188 : The Complexity of Inequity (w/ Dr. Oni Blackstock)

Zach welcomes Dr. Oni Blackstock, the assistant commissioner for the Bureau of HIV/AIDS Prevention and Control for the NYC Health Department, to the podcast to discuss a wide variety of topics, ranging from her unique career journey to dismantling white supremacist constructs, and she graciously offers a couple points of recommendation regarding how to get started when it comes to advocating for yourself to get the health-related help that you may need at work.

Connect with Dr. Blackstock on LinkedInTwitter, and Instagram!


Zach: What’s up, y’all? It’s Zach with Living Corporate, and look, man, you know what we do. It’s 2020. You know, fresh vision. You know, we’re out here making moves, having conversations with movers and shakers, influencers, educators, public servants… what else? Who else? Executives, recruiters, entertainers. You know what I’m saying? Anybody who’s willing to have an authentic conversation centering and amplifying underrepresented voices at work, and today, you know, I’m really excited about this particular interview. And I say that every time, but, like, I mean it every single time, even though I say it, like, over and over, but I really do mean it. And so I’m really excited. This particular episode we have Dr. Oni Blackstock. Dr. Blackstock, how are you doing? What’s going on?

Oni: I’m good. Thanks so much for having me.

Zach: Thank you so much for joining us. Now, look, what I would like to do–’cause see, what I sometimes do, in the past I would give this, like, kind of, like, generic–I don’t want to say generic, but I would, like, read off an intro, almost like a late-night show, and then I’d go in and I’d ask people to introduce themselves again. It seems kind of redundant, so what I want to do this time is just give you space and, for those of us who don’t know you, just give you some space to talk a little bit about yourself.

Oni: Okay, great. So again, I’m Oni Blackstock. I’m a primary care physician and HIV specialist. I also spent about the past 10 years conducting HIV research, but I now lead the Bureau of HIV at the New York City Health Department, meaning I oversee our city’s response to ending the HIV epidemic. I’m originally from Brooklyn, New York. Parents, my dad is an immigrant from Jamaica, and my mom is Brooklyn-born and bred. And I have a twin sister, Dr. Uche Blackstock, and, you know, we’re very much inspired by our parents to really meld medicine and public health with activism and advocacy, and so I get to do that in my current role leading the Bureau of HIV here in New York City.

Zach: Okay. So first of all, incredible background, incredible legacy, and shout-out to the Blackstocks, the family, and shout-out to your sister of course as well. So I know, you know, the background being Jamaican–now, you know we do air horns. Now, let me ask you this. I’ve asked past Jamaican guests, but it is offensive or culturally appropriative that we also use air horns on our podcast?

Oni: No, not at all. It’s great. It’s about the diaspora.

Zach: Okay, cool, ’cause I gotta let ’em fly for you. Let me just drop ’em right here. [air horns sfx] Okay, ’cause I’m just very excited and thankful that you’re here. Now, let’s talk a little bit more about your background, right? So you talk about your focus being HIV and that particular illness. What was it about that work that drew you in particularly?

Oni: Yeah. So I was in medical school when I feel like I quote-unquote first discovered HIV, and that was actually when I was doing global health work. So I had traveled to Ghana and West Africa, as well as South Africa, to do HIV-related research, and when I came back I did a rotation as a medical student back in New York City and saw that we had black people, Latino people, dealing with many of the same sort of medical-related issues, and even just sort of socio-structural issues, as I did when I was in Ghana and South Africa, and became very interested in our domestic HIV epidemic, and so I ended up doing my residency, which is the training that you do after medical school, in the Bronx at Montefiore Medical Center, where again I was seeing young black and brown people dying of, like, advanced AIDS, which was something I was really surprised and I think maybe people didn’t realize was stlil happening in New York City. And I think what I in particular–what draws me to HIV is that it’s really–it’s not just an interesting bio-medical condition, but it’s also, like, a social condition, and it’s really an epidemic of not behavior, but an epidemic of inequality. So it’s a confluence of lots of isms and lots of phobias, and you put all of those together and you sort of get HIV and you see the communities that are most impacted.

Zach: And, you know, it’s really interesting, this conversation particularly, because you’re in a position where you’re providing awareness and research and thought leadership and care for underrepresented, underserved populations–and often times stigmatized and just oppressed populations–while also being an intersectional member of a variety of underrepresented and oppressed populations and identity groups. Can you talk about, like, what that experience, that compounded experience, is like for you? Like, being in this space, being who you are?

