulting black lives matter peaceful protests National organizing of millions of people and a deadly mob of mainly white racist trump supporters Attacking the capital to force many whites to take a look at the reality we suffer from every day of our lives How long will that last If you acknowledge the existence of systemic racism anywhere you are acknowledging that it exists everywhere I am not talking about implicit bias unconscious Prejudice or other whitewash words and excuses for individual behaviors Used to justify the individual role you play in perpetuating systems that benefit you As a woman of color, I can't afford to care how you feel about me on an individual level Thankfully, I don't need your approval or affirmation to exist or to tell the truth I do care that you as elected officials have a history of being complicit through your inaction and poor stewardship over your power This isn't an urgent and real need to change 400-year-old systems that are by design causing harm to a specific group of people right now Some people have 30-year plans because they see dollar signs.  Do they? Finally, I ask you to consider what I'm going to tell you as I finish It is something to help you examine more deeply the intricacies of the constructs of systemic racism If you were embrace the truth in what I'm about to say It will at least enhance and at best transform your limited understanding of the harmful role of racist beliefs It is the collection of these beliefs that underpin the oppressive caste system. We all We call American society That tells us we should just pull ourselves up by our bootstraps This moment is hopefully a teachable one When we were developing the language of this bill We had to face the reality that all the other groups have to be included in order for it to pass Black American people can't demand progress without carrying other groups along the way Kind of reminds me of slaves preparing food for their owners before they could eat the leftover crap off their tables Why is that true?   Is being black a lifetime sentence of poverty wages to feed Vermont's dairy industry and keep ben and jerry's in business Why do so many other groups enjoy your support economically politically? And why are they so easily afforded space to stand alone with a single singular group identity? Why do new americans lbgt disability community migrant workers hesitate to stand with us? And as they establish themselves Eventually distance themselves from us As white privileged people you don't have to give give the caste system dynamics any thought They have been designed By your people for you Even sex offenders with developmental disabilities have a law that protects them act 248 enacted in 1987 And and most of you know about all the state funds and support that have been invested in COSA programs, which are also designed for sex offenders as they're released from prison Indigenous people many of whom acculturated Historically into whiteness and owned slaves Have land grants and political power because politically it works. Why is that? Do european immigrants in america need your help? Why not? Why isn't an either or conversation instead of an and proposition? If the newly formed reparations task force in burlington Makes recommend recommendations a year from now and it will where will you stand on that? What political or economic power do black and brown descendants of american slaves have? The descendants of american slaves are slaves are still expected to take whatever crumbs fall off the master's table While immigrants and so-called new americans and every other non white able-bodied group enjoys a preferred minority status Why? The descendants of slaves are the people whose lives labor culture Roots and civilization music art wombs Resilience and existence have been the key ingredients aside from white greed that makes america a superpower With economic and political superiority in the global scene Vermont never actually abolished slavery read pr2 if you don't understand that Why is there so much resistance to us establishing our own singular identity and political agenda agenda? Why is that do you have the mental bandwidth and moral courage to examine and recognize these things? Am I making you uncomfortable? Even though there are not a lot of us in the state of vermont our lives our medical needs our wellness Matters if anything i have said disturbs or better yet Disturbs disrupts your comfort zone. I've done my job when I see something. I will say something Your public servants do your job. Thanks for your time Thank you christine Hughes Um, so next we have mayumi cornell Are you ready to go? Yes, i'm ready to go. All right. Thanks for joining us today. Take it away Good morning, um all I am Miami cornell.  It took a long time to get what I needed Now I can't say that's definitely because i'm african-american or Whatever the reason is i'll leave you to draw your own conclusion The only thing that I can say is Is that i'm able to speak for myself But there are people who are not able to speak for themselves who cannot articulate What they're feeling and why And so i'm telling you that even if They were not concerned With my parenting I was I still am Both of my children myself and my mother all have mental health issues. My mother killed herself When I was 11 So for me mental health is not something that I can put on a shelf and take it down when I feel like it It's an everyday matter for me questions What we're gonna hold questions. Um, one thing I May only one thing I would say is um that earlier I meant to just Point out to the committee that although you're gonna hear you're gonna hear a group of different people one thing we all share We are all patients We all have experienced the health care system as patients Some of us might also be providers or advocates or ministers It's parents, etc. But we all as individuals have experienced The disparities and inequity in the health care system all of us in this group presenting today That being said mayumi is there anything else you want to share about your health experience before we move on to the next person Any other stories you would mention one to me? I don't know if you decided not to tell that one, but um Well, there is another one where um, you know, I Uh, I I'm sorry. I I'm Well, maybe I'll talk on this because this does have this does concern mental health Um, I lost my neighbor nearly a week ago And he was extremely depressed. He was very sick and he was dying of liver failure And for me the the fact that there was nothing I could do to get him any Any help at all whatsoever was So gut-wrenching and the fact that there was no one from his family that was trying to get him any help whatsoever was also hard um, so just when you consider mental health consider that It comes at end of life. It comes at middle of life. It comes at beginning of life It's a Reality for thousands of us and for far too long We spent time saying that it's not important. It is important You know, it it impacts our well-being. We know that if people don't take care of their teeth It can lead to our disease I don't see why mental health would be any different and also when my daughter was about two and a half I had fibroids and It took me two and a half years To get anyone to listen to me for the fact that I was bleeding three weeks out of the month And I was so tired and I couldn't figure out why and it finally took somebody who was a white healthcare worker to say something to get me an appointment with um a really wonderful doctor who is no longer at um the UVM women's health clinic, but you know, she was able to tell me what all my options were And said, you know, we'll try this treatment if it doesn't work. We will try surgery You know, and I tried the treatment. I think for three months. I said it's not working for me So we went in and I had surgery and I had the doctors were so wonderful and caring But the thing is it should not have taken two and a half years For me to get the care that I needed And the thing is it's not unusual for any woman to not have a healthcare story like that I can remember that my friend had on her feed We were all discussing how we all had stories about our healthcare where It's not taken seriously simply because we're women And we must be