Gregg Masters  00:08  This is PopHealth Week on HealthcareNOW Radio. Today’s episode is sponsored by Health Innovation Media. We bring your brand messaging alive on the ground and now in the virtual space for major trade show conference and innovation summits via our signature pop up studio connect with us at www.popupstudio.productions. I’m Gregg Masters Managing Director of Health Innovation Media publisher of ACOwatch.com and your PopHealth Week co-host with my partner co-founder Fred Goldstein, President of Accountable Health, LLC, a Jacksonville, Florida based consulting firm. On today’s show, our guest is Marino A. Bruce who holds several degrees including a doctorate, a Master of Science in rehabilitation counseling and a Master’s in Divinity. Dr. Bruce directs the program for Research on Faith, Health and Justice in the department of Population Health Science at the University of Mississippi Medical Center. He is a social and behavioral scientist with interests in the integration of the full range of health determinants specifically for young African American males and their risk factors for chronic kidney disease and cardiovascular disease. His current research explores the intersection of race, gender, spirituality, religiosity and behavior and their implications for social and health outcomes among African American male boys, adolescents and emerging adults. Dr. Bruce is also a certified rehabilitation counselor and an ordained Baptist minister. With that introduction, Fred over to you help us get to know Dr. Marino Bruce,

Fred Goldstein  01:50  thank you very much, Greg and Marino, welcome to  PopHealth Week.

Marino A. Bruce  01:53  Thank you so much for having me.

Fred Goldstein  01:55  Yeah, it’s really a pleasure to get you on the show. You know, we’re trying to focus now on some of the major issues that have come about because of the George Floyd incident and the murder there and COVID, etc. And it was really exciting to find out that you’re on the faculty UMC in the School of Population Health and your background, which is really right in the middle of a lot of these things. So why don’t we start if you could give a little bit of your background to our audience, they get a sense of who you are and what you do.

Marino A. Bruce  02:18  Sure. I am a sociologist by training, I was trained got my Ph.D. at North Carolina State University, spent eight years at on the faculty in a traditional sociology department at the University of Wisconsin Madison, then discovered a real interest in health after studying violence among African-American males for a number of years, and then began to focus on looking at the health of African-Americans more generally, and then began to have a clear focus on a more direct focus on the health of African-American males across the life course. So, it’s been a number of years after leaving Wisconsin going to the going to Vanderbilt University, and Meharry Medical College for five years, beginning my career in health science. And after that, I left and came to the University of Mississippi Medical Center and Jackson State University, to work with the Jackson Heart Study, which is the largest epidemiological study of African Americans probably in the world, be quite honest. And it’s been going on since 2,000. Then I left Mississippi for a while back to Vanderbilt to do some work on precision medicine. In that type of work, focusing on how precision medicine in its applications can be explained to apply with or working with communities of color in Nashville and Miami. And I got recruited back to the University of Mississippi Medical Center to continue all of that work that I’ve been doing over over a career of that now. 20 years, believe it or not, wow, that’s fantastic. And you raise something that actually we had a discussion last week it went on for a long time, you talked to me here about some precision medicine work. And I’d love to sort of dive into that maybe a little bit. And, and because you’re always been this talk of health disparities and access. So, what sort of things were you looking at with precision medicine in terms of African Americans and males in particular?  Oh, sure. So, with precision medicine, I was brought on that because of my interest and expertise in social factors, which some people call the social determinants of health. But as a sociologist, they are those are the things that we that we train to study. And so, they’re a little bit more than, than determinants to us. But I begin to think about how stress in particular is transmitted across generations, not only across the life course, but across generations, given that I spent a number of years and still live in Mississippi right now, thinking about how poverty we talked about multi multi-generational poverty. Well, they have stress attached to that that comes with that, and how does that impact generations downstream. So, we wrote a couple of pilot grants that were that were approved, but because of the timing, we did not get a chance to launch it off the ground. So, we still are working on that trying to find ways to get support from NIH to do this work, particularly in rural areas, I have a real interest in understanding how generational poverty, generational racism has implications for the health trajectories of kids. So, in our study, we were going to look at three generations, grandparents, parents and kids, particularly males, to see how that had applications for hypertension, for example, over time,

Fred Goldstein  05:47  fascinating. That’s really neat. And, and I and we know, obviously the huge impacts of racism, bias and discrimination on stress, anxiety, substance use, etc. We also talked some about this issue of violence and violence as a form of communications. Can you sure talk about that? And explain that to our audience?

