January 21, 2025 • 50 mins
In this episode, Dr. Kaz Rafia shares his inspiring journey as a leader in health equity, highlighting the systemic barriers to oral healthcare and the transformative power of advocacy. From expanding access to underserved communities to fostering psychological safety in teams, Dr. Rafia provides actionable insights on creating meaningful change. Join us as we explore the intersection of leadership, resilience, and equity in healthcare.
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Episode Transcript
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Welcome back to bridging worlds. I'm Amanda, your co-hosts, joined by Malcolm. And we are located
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on a traditional ancestral and unceded territory of the Mohican people. Now present day,
Stanford kinetic. Today we're diving into a conversation that beautifully reflects what this podcast
is all about. Bridging the professional and the personal to explore stories of growth,
resilience and meaningful change. Thank you, love you, wife. I appreciate that intro.
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Our guest today is so when I've had the pleasure to work with, and this is the former chief
health equity officer at CareQuest Institute, Dr. Kaz Raphia, as ability extraordinary career
at the intersection of health care, equity, and leadership. We're so excited to have them here with us.
From his groundbreaking initiatives at CareQuest Institute to his current roles on the Massachusetts
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Board of Registration in Dentistry. And as an Ajax Associate Professor at the University of
Pennsylvania, Kaz has made a lasting impact. Kaz, worth thrilled to have you here. How are you
feeling about joining us today? I'm just excited to be here. Malcolm, just reconnecting with you
as always a pleasure and Amanda. I love the energy and the thoughtfulness that you both bring
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to these conversations. I've been looking forward to this dialogue because I really believe just
digging deep in these intersections of leadership and health equity and impact is that's how we
move the needle. And really to me, these moments of reflection are really, really important when
you're in the middle of the work, and when you think of doing the work, you don't always have
the chance to pause and appreciate the journey. So this conversation is a great opportunity to take
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really stock up what we've been and what we've learned and what we're headed. So grateful to be here
and excited to dive in. Yeah, awesome. In Kaz, I would like you know, I'm very thankful to have
worked with you because you started before me. And when I came on board at CareQuest Institute,
it was a treat to be able to interact with you to talk with you, have professional as well as
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personal conversations. And I thought that you would be a perfect fit for what we're trying to do
with the Bridgie Rose podcast. Thank you, Malcolm. What a privilege to be here with you.
Let's dive into this incredible journey. So first we're going to talk about the journey to health
equity. Kaz, let's start with your journey. What inspired you to pursue a career in health care
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and how did health equity become such a central focus for you? Yeah. So I'd say that my path to health
care, specifically your question, health equity, wasn't something that I strategically planned and
drew it on a board somewhere. It was really shaped by my personal lived experience and you know,
like a lot of us, the stories that we encounter, shape our paths forward. And it really had
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growing understanding that the health outcomes that we're seeing aren't just dictated by medical
interventions and the care that we're receiving. But really by the systems and the policies and
really access, you know, the old adage to 80, 20 rule. We know that 80% of all health care outcomes
have nothing to do with direct delivery of care. It only 20% of them have to do with
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seeing your doctor and actual medical interventions. I first became interested in dentistry because I saw
how our health really impacts every aspect of an individual's life. If you're a pain,
you can't focus up school or at work. And if you're really embarrassed about your teeth,
you might not speak up in a meeting or go after opportunities that you might be afforded. I've
seen people in patients who've struggled with basic preventable conditions just because they
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couldn't afford care. And it made me realize that dentistry in oral health isn't just about fixing
teeth, but it's about dignity and opportunity and fairness. There's an anecdote that comes to my mind,
just based on what you just said, and that is in one of my women's recovery groups. There's a
young woman. This is not uncommon. There are young, affluent women. There are silver mothers. And a number
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of them admit that they haven't been to a dentist in years. And the reason is because shame from drug
use, or meth, or alcohol, or what have you. And one young woman went to her dentist after being sober
for a certain amount of time. It was just so anxious and in tears and crying. And her dentist had
emotional intelligence enough to say to her, to just stop her and say, welcome back. I'm so glad you're
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here. And she took it as welcome back to life, not just welcome back to the dentist. So I really
feel you on the mental health aspects of this powerful. Yeah, it's a powerful. I love that story
for multiple multiple reasons because it really demonstrates that, you know, for an individual who's
been through a lot to show the fortitude to be able to actually step back in an environment where
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it might be an additional layer of challenge. So we got to recognize the effectively to victim,
if you will, and this is in all of us as well, the person who's dealing with the emotional
toll of the turbulence that they've had to experience, but also the provider who stepped up to
the plate and made sure that they were able to create the space for the patient to feel at ease.
And that in a lot of ways, and I know we're we're going to talk about this down the road. It's about
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that safety, if you will, that we're trying to create for everyone around us. Excellent. Thank you.
Cause your career has been incredibly diverse, spanning so many impactful roles. Was there a
particular moment or experience that made you say, this is what I meant to do? Well, you know,
if I can necessarily identify A-momum, but I would say one of my pivotal moments was during my
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residence program at Oregon Health Sciences University. We had tribal community members. We
had to travel for hours to come to our hospital residency program clinics and many of them struggle
with co-morbidities and really nothing about that felt fair or right. And we'd see the impact
that we were able to make and then the transformation that the patients underwent and just
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basically for us providing care to them with respect and compassion, which is a really basic formula.
It didn't take much, but you see firsthand the the system that has turned its back on people.
And you can't help but to want to do something about it. In really moments like that reinforced
to me, at least that it's not the policy being about paperwork and legislation. It's about real
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people, real lives, real impact of systemic barriers. And that's why shifted my focus towards
policy now, you can see inequity because delivery care one on one is incredibly meaningful.
But the force multipliers I was like to say and it's a stickingness of the changes happen
when the system itself changes. I think that's great. I think it makes it very sort of universal.
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And there's something of what you're being at everyone can attach themselves to.
I'm reminded of some domestic violence work that I did when I first moved to New York City
and the triangulation of the victim survivor and then the perpetrator. And then there's usually
a silent observer who sees what's happening, often it's sort of blamed or allocated to the
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woman. Like the mother didn't protect the child from the father who is abusing the child.
And so it's this triangular way of looking at things that I see in the health system because I
identify as a victim survivor. I think we all are to a certain extent in health care system.
And sort of identifying also that same silent observer who knows what's going on.
Right? That's making the legislation that it doesn't affect on a personal basis. It doesn't affect
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their mother. It doesn't affect their son. And they need to be held accountable too. And in the
meantime, we have to reach around and figure out how to help that victim survivor.
Precisely. Well put. Thank you. Yeah. And speaking of policy and advocacy,
I know that you've worked extensively in this area, both a care quest and your role currently
with a Massachusetts-Dinnissue Board. What's been the most rewarding part of influencing policy
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and what challenges have you face, Cass? You know, so I would say strangely enough that the
journey and the process itself has been one of the most rewarding parts just to work in the long
fearless individuals. People who are bringing an energy and a passion, juice and a fire to this work.
These are the folks who challenge a status quo and they're really the ones making things happen
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down range. But when you're doing this work, you also have to be aware of some major hurdles
like competing and shifting interests. We know that policies shaped by a lot of stakeholders and
not everyone's growing the same direction all the time. And then you have some folks who really
see this work as an individual endeavor rather than a team effort, which can really slow
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meaningful progress. But despite the challenges, I stay in this work because I know policy shift
is the right direction. It has real and lasting impact on people's lives and that makes
every battle worth it. As for challenges, I would say one of the biggest challenges with
in policy and advocacy work is that incremental nature of policy investment. We know that
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real challenge to people stay focused on policy and advocacy work is that they want the sort of
immediate gratification, but we also at the same time are aware that real change just doesn't happen
overnight. You push, you make progress, sometimes you take a step back before moving forward, it
requires persistence. And that's that juiced and fired that I was talking about. And you need to
spend years working on an issue. You may not even see it formulated while you're even
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in the field. But that's really the nature of the work. It's about contributing to something
larger than yourself. Yeah, I mean listen, I feel that completely my father was a lobbyist
and a stated Michigan as well as Washington DC. I used to work on capital hill work for
US Senator Donald Riggle Jr. And seeing people trying to bring an advocate policy out there,
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sometimes they just don't know the route to take or have a patience to work through a system
to ensure that you can get things done. A sometimes timing of the efforts, I worked with health
care back during the day when Hillary Clinton was trying to get that through during bill start
of his presidency and how challenging it was with somebody who has a seat at the table. And when
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you don't, it really becomes a challenge. But you have to understand, you have to learn, you have to
stay with it because a lot of these things that don't get past should get past in our society,
including the things that you did with on an everyday basis in terms of dental health care.
I like what you said to cause about just it really does sort of depend on the chemistry among
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co-workers too and how frequently you exchange ideas. And of course there's such a thing as
caretaker is burnout where I consider you to one of the health helping professions. And I think
that for those of us that are sort of on the front lines and just trying to put food on a table
and raise their kids right and take care of their pets and further their education, it's exhausting.
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And it's the thing that it's important to highlight that and to create healthy boundaries.
Self-care has been used so often that it's sort of meaningless. Nonetheless, it's like I think
of veterinarians for instance, like veterinarians have a very, very, very, very high rate of suicide.
It's a very high academic rigorous process and yet caring for sick and dying animals who
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have no agency in speaking to their own nails and wills and frustrations and pains.
It completely like tears them apart to the extent where they didn't have mental illness now they do.
So I'm wondering how you deal with burnout sort of being on the front lines.
Yeah, that's a great question. I think it's a couple of things. I'll be honest with you.
I think the starting point to that answer that is we don't have formal training.