hysterical And that's not the case if a patient tells a doctor that something's wrong There is something wrong and You know, if a man in Canada can have gillian beret syndrome And tell you that he's being treated for his mental health and it's all under control But no one takes him seriously And the fact that he's crawling outside to a cab doesn't tell you that something's wrong It is Thank you for um, thank you for sharing the additional stories Because I know when we had spoken in advance You had told me some more and you just shared it now and I thought it would be important for the committee to hear those direct stories of Feeling that you were not but not even feeling but not being believed by health care providers and and the barriers You had to overcome to get the treatment you needed. So thank you for sharing that We're going to move on to two other witnesses You know, we're like I said, we're a mix of patients and providers Often people might not think about About the the health care that's provided by ministers and reverends and that our health are It's not just the medical system But so much of our health is connected to mental and spiritual health and how we're dealing with Um, the the hardships of the world and how we cope with that trauma Through how we make meaning of it and how we come to understand it And so I think the perspective of uh, the reverend and the minister who are here today are important in that conversation So I think we'll start with it looks like Reverend Christopher is ready to go. So why don't you start us off and then we'll be hearing from minister Roy Good morning. Thank you very much for this opportunity to share with such distinguished individuals this morning My name is rovin dr. Christopher von cockrell I've been living now as a resident in vermont just a little over a year now um, I I have experienced healthcare Disparancies among my family my my wife in particular As well as my congregants One of the problems that we have here in vermont Being that that that rent is so high here for us to stay here You have problems with that Even though my wife did have insurance the only insurance that she could afford did not really have a Medicine plan on it and that medicine plan did not allow her Even when she was able to be diagnosed with high blood pressure Just the mere cost out of cost pocket for her blood pressure medicine was over 200 dollars a month To add that with the rent that we're paying that they stream the eye with that also even though she was working We were faced with situations. Can we afford to get her medicine and and and that's the problem across the board We have members that are actually sharing medicines Well, I've got some extra pills, you know, I take the same thing And so we're dealing with these types of situations And not only that transportation is a problem here. A lot of people don't have Cars and so forth So they depend on public transportation to get them to their doctor's appointment and even though they're getting Transportation by the public bus system They they still have to walk a good distance And for those members who are unable to walk that extra two or three blocks to get to the doctor It's a situation that they have to deal with There's a myth about black women's color Is that they have a high threshold of pain? And so a lot of times we're not given pain medicines in a time the manner in which we're able to To calm these situations. We have members that they're dealing with that have sleep out here They can't afford to co-pay For this because many even though they do have medicated medicaid There's a co-pay to go on with this and the co-pay they don't have the co-pay money And and for those of us who make decent salaries The co-pay for $50 or $100 or an extra hundred and twenty dollars for medicine is not there So there's the stress of that that goes along with it We have the problem Appointments and yes, they said well, yes, we have free clinics here Yes, but those slots go up so quickly It's hard for people to get in for that with the cold but situation We're having to do more virtual Appointments well a lot of individuals do that on computers. A lot of them don't even own smartphones A lot of them have these government phones that are flip phones and don't have that capacity So we're struggling with a lot of things that that just ingrained in the situation We're looking at how can we move forward and making sure that it's just not people of color thing This is a poverty thing This is a poor people's process because poor whites deal with the same problems We do gays transenders individuals they deal with these problems And as a state to be concerned about all of the citizens We have to start taking more Better approaches and how do we make sure that these people do not suffer through these health care crisis Getting there and so yes our numbers are higher and dying because we can't Get the health care that we need And then there's a level of spiritual care that I work with desperately Because of the lack of churches and household fees I happened to pass the only african-american baptist church in the state of rama And I still find that hard to believe So there are a lot of people are struggling trying to find that spirituality and wish to help them through these disparities And so thank you very much for giving me these two moments to share My perspective from my personal family experience as well as those of my congregants Thank you. Thank you reverend So next we're gonna have uh roya v hill.  Am I okay? Good. I saw people move and I'm like, oh, no, am I the one now who's frozen? Um, you're fine. Okay. I'm moving. So roya. Are you ready to go roi? If not, we can come back to you, but Oh Yes, we can Okay, it must have been my computer. Sorry about that. I'll start over. I was well Speech quote unquote or sharing you might say well I agreed those who are immigrants and descendants of immigrants who populate this place we call the america vermont in particular I've been a vermont resident some 32 years. I ride zai specifically here in franklin county where Just recently one of the residents said quote there is no racism in vermont. Well We the people occupy a land That technically belongs to native americans That's racism as we deny the fact of our occupancy. I stand to speak on behalf of and support h2 1 Oh, I am a member of the steering committee and the vermont racial Justice alliance for those who may have Fleeting amnesia The vermont racial justice alliance is under the leadership of a people of color steering committee And assisted by a network of individuals and organizations across vermont across vermont And we place priority on policies that affect changes across a broad spectrum Including housing education employment health services economic development the criminal justice system and health equity each one of those Effects is affected in terms of health care A focus our focus is on mitigating direct impact and dismantling the root or systemic origins of racism In vermont, you know that act 54 affirms that with the data that shows Racial disparities across all agencies across all agencies You see post-16 19 Years in america has allowed american structural racism and other societal norms that resulted in health disparities Oftentimes or most of the times I submit when the cops shoot unarmed People of color They're generated by some kind of mental disparity in their own heads mental health racism Crises in america If I look at my family And if I look at me and my wife in particular I reminded of the time that I went to the doctor for the annual annual medical exam when I was working at Dartmouth And the Dartmouth grad looked MD looked at my leg and said Where did you get all those cuts those knife cuts on your leg? Were you not knife fight? I counted to 10 and then explained I grew up on the farm and we often did jump rope and a bob wire fence Had egregiously cut up my leg And we didn't go to the doctor because in the South especially during my early years You went to the doctor When you almost dead or dying Because medical didn't want to have anything to do with you in Tennessee Which has the ranking of being number fifth number sixth among the states known for killing and raping killing black men raping black women today