Oni: Right. Yeah, so I think what has driven me to do this work is because I’m from many of the different communities that are impacted by HIV. So I think sometimes for people who do this work it’s maybe about careerism or they find it intellectually interesting, but for me it’s really about helping my people and my community. So yeah, I mean, I think having the different identities, being a cisgender black woman, being someone who’s queer and being at the intersection at these different marginalized identities gives me a different appreciation and understanding of what the factors are that folks are dealing with out in the community, and also the position. You know, even when we’re designing, for instance, social marketing campaigns, like, I can say–you know, I’m able to give my input and–you know, we had a campaign, for instance, that was focused on pre-exposure prophylaxis, or PrEP. It’s a once-a-day pill that people who are HIV-negative can take to stay HIV-negative. We did one for a focus on cisgender and transgender women, women of all different backgrounds, but what I did notice that I think most other people didn’t notice is that all of the women were very, like, fem-presenting, and so, you know, I was like, “In the future when we do this work, we might want to have folks who may be non-conforming in their appearance.” You know, just have different folks who may identify as women but have a different gender expression. And so I think, like, just sort of that awareness of understanding the different needs that may be out there of having these different perspectives is something that I think I can bring to this role and I think is, you know, really important, because the reality is that in many cities we don’t have people who are leading this type of work who are reflective of the communities that are most impacted.

Zach: You know, that’s just a really good point. It’s interesting because, you know, even as we talk about, like, representation and diversity in our marketing and, like, presentation, it’s interesting how colorism and patriarchy still, like, sneak in to those spaces too, right? So, like, if you have–like, if you’re presenting as a woman, often times it is going to be someone who is, like, traditionally fem or lighter-skinned or with hair that is a certain texture. Like, there’s still, like, this template, right? That individuals are going to–that we either consciously or subconsciously seek to, like, place people in. Even when you see, like, people in positions of authority or any type of subject matter expertise in the space, you end up–I don’t know. Again, they fit certain templates to me, and that leads me to another question though. Kind of starting at the top. So your lived experience brings a certain level of empathy along with your actual academic expertise. May I ask, are there ever moments or times where you believe that sometimes your lived experience or the passion that comes with that lived experience is almost counted against you because you lack a certain level of [laughs] intellectual objectivity that maybe white individuals or just folks who are not necessarily identifying these particular identity groups, that they can relate to?

Oni: Well, I think–right, so that idea of, like, objectivity… I mean, it’s, like, a construct. It’s, like, a white supremacist construct, because we all come with our own perspectives and backgrounds. So it’s sort of, like, a fallacy, I think, but yeah, I think that might happen. I think I am also fortunate, or maybe some might say unfortunate, but, you know, I did get my college degree at Harvard undergrad. I was a computer science major and I was pre-med. I went to Harvard Medical School. I got my Master’s in Health Sciences from Yale’s School of Medicine. So I have, like, sort of these bonafides that are sort of respected more by white culture, the dominant culture, which I feel like gives me quote-unquote credibility among some of these folks, if that makes any sense. So I feel like that somehow, like, helps to open doors in a different way, and then obviously having–you know, and sometimes just even having an MD, people make assumptions, and sometimes you can use those to your benefit, which is helpful. But, you know, at the same time, it does feel–it’s kind of cringe-worthy and kind of not the best feeling to be benefitting from these same systems which also act to, like, oppress us as well, so… [?]

Zach: Well, it’s complex and nuanced. I’m just curious about that, because as I continue to get into just this work, any time you talk about, like, underserved folks or, like, doing work that seeks to push for equity in certain spaces, there seems to be, like, this underlying kind of attitude sometimes, so I was just curious about that. You know, you just spoke about–you used one of the buzzwords that triggers a lot of fragility in today’s society, white supremacy. I’m curious, you know, on Living Corporate we’ve discussed the concept of decolonization, and one of the ways that we’ve seen colonization demonstrated is in language. Can we talk a little bit about medical terms that, intentionally or unintentionally, undermine the reality and complexity of systemic racism and other isms and various forms of oppression?

Oni: Sure. Okay, so I think any term that, like, focuses the issue on the individual as opposed to, like, the structures and systems that drive risk and disease and poor health and poor well-being, so–I mean, for me, I mean, there’s [?]–I actually tweeted about this recently. So, you know, terms like someone being a “medically-complex patient” or someone being high-risk or non-compliant really is about–you know, white supremacist culture puts the onus and responsibility on the individual and doesn’t–you know, it ignores, like, completely, the context in which people are making decisions and choices. And so, you know, these are–you know, we’re trying to, like, move away, at least at the Health Department, my bureau, from some of these terms, which are victim-blaming and lack recognition for these broader systems that increase risk for individuals.