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And most other fields behavioral and mental health is not emphasized and have
balanced that you were talking about is not highlighted. I also think within health care professionals,
it self-selects for individuals who are very, very driven. They're focused on the goals and targets.
And at times that drive and ambition ends up costing them their behavioral and mental health
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and well-being and have balanced that you are referring to. So that's the reality and that's
a background. The good news is though that sort of narrative is changed. Everybody from academia to
organized industry and a lot of advocates on the ground individuals who are really highlighting and
talking about why this sort of demonstrating vulnerability. Be able to talk to your colleagues.
Be able to share the pain and everything that you're going through is important.
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Prioritizing and making sure you're family and your mental well-being is ahead of your career
and your professional ambitions is also significant and important. But I think to stigma has been
changing from when I started about 25 years ago and that's really the progress, if you will.
On a day-to-day basis, I would say across the continuum between the different levels of
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abilities that the clinicians might have but also their exposure to the disfainance offering.
I think it comes down to what tools have you availed yourself? Where's your mental,
state and well-being? And how open are you? And how safe do you feel demonstrating vulnerability
that it takes to want to seek help? I think we've come a long way. There is still a long way to go
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but these conversations are the kind of fuel that I think we need to make sure that we accelerate
the pace for this overall well-being and mental health. That's excellent. I love your response
to that. I love how you run for in sort of modeling a healthier sense of self and behavior.
There are psychological safety. These are all tenants that we've been bringing up since the
get go. Modeling vulnerability. And this sort of leads in my next question for you as an educator.
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And that is, you also work as an adjunct associate professor at U Pen and you teach policy and
advocacy. So as someone whose my mom was a PhD student and professor at Penn Slerasore
raised around you, smart nicks and everything, I know how much this institution values shaping
future leaders. How do you make these complex topics accessible and engaging for your students?
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It's a great question and Malcolm just touched on it based on the experience of his dad that he
shared. And that sort of what it tells us at healthcare policy and landscape is really complicated.
It is core when you look at the politics of it though, it's about decision. Who makes some who
benefits from them and who can get slept behind? And you try to really peel back the layers. You
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notice that the cardinal challenge and complexity is bridging the gap. No pun intended between
policy theory and live the experience of real people whose lives are touching. That's something
that you are sharing a man about what policies that are out there who are the folks being impacted.
So for example, we're talking about workforce development benefits and access medical
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dental integration. We're not just talking about numbers on a page or just a quance. We're talking
about whether a single mother can get time off, take the kids to the dentist or whether senior
on fixing, come to the foretreat man or from veteran living in rural community has a right benefits
as well as a providers within driving distance to see for their dental needs. And this is
something I emphasize in my work that Penn, what I'm talking about policy and advocacy, I don't
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just focus on a technical aspects. There are plenty there's all kinds of frameworks and a
lingo and a jargon. But I focus on a human stories behind these policies. A really my goal is to
make sure that the scholars really understand that advocacy isn't just about lobbying and legislating
the action even. But it's really about knowing how to leverage data to tell a compelling story
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and how to elevate the community voices and how to navigate systems effectively. That's really
the sort of navigation piece Malcolm that you were talking about earlier and how challenging it is
to find a path forward. And we see this in a lot of different spheres and areas like I think of
recidivism, rates and what the health as country has responded to rates of recidivism. And
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traditionally what it's done is just really restrict people who have been incarcerated but who
serve their time and pay their bail and they're out and they've survived prison. And then
they're told that they have to write their legal history, they have to say that they were arrested,
they have to say that they were incarcerated on job applications. So then they're immediately
self-selecting them to be rejected. So this was reflected in the central part by as you know, where
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to come back from prison after being freed, they can't even leave their room in the section
in the housing project because they feel only feel safe and that's well by five room.
Or they're re-arrested because they're not supposed to step foot in any family's housing that's
sexually housing. Or they're bringing their grandmother groceries and their grandmother can't even
let them in or else she may go to jail. So it's very sneaky outdated practices that are still
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being used. They're still being weaponized. I think against the weakest people in society even
knows who have navigated what they need to navigate to get out of a bad situation in life.
I think those are precisely systems type barriers those those sort of obstacles that are
poured in concrete around us and I think that's the sort of hard work that needs to be done
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if we're going to have the changes that we're seeking. Yeah, I've seen it from a business standpoint
for about eight years. I worked in energy and I was working for multiple energy pipeline
companies, oil and gas pipeline companies and I've worked in some pretty remote areas of the
country where you know their digital deserts out there. There are people who don't have the
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care that they need and sometimes that becomes a factor with multiple things that you're talking
about a man if you're a personal standpoint. It affects them when they are working in the business
and it's up to leadership I believe to help support these people that are out there. And at least
to my question, in leadership creating a culture of psychological safety is critical,
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especially in spaces where people are addressing equity and systemic challenges. How do you foster
psychological safety within your teams and discussions to encourage openness and progress?
I love the tie-in about come by date and it's may not seem obvious but all this ties to this
ideal psychological safety that you talked about. If people don't feel safe, bringing their ideas
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up perspective into the conversation, progress stalls. They've one of the biggest misconceptions
about leadership is that it organically just happens. If you put folks at a room, great teams will
naturally emerge but the reality is that building a high-performing team is an intentional act.
It requires thoughts that you've got to put an effort and probably most importantly the
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element that ingredient in there is trust. Without that foundation, you could put the most talented
folks in a room and they'll struggle to collaborate effectively. What I've learned from my years in
academia or nonprofit work or government is that really that leaders through mandate and charge
is to set the tone as to how the team will function and how they're going to interact with each other.
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In that trust and tone that we just talked about represent the two core components from
my perspective of psychological safety which is the operating system of an effective team.
Psychological safety is what lets people bring their big best ideas and knock it shut down or
ignored or dismissed. The other thing that I want to bring up there is that there is also this
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stereotype that if you're too nice and make sure you're ineffective and then you have to be tough and
cut-trolled or authoritative to get results. And we see this around us a lot these days. If you
will in micro and miso environments all over the TV and news. But in my experience,
nice guys do finish first. And not because they avoid conflict or keep a want to keep everyone
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happy all the time but because they prioritize relationships trust, respect a lot of the stuff and
themes that you all touch on. I think back about some of the best things that I've worked,
they weren't led by the loudest person in the room, they're led by people who made others feel valued,
who lifted people up, who led with humility instead of ego. Really people go above and beyond
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for a leader they trust. They'll innovate, they'll take risk-ask hard questions, but they're
fully committed to the work and they bring their energy that's needed because they know their
contributions matter. What I do want to make clear here though is that leading with kindness
isn't about having a card conversation. And I know Malcolm, you and I have talked about this
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when we were discussing psychological safety. It's also not about not holding people accountable.
It's about really making sure that accountability is rooted in fairness and shared purpose.
It's rooted in trust. And that's what's going to lead us to collaboration and problem-solving
instead of hesitation. I think a lot about our work and the next generation. I got a 15-year-old
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who's getting older and we have two warriors uphand probably in the home because he's going to
go off to college and I think a lot about the next generation of leaders, especially when I'm
talking about advocacy and healthcare. I think about how do we create workplaces where people
feel empowered? How do we make sure that diverse perspective aren't just present because that's
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the first step, but they're heard and value. And those present are without the burden of having to
justify their place at the table day in and day out because I'm telling you that's the exhaustion.
That is the point of burn. And really to me, as I think about and I reflect on the question
about psychological safety, it's not a nice to have. It's an necessity. It's what makes teams
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be innovative. Again, to take risk and drive meaningful change. You know what the best part is?
When you create a culture where people feel safe when they're respected and empowered,
magically, not just for performance, follows every time. It's really, it's not a whole lot to it if you
will. So it's an underrated environmental condition and a secret sauce to those effective teams
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that just doesn't get enough coverage. And that's really, really important. It is I reflect
not just on my past career, but again, as I shared about future leaders for this country,
for healthcare, for advocacy, and those who are going to take us to where we're headed.
Yeah, I really think that's because stuff there. And I think about a situation. I don't
think I'm ever shared this with my wife. It's important. It was also kind of a funny situation
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that happened to me. I was working in Ebbitton Alberta in Canada. And I was flying back and
for between New York for about two and a half years every single week. And I was at JFK airport.
There's a diner, or at least it used to be a diner right in the entrance way where Delta is.
And my flight was the lake, because it was just snowstorm happening in Minneapolis or Ebbitton
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wherever I ended up having to admit it. My flight was. I broke my tooth when I was at the diner.
And I looked like a hot mess. And I ended up having to call my dentist the it was crazy because
the fight was canceled. And I was glad to broke that tooth. Yeah, well yeah, because I broke my tooth.
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Yeah, yeah, yeah, yeah. Yeah, we're going to go and continue to take everyone out of the
flight. So, when I had a team waiting for me, I was delivering some technical training for the team out
there. And I caught my dentist and said, hey, I just broke my teeth. And fortunately, I had a
relationship. I built my dentist for two and a year. So, I have a relationship and never I could call
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my homes. He met me at the office the next morning. It took care of my need. But that's a special case,
right? Not everyone. It do that. Actually, go and see their dentists and call them at home.
What if I didn't have that privilege? What if I had to go to work? And I had this broken tooth
and had the liver training. I had a team with me that I was in charge of. But I had to make sure
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that everything flowed well, all the technology behind it well. And I'm in front speaking in front of a
group of people with leadership there with this broken tooth. That would make me not feel that I was
empowered to lead this group of people understanding what they need to do on that job. So, I
I could get a bit of really scary situation for me in that circumstance. I think you really
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speaks to a couple of things, and as you share that story. First, I think that how much pool you have
with the airlines so that out of the gate is really expensive. So, thanks. I did not know
you knew you could do that kind of stuff. But all joking aside, I think it really talks about
the value of that patient provider relationship. And we're seeing less and less of that.