A lot of that ignorance still persists Dr. Clemens who used to work at UVM in the medical field often talks about Challenges thrown at him by his white colleagues as he was trying to bring the reality of research And truth to their attention in the curriculum After he left they adopted they adopted much of what he had to say But denied him when he was there My wife suffers from or has been diagnosed with what's called dissociative concern That affects it brings about depression That depression affects people across the board here in Vermont during the winter years, you know, no sunlight or little sunlight vitamin D deficiency, etc So it's aggravated her situation When we've gone to doctor's office, some of them have either Well, they've used excuses to say Well, you can't come in We're just meeting with her. She's the patient And so I have to go through this long thing about well, she has a dissociative There's certain questions. She will not be able to answer There's a cultural void. There's a denial That says to us people of color People of African descent We have to As white people go with the white template and if it's not white, it ain't right So those are necessary pressures Now my blood pressure is up. My stress is up as I'm trying to talk to this physician and this nurse About why it is important for them to Broughten their perspective or go back to school and recognize That you may see one or two of us here as part of Vermont's majority population But we are one or two of the eight billion people populating planet earth. So we are part of that majority Who are people of color? But in the essence the final in the essence we're all people Of one human race If we talk about freedom and unity as our motto in the state of Vermont There can be no freedom. There can't be no unity If you keep your knee on my neck So take it off Look with will and intent To embrace and make real H2 10 Yes, I stand in support of h2 10 This bill that says hey, let's have that office of health equity Let's establish that health equity advisory commission and let's put money behind it This is the capitalistic society you and I both know even though you are white and part of the majority and I am not We live in a capitalistic society and when things move it costs money when white folks say out Money grants We say get your knee off my neck And you said well, you know, let's wait a while. We'll think about it We'll keep it in committee and one day we'll release it from committee and we'll well gee whiz Let's wait until african. Let's wait until february of next year. You know, that's uh Black history month and we'll do something so we can look liberal Proverbs six Is in line with The currency in america that currency says in god we trust Proverbs six speaks to the things that god hates That's a little hard for some people in vermont to chew on I know that 30 Almost 35 of vermont residents are anti church anti god anti religion But we love that money Even though it says god we trust Let's have more trust in each other Let's move forward with h2 10 The legislative body our legislative body says there are racial disparities across the agencies But it isn't a fact that is confined to montpellier It's a fact that's found exercised in Your white neighbors your white relatives your sisters your brothers And that's also good there So let's magnify the good and go forth Because let's face it my brothers and my sisters in this one human race This one human family We are all marchi from the womb to the tomb So before we get to the tomb and they close the lid You know, let's leave something behind Some of you saw the burlington and I closed on this note Some of you saw the burlington free press february 1 Front page that talked about baits the sheriff in virgins And the fact that this first black sheriff or law enforcement person in vermont Was loved by all and respected by all of his neighbors Let's do those things that make it possible For some respect all of our nature all of our neighbors Let's embrace illustrate Stand for freedom and unity in healthcare and health wellness Amen Thank you, roy I just want to take a moment to pause and acknowledge that We've heard from Four witnesses Now have to count four witnesses so far And that our four witnesses Just I want to acknowledge that The the courage it takes as a black person to speak truth in in society and to speak truth to power Especially in a context like this where you're being recorded for posterity and posted on the internet and just to acknowledge that The threats that black and other brown people Have what we have to live under on a regular basis. Um, and so I just want to acknowledge you I just want to I don't think we can thank you enough for coming here today virtually And sharing your stories and and sharing the qualitative Data because this is qualitative data people's stories about why the bill needs to happen. So thank you And you also just want to remind everyone that this bill was developed as part of an organization That's led by by black And other people of color, but that centers the black experience and that the rest of us work It to acknowledge that to fight against anti-blackness um, and so That being said I we're going to shift focus now and hear some of the quantitative data Because not only has our bill and our and our suggestions been grounded in the Direct experiences of people and the stories we share, but it but also it's been grounded in findings that are Rooted in quantitative data in numbers. So I'd like to hand the floor so to speak over to pato atilio who's um, probably I could say our main data expert in the racial justice alliance Um, I don't know if that's if if you know, I don't know if you want to be called an expert But we view you as our one as our main data person Thank you for all the work that you've been doing for us and please take it away and um, and You have the floor. Thank you Okay, uh, thank you represent representative Gina and uh, thank you all for having me here and give me the opportunity to talk And I I also want to acknowledge The other other folks who testified here and their courage and thank them for coming forward My name is pat atilio. I'm a resident of qui chi I lived in vermont for just three years now Uh, but I've been busy I've been retired for several years From a career as an it professional project manager and a software engineer And my special focus when I was working for hula packer and other companies was in and data modeling data analysis and so When I retired I wanted to find More productive uses for the for that expertise And I was very happy to find mark in the racial justice alliance a couple years ago And I'm now a proud member of of that group So, um, I support h2 10. I think it's it's uh, very Well put together a piece of legislation But as a data person i'm going to speak primarily to the findings section Which I think is very helpful I think any conversation about health care and about race Used to be grounded in data to know what we're talking about To validate the reality of it and and You know to ground ourselves in that and And help help us convince others of the the reality of the problem For those who who respond to data Um, as opposed to qualitative testimony So, um, yeah, so, uh, I I think the The findings section is is quite good. I did Provide some input to that but reviewing reviewing it I had some other comments now that we're we're thinking of from the health care standpoint I did have some comments and additions. So I'll take a couple minutes on that Uh, things that you know, the findings is not meant to be a total totally covering all relevant health care statistics For for these communities for BIPOC and other communities in in vermont But there's some interesting ones and important ones perhaps that We might want to consider adding or at least covering In the long run One is so uh to start in on that vermont The uninsured rate in vermont is from what I understand from what I can tell is is quite quite good in the aftermath of the aca Is uh compared to other states of vermont's uninsured rate is pretty low, but even so Blacks are 25 more likely to be uninsured And whites this in the state So that's a measure that perhaps we want to include here and And keep track of As I as I mentioned