Zach: And I’m curious about that. Like, what does it look like to drive those conversations and to have folks say, like, “Stop. Let’s take a step back and actually look at the systems that are impacting these individuals.” Like, what does that look like? How do you broach those topics?

Oni: Yeah. So I think one of the cool things here, at least the New York City Health Department, is the former health commissioner–her name is Dr. Mary Bassett. She’s a black woman, and she started a whole initiative called Race to Justice, which was sort of an effort to understand and recognize the impact on racism on public health and health outcomes, and so by someone in her position sort of normalizing the conversations around racism really sort of opened the door for a lot of the work that I’m doing in my bureau with the staff here. So for instance, we received millions of dollars in funding from the federal government and from the city government that we then bid out in a competitive process to clinics and other community-based organizations to provide HIV prevention treatment services, and we were looking at this process and, you know, seeing that the same sort of large organizations that are typically not run by folks who look like the folks who are impacted tended to get a lot of the contracts. And so the great thing about being able to lead a bureau, lead an organization, is that we made sure that–we started looking at the process and figuring out “What are the ways that we could make this process more equitable?” But what we also did is in our request for a proposal we called out these different systems of oppression. You know, many times–before I came here, like, a lot of the requests for proposals would say things like “poverty” and “food insecurity,” and it’s like, “But what are the things that drive those things?” Right? Like, we need to call them out, and if we call them out, the organizations that we fund will know that these are issues that we are thinking about, and we’re thinking explicitly about equity in this work, and so I made sure that in our request for a proposal that we use this language, that we don’t just say people of color, that we say specifically the groups that are impacted. We say black and Latinx people. Like, you know, it’s just calling it out and being really explicit and really putting it out there so that it becomes normalized and really part of the work that we do.

Zach: And it’s interesting, because I’ve noticed over the past–I would say since, I don’t know, since… so over the past, like, decade or so. ‘Cause I’m 30, so I’ve been working for about 9 or 10 years, right? So as I just kind of come into adulthood, just looking around, looking at the language that people use when it comes to just, like, systems of injustice or inequity, it’s almost like they just–we use language that is… like things just happened. It’s like we don’t talk about how things are connected at all. I think I was reading some story about a young man who had a mistaken identity, and it said “A teen was hospitalized after being mis-identified by police.” Well, no. He wasn’t hospitalized because he was mis-identified by police. He was hospitalized because he was beaten by the police because he mis-identified him. It’s almost like we take out the action or the accountability in the language and framing that we place. So let’s do this. As you know, since the publication of Healthy People 2020, it’s been confirmed that stress is one of the primary drivers of racial and socio-economic health disparities. Can we talk a little bit about the practical impacts of chronic stress for black and brown folks and how it shows up when it’s under-treated? And then, you know, as you talk through a bit about what that looks like, I guess my Part B to that question is what are things that black and brown folks should be looking out for regarding their own stress and what ways can they advocate for themselves as patients?

Oni: Mm-hmm. Yeah, so obviously these are, like, very weighty, big issues. You know, I think stress has, you know, wide-ranging impacts on our overall health and well-being. You know, when we are exposed to stress, or just the stress of being a black or brown person in this country–you know, I don’t know if folks realize this, but it leads to, obviously, an elevation in [stress?] hormones like cortisol and norepinephrine and ephinephrine, and those have, like, very harmful effects on the body. And so we can think about mental health, so, you know, depression and anxiety, and I have to–full disclosure, I myself am dealing with depression and anxiety, and I think a lot of it is attributed to really the chronic stress that we face, I think particularly in some of these professional work environments where we are held to very different standards than other people, and so having, you know, a support network and having a spiritual practice–which is something that I really want to develop more–are ways to really I think counteract these–you know, and the impact on the quality of sleep that we have, our metabolism, cardiovascular risk. You know, chronic stress predisposes us to a wide range of medical conditions, so yeah. So I think when we see–you know, a lot of the disparities or inequities that we see, you know, are driven by, you know, the impact of, you know, racism, and then it sometimes has direct, you know, effects on us, in terms of, like, the violence that, you know, is committed against us by police, but then also some of these indirect effects of dealing with chronic stress and the impact that it has on our bodies and minds.