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If you will, as a landscape is shifting. But it really talks about that ability that trusts
feature if you will that is part of your relationship with a provider that continuing to
have care. And really speaks to the provider also stepping up to do the right thing for you at
your moment of need. So, all in all, just a great story. I'm hope your tooth is okay. You got a
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beautiful smile. So, I'm good. I'm good. Thank you. You haven't shut out. Suppalled. Do you
a topless thank you doctor G for helping me out? Okay, so I'm going to ask you a question.
It might be a little backtracking or repetitive. So, let us know. So, so, CAS health equity is such
a critical and complex issue, obviously. What do you see as the biggest barriers to achieving
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equity in oral health today? So, really, the perennial challenge in achieving equity in oral health
is that our healthcare systems still treats dental care separate from oral health. I mean, we,
I mean, we are horse and we are exhausted from telling the story how oral health is deeply connected
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to systemic conditions like diabetes and cardiovascular health, pregnancy outcomes. But a lot of
cases dental care isn't prioritized to say my medical care is, and you look at it, there's millions
of people, especially those who are historically underserved and marginalized communities are left
with that access, even like the most basic of care. Another major barrier to me is that the work
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for shortage and distribution of providers, not all states have Medicaid to build dental benefits,
and even the states that do have Medicaid adult dental benefits, they're simply just not enough
dentist and rural low-income or underserved urban communities. So, that's the other challenge of it.
And really, what those together mean that when people technically have coverage, they still face
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barriers like long way not being able to access their provider, along this is to have to travel
to receive care. And this is an important piece of all of this, right? It's a lack of culturally
responsive care. People don't talk about this enough. And the other end of it, if you will, and this
is again, speaks to the sort of history and where we've been and where this all got started at
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is that the system and the distrust of people towards the system. There's a long history of
communities, particularly black and indigenous and immigrant communities that have been excluded,
but also harmed from by the health care system. And we all know what those are. So, just look up
to us, Kee-hee, and what they did there. And when people have really experienced that discrimination
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or have been told no too many times that have had doors closed on them too many times,
that distrust is a just goal way overnight. It has to be actively rebuilt. It takes
intentionality. So, when you look at broadly these challenges, it's more than just funding that's
needed. I mean, it really requires fundamentally refaking how we deliver care. How do we expand
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workforce? How do we build trust in the system? And all of this, along with investments and
invasions, that center equity is a key outcome measure of success. So, you have the flow of capital,
you have the flow and drive for innovation, but those that really have already built in health
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equity as a key metric for success, not as a performative on this side, checkbox that gets
at taking care of and then we can proceed and move forward. So, all of this really, as you think
about the barriers, it needs to be almost at this full frontal assault on every front,
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to be able to do the work because there's just such a complex sort of a set of challenges that are
before us. I agree, completely. And I think that it's just so entrenched in society to be racist,
classes, sexists, like my own journey through Perry, Maniposa, and Maniposa, it created all sorts of
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like, it worsens like any kind of emotional health that I had going for me at the time because
like, couldn't get in. Gynecologists aren't taking any insurance period. The waitlist is three or four
months long. I had been told that I shouldn't have a historicity for three decades because I was
in so much pain because I might change my mind about having biological kids. This is into my late
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40s. You might change your mind. And so the way that people of color and women are treated
reflects exactly what you're saying. So the rate of mortality for black women giving birth, how
I had a historicity and my doctor told me to buck up and that I didn't need any pain killers.
Meanwhile, I had my stomach held open. Well, the historicity was performed. So I think there's a
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lot of unconscious bias going on as well as conscious bias going on. So it turns it can feel very
overwhelming to fight or even think about it. And I think that's intentional. When we need help
and we kept getting denied, we give up eventually. And if it's hard, it makes me want to give up.
How does someone for whom English is not their first language who has to take off from work,
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who has no child care, who is a single parent? There are so many barriers that I just find them
completely complicit these big, powerful structural systems. Yeah, I agree. And I saw this with my
mother back in 1980. She decided she was going to tube stop and my dad would have more children.
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She did not. So she decided to take off work, go to her doctor, go to hospital and get her
tubes tie. And the doctor said, does your husband know that you're doing this?
And she had to lie and say, yes, he knows. And why are you asking me that question? That was just
1980. Yeah, but back then, too, you know, like it took until the late 70s, there's something for
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women to even be able to get lines of credit or their own bagging count or credit cards. And so
other women who's our friend in the building, he's handy. She was discussing payment terms or
something or speaking to medical person. And she was literally told to put her husband on the phone.
And they're both in their early 80s. And this was just last week. So this stuff is still happening.
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But I think that like, here's the thing. And this just really speaks to how do we
unwind and how do we peel the layers back and the complexity of it. I think a lot of times you see
folks leaning heavily on quance and data and numbers. YouTube were just able to really paint this
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vivid and tactile picture by telling stories and individuals lived experiences and their journey
and their struggle and healthcare system that does not serve all, but it's functioning the way
it was meant to function, which is for some only. What's really fascinating is that you could have
given me a whole bunch of numbers. And I would have been like, wow, I guess 43% is pretty good number,
(31:46):
or 17 is a bad number. But you just describing it qualitatively sharing these stories. It's so much
more poignant. It's so much more heart-hitting and it so brings it to life. I think this is the kind of
still set that we all need to develop more of. And one of the things that I talked to my my students,
(32:07):
the scholars at University of Pennsylvania is just that. It's being able to tell stories,
be able to capture them and frame them in a way that everyone can relate to. And so I just
appreciate both of you sharing these with me because this really again underscores that sort of
that additional angle that we need to cover are advocacy for a big way. Once again,
(32:31):
we're Dr. Cass here. We're excited to have it. Talk to us today in this episode of bridging
worlds and speaking at top and as a black man, married to a white woman, I've seen how racial
and cultural dynamics can shape personal and professional interactions in your experience as a leader
of Middle Eastern heritage. How do you navigate conversations about race,
(32:56):
your representation within your work and the healthcare space at large?
A such an important question, Malcolm. I appreciate your bringing this into the conversation.
I know Amanda just just talking about the sort of the race and gender facets of our health care
and how are the communities interface with it. The thing is a leader of experience first-hand
(33:17):
how representation or lack of it affects opportunities, credibility and how the ideas are received
in a room. When you zoom out, we know that diverse teams function better and they have better outcomes.
And so to me, everyone has to be intentional and on the same page when it comes to how they show
(33:38):
up and to look around to see who else should be present because really as we navigate and we talk
about navigating representation and leadership, it's about more than just visibility. It's about
impact. It's about really moving from the optics and the window dressing to real outcomes in my opinion.
(34:00):
I'm just thinking about an instance where I would have faced something like this when I was heavily
involved in an national development. I saw how quickly racial and ethnic dynamics could either
make or break a team, whether we were in Nepal or Guatemala or Haiti. We had people from all
sorts of different cultures, completely different backgrounds. And so with that came a lot of
(34:23):
cultural context and you have to find common ground, no matter of days and sometimes it could be as
simple as breaking bread with somebody or getting to know them by spending time with them. But
really what made the difference so is I think back as to some of those successes. There's been
humility and listening and shared purpose come to mind and really the best teams that I have
(34:46):
worked with weren't even the ones that ignored the difference. They're not the ones that said,
well, let's not talk about it. They're the ones that acknowledged our differences, but then leveraged
them to a point of growth. Yeah, I tried to bring the same mindset at least I attempt to
leadership whether we're thinking about cultural concordance in workforce. We talked about
(35:07):
representation. Talked about policy making and how policy show, how the man you were talking about
some of the struggles that you personally as well as folks you know have had to deal with.
Boy that trust piece, the reality is that equity work doesn't really succeed unless an
until diverse voices are included and empowered. That's the piece that I always want to add in at the end.
(35:30):
So to me it's not just about being at the table, it's about making sure that the table
changes, it's shape and form to include voices. So that in the future these conversations
don't feel like exceptions, but they're the norm. So it's really normalizing, inclusion,
(35:51):
normalizing, inclusivity, in normalizing, accepting diverse voices and really seeing them as an
added bonus and a differentiator of teams and something that's going to allow us to
even be more effective and collaborative. Not something that creates fracture lines. So
I love what you just said and as a storyteller that I think that you brought that up previously too.
(36:16):
I think that's so important and overlooked and minimized and important because it's not hard-wrought
data in a bar graph or something that you I think that you said something to the effect of
who's telling the story. It's very important because you can have the same thing happen. You can
get nine different interpretations based on a million different factors. But narrative and storytelling
(36:39):
I'm finding is universally helpful, not just in academia, not just in writer circles.
And I think that more of these, I mean we can maybe more in corporate world is more acceptable
to call them test case studies or anecdotes or something like that. But it's just storytelling.
It's also done visually. Like when you have diversity and commercials and in movies and in
(37:03):
Marvel films that's more reflective of American society, I think I like like Caleb who's A,
it blows my mind to think that this young boy is growing up seeing women as the main star,
the main savior in superhero movies. More often than not these days and black Panther and you know
(37:26):
what? That freaking makes a lot of money because that's what we want. Like that's what most
of the earth is meant. Black Panther broke all of the blockbuster rules and highs for our
how many billions of dollars made. So I really think that it does give me a little bit of hope
as future generations and learning to take this for granted that they will see themselves reflected
(37:49):
in the things that they consume and media, TV, news, etc. I agree Amanda. It's really emotional
intelligence, right? This is really you know people having the ability to understand the situations
that they're in, the people who are in these situations, being able to relate to them, being able
to have a conversation with them to make them feel comfortable so they can have the ability to
(38:14):
be psychological safe in these high performance teams, right? So I had a situation long time ago,
I was in Houston now as being introduced by the leadership of this company that I consulted for.