some of these data points I can provide the sources. I won't belabor that today, but One of the challenges we have with presenting these findings or any any data gathering Is actually getting the data So I appreciate the bill containing Stipulations that the agencies who contribute data and metrics provided disaggregated by by By race and by sexuality and by disability that will make my job and jobs of Activists and researchers in vermont all that much easier because it's not too easy right now um so COVID-19 obviously is a is an important data area one thing that's not mentioned here in the findings I just thought I'd throw it out there as we are starting to get statistics around the vaccination rate in vermont that the department health department of health provides on a weekly basis and I see that You know vaccination rates are chugging law, but uh blacks and Native americans and asians all their vaccination rates are lower than than the white rate in vermont in particular Whites most recently are 10 per 10.5 percent vaccinated And blacks are 6.6 vaccinated. So that's uh, That's worth worth pointing out. It's not in findings Um Section 4c of the findings mentions that there's no statistically significant differences in the rates of pre-existing conditions Including cardiovascular disease. That's not what I found when I was looking into this so, uh My understanding is that nine non My discovery is that non-Hispanic blacks are 50 percent more likely to die of heart disease And that's a cdc number. Okay, so That is a you know, a significant health disparity that we don't want to lose sight of So I'd point that out Some of the other important measures like a life life expectancy by race annual mortality rate by race those are both At a national level that there is quite a disparity Blacks life expectancy of birth in 2016 blacks are Expected to you live three years less than whites Um the mortality rate is much higher. Um black males versus white males have a 25 percent higher mortality rate Um black females versus white females have a 15 percent higher mortality rate Those are nationwide figures and here I'll point out It was not easy and I have not been able to figure out what those numbers would be for fermat But I have to imagine they would be similar Um So, uh, let's see here opiate opioid addiction. Uh, it's clearly something that's a big problem in fermat um In vermont ranks, uh, well vermont, so nationwide opioid deaths in 2018 were 14.6 was the rate of death per 10,000. I think that is or maybe a hundred thousand but The point is that it's nearly double for vermont the opioid deaths And here again, I was this I was not able to break down by race in vermont So, uh, it would be worth looking into and I think that's an important aspect of health care Or mental health physical wellness. However, you want to look at it That needs to be considered because it's so Important and a significant issue in vermont Um Yeah, so, uh, the uh, this opioid infant mortality rate It tends to be, uh, you know, it's higher for for people of color in this country um, and I uh, again, I don't Over mind I have is that About a third there's a 16th Best state when it comes to infant mortality statistics overall, but I was again not able to Disaggregate that by race So, uh, another that's another common metric that one would want to have When looking into disparities and but we I I at least have not been able to uncover that data Uh, finally, um Kind of broadening out a bit before I finish into the The uh, what do you call social determinants of health? I'm glad that's in here and um And this is important that the uh, there's a lot of factors that come into Determining our our health outcomes As human beings and uh, like the ones that were cited in the findings. I would want to point out that, uh Level of educational and energy achievement is important as well. It's not a huge disparity in vermont, but uh That uh, like for example, achieving a bachelor's degree Um is uh whites whites are Two percentage points higher than blacks in terms of getting bachelor's degrees And in terms of how's that relate to health outcomes? Well, bachelor's degrees lead to Better income Be lead to better health care leads to Leads to better health. So there's a direct connection between education and health outcomes turns out And um Poverty rate is important to point out for similar reasons Um, and I want to know the child poverty rate Uh in vermont By race and again, I was not able to track that down But uh, we know the poverty rate is significantly different between black vermonters and white veronters black vermonters are more than twice as likely to live in poverty as white vermonters and child poverty is Uh Is also and really is related to that and also quite important So, uh, that that sums up kind of uh, like my just getting this bill in my hands and looking through the the findings here Um, and to some in some there, you know, we want to want to be sure we're tracking all the critical metrics So we can prioritize what we should be focusing our efforts on so again, thank you for uh For allowing me this time and to give that some feedback Thank you pat and uh, and you know, I especially appreciate the point you're making um around how Although we have provided in this bill some findings Demonstrating the need for action to address disparities and to promote health equity That this is just the beginning of the information and that a lot more is needed for us to understand the full picture Um, and that's why we have data collection in the bill. So thank you And also for pointing out that We can try to change the system itself and work on how we're treating But that there's so much more we can do for prevention when we look at social determinants of health because that is Needs to be part of the discussion. So speaking of the yeah, so thank you. So speaking of the bigger picture And sort of to wrap things up for us in our testimony today. We have mark hughes who's going to join us at this point Um, so last but not least the bases are loaded mark Bring somebody home. Take it away Well, that's that's encouraging. It's it's also intimidating, you know, because I could just strike out But um, I just want to thank um, I wanted first. I want to acknowledge um representative uh courtesies uh tenacity and uh in her uh just uh intestinal fortitude just to keep her hand up for the duration of an hour And a half. Um, because I've been watching that and I'm thinking man, she must be tired. Uh, so Chair um, uh chairman, uh, it's good to see you. Thank you for giving us the opportunity to come into your committee on fast track Good to have you here um We do have a connection in uh history with uh the chair. Uh, there are others on the committee that um, I really appreciate and respect your work I I also uh want to just give a shout out uh to Maybe she's gone. Um, I I think Oh, there you are representative taylor small. Uh, give you a shout out. I see you and uh and just congratulate you So just you know briefly just in high level I'm not going to go and allotted to the bill But I just want to tie some stuff together for you real quick and uh, if if it's possible And I'm also katie. I want to thank you too and for the work you've done I've been watching I've been watching what you've been doing katie And if it's possible to give me an opportunity if I can get to it over over the next eight minutes What I'll do is I'll maybe share a slide uh as well So if you can afford me that opportunity to do so I'd appreciate it. Um, you know as far as the alliance the racial justice alliance We're doing um a lot of things at the same time. We're working on platform initiatives, which includes act act I think some of you've heard about act statewide policy. There's also um, you know community engagement and support There's outreach and education. There's cultural empowerment a lot of stuff going on Um, you know, obviously I think a lot of folks know about the scaffolding that we've laid uh for the um Discussion on systemic racism one of our colleagues and one member of the board of directors mentioned to you just a minute ago um Act 54 which many of some of you have forgotten some of you probably never heard of 2017 that was formerly known as the racial disparities in the