Zach: And I think–so I’ll speak for myself in this example. I’m an example of this, right? Like, just kind of, like, moving and shaking in these spaces, finally taking a second to breathe and I’m looking back and I’m like, “Wait, I can’t sleep. I’m having, like, auditory hallucinations. I’m, like, crying for no reason. Like, I feel sick.” You know, there’s all these different issues that have, like, you know, over time just been so untreated, and like, so, finally just now starting to get help for that. I’m curious though, what points of recommendation would you have for folks who are at the very beginning of this? Like, and how–what would you say to them who are just kind of looking to get started and kind of advocating for themselves to get the help that they need?

Oni: Right. So I think, you know, obviously having a support network obviously is key, and so that people who are close to you, who you can speak to about, you know, the various stressors that you may have at work, in particular if you may be one of a few black people, or even if you aren’t one of a few black or brown people. You know, our experiences in the workplace are very different from other people’s. So definitely having a support network, and I think also not waiting for people to check in on you, but also to the extent that you can sharing with, like, your family and loved ones, particularly those who will be helpful, like, how you are feeling, ’cause I think sometimes, for many of us, we are very high-functioning, and so when you–you may be depressed, feeling depression and anxiety, but you are, like, highly productive. You’re getting things done. You have a family. You have a great job. But, you know, you still need support, and it may not be, like, overtly obvious to your family. So I think, to the extent that we can, reaching out when we can. Obviously, you know, for instance, depression can sometimes impact people’s ability to motivate and to be able to reach out to people, so obviously then we have to check on each other. I think also something that I have been increasingly learning is having some sort of, like, spiritual practice or some way of, like, grounding yourself, whether it’s yoga or meditation or prayer. Whatever it is or whoever you pray to, having that be a regular part of your day and of your practice is I think incredibly important, because, like, you know, it’s very hard to change these systems, and for the most part we have ourselves and we have our support networks. And so those are some of the recommendations that I would have. And I think also mentorship. If folks have mentors who, you know, have been in similar fields, or maybe even in a different field but can provide guidance and support, that makes a huge, huge difference. And also peer mentors as well, having folks who may be going through similar experiences as you where you can kind of commune and, like, come together and commiserate and also be helpful.

Zach: You know, it’s interesting. So you talked a little bit about your twin sister Dr. Uche Blackstock, and recently she published an article titled “Why Black Doctors Like Me Are Leaving Faculty Positions In Academic Medical Centers,” and in the piece, towards the end of it, she says, “Academic medical centers must begin to recognize and rectify the historical and current impact of racism on the health care workforce. Their leaders should listen actively and respond accordingly to the concerns of black faculty members and students, adopt an anti-racist philosophy, and, through a lens of racial equity, intentionally commit the time, effort and resources required to dismantle the structural racism and white supremacy embedded in their current institutional cultures.” Now, your work–again, we’ve been talking about it this entire conversation–is to combat the attitudes and white supremacist institutions that not only create but thrive off of inequity. I’m curious, in your mind, what incentives do these institutions have to actually make substantive, long-standing institutional changes?

Oni: Yeah, that’s a really tough question. You know, I think what we see motivates folks in society tends to be financial incentives, so I think if there is something in it, like, sort of profit-wise for these institutions, like, that can be helpful. I really don’t know, because I think, you know, for many of these institutions–you know, I work at a government agency. The government has played a role for more than a century or two, probably several centuries, in perpetuating, you know, racist policies, and I think–you know, nowadays obviously we want to do the right thing and rectify things, but there’s still–you know, the workplace here reflects what we see outside. Like, the public health department isn’t immune from the inequities that we see outside, and I think that it requires really visionary leadership and commitment to change, but what it also requires is, like, white people to step to the side and there to be more leadership opportunities for black and brown people, and I think that’s really a struggle. I think people support the idea of equity in theory, but then in practice it looks really different. I think, even just from conversations I had today with some of my staff, you know, in practice it can feel very uncomfortable. I think there’s that saying, like, “When you’re used to privilege, equity feels like oppression,” or something like that. Yeah, so it’s like, you know, when the going gets rough and you’re really wanting to institute these changes, I mean, there’s gonna be–there’s tremendous pushback and resistance, and they’re the reason why things have stayed the way that they are. So I have to be honest, I don’t have, like, an answer. I would be curious to know about institutions that have had transformations and have done this well. It’s a process. I know here at the agency, at the health department in New York City, you know, since Dr. Bassett came in 2014, and then the initiative started I believe in 2015, you know, it’s slow-going, because these are, like, processes and structures that have been in place for centuries that we’re now trying to undo. So I think–there’s this organization that we work with called Race Forward, and they talk about equity being both a process and an outcome, and so we try to emphasize the process part, because people often want to see, you know, concrete change, and where there’s an opportunity to show concrete change we try to, but we realize that this work takes a long time.