And Carl, who was the leader, he kind of said, hey, I want to introduce you to Malcolm Carter,
but he's not related to Jimmy Carter and got a laugh out of people. Keep in mind, I'm the only
(38:38):
black person in the room, everyone in the room and white. This is Texas, which I love, but this is
Texas and then I threw a little comedy in there myself and said, yeah, I'm not related to Jimmy Carter,
but I am related to June Carter who courses from the very famous Carter family and Johnny
(38:58):
Johnny Cash is wife. So, but then when I was able to do was they connected with me and me
through the humor and then I was able to kind of they were able to listen to me as I was able to listen
to them and then we had a really good session and learning and understand each other's points of
views, understand how we can advance in the work that we were doing and it became something that
(39:22):
we can see as you do within that organization. And Nina, subconscious level, I mean, find a way
cast like that's true. He is related to June Carter and I think that maybe this wasn't your primary
intention, but it did make people think about their unconscious bias and how that transmit,
you can't look at somebody and know what they are, all of a sudden or just include them from
(39:44):
certain other racial categories just by looking at them. So I think that they learned a lot on that.
That's awesome. Me on other hand, like I'm related to John Wilkes Booth. So I try not to
yeah, my grandmother's main name is Booth. Oh John Delos. I try not to bring that up.
Yeah, yeah, probably not going to make you too many friends at the theater. So
(40:09):
you're not going to hear the heart. Yeah, good thing I've not assessed. Yeah. So,
Cass, what keeps you motivated to continue pushing for change in such a challenging and evolving
field? How do you say grounded while leading at such a high level? What keeps me motivated is
that really the next generation of leaders. You know, I've had the privilege of mentoring
(40:30):
students and young professionals and merging advocates and folks in the space that are that are new
to it. And it's their passion that gives me hope. Again, is that the fire that they bring in a
little bit of the idealism that they bring with them. And when I see students in, for example,
American dental education Association, student diversity leadership program that I'm leading.
(40:52):
I see them and their confidence and their energy and their ability to use their voice to drive
change. I know that future of healthcare is in good hands. I also think a lot about, again,
being a little bit in a reflective mindset. I think about legacy. Not in terms of titles and
accolades and or your resume or your CV, but really in terms of impact. What kind of systems are we all
(41:19):
collect, collectively building as for the next generation? We're making it easier for this next generation
to continue their work. Or we leave it on this for the same fight, the same obstacles, the same
barriers that we had to overcome to get us over here. So how do we move the ball? Where do we
stall out? So these are the things that I think about, but this is what also gives me the energy to
(41:42):
go back at it again and to engage and to be around the newest and the new world leaders in a space
or advocates for equity. I love the next generation of me too in Black Lives Matter. Like you,
I really find a lot, at least an activist playing field to be inspired by these next generations
(42:05):
that are coming up in spite of what we see on the news. Absolutely.
Okay, as if you could wave a magic wand and change one thing in healthcare tomorrow. What would it be?
So magic wand was our, I don't know if this came out of our conversations or what now, but this
is a, this is a favorite of ours with Oregon Health Authority. We talked about it. If you had a magic wand,
(42:30):
what would you, what would you use it for? What could you make happen? It's this really
refers to that blank slate that magical ability to to oversee some of the short-term hurdles and
look at the future and dried. What would it look like? For me, it sounds really simplistic, but we're
playing the magic wand game. It would be eliminating the structural barriers, the things that we
(42:52):
just talked about when it comes to the axis and care. Nobody should have to decide between
pain, rent, and go into their doctor. Nobody should have to navigate a maze of bureaucracy just
to get the treatment they need. Nobody should have to sit there and be told buck up. Nobody should
have to deal with the amount of financial burden that people are left with after they get the
(43:17):
care that they were promised to get. We talked a lot about innovations also in healthcare,
but sometimes, really, as you think about the most impactful innovation, it's just simplifying the
systems, allowing the community to be able to navigate those hurdles. I'm reminded of it. I use this a
lot, and I'm hoping I did not use it in this conversation. I don't think I have. Really, it is about
(43:38):
Dr. Heather McGee's point about this zero sum game. People are afraid of the word equity and
health equity because it's really, they think about it as giving special privileges to some
special select group. But it's really, it's not about improving outcomes for certain groups.
It's about building a system that works for everyone. And I know we have a long way to go.
(44:02):
We just talked about what gives us energy. We have future leaders who are incredibly capable,
who bring the system and energy and power in different and new ways of doing these things.
And there's certainly plenty of headwings that we need to get to acknowledge. And this is just
the reality that we're working with. But in my heart, I fully believe that if we continue to push
(44:24):
to challenge and to build, we'll get there. That's great. That's great. Thank you for sharing that.
That's very inspiring and hopeful. Yeah. Well, one of the things that we've been dealing with
unfortunately this year, this is just January of 2025 in the winter. And it's scary to think about
what could happen in the future. And hopefully nothing drastic. But the wildfires in Southern
(44:49):
California, Los Angeles areas have impacted so many people. Not just their homes, but emotionally,
what they've dealt with as well as physical issues that come from the smoke, etc. And what are your
thoughts in terms of what's happening there and how the healthcare affects people and what we
should possibly do? So I'll just start by saying I've got family up in 95 starting from Seattle all
(45:14):
the way down to the border. A major side of my family is in Southern California. Fortunately,
no one that has been impacted by these horrible horrible events and these fires. And you know,
I was just reading and I don't know how big they are now. But yesterday, the acreage of the footprint
of the fire is bigger than the city of Boston, which is horrible to think about. And it's quite
(45:37):
frankly scary. But a couple of things. In immediate thought, if you will, is that hearts and minds go
out to families and individuals to really to wildlife even and the the greenery and the natural
beauty that has been devastated and destroyed. Also thinking about those who are risking their lives
every day to go out there and put themselves in front of fire. You've got a lot of amazing firefighters.
(46:01):
You've got a volunteer workforce. You have just this involved in individuals who have been trained to
fight these fires. People who are trying to battle this and putting themselves in a harm's way for
me. It's just it's just something incredibly awe-inspiring and frankly, something that I'm
daring to say most of us would not have the gumption to pull off. So hats off there. I also think
(46:24):
of lost lives in the wardee and how the recovery is going to go and how long it's going to take.
On the back end of it, if you will, as you zoom out a little bit and you start to ask yourself
these tough questions, these hard questions as to why. Look, I don't not to, you know, this isn't
too shift focus away from individual families who are suffering with this, but you have to
(46:48):
to your point. Think about how this is the winter. It's something I'll for any end. I understand
Santa Ana and Winsysha have been in absolutely madness and insane. But a couple of things come
in a play. On one hand, you have to ask yourselves the challenge that we are all facing with
people find hard, factual science, unpleasant and inconvenient to accept. And so that there is
(47:13):
climate change that we are dealing with. And according to many scientists, we've missed the
the window if you will for taking action. I'm an optimist. I'll always be an optimist. I think there
is opportunity, but denying science and questioning facts and living in an alternate reality,
an alternate world because the real world is achy and it requires tough work isn't going to
(47:35):
get us anywhere. We're just going to have more and more of these events.
Firstly, secondly, we know the burden if you will ultimate burden of these sort of situations when
you've got these environmental disasters are going to be, out of the air load on communities that
I've already don't have the safety net to deal with them. And balancing that against is some
(47:58):
of the narrative going on currently, some of the actions that corporations take to really take
advantage of individuals for in these spaces and are dealing with these tragedies. That to me
is really important juxtaposition where action needs to be taken. I think we can step up. I think we
can protect our communities. I think we can, there are ways to if we're serious about them.
(48:22):
I believe it future occurrences like these, but an immediate moment, all I'm thinking about is
the pain and the suffering that that folks in Southern California are dealing with in those
communities and just sending them all my best and really wishing this to be to be behind them as soon
as possible. Yeah, thank you, Cas. I know, back in 2019, I was working in Salt Lake City.
(48:48):
That was a regular stop for me to work for, I worked at HECCEL Corporation. And there were fires
in Utah, but not as heavy as the fires in California that year. So the smoke from California
carried into Salt Lake City. And I was breathing and it was such a strong smell. I didn't want
(49:11):
to be outside even as like sitting from the California fires. When I did go outside, I had to go back
inside and blow my nose and you can see the coming out of my nose because of the fires. I can't
imagine what that's like for the people who are in California that are so close breathing that air.
(49:32):
And I really hope that people that are there where your masks go see a doctor when you can
to make sure you're okay. Because there are very much so long-term effects from these fires
in just breathing the air. I agree? All right. So, Cas, thank you so much for sharing your incredible
(49:53):
journey and insights with us today. You're working health equity and your perspective as a
leader are truly inspiring. To our listeners, if you'd like to learn more about Dr. Cas,
Raffia's work, check out the links in the episode description. Don't forget to follow us on social
media and visit bridgingworldspotcast.com to stay connected. And so next time, remember bridging
(50:17):
world starts with building connections that matter and thanks for listening. Thanks, Cas. I appreciate
you time. Thank you so much. Pleasure was mine. Thank you both for this is great.
Welcome back to bridging worlds. I'm Amanda, your co-hosts, joined by Malcolm. And we are located
(00:26):
on a traditional ancestral and unceded territory of the Mohican people. Now present day,
Stanford kinetic. Today we're diving into a conversation that beautifully reflects what this podcast
is all about. Bridging the professional and the personal to explore stories of growth,
resilience and meaningful change. Thank you, love you, wife. I appreciate that intro.