criminal juvenile justice system advisory panel Which still exists today. You see aton from time to time there Um, well what also came out of that was the attorney generals in the human rights Commission's task force report which reported racial disparities across all systems of state government That was before we learned a vernacular systemic racism We introduced that vernacular in type in act nine in um into special session 2018 Where we created susana davis's position as well as the racial equity panel Okay, so that's kind of a little bit of a background in the work We've been doing but we didn't stop doing that work So we're still moving stuff forward and we've you know been continued to work You know in criminal justice system as well as all systems across state government and we'll become to understand over the last couple years It's kind of like dr. King's been saying the entire time is you cannot fix this without a radical redistribution of political and economic power Hard stop. So what we've been looking at this session is is eliminating these obstacles to economic opportunity Um, we've been looking at home and land ownership as well as wellness Which is the center of this entire conversation Because it's a broad sweeping representative donahue. I know you know what i'm talking about It's a really broad sweeping conversation when you talk about wellness. That means wholeness. That's everything We've also been talking about covet 19 relief targeted intentional attention In terms of uh covet 19 relief I don't think anybody who's around last session could agree that we did a good job at that in terms of the targeted Relief and and in fact, I don't need to think anybody can agree that we're administering the vaccine in a targeted manner Today the last piece is is a cultural empowering because that's where we find our history That's where we find our culture. That's where we find our relevance. That's where we find our contribution That's where we find our resilience That's where we find a component of our wellness as people people of african descent So that's incredibly important even as it pertains to wellness. So i'll just go on it and just briefly share with you Just a couple slides just to give you some background but i'm just just trying to tie it all together before we talk briefly about the um The the policy itself not a policy You know, obviously there's there's a hope That that we get the opportunity to get some additional testimony in I mean that's that's somewhat of a no-brainer I would imagine um, there is a hope Uh that uh, you know that we'd be able to get some different perspectives to the table To talk about this policy because there's there's still work to be done There's still stuff that needs to be done in this policy. We realize that Uh, i'm i'm thinking that this the appropriate stakeholders will come to the table. We'll have additional conversation about this. We'll move this forward um So I just wanted to share with you briefly about you know We talked a lot about the the mental wellness or the wellness working group of the the racial justice alliance in this group It's pretty diverse group and what we're really what we're really focusing on is is um Enabling folks the ability to live daily and join your highest levels of wellness, okay? This this is this is involving creating and managing what we're referring to as disruptive initiatives Why why do we refer to it as disruptive because the system wasn't created to accommodate black folks? It just wasn't it's not broken. It's doing exactly what it's supposed to do Um, the other thing is a developing long range Strategy so just wanted to make sure that you got that as proper framing kind of heading into this policy Because we agreed that this policy was going to be a component of the work that we do briefly Pardon me we um, we speak we speak about determinants and I just wanted to just elaborate on that because we're there there's a lot of conversation about determinants and they are somewhat divergent and we are creating we have created a list of determinants here within the um Our our own working group and in and many of those have been communicated outwards to um To the uh racism is a public health emergency Group here in chitin and county and so these determinants are reflective Reflected in that group as well. So what I'm showing you here is is you know, how we're framing the impact. Thank you how we're framing the impact um That these what we refer to as social determinants and they are derivatives of what you've seen in this policy, but we've got to emphasize the fact that you know the you know, the COVID-19 is not necessarily the um, the the the public health emergency Racism is the public health emergency and I just want to pause there for a minute and let you know You will see a declaration You will see a request for a joint resolution from the house and senate to declare it as such because that is A pre-existing condition that has always impacted every single one of these determinants So I just wanted to make it very clear. Yes. COVID is alive and well yet, but it is exacerbating a pre-existing condition Very important to understand in the conversation We're having in terms of wellness because the conversation about wellness It involves all of those determinants as they bear down on black and brown folks And as they are as they're they're bearing down with their natural inequities of Inequitable outcomes that are now exacerbated by COVID-19. So I'll just share with you that yes, you will see a a request I'm asking your endorsement on that the declaration or if you will a I should I should say a resolution of Racism as a public health emergency that will be forthcoming I'll be talking to the pro tem at some point or another as public now So everybody knows and we'll be getting back to the speaker as well talking more about that It's going to happen And and if you can't do it, we'll ask the governor to do it Regarding this policy um, I do feel Um that do I have the right policy in my hand regarding this policy. Um, I think the um You know, there's one thing that's dramatically missing from this policy. What is Money There's no money in this policy. So I want you to know we flag that. I think we got a you know This is something this is something that I I'm I'm confident you're going to do I here's what I believe is going to happen. You're going to go in you're going to get testimony from other folks You're going to be other versions of policies that are similar to this. There'll be overlaps There will be things that there will be testimonies folks will agree folks will not agree at the end of the day We're going to come up with a policy at the end of the day. I am asking you Put some money on this policy. Put about three million dollars on this policy Put about three million dollars on this policy to pay you talk about an office of racial of equity of health But you can't it's kind of like, you know, the office of racial equity. How's that working out for us? Okay, so put some money Put some money on this get a few million dollars on it get a few people butts and chairs Uh and also in addition to that You talk about grants put the money in place Okay, so that's what I'm really recommending that you do here in closing. I just say that um There's been a lot of work that's going into this already, but it's not all of the work. We acknowledge that We acknowledge that um, I encourage you to take additional testimony On this we may even come back and change our mind on some of our own propositions You know, um and bill you say I mean I'm Mr. Chairman you've seen this a thousand times. So so but I am confident that This is headed in the right direction I I think there is an imperative This is an emergency the house is on fire And so I'm asking you to take some action take this up I want to thank representative uh, chino for his tireless work And in everything he does you have no idea committee Uh of the work he does behind the scenes working with us and putting up with me Quite frankly, um and Brian don't you? And so I want to thank you publicly But I also want to thank the work thank the folks in this committee I want to thank the folks of the working group of the racial equity The racial justice alliance I want to thank the