Marino A. Bruce  06:08  Yes, my earliest work focused on violence among African American males. And I really wanted to break down violence, we spend time looking at the horror because it’s a violent act. Typically, someone gets hurt. So, let’s start there. However, it is a form of communication. It’s used in at the individual level, but it’s also used at the national level to convey if you don’t do something, then bad consequences are going to happen. And it just so happens at the individual level, the threat of violence actually can persuade people to act one way or another. So, for example, in the drug trade, typically, violence is a way that people try to keep folks in line. Well, of course, but you see the patterns in national deployments. So, what happens when, let’s say the Middle East gets a little hot, and one of the US United States allies will get in trouble? What do you see, you will see military ships, aircraft carriers will move into a particular region, the Air Force will will begin to have planes fly over. Well, what’s that that’s the threat of violence is basically saying, if you don’t get your act together, we will bomb you, we will hurt you, we will injure you. It’s real, the parallels are actually striking to what goes on on the street, per se that we think about in terms of the drug trade, that with those same parallels are with what happens in diplomacy. Now, in diplomacy, supposedly military action is of a last resort, as opposed to the first resort. However, it’s still a tool that’s in the diplomacy tool belt. So, wars start, because other forms of diplomacy aren’t successful. So, violence is something that’s always in the arsenal to get either a person or a group of people to behave in a particular way.

Fred Goldstein  08:13  And I know you talked about this, as I found this interesting, the period of most violence, I think he said was that when people are two years old?

Marino A. Bruce  08:22  Yeah. Two years old. Yes. There have been studies, well-known studies that were done. Now, some time ago, I think, roughly 15, 20 years ago, the investigators were Canadian, and they were studying infants. And one of the things that they found was that that the most violent time in anyone’s lifetime is when you’re two years old. Why do I say that? Because on the national victimization survey, when you ask a person about their violent encounters, they will ask, have you been kicked, punched or bitten? Right? Those three actions are violent acts. If you kick someone, you punch someone or you bite someone, that’s, that’s a violent act. And as a matter of fact, if you look at the Criminal Code doing that, you can be charged with assault. So those acts are still they’re used by two-year old’s, to convey their anger or their displeasure, or what have you. And they do it a lot. Now, why would that be the case because they can’t communicate in many other ways. They don’t have command of language; they often are not paid attention to in the same way that you would have as adults . So, they get your attention by doing those things. So, if they’re upset, they will strike out their cake or hit someone. If If a parent will do something that that displeases them, they’ll you know, they’ll hit the parents and the parents will say, stop it or what have you. But that act, just, you know, again, now the damage they do is minimal. However, the act itself is still can be considered a violent act. So violent is something that most if not all individuals have access to because they can they typically You can strike out in a certain way. So, it’s, it’s, it’s within us to behave in a violent way. So, it’s not that one group is more violent than the other innately. It’s more along the lines of what other tools, what other communicative tools are available to them. That way, you may see differences in violence among particular groups.

Fred Goldstein  10:22  Fascinating. I know, you’ve also, you know, done a lot of research in this area, and you are co-author on the book racism, science and tools for the public health. What should we be measuring in this area? And what are the benefits we gained by doing that?

Marino A. Bruce  10:37  Well, I think what we need to do we should be measuring races. It’s really funny. I was talking with a colleague a few minutes ago about the very thing, how do we measure races, there are a few measures out there Index for Race Related Race Related Stress sort of gets at that there’s a schedule of racist events that was published in 1996. So, it’s been around a while. But those have been largely used by smaller studies, generally, typically, they’ve been used in college settings. So, they’ll give it to their students or, you know, maybe at a university or what have you. But we have not used that on a large scale. Part of it is racism is a term that until I would argue six to eight months ago that you would not see or hear on, let’s say, the national news, you wouldn’t hear the idea of structural racism, or racism, per se. Those were those were terms that were reserved for more academic settings, or maybe interpersonal settings, but never in the national discourse. Well, things have changed dramatically, over the last six to eight months, both with COVID in terms of the disparities that people see with respect to not only infection, but mortality from infection. And, of course, you know, the initial explanation Well, you know, African Americans have a higher propensity for these underlying conditions or the risk factors for mortality, you know, if someone is infected with COVID, however, are the folks David Williams and a lot of other prominent health scientists have have been very loud in saying, well, you have to look at what causes the higher propensity for these underlying conditions. And racism is part of that, as part of that, because racism is baked into our society. And, and so coming to terms with that requires one to examine what do we mean by institutional racism or structural racism, systematic racism, all of those terms, they, they are not a synonym for one another. They are obviously related, but they speak to, for example, institutional racism is is how institutions like education institutions, judicial institutions, social institutions, how they work, just just the way they work on a normal basis, discriminate one group, while it may not discriminate against another group, for example, educational institutions, we know or we will say that, if they are, let’s say that 50 seats that are available for college admissions, right, so they look at things like SAT scores, grades, you know, those type of individual types of indicators, what’s not considered in a standardized way, is the context under which those grades were earned those scores were achieved or anything like that.

Fred Goldstein  13:40  Correct.