(00:49):
Our guest today is so when I've had the pleasure to work with, and this is the former chief
health equity officer at CareQuest Institute, Dr. Kaz Raphia, as ability extraordinary career
at the intersection of health care, equity, and leadership. We're so excited to have them here with us.
From his groundbreaking initiatives at CareQuest Institute to his current roles on the Massachusetts
(01:14):
Board of Registration in Dentistry. And as an Ajax Associate Professor at the University of
Pennsylvania, Kaz has made a lasting impact. Kaz, worth thrilled to have you here. How are you
feeling about joining us today? I'm just excited to be here. Malcolm, just reconnecting with you
as always a pleasure and Amanda. I love the energy and the thoughtfulness that you both bring
(01:36):
to these conversations. I've been looking forward to this dialogue because I really believe just
digging deep in these intersections of leadership and health equity and impact is that's how we
move the needle. And really to me, these moments of reflection are really, really important when
you're in the middle of the work, and when you think of doing the work, you don't always have
the chance to pause and appreciate the journey. So this conversation is a great opportunity to take
(01:58):
really stock up what we've been and what we've learned and what we're headed. So grateful to be here
and excited to dive in. Yeah, awesome. In Kaz, I would like you know, I'm very thankful to have
worked with you because you started before me. And when I came on board at CareQuest Institute,
it was a treat to be able to interact with you to talk with you, have professional as well as
(02:18):
personal conversations. And I thought that you would be a perfect fit for what we're trying to do
with the Bridgie Rose podcast. Thank you, Malcolm. What a privilege to be here with you.
Let's dive into this incredible journey. So first we're going to talk about the journey to health
equity. Kaz, let's start with your journey. What inspired you to pursue a career in health care
(02:40):
and how did health equity become such a central focus for you? Yeah. So I'd say that my path to health
care, specifically your question, health equity, wasn't something that I strategically planned and
drew it on a board somewhere. It was really shaped by my personal lived experience and you know,
like a lot of us, the stories that we encounter, shape our paths forward. And it really had
(03:01):
growing understanding that the health outcomes that we're seeing aren't just dictated by medical
interventions and the care that we're receiving. But really by the systems and the policies and
really access, you know, the old adage to 80, 20 rule. We know that 80% of all health care outcomes
have nothing to do with direct delivery of care. It only 20% of them have to do with
(03:23):
seeing your doctor and actual medical interventions. I first became interested in dentistry because I saw
how our health really impacts every aspect of an individual's life. If you're a pain,
you can't focus up school or at work. And if you're really embarrassed about your teeth,
you might not speak up in a meeting or go after opportunities that you might be afforded. I've
seen people in patients who've struggled with basic preventable conditions just because they
(03:47):
couldn't afford care. And it made me realize that dentistry in oral health isn't just about fixing
teeth, but it's about dignity and opportunity and fairness. There's an anecdote that comes to my mind,
just based on what you just said, and that is in one of my women's recovery groups. There's a
young woman. This is not uncommon. There are young, affluent women. There are silver mothers. And a number
(04:10):
of them admit that they haven't been to a dentist in years. And the reason is because shame from drug
use, or meth, or alcohol, or what have you. And one young woman went to her dentist after being sober
for a certain amount of time. It was just so anxious and in tears and crying. And her dentist had
emotional intelligence enough to say to her, to just stop her and say, welcome back. I'm so glad you're
(04:34):
here. And she took it as welcome back to life, not just welcome back to the dentist. So I really
feel you on the mental health aspects of this powerful. Yeah, it's a powerful. I love that story
for multiple multiple reasons because it really demonstrates that, you know, for an individual who's
been through a lot to show the fortitude to be able to actually step back in an environment where
(04:59):
it might be an additional layer of challenge. So we got to recognize the effectively to victim,
if you will, and this is in all of us as well, the person who's dealing with the emotional
toll of the turbulence that they've had to experience, but also the provider who stepped up to
the plate and made sure that they were able to create the space for the patient to feel at ease.
And that in a lot of ways, and I know we're we're going to talk about this down the road. It's about
(05:22):
that safety, if you will, that we're trying to create for everyone around us. Excellent. Thank you.
Cause your career has been incredibly diverse, spanning so many impactful roles. Was there a
particular moment or experience that made you say, this is what I meant to do? Well, you know,
if I can necessarily identify A-momum, but I would say one of my pivotal moments was during my
(05:45):
residence program at Oregon Health Sciences University. We had tribal community members. We
had to travel for hours to come to our hospital residency program clinics and many of them struggle
with co-morbidities and really nothing about that felt fair or right. And we'd see the impact
that we were able to make and then the transformation that the patients underwent and just
(06:05):
basically for us providing care to them with respect and compassion, which is a really basic formula.
It didn't take much, but you see firsthand the the system that has turned its back on people.
And you can't help but to want to do something about it. In really moments like that reinforced
to me, at least that it's not the policy being about paperwork and legislation. It's about real
(06:28):
people, real lives, real impact of systemic barriers. And that's why shifted my focus towards
policy now, you can see inequity because delivery care one on one is incredibly meaningful.
But the force multipliers I was like to say and it's a stickingness of the changes happen
when the system itself changes. I think that's great. I think it makes it very sort of universal.
(06:48):
And there's something of what you're being at everyone can attach themselves to.
I'm reminded of some domestic violence work that I did when I first moved to New York City
and the triangulation of the victim survivor and then the perpetrator. And then there's usually
a silent observer who sees what's happening, often it's sort of blamed or allocated to the
(07:09):
woman. Like the mother didn't protect the child from the father who is abusing the child.
And so it's this triangular way of looking at things that I see in the health system because I
identify as a victim survivor. I think we all are to a certain extent in health care system.
And sort of identifying also that same silent observer who knows what's going on.
Right? That's making the legislation that it doesn't affect on a personal basis. It doesn't affect
(07:33):
their mother. It doesn't affect their son. And they need to be held accountable too. And in the
meantime, we have to reach around and figure out how to help that victim survivor.
Precisely. Well put. Thank you. Yeah. And speaking of policy and advocacy,
I know that you've worked extensively in this area, both a care quest and your role currently
with a Massachusetts-Dinnissue Board. What's been the most rewarding part of influencing policy
(07:58):
and what challenges have you face, Cass? You know, so I would say strangely enough that the
journey and the process itself has been one of the most rewarding parts just to work in the long
fearless individuals. People who are bringing an energy and a passion, juice and a fire to this work.
These are the folks who challenge a status quo and they're really the ones making things happen
(08:18):
down range. But when you're doing this work, you also have to be aware of some major hurdles
like competing and shifting interests. We know that policies shaped by a lot of stakeholders and
not everyone's growing the same direction all the time. And then you have some folks who really
see this work as an individual endeavor rather than a team effort, which can really slow
(08:39):
meaningful progress. But despite the challenges, I stay in this work because I know policy shift
is the right direction. It has real and lasting impact on people's lives and that makes
every battle worth it. As for challenges, I would say one of the biggest challenges with
in policy and advocacy work is that incremental nature of policy investment. We know that
(08:59):
real challenge to people stay focused on policy and advocacy work is that they want the sort of
immediate gratification, but we also at the same time are aware that real change just doesn't happen
overnight. You push, you make progress, sometimes you take a step back before moving forward, it
requires persistence. And that's that juiced and fired that I was talking about. And you need to
spend years working on an issue. You may not even see it formulated while you're even
(09:23):
in the field. But that's really the nature of the work. It's about contributing to something
larger than yourself. Yeah, I mean listen, I feel that completely my father was a lobbyist
and a stated Michigan as well as Washington DC. I used to work on capital hill work for
US Senator Donald Riggle Jr. And seeing people trying to bring an advocate policy out there,
(09:45):
sometimes they just don't know the route to take or have a patience to work through a system
to ensure that you can get things done. A sometimes timing of the efforts, I worked with health
care back during the day when Hillary Clinton was trying to get that through during bill start
of his presidency and how challenging it was with somebody who has a seat at the table. And when
(10:08):
you don't, it really becomes a challenge. But you have to understand, you have to learn, you have to
stay with it because a lot of these things that don't get past should get past in our society,
including the things that you did with on an everyday basis in terms of dental health care.
I like what you said to cause about just it really does sort of depend on the chemistry among
(10:31):
co-workers too and how frequently you exchange ideas. And of course there's such a thing as
caretaker is burnout where I consider you to one of the health helping professions. And I think
that for those of us that are sort of on the front lines and just trying to put food on a table
and raise their kids right and take care of their pets and further their education, it's exhausting.
(10:52):
And it's the thing that it's important to highlight that and to create healthy boundaries.
Self-care has been used so often that it's sort of meaningless. Nonetheless, it's like I think
of veterinarians for instance, like veterinarians have a very, very, very, very high rate of suicide.
It's a very high academic rigorous process and yet caring for sick and dying animals who
(11:13):
have no agency in speaking to their own nails and wills and frustrations and pains.
It completely like tears them apart to the extent where they didn't have mental illness now they do.
So I'm wondering how you deal with burnout sort of being on the front lines.
Yeah, that's a great question. I think it's a couple of things. I'll be honest with you.
I think the starting point to that answer that is we don't have formal training.
(11:36):
And most other fields behavioral and mental health is not emphasized and have
balanced that you were talking about is not highlighted. I also think within health care professionals,
it self-selects for individuals who are very, very driven. They're focused on the goals and targets.