board of directors of the racial justice foundation All of the folks who contributed to this the data folks pat you and your folks all of the effort that's gone into this thus far Because we still got some work to do And I want to commit to you that we will partner with you to help you get this thing over the line So just you know, thank you. Thank you again. Thank you for having me. I wish you all a great afternoon and um Representative chino I guess is back to you I I would just say thank you mark and thank you all of our witnesses for making time out of your lives to come talk today and Um, just like mark mentioned all the work that I've done that people don't see that every person you see you you heard from today Is doing massive amounts of unpaid labor Um to for the betterment of not only their lives, but their community and the greater society that we live in So thanks to everyone. Thanks to all the people who are not here today who help work on this bill It really does represent the work of dozens of people In our community and and hopefully more if we take it up for further action So, um, I'll just stop there and say thank you and um, I'm not the chair of this committee So I'm not going to try and manage the questions. So thanks for letting me at least present my witnesses though Right. Well, I want to I want to thank brian and but particularly I want to thank uh Mark and the other witnesses who've come to spend their time with us today And as you acknowledged who are doing a lot of work In so many areas, but this being one of the key areas And I want to I want to I want to also acknowledge The work that brian and and katie have done At my request to Move this bill. Uh, so we could bring it to our committee's attention and in our deliberations As we as we both look at Policy issues and also budget issues So, uh, it's important that we have this in front of us you know, I I am uh, I'm aware of the time, uh, and I'm I'm I'm inclined to not try to begin a committee discussion at this point in time We are so close to the to the noon hour. There's much to be said. There's, uh I think I think it will not profit us to try to engage right now Um, but let me let me check in with committee members. Uh Can can we would committee members? Be willing to take 10 10 minutes more of our time into the lunch hour to entertain questions if there are questions at this point I would in the I have Just two things that I want to put on the table while we have all of these amazing witnesses here for a discussion Is that we have witnesses with us and let's take advantage of that. Okay. Let's let's let's take a few more Let's take a little more time. Uh, and uh, and then we'll we'll see where we are I'll represent of court is Thank you before I ask my two. I think fairly quick questions I also want to take a moment to honor and acknowledge the emotional physical mental spiritual labor from all of you and all of the people that are not here with us that have Worked on this and shared your skills your lived experience To a group of people who historically have devalued you I Acknowledge and honor that My The two things I'd like to talk about and mark hughes you We're saying that This you acknowledge that this we're just beginning with this bill. Um, at least as far as this committee goes So I hear that My two concerns are the phrase non-white which the first use of it is on page two under the findings and I I Would appreciate hearing what your process was in Putting that Potentially putting that into statute and therefore institutionalizing that term Which I believe is problematic in that it normalizes white as the dominant culture and others everyone else and then The other thing that I hope we can work on is inviting Not just physicians To do continuing education, but nurses respiratory therapists. So I look forward to taking testimony from other healthcare professionals In how that how we can include the continuing education For them as well. Again, thank you very much Great. Thank you Brian do you want to comment and yeah, I think I can answer those questions really quickly that we use None white in the in the legislation because data is collected that way in vermont not all data, but some data and so if we had to Present our findings. We wanted to define Explain what none white means and we also make a statement in the definition about critiquing about the use of that word So if you read the language, we actually critique In our definition critique the use of the word and say we're only using it because that's how data is Collected in some areas the second piece. We did have some Additional pieces for health education that didn't make it into the final draft in the in the shuffle at the end of fast-tracking the bill So I'm happy to bring that language to committee if we decide to work on the bill And I we may enhance that language, but that's why that's not in there. So That's my quick answer. Okay, um mark. Do you want to make a comment? Thank you. Um Representative court is I think that's a great observation and I I happen to be in agreement with you And I think that we will find additional language Throughout this bill that may not be the language that we want to land on So this is a starting place. Uh, I know that um, you know Later on in the bill when we start talking about social determinants I'm not quite settled with that yet. You know with that, you know, based upon the slide that I showed you Um, we should I think there should be additional Uh testimony debate, uh, so on and so forth get other people's perspectives Maybe this is where it lands don't know and then I'll just conclude with saying You know, there's this conversation about Oberon page 15 of 28, uh item numbered, um L2 about office may Office may are you kidding me? I mean, uh, so I I think that um You know, we might want to talk about what what, you know, shell and what may the difference between those as well So there's and that's one thing I've learned over the last several years messing around walking the halls of the state house Is is you you misplaced one shell with one may you're out of luck. Uh, so so there's a lot of um There's a lot to get to cover in this and that's why you know, my opening was is we're not there yet Um, we hope there's more testimony that comes in and um, you know, we're happy to continue to collaborate on this And maybe some of the changes maybe changes to our own Yeah I'm going to I'm going to have us finish with that comment. Uh, given where we are this afternoon this morning and now this afternoon Um, I think this has been a good start and as it's been indicated. This is not uh, finished Uh, we will we will take more testimony. Uh, we will have time for committee discussion and also to look at, uh Money and budget implications But this I again, I greatly appreciate, uh, the work that has been done to put this in front of us Mr. Chairman if if I may be alive, uh, just one last comment Again, I want I want to really thank the committee and I want to I cannot I cannot over emphasize The gravity, uh, that this particular policy brings, uh, to this to the table in terms of the You know the the summation of the efforts that we're making this legislative term to advance this, um, this this, um This approach that we're taking and addressing systemic racism. Um Wellness is at the center of everything And which is why this bill, you know comes before Uh anything else that we're doing we have so much appreciate. Um, Mr. Chairman Um Your support in getting this thing out front and enabling us to be able to communicate this in the way in which we have Uh, I hope folks I hope folks watch this testimony over and over and over again But if this is not working, um, then we've got big problems everywhere else and everything else is informing this So I hope that the work of the committee is not just blinded by the fact that there are a lot of other factors involves surrounding housing employment, uh Home ownership, um, not just health services access but economic development and and you know, all of the other systems. So, um, I do appreciate again I do appreciate what you're doing by taking this up And I just want to just leave that the gravity of how important this policy is to advancing the work on a whole and so I encourage you to um To take the testimony and and I appreciate, um, having the opportunity to come out and be a part of this. So Thank you. Thank you. And thank you to all our other witnesses. Uh, and to representative china for Taking the lead on sponsoring this bill We're going to have plenty of time. Well, plenty of time. We're going to have time We never have enough time as we as much time as we'd like but we have all the time that we have That we can prioritize our our work and with that, um, I look forward to some robust committee discussion as well as, uh Looking at the bill more closely When we take it up formally, but today was a Important first step in that process So, thank you all, uh for committee members. Uh, let me we can go off youtube at this point