Marino A. Bruce  13:41  So if you go to a private school with SAT, ACT prep, you are in communities that are deemed safe, you’re you have access to other types of resources that sort of propel you and move you forward create an environment of expectation that college is something that is more of a right than a privilege for you, you’re likely to score better, you’re likely to have higher grades to score better on the SAT or ACT, you’re more likely to be to get exposure to what’s known as cultural capital. Those summer internships, travel abroad , being well-read all of those types of things, you’re more likely living in a community like that to be a strong candidate. But if you don’t come from that, let’s say you come from a rural environment where they are not private schools. They are public schools that are under-resourced, underfunded. We know that folks in rural areas tend to make less than than those in more affluent areas, and their access to cultural capital is limited. So when they come and their grades may be good, but when you look at the standardized tests, which measure a lot of cultural capital, quite frankly, they’re gonna score lower. So, you Even if they have the same quote unquote IQ, if you could standardize that, then once the student from the more affluent area will more likely to be in line to get that seat versus the person with the same intellectual quotient. But because of that background, they just don’t have the resources. They didn’t have the resources available, so that they would score in the same way.

Fred Goldstein  15:25  Right.

Marino A. Bruce  15:25  So those so the way the institution admits folks, has inequality baked into it, and unfortunately.

Fred Goldstein  15:34  And the system that that helps those kids grow up? Has it baked into it?

Marino A. Bruce  15:38  Yes. Yes

Fred Goldstein  15:39  So

Marino A. Bruce  15:40  that’s just an example

Fred Goldstein  15:41  right around their health,

Marino A. Bruce  15:42  Correct

Fred Goldstein  15:42  that caused all the people to have more comorbidities in that population, because of where they lived and what they had access to, or they’re education, or the other issues that we deal with.

Marino A. Bruce  15:53  Correct? That’s absolutely true. So, when you look at health, for example, well, you said, you know, co-morbidity or mortality, for example, well, if let’s look at African American male life expectancy, for example. So, if African American males have a shorter life expectancy, let’s say I think it’s eight to ten years shorter than I think white-women, and particularly maybe four to five years shorter than your average Caucasian male. What does that mean? Well, that means that the wisdom that let’s say, a 65-year-old who and the life expectancy, life expectancy is around six 67 68, in general for an African American male, whereas others are 72. And I think it’s close to 80. For Caucasian women, well, look at the number of years of wisdom that is lost, look at the resources that could be used to help someone along well, if someone dies at 68, and others live to be 72 to 80, when they are around, they could be a benefit to subsequent generations.

Fred Goldstein  16:57  Wow.

Marino A. Bruce  16:58  That has a has a huge impact on how individually the wisdom that shared, the life lessons that are said, when someone dies, all of those things go away, you can have the memory, but you don’t have an active engagement that’s there. So that when we think about health disparities, it has real impact on families and communities, when folks are suffering with chronic kidney disease, which which changes your life in terms of being able to travel, how you feel on a daily basis, all of those types of things. It can take you out of living, right, because then you focus on dealing with the whole issue of, I got to take these pills, I got to eat a certain way I got to do all of this. Well, why don’t I raise chronic kidney disease arrays chronic kidney disease, because it is a disease that becomes a leading cause of death. for African Americans when they are 35 years old and older, it becomes a leading cause of death for Caucasian men at 55. So, you have So again, the early onset, again, has huge implications for what they’re able to do in the households in their communities. Because if they’re sick, they got to focus on dealing with their illness. And the time that they spend dealing with their illness and not spend focusing on the kids or focused on a community members, focusing with their spouses and or focusing on themselves in other ways. So, it had a real impact for not only that generation, but subsequent generations because the losses are so great.

Gregg Masters  18:33  And if you’re just tuning in, you’re listening to PopHealth Week on HealthcareNOW Radio, our guest is Dr. Marino A. Bruce, the Director of the Program for Research on Faith, Health and Justice in the department of Population Health Science at the University of Mississippi Medical Center. Dr. Bruce is a social and behavioral scientist with interests in the integration of the full range of health determinants, specifically for young African American males and their risk factors for chronic kidney disease and cardiovascular disease.

Fred Goldstein  19:06 Wow. So, let me ask you this, how is your training as a counselor and a Baptist minister informed or guided your academic work has that impacted it?

Marino A. Bruce  19:16  Quite substantially. I got training in rehabilitation counseling because I wanted to understand more of the psychological aspects of illness and disease. I wanted to also find out more about how the mind works or the mind-body interaction. And so, what happened is that my I got a career development award when I was at Meharry Medical College, and I decided, you know what, if I want to talk about Mind-Body interaction, I need to understand more about how the mind works and how the mind impacts the body. So, I got another degree in rehabilitation counseling because I was really interested in chronic kidney disease. And because chronic kidney disease has such an impact on individuals, I thought getting a degree in real rehabilitation counseling would be beneficial. And it really was because a rehabilitation counselor, if those are able to, let’s say work to the top of their training, they are critical aspects of any healthcare team. Because they think about rehabilitation counselors think about how to make accommodations for people struggling with chronic diseases, or debilitating diseases. So, I found that training invaluable in terms of thinking about how disease impacts not only individuals, but their families, because that became, you know, a larger part of the focus. As far as being a minister. Well, I’ve been ordained for over 20 years now. And I’ve been actively serving in churches in every community that I belong to. And I learned that well wait a minute here, there’s another piece, instead of trying to