And at times that drive and ambition ends up costing them their behavioral and mental health
(11:59):
and well-being and have balanced that you are referring to. So that's the reality and that's
a background. The good news is though that sort of narrative is changed. Everybody from academia to
organized industry and a lot of advocates on the ground individuals who are really highlighting and
talking about why this sort of demonstrating vulnerability. Be able to talk to your colleagues.
Be able to share the pain and everything that you're going through is important.
(12:23):
Prioritizing and making sure you're family and your mental well-being is ahead of your career
and your professional ambitions is also significant and important. But I think to stigma has been
changing from when I started about 25 years ago and that's really the progress, if you will.
On a day-to-day basis, I would say across the continuum between the different levels of
(12:44):
abilities that the clinicians might have but also their exposure to the disfainance offering.
I think it comes down to what tools have you availed yourself? Where's your mental,
state and well-being? And how open are you? And how safe do you feel demonstrating vulnerability
that it takes to want to seek help? I think we've come a long way. There is still a long way to go
(13:05):
but these conversations are the kind of fuel that I think we need to make sure that we accelerate
the pace for this overall well-being and mental health. That's excellent. I love your response
to that. I love how you run for in sort of modeling a healthier sense of self and behavior.
There are psychological safety. These are all tenants that we've been bringing up since the
get go. Modeling vulnerability. And this sort of leads in my next question for you as an educator.
(13:29):
And that is, you also work as an adjunct associate professor at U Pen and you teach policy and
advocacy. So as someone whose my mom was a PhD student and professor at Penn Slerasore
raised around you, smart nicks and everything, I know how much this institution values shaping
future leaders. How do you make these complex topics accessible and engaging for your students?
(13:53):
It's a great question and Malcolm just touched on it based on the experience of his dad that he
shared. And that sort of what it tells us at healthcare policy and landscape is really complicated.
It is core when you look at the politics of it though, it's about decision. Who makes some who
benefits from them and who can get slept behind? And you try to really peel back the layers. You
(14:15):
notice that the cardinal challenge and complexity is bridging the gap. No pun intended between
policy theory and live the experience of real people whose lives are touching. That's something
that you are sharing a man about what policies that are out there who are the folks being impacted.
So for example, we're talking about workforce development benefits and access medical
(14:36):
dental integration. We're not just talking about numbers on a page or just a quance. We're talking
about whether a single mother can get time off, take the kids to the dentist or whether senior
on fixing, come to the foretreat man or from veteran living in rural community has a right benefits
as well as a providers within driving distance to see for their dental needs. And this is
something I emphasize in my work that Penn, what I'm talking about policy and advocacy, I don't
(15:00):
just focus on a technical aspects. There are plenty there's all kinds of frameworks and a
lingo and a jargon. But I focus on a human stories behind these policies. A really my goal is to
make sure that the scholars really understand that advocacy isn't just about lobbying and legislating
the action even. But it's really about knowing how to leverage data to tell a compelling story
(15:21):
and how to elevate the community voices and how to navigate systems effectively. That's really
the sort of navigation piece Malcolm that you were talking about earlier and how challenging it is
to find a path forward. And we see this in a lot of different spheres and areas like I think of
recidivism, rates and what the health as country has responded to rates of recidivism. And
(15:43):
traditionally what it's done is just really restrict people who have been incarcerated but who
serve their time and pay their bail and they're out and they've survived prison. And then
they're told that they have to write their legal history, they have to say that they were arrested,
they have to say that they were incarcerated on job applications. So then they're immediately
self-selecting them to be rejected. So this was reflected in the central part by as you know, where
(16:06):
to come back from prison after being freed, they can't even leave their room in the section
in the housing project because they feel only feel safe and that's well by five room.
Or they're re-arrested because they're not supposed to step foot in any family's housing that's
sexually housing. Or they're bringing their grandmother groceries and their grandmother can't even
let them in or else she may go to jail. So it's very sneaky outdated practices that are still
(16:32):
being used. They're still being weaponized. I think against the weakest people in society even
knows who have navigated what they need to navigate to get out of a bad situation in life.
I think those are precisely systems type barriers those those sort of obstacles that are
poured in concrete around us and I think that's the sort of hard work that needs to be done
(16:53):
if we're going to have the changes that we're seeking. Yeah, I've seen it from a business standpoint
for about eight years. I worked in energy and I was working for multiple energy pipeline
companies, oil and gas pipeline companies and I've worked in some pretty remote areas of the
country where you know their digital deserts out there. There are people who don't have the
(17:19):
care that they need and sometimes that becomes a factor with multiple things that you're talking
about a man if you're a personal standpoint. It affects them when they are working in the business
and it's up to leadership I believe to help support these people that are out there. And at least
to my question, in leadership creating a culture of psychological safety is critical,
(17:41):
especially in spaces where people are addressing equity and systemic challenges. How do you foster
psychological safety within your teams and discussions to encourage openness and progress?
I love the tie-in about come by date and it's may not seem obvious but all this ties to this
ideal psychological safety that you talked about. If people don't feel safe, bringing their ideas
(18:04):
up perspective into the conversation, progress stalls. They've one of the biggest misconceptions
about leadership is that it organically just happens. If you put folks at a room, great teams will
naturally emerge but the reality is that building a high-performing team is an intentional act.
It requires thoughts that you've got to put an effort and probably most importantly the
(18:26):
element that ingredient in there is trust. Without that foundation, you could put the most talented
folks in a room and they'll struggle to collaborate effectively. What I've learned from my years in
academia or nonprofit work or government is that really that leaders through mandate and charge
is to set the tone as to how the team will function and how they're going to interact with each other.
(18:49):
In that trust and tone that we just talked about represent the two core components from
my perspective of psychological safety which is the operating system of an effective team.
Psychological safety is what lets people bring their big best ideas and knock it shut down or
ignored or dismissed. The other thing that I want to bring up there is that there is also this
(19:09):
stereotype that if you're too nice and make sure you're ineffective and then you have to be tough and
cut-trolled or authoritative to get results. And we see this around us a lot these days. If you
will in micro and miso environments all over the TV and news. But in my experience,
nice guys do finish first. And not because they avoid conflict or keep a want to keep everyone
(19:35):
happy all the time but because they prioritize relationships trust, respect a lot of the stuff and
themes that you all touch on. I think back about some of the best things that I've worked,
they weren't led by the loudest person in the room, they're led by people who made others feel valued,
who lifted people up, who led with humility instead of ego. Really people go above and beyond
(19:57):
for a leader they trust. They'll innovate, they'll take risk-ask hard questions, but they're
fully committed to the work and they bring their energy that's needed because they know their
contributions matter. What I do want to make clear here though is that leading with kindness
isn't about having a card conversation. And I know Malcolm, you and I have talked about this
(20:17):
when we were discussing psychological safety. It's also not about not holding people accountable.
It's about really making sure that accountability is rooted in fairness and shared purpose.
It's rooted in trust. And that's what's going to lead us to collaboration and problem-solving
instead of hesitation. I think a lot about our work and the next generation. I got a 15-year-old
(20:41):
who's getting older and we have two warriors uphand probably in the home because he's going to
go off to college and I think a lot about the next generation of leaders, especially when I'm
talking about advocacy and healthcare. I think about how do we create workplaces where people
feel empowered? How do we make sure that diverse perspective aren't just present because that's
(21:02):
the first step, but they're heard and value. And those present are without the burden of having to
justify their place at the table day in and day out because I'm telling you that's the exhaustion.
That is the point of burn. And really to me, as I think about and I reflect on the question
about psychological safety, it's not a nice to have. It's an necessity. It's what makes teams
(21:25):
be innovative. Again, to take risk and drive meaningful change. You know what the best part is?
When you create a culture where people feel safe when they're respected and empowered,
magically, not just for performance, follows every time. It's really, it's not a whole lot to it if you
will. So it's an underrated environmental condition and a secret sauce to those effective teams
(21:51):
that just doesn't get enough coverage. And that's really, really important. It is I reflect
not just on my past career, but again, as I shared about future leaders for this country,
for healthcare, for advocacy, and those who are going to take us to where we're headed.
Yeah, I really think that's because stuff there. And I think about a situation. I don't
think I'm ever shared this with my wife. It's important. It was also kind of a funny situation
(22:15):
that happened to me. I was working in Ebbitton Alberta in Canada. And I was flying back and
for between New York for about two and a half years every single week. And I was at JFK airport.
There's a diner, or at least it used to be a diner right in the entrance way where Delta is.
And my flight was the lake, because it was just snowstorm happening in Minneapolis or Ebbitton
(22:39):
wherever I ended up having to admit it. My flight was. I broke my tooth when I was at the diner.
And I looked like a hot mess. And I ended up having to call my dentist the it was crazy because
the fight was canceled. And I was glad to broke that tooth. Yeah, well yeah, because I broke my tooth.
(23:02):
Yeah, yeah, yeah, yeah. Yeah, we're going to go and continue to take everyone out of the
flight. So, when I had a team waiting for me, I was delivering some technical training for the team out
there. And I caught my dentist and said, hey, I just broke my teeth. And fortunately, I had a
relationship. I built my dentist for two and a year. So, I have a relationship and never I could call
(23:23):
my homes. He met me at the office the next morning. It took care of my need. But that's a special case,
right? Not everyone. It do that. Actually, go and see their dentists and call them at home.
What if I didn't have that privilege? What if I had to go to work? And I had this broken tooth
and had the liver training. I had a team with me that I was in charge of. But I had to make sure
(23:49):
that everything flowed well, all the technology behind it well. And I'm in front speaking in front of a
group of people with leadership there with this broken tooth. That would make me not feel that I was
empowered to lead this group of people understanding what they need to do on that job. So, I
I could get a bit of really scary situation for me in that circumstance. I think you really
(24:12):
speaks to a couple of things, and as you share that story. First, I think that how much pool you have
with the airlines so that out of the gate is really expensive. So, thanks. I did not know
you knew you could do that kind of stuff. But all joking aside, I think it really talks about
the value of that patient provider relationship. And we're seeing less and less of that.