Ladies and gentlemen, to enlighten us on how hyper personalisation and artificial intelligence are ruling this space, let's call upon Mr. Tarun Katyal from Z5. A media veteran for over two decades, Mr. Tarun Katyal. But I would like to speak something about you when the media mogul is beside me. I'd like to take this opportunity. Mr. Tarun Katyal is a media veteran for over two decades. Mr. Tarun Katyal, sir, is the CEO of Z5 India in his current role. Well, he's a TEDx speaker and part of industry forums, including jury chair of Air Club AB and DMAI, committee member with FICCI and CII, XCOM at IAAA and vice president at Association of Radio Operators for India, AROI. So ladies and gentlemen, let's give it up for the super energetic and ever-enthusiastic Mr. Tarun Katyal from Z5 who's already here with us. God, that was a long introduction. Thank you so much. I know this is a session post, I didn't think post tricks, but post coffee. Interesting times and an interesting topic. I hope I can keep you engaged for the next 10 to 15 minutes. We'll keep this crisp, but I hope we can keep it interesting. They talk about hyper personalization and they talk about, you know, the need of the changing consumer and being served to a segment of one. Now, I think, you know, most of us as marketers and advertisers, as agency folks started in, you know, in the late 90s and early 2000 looking at target audiences, it was fairly broad. We were told, you know, you can look at four plus, then we were told you can look in the upper cap of 25 to 44. You could add gender to it. You could then add geography to it. Then there were some studies that could have some lifestyle attributes to it and so on and so forth. But then came digital about five to seven years ago, which started to do user level attribution and started to understand user cohorts and segments. And then, you know, we all got very excited. Google can tell us more than what we know about our audiences. They can tell us what they consume, what they do, what they eat, you know, and so on and so forth. And all of that data that we passed to Google search and many other platforms are on an everyday basis. And that then led to what we call the segment of one. Now, what is the segment of one and why do you need hyper personalization, right? Most of our user journeys today are, you know, taken for granted. So when you get onto a food delivery platform, you expect the food delivery platform to understand what you ordered last, to have descriptive data to be able to tell you where and what are your likes and preferences, to have prescriptive data and recommendations and lookalikes to be able to tell you what you possibly will like and where you could order from, to have your payment history and to be able to understand what kind of discounts you would like, what kind of cards you own, what kind of, you know, payment history that you've shown or you've displayed over a period of time, all that is kind of taken for granted. Why is it taken for granted? It's because each individual today believes that they must be served to their individual level rather than even a segment level, right? Now, where does that take, you know, us as marketers? Where does it take us as product owners? Where does it take us as businesses? Now, all of what looks very simple is actually very complex. It's complex because, you know, whether it's a video delivery platform like ours or whether it's a food delivery platform like Zoomato or Swiggy or some of the others, or whether it's a search platform like Bling or Chrome or Google or so on and so forth, each of them have to deal with millions and millions of users, millions and millions of profiles, much understanding of, of being able to predict how each of those users will behave, much understanding of where they will go from where, what are they going to be their user journeys, what are they going to be their likes, dislikes, and what do they really want to end up at? And you're not going to go right all the time, right? The 20 things that come up on your search on any platform are not always going to be correct. And so there can be intuitive search, there can be descriptive search, there can be prescriptive search, there can be recommended search. But all of it is continuously learning, right? Machine learning is, is a very broad subject and, and artificial intelligence machine, machine learning are almost two words that are most abused in data sciences today. Everybody believes that their tool or, or their product or their platform today is well equipped with each one of them. What do we expect some of these things to do? What do we expect the user to do with them? How do we really look at uplift numbers when we use them? Where do we go when we get to a point of saturation on using them? Is only descriptive data good enough? Are recommendations really the way to go and are they getting into data privacy? What happens when things like GDPR and data privacy laws come into countries like us? What happens when opt-ins become lesser and lesser? These are questions that all of us will and continue to answer. The world is extremely dynamic when it comes to machine learning.  Unfortunately, as you realize what is happening with this data and there are in, you know, enough and more reports about how your conversations are being recorded by some of the tech companies or how most people know what you interact with. Are you willing as users to be able to give as much as you give today? And if you don't give as much and if you don't believe that, you know, you want to part with your personal data, then how will the machine learn and come back to you? So the balance between machine learning and data privacy, machine learning and descriptive data is something that, you know, all product owners and all marketers today are struggling to keep. Now there are things that, you know, all of us have learned over the last, I would say, three to four years, one, that however, you know, you want, unless your user journeys are intuitive and unless you continuously look at data to be able to create more efficiency and improvise them, you're not going to be able to hold on to a user. Now, this also looks very broad, but I'll give you an example of, you know, our own platform called Z5. When we got onto the platform, we realized that there were three things that were essential to hold on to users, to be able to create better DAUs, better MAUs, better retention, better time spent. And this is what we call the strategy of three Vs, which was, the first of them was video. Now, video is kind of a broad word, but we realized that serving video was as intuitive as it, you know, as anything else. India is a country of humongous amount of device and OEM ecosystem, right? So it starts from something that is not even in most other parts of the world, which is a feature phone that delivers video. So the geo feature phone, which is the lowest end device, which you can buy at 50 rupees monthly and, you know, and a 1500 bucks one time cost, also delivers video at one end. And the smart TV, which delivers 4K with Samsung and LG and some of the others, also delivers video at the other. The adaptive betray technology that really needed to be put into place to understand what platform is the video going on to, what's the bandwidth of the platform, what's the ability of the platform in terms of serving video, what's the memory of that phone, what's the CPU of that phone, how will you deliver video in the best way, how do you make sure that there are lower and low video start failures, lower and low exit before video starts, and the quality of experience that can get better and better. That in itself was technology that India hadn't seen or even the world hadn't seen that we had to work towards over the last 18 to 24 months. We partnered with some of the, you know, cutting edge technology developers in the world like AWS Elemental and the others to be able to do just one thing, which is serve good video. Because we knew that on a video streaming platform, forget all the UI, forget everything else, people eventually come to consume good video. And if you can't give them a great video experience, you're not going to be able to retain them. And that had to be personalized to their device, to their memory, to their ability to hold on to downloaded videos, and so on and so forth.  