Zach: So, you know, out of respect to the time, you know, I haven’t been putting a lot of sound effects in, but let me just tell you, you’ve been casually dropping crazy Flex bombs this entire interview. So I just want to react to that. [Flex bomb sfx] You was also lighting ’em up like [blatblatblat sfx], you know what I’m saying? [both laugh]

Oni: Wow, that’s impressive.

Zach: Thank you very much. I appreciate it. That was also Cardi B, ladies and gentlemen.

Oni: Oh, I love her.

Zach: [Cardi B “ow” sfx] All right, so let’s do this. Before we let you go, we typically give folks space, shout-outs, parting words. What you got for us?

Oni: Wow. Okay, so I would say that I’m sure many of your listeners or people who have been quite successful by this society’s standards, and I think often, like, we use, you know, degrees and job titles and stuff to, you know, say how successful we’ve been, but what I realized, you know, with the different leadership opportunities I’ve had, the different degrees I’ve gotten, it’s really about finding happiness. I know it sounds really hackneyed and trite, but really doing the internal work to be happy regardless of whether you have, like, these accolades or not, because, like, my leadership job here and my degrees aren’t gonna keep me, like–you know, happy at night, you know? Like, it’s really believing in myself and that, you know, regardless of whether I’m working in a clinic, whether I’m leading the Bureau of HIV in the health department, I still–you know, I am really the work of, like, all of my ancestors who came before me. I, like, represent everything that they have been through, so to then think about success in, like, this white supremacist framework would not be something that they would be happy about. So I just try to, like, think about, you know, the family members and [?] that got me here and really about my own self-worth and happiness and not to measure that by these different accolades and positions and degrees.

Zach: Wow. You know what? Just shout-out to you. Like, this is incredible. You know, there are people–I will say this as we wrap up–you know, there are people that I–that Living Corporate and myself individually, but also, like, our team, will, like, look for to get on the platform, and we’ll look at their social media and we’ll be like, “Dang, they look like they’re real spicy on social media,” then they get on the podcast and they’re not as spicy. It’s kind of like, “Come on, what are you doing?” But, like, I feel like you have matched, if not exceeded, your spiciness. Like, if I was to rate it, like, it is higher. Like, three curry goats, like, [?]. Anyway, it’s great. All right, now, look, y’all. This has been dope. Y’all know what we do. We’re having these conversations every single week, coming to y’all with dope conversations. This has been Zach. You have been talking to Dr. Blackstock, okay? Dr. Blackstock is the assistant commissioner of the NYC Department of Health & Mental Hygiene, focusing on HIV prevention and research and study, doing all the amazing things up in New York. Let’s see here. What else? You know, check us out on Instagram @LivingCorporate, Twitter @LivingCorp_Pod, and check us out on our website www.living-corporate.com–please say the dash. We do livingcorporate.co, livingcorporate.tv, livingcorporate.org, .net. We have all of the livingcorporates. ‘Cause, see, people hit me up, Dr. Blackstock, and they’ll be like, “What’s the website?” And I’m like, “Look, it’s livingcorporate.co or living-corporate.com,” but people go livingcorporate.com, and then it pops up some Australian website, and I’m like, “Look, we don’t have that domain. We have all the other domains.” So you gotta make sure–you know, you gotta keep with us. You know, don’t slow down. Keep up. You might get left behind. So my biggest thing right now is I want y’all to make sure y’all check the show notes, y’all look at the research and the work that Dr. Blackstock is doing. Make sure that you educate for yourself, advocate for yourself, shoot, and stay courageous out here. Did y’all hear all the stuff she was saying? Casually. She works for the government and she’s talking about white supremacy. What you talking about? She’s not scared, you know what I mean? Ain’t nobody coming up here talking about [Law and Order sfx], you know? She’s not afraid, okay? She’s ready.

Oni: And Zach, can I just say really quickly just as–I don’t know if I’m an OG now ’cause I’m over 40, but I just want to say that I’m incredibly proud of you and this effort that you have and your Living Corporate podcast. It’s really wonderful to see young people just thriving, so congratulations.

Zach: Oh, my goodness. Well, look, we’re both thriving, and I’m just over here like [look at us sfx]. You know? That’s a Paul Rudd reference, everybody. Okay. All right, y’all. ‘Til next time. This has been Zach. Again, you’ve been listening to me chop it up with Dr. Blackstock. ‘Til next time. Peace.

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