(24:36):
If you will, as a landscape is shifting. But it really talks about that ability that trusts
feature if you will that is part of your relationship with a provider that continuing to
have care. And really speaks to the provider also stepping up to do the right thing for you at
your moment of need. So, all in all, just a great story. I'm hope your tooth is okay. You got a
(24:57):
beautiful smile. So, I'm good. I'm good. Thank you. You haven't shut out. Suppalled. Do you
a topless thank you doctor G for helping me out? Okay, so I'm going to ask you a question.
It might be a little backtracking or repetitive. So, let us know. So, so, CAS health equity is such
a critical and complex issue, obviously. What do you see as the biggest barriers to achieving
(25:20):
equity in oral health today? So, really, the perennial challenge in achieving equity in oral health
is that our healthcare systems still treats dental care separate from oral health. I mean, we,
I mean, we are horse and we are exhausted from telling the story how oral health is deeply connected
(25:42):
to systemic conditions like diabetes and cardiovascular health, pregnancy outcomes. But a lot of
cases dental care isn't prioritized to say my medical care is, and you look at it, there's millions
of people, especially those who are historically underserved and marginalized communities are left
with that access, even like the most basic of care. Another major barrier to me is that the work
(26:06):
for shortage and distribution of providers, not all states have Medicaid to build dental benefits,
and even the states that do have Medicaid adult dental benefits, they're simply just not enough
dentist and rural low-income or underserved urban communities. So, that's the other challenge of it.
And really, what those together mean that when people technically have coverage, they still face
(26:28):
barriers like long way not being able to access their provider, along this is to have to travel
to receive care. And this is an important piece of all of this, right? It's a lack of culturally
responsive care. People don't talk about this enough. And the other end of it, if you will, and this
is again, speaks to the sort of history and where we've been and where this all got started at
(26:52):
is that the system and the distrust of people towards the system. There's a long history of
communities, particularly black and indigenous and immigrant communities that have been excluded,
but also harmed from by the health care system. And we all know what those are. So, just look up
to us, Kee-hee, and what they did there. And when people have really experienced that discrimination
(27:14):
or have been told no too many times that have had doors closed on them too many times,
that distrust is a just goal way overnight. It has to be actively rebuilt. It takes
intentionality. So, when you look at broadly these challenges, it's more than just funding that's
needed. I mean, it really requires fundamentally refaking how we deliver care. How do we expand
(27:37):
workforce? How do we build trust in the system? And all of this, along with investments and
invasions, that center equity is a key outcome measure of success. So, you have the flow of capital,
you have the flow and drive for innovation, but those that really have already built in health
(27:57):
equity as a key metric for success, not as a performative on this side, checkbox that gets
at taking care of and then we can proceed and move forward. So, all of this really, as you think
about the barriers, it needs to be almost at this full frontal assault on every front,
(28:19):
to be able to do the work because there's just such a complex sort of a set of challenges that are
before us. I agree, completely. And I think that it's just so entrenched in society to be racist,
classes, sexists, like my own journey through Perry, Maniposa, and Maniposa, it created all sorts of
(28:40):
like, it worsens like any kind of emotional health that I had going for me at the time because
like, couldn't get in. Gynecologists aren't taking any insurance period. The waitlist is three or four
months long. I had been told that I shouldn't have a historicity for three decades because I was
in so much pain because I might change my mind about having biological kids. This is into my late
(29:04):
40s. You might change your mind. And so the way that people of color and women are treated
reflects exactly what you're saying. So the rate of mortality for black women giving birth, how
I had a historicity and my doctor told me to buck up and that I didn't need any pain killers.
Meanwhile, I had my stomach held open. Well, the historicity was performed. So I think there's a
(29:30):
lot of unconscious bias going on as well as conscious bias going on. So it turns it can feel very
overwhelming to fight or even think about it. And I think that's intentional. When we need help
and we kept getting denied, we give up eventually. And if it's hard, it makes me want to give up.
How does someone for whom English is not their first language who has to take off from work,
(29:52):
who has no child care, who is a single parent? There are so many barriers that I just find them
completely complicit these big, powerful structural systems. Yeah, I agree. And I saw this with my
mother back in 1980. She decided she was going to tube stop and my dad would have more children.
(30:14):
She did not. So she decided to take off work, go to her doctor, go to hospital and get her
tubes tie. And the doctor said, does your husband know that you're doing this?
And she had to lie and say, yes, he knows. And why are you asking me that question? That was just
1980. Yeah, but back then, too, you know, like it took until the late 70s, there's something for
(30:38):
women to even be able to get lines of credit or their own bagging count or credit cards. And so
other women who's our friend in the building, he's handy. She was discussing payment terms or
something or speaking to medical person. And she was literally told to put her husband on the phone.
And they're both in their early 80s. And this was just last week. So this stuff is still happening.
(31:01):
But I think that like, here's the thing. And this just really speaks to how do we
unwind and how do we peel the layers back and the complexity of it. I think a lot of times you see
folks leaning heavily on quance and data and numbers. YouTube were just able to really paint this
(31:22):
vivid and tactile picture by telling stories and individuals lived experiences and their journey
and their struggle and healthcare system that does not serve all, but it's functioning the way
it was meant to function, which is for some only. What's really fascinating is that you could have
given me a whole bunch of numbers. And I would have been like, wow, I guess 43% is pretty good number,
(31:46):
or 17 is a bad number. But you just describing it qualitatively sharing these stories. It's so much
more poignant. It's so much more heart-hitting and it so brings it to life. I think this is the kind of
still set that we all need to develop more of. And one of the things that I talked to my my students,
(32:07):
the scholars at University of Pennsylvania is just that. It's being able to tell stories,
be able to capture them and frame them in a way that everyone can relate to. And so I just
appreciate both of you sharing these with me because this really again underscores that sort of
that additional angle that we need to cover are advocacy for a big way. Once again,
(32:31):
we're Dr. Cass here. We're excited to have it. Talk to us today in this episode of bridging
worlds and speaking at top and as a black man, married to a white woman, I've seen how racial
and cultural dynamics can shape personal and professional interactions in your experience as a leader
of Middle Eastern heritage. How do you navigate conversations about race,
(32:56):
your representation within your work and the healthcare space at large?
A such an important question, Malcolm. I appreciate your bringing this into the conversation.
I know Amanda just just talking about the sort of the race and gender facets of our health care
and how are the communities interface with it. The thing is a leader of experience first-hand
(33:17):
how representation or lack of it affects opportunities, credibility and how the ideas are received
in a room. When you zoom out, we know that diverse teams function better and they have better outcomes.
And so to me, everyone has to be intentional and on the same page when it comes to how they show
(33:38):
up and to look around to see who else should be present because really as we navigate and we talk
about navigating representation and leadership, it's about more than just visibility. It's about
impact. It's about really moving from the optics and the window dressing to real outcomes in my opinion.
(34:00):
I'm just thinking about an instance where I would have faced something like this when I was heavily
involved in an national development. I saw how quickly racial and ethnic dynamics could either
make or break a team, whether we were in Nepal or Guatemala or Haiti. We had people from all
sorts of different cultures, completely different backgrounds. And so with that came a lot of
(34:23):
cultural context and you have to find common ground, no matter of days and sometimes it could be as
simple as breaking bread with somebody or getting to know them by spending time with them. But
really what made the difference so is I think back as to some of those successes. There's been
humility and listening and shared purpose come to mind and really the best teams that I have
(34:46):
worked with weren't even the ones that ignored the difference. They're not the ones that said,
well, let's not talk about it. They're the ones that acknowledged our differences, but then leveraged
them to a point of growth. Yeah, I tried to bring the same mindset at least I attempt to
leadership whether we're thinking about cultural concordance in workforce. We talked about
(35:07):
representation. Talked about policy making and how policy show, how the man you were talking about
some of the struggles that you personally as well as folks you know have had to deal with.
Boy that trust piece, the reality is that equity work doesn't really succeed unless an
until diverse voices are included and empowered. That's the piece that I always want to add in at the end.
(35:30):
So to me it's not just about being at the table, it's about making sure that the table
changes, it's shape and form to include voices. So that in the future these conversations
don't feel like exceptions, but they're the norm. So it's really normalizing, inclusion,
(35:51):
normalizing, inclusivity, in normalizing, accepting diverse voices and really seeing them as an
added bonus and a differentiator of teams and something that's going to allow us to
even be more effective and collaborative. Not something that creates fracture lines. So
I love what you just said and as a storyteller that I think that you brought that up previously too.
(36:16):
I think that's so important and overlooked and minimized and important because it's not hard-wrought
data in a bar graph or something that you I think that you said something to the effect of
who's telling the story. It's very important because you can have the same thing happen. You can
get nine different interpretations based on a million different factors. But narrative and storytelling
(36:39):
I'm finding is universally helpful, not just in academia, not just in writer circles.
And I think that more of these, I mean we can maybe more in corporate world is more acceptable
to call them test case studies or anecdotes or something like that. But it's just storytelling.