The second one was language, what we call vernacular. We realized that India lived in its languages and Indians were not unidimensional. As most of you may not know, even Google and YouTube are only available in six languages. We are available in 11 to 12 languages today. And that was a big ask of us. So to be able to do display in those many languages, to be able to do UI in those many languages, and most importantly, to be able to create search in those many languages. And that was a big ask again, because most phones didn't support so many languages on their keyboards. So we had to then move to voice, which was our third V. So we created voice search in those many languages for everybody to be able to do content discovery. And that, between vernacular, voice, and video, was an extremely personalized, hyper-personalized experience that was built on artificial intelligence and machine learning for us to be able to get to the number we did. And how we've improvised this over the years has led to every quarter and every spin showing us enough delta, enough uplift for us to be able to serve more and more consumers and more and more languages in more and more content of their choice. And this, I must tell you, is an ongoing experience that has got us to having not one app, but 15 applications in the market today. You have a different application for iOS. You have a different application for iOS. You have a different application for Android, for LG, for Tizen, for Samsung, for Xiaomi, for AFS, for Apple TV, and so on and so forth. Unless you have those many applications that are catering to every single individual and with video players that can understand, and different video players that can understand adaptive bit rate, that can understand your ability to consume data, can understand what kind of data plan you're on, slow 3G, slow 4G, broadband, and so on and so forth, you will not be able to create user experience that would proliferate the brand into hundreds and millions of people in this country. This is really easier said than done. And increasingly personalization or hyper-personalization is something that we should take back into marketing, into building media plans, into being able to do targeting. So right from a 4 plus, 12 plus kind of a media plan to getting to cohorts and segments, to getting to an ability to personalize advertising at an individual level, it's a journey that all of us are taking. I'll also talk about another tool that I was telling a colleague right behind. We partnered with somebody, somebody called Minitly, to be able to create an auto preview technology. What is an auto preview technology? An auto preview technology is very different from what you believe in auto play technology. What's auto play? Auto play is when you get onto a video, it starts to play on its own. And it's a recommended personalized video that starts to play out and starts to show you what you want to get to without you having to even trigger the play button on the video. The auto preview technology takes a step further. You've got hundreds of curated tiles on video OTT platform or a video streaming platform. The auto preview technology scrubs all of the 30 minutes, the 30 seconds that you are going to most likely like to see out of the 30 minutes, and creates an auto preview of the video out of all the 10 videos that you can see, it will pick one or two videos, scrub those videos, and then auto preview the video on an ongoing basis at a hyper-personalized level to you. That is the level of personalization that people are getting to or video platforms are getting to. So while there's one level of understanding the kind of idly that you will want to order on Swiggy, the other level there is the kind of video and the kind of scrub off the video that we'll have to watch. And this is not just ending, right?  At some point in time, we want to get to a subscription plan that can allow you to choose the amount of content and build your own subscription plan on the fly. And things like this may or may not happen, but the journey to hyper-personalization has just begun, and I welcome marketers, advertisers, and everybody else to join this journey in being able to serve the segment of one. Thank you so much.


Since we are interested in understanding how exactly carrier aggregation works, it is important to look at the role of the user equipment that is the mobile terminal in carrier aggregation. After all, the carrier aggregation is going to be implemented on the wireless side. For that, we would look at the initial 4G devices which were taken up for deployment of carrier aggregation and then we are also going to look at the layered model. Initially, the mobile phones were considered for the deployment of carrier aggregation. However, there were certain constraints. The first one was the hardware complexity because carrier aggregation actually meant to have multiple MAC layer and the radio link control layer interfaces available on a single mobile phone. That's the hardware complexity. Then, there was a requirement for increased power which was to be transmitted because after all multiple carriers would be transmitted and received. The third one, of course, was the involvement of the Federal Commission on Communication Guidelines which says that the mobile phone need not transmit beyond a certain radio power which could be hazardous to the individual carrying the mobile phone. For that, initial deployment instead was considered on laptops. And if you recall, we had LTE advanced radio interface which was provided on laptops via the USB port. The carrier aggregation as the concept entails is the grouping of the resultant bit stream that is coming from multiple carriers. Each carrier is going to send its own bit stream over the MAC. Now, we know that at the data link layer, we have the logical link control that sits on top of the medium access control sublayer. In the context of wireless, it is the radio link control sublayer. The responsibility of the radio link control sublayer is to provide an aggregate bit rate which is obtained from all the carriers below it. So correspondingly, it means the RLC is going to talk to multiple carriers each coming from the physical layer and its corresponding MAC layer. And since we have up to five bands and we can have from 1.4 to 20 MHz bandwidth allocated on a single band and we could have up to five bands. Let us look at the overall diagram. Here, we are looking at the OSI protocol model. That is, we have the network layer on the top, we have the data link layer and then we have the physical layer. We see that we have one IP protocol layer implementation which sits on top of the packet data convergence protocol layer. Now this PDCP is actually responsible for aggregating all the traffic stream. The radio link control aka the logical link control is responsible for talking to multiple individual MAC layer implementations. Each intern has its own physical layer which is responsible for managing a certain carrier in a certain band. So at the physical layer you see, we have the LTE spectrum, we have up to five carriers. Each of these individual frequency is providing a bit stream to the MAC layer right to the radio link control. The radio link control manages it and passes it on to the packet data convergence protocol. So we see how exactly in a layered manner these protocols work together to provide an aggregated bit stream which is the hallmark of the LTEA.