It's also done visually. Like when you have diversity and commercials and in movies and in
(37:03):
Marvel films that's more reflective of American society, I think I like like Caleb who's A,
it blows my mind to think that this young boy is growing up seeing women as the main star,
the main savior in superhero movies. More often than not these days and black Panther and you know
(37:26):
what? That freaking makes a lot of money because that's what we want. Like that's what most
of the earth is meant. Black Panther broke all of the blockbuster rules and highs for our
how many billions of dollars made. So I really think that it does give me a little bit of hope
as future generations and learning to take this for granted that they will see themselves reflected
(37:49):
in the things that they consume and media, TV, news, etc. I agree Amanda. It's really emotional
intelligence, right? This is really you know people having the ability to understand the situations
that they're in, the people who are in these situations, being able to relate to them, being able
to have a conversation with them to make them feel comfortable so they can have the ability to
(38:14):
be psychological safe in these high performance teams, right? So I had a situation long time ago,
I was in Houston now as being introduced by the leadership of this company that I consulted for.
And Carl, who was the leader, he kind of said, hey, I want to introduce you to Malcolm Carter,
but he's not related to Jimmy Carter and got a laugh out of people. Keep in mind, I'm the only
(38:38):
black person in the room, everyone in the room and white. This is Texas, which I love, but this is
Texas and then I threw a little comedy in there myself and said, yeah, I'm not related to Jimmy Carter,
but I am related to June Carter who courses from the very famous Carter family and Johnny
(38:58):
Johnny Cash is wife. So, but then when I was able to do was they connected with me and me
through the humor and then I was able to kind of they were able to listen to me as I was able to listen
to them and then we had a really good session and learning and understand each other's points of
views, understand how we can advance in the work that we were doing and it became something that
(39:22):
we can see as you do within that organization. And Nina, subconscious level, I mean, find a way
cast like that's true. He is related to June Carter and I think that maybe this wasn't your primary
intention, but it did make people think about their unconscious bias and how that transmit,
you can't look at somebody and know what they are, all of a sudden or just include them from
(39:44):
certain other racial categories just by looking at them. So I think that they learned a lot on that.
That's awesome. Me on other hand, like I'm related to John Wilkes Booth. So I try not to
yeah, my grandmother's main name is Booth. Oh John Delos. I try not to bring that up.
Yeah, yeah, probably not going to make you too many friends at the theater. So
(40:09):
you're not going to hear the heart. Yeah, good thing I've not assessed. Yeah. So,
Cass, what keeps you motivated to continue pushing for change in such a challenging and evolving
field? How do you say grounded while leading at such a high level? What keeps me motivated is
that really the next generation of leaders. You know, I've had the privilege of mentoring
(40:30):
students and young professionals and merging advocates and folks in the space that are that are new
to it. And it's their passion that gives me hope. Again, is that the fire that they bring in a
little bit of the idealism that they bring with them. And when I see students in, for example,
American dental education Association, student diversity leadership program that I'm leading.
(40:52):
I see them and their confidence and their energy and their ability to use their voice to drive
change. I know that future of healthcare is in good hands. I also think a lot about, again,
being a little bit in a reflective mindset. I think about legacy. Not in terms of titles and
accolades and or your resume or your CV, but really in terms of impact. What kind of systems are we all
(41:19):
collect, collectively building as for the next generation? We're making it easier for this next generation
to continue their work. Or we leave it on this for the same fight, the same obstacles, the same
barriers that we had to overcome to get us over here. So how do we move the ball? Where do we
stall out? So these are the things that I think about, but this is what also gives me the energy to
(41:42):
go back at it again and to engage and to be around the newest and the new world leaders in a space
or advocates for equity. I love the next generation of me too in Black Lives Matter. Like you,
I really find a lot, at least an activist playing field to be inspired by these next generations
(42:05):
that are coming up in spite of what we see on the news. Absolutely.
Okay, as if you could wave a magic wand and change one thing in healthcare tomorrow. What would it be?
So magic wand was our, I don't know if this came out of our conversations or what now, but this
is a, this is a favorite of ours with Oregon Health Authority. We talked about it. If you had a magic wand,
(42:30):
what would you, what would you use it for? What could you make happen? It's this really
refers to that blank slate that magical ability to to oversee some of the short-term hurdles and
look at the future and dried. What would it look like? For me, it sounds really simplistic, but we're
playing the magic wand game. It would be eliminating the structural barriers, the things that we
(42:52):
just talked about when it comes to the axis and care. Nobody should have to decide between
pain, rent, and go into their doctor. Nobody should have to navigate a maze of bureaucracy just
to get the treatment they need. Nobody should have to sit there and be told buck up. Nobody should
have to deal with the amount of financial burden that people are left with after they get the
(43:17):
care that they were promised to get. We talked a lot about innovations also in healthcare,
but sometimes, really, as you think about the most impactful innovation, it's just simplifying the
systems, allowing the community to be able to navigate those hurdles. I'm reminded of it. I use this a
lot, and I'm hoping I did not use it in this conversation. I don't think I have. Really, it is about
(43:38):
Dr. Heather McGee's point about this zero sum game. People are afraid of the word equity and
health equity because it's really, they think about it as giving special privileges to some
special select group. But it's really, it's not about improving outcomes for certain groups.
It's about building a system that works for everyone. And I know we have a long way to go.
(44:02):
We just talked about what gives us energy. We have future leaders who are incredibly capable,
who bring the system and energy and power in different and new ways of doing these things.
And there's certainly plenty of headwings that we need to get to acknowledge. And this is just
the reality that we're working with. But in my heart, I fully believe that if we continue to push
(44:24):
to challenge and to build, we'll get there. That's great. That's great. Thank you for sharing that.
That's very inspiring and hopeful. Yeah. Well, one of the things that we've been dealing with
unfortunately this year, this is just January of 2025 in the winter. And it's scary to think about
what could happen in the future. And hopefully nothing drastic. But the wildfires in Southern
(44:49):
California, Los Angeles areas have impacted so many people. Not just their homes, but emotionally,
what they've dealt with as well as physical issues that come from the smoke, etc. And what are your
thoughts in terms of what's happening there and how the healthcare affects people and what we
should possibly do? So I'll just start by saying I've got family up in 95 starting from Seattle all
(45:14):
the way down to the border. A major side of my family is in Southern California. Fortunately,
no one that has been impacted by these horrible horrible events and these fires. And you know,
I was just reading and I don't know how big they are now. But yesterday, the acreage of the footprint
of the fire is bigger than the city of Boston, which is horrible to think about. And it's quite
(45:37):
frankly scary. But a couple of things. In immediate thought, if you will, is that hearts and minds go
out to families and individuals to really to wildlife even and the the greenery and the natural
beauty that has been devastated and destroyed. Also thinking about those who are risking their lives
every day to go out there and put themselves in front of fire. You've got a lot of amazing firefighters.
(46:01):
You've got a volunteer workforce. You have just this involved in individuals who have been trained to
fight these fires. People who are trying to battle this and putting themselves in a harm's way for
me. It's just it's just something incredibly awe-inspiring and frankly, something that I'm
daring to say most of us would not have the gumption to pull off. So hats off there. I also think
(46:24):
of lost lives in the wardee and how the recovery is going to go and how long it's going to take.
On the back end of it, if you will, as you zoom out a little bit and you start to ask yourself
these tough questions, these hard questions as to why. Look, I don't not to, you know, this isn't
too shift focus away from individual families who are suffering with this, but you have to
(46:48):
to your point. Think about how this is the winter. It's something I'll for any end. I understand
Santa Ana and Winsysha have been in absolutely madness and insane. But a couple of things come
in a play. On one hand, you have to ask yourselves the challenge that we are all facing with
people find hard, factual science, unpleasant and inconvenient to accept. And so that there is
(47:13):
climate change that we are dealing with. And according to many scientists, we've missed the
the window if you will for taking action. I'm an optimist. I'll always be an optimist. I think there
is opportunity, but denying science and questioning facts and living in an alternate reality,
an alternate world because the real world is achy and it requires tough work isn't going to
(47:35):
get us anywhere. We're just going to have more and more of these events.
Firstly, secondly, we know the burden if you will ultimate burden of these sort of situations when
you've got these environmental disasters are going to be, out of the air load on communities that
I've already don't have the safety net to deal with them. And balancing that against is some
(47:58):
of the narrative going on currently, some of the actions that corporations take to really take
advantage of individuals for in these spaces and are dealing with these tragedies. That to me
is really important juxtaposition where action needs to be taken. I think we can step up. I think we
can protect our communities. I think we can, there are ways to if we're serious about them.
(48:22):
I believe it future occurrences like these, but an immediate moment, all I'm thinking about is
the pain and the suffering that that folks in Southern California are dealing with in those
communities and just sending them all my best and really wishing this to be to be behind them as soon
as possible. Yeah, thank you, Cas. I know, back in 2019, I was working in Salt Lake City.
(48:48):
That was a regular stop for me to work for, I worked at HECCEL Corporation. And there were fires
in Utah, but not as heavy as the fires in California that year. So the smoke from California
carried into Salt Lake City. And I was breathing and it was such a strong smell. I didn't want
(49:11):
to be outside even as like sitting from the California fires. When I did go outside, I had to go back
inside and blow my nose and you can see the coming out of my nose because of the fires. I can't
imagine what that's like for the people who are in California that are so close breathing that air.
(49:32):
And I really hope that people that are there where your masks go see a doctor when you can
to make sure you're okay. Because there are very much so long-term effects from these fires
in just breathing the air. I agree? All right. So, Cas, thank you so much for sharing your incredible
(49:53):
journey and insights with us today. You're working health equity and your perspective as a
leader are truly inspiring. To our listeners, if you'd like to learn more about Dr. Cas,
Raffia's work, check out the links in the episode description. Don't forget to follow us on social
media and visit bridgingworldspotcast.com to stay connected. And so next time, remember bridging
(50:17):
world starts with building connections that matter and thanks for listening. Thanks, Cas. I appreciate
you time. Thank you so much. Pleasure was mine. Thank you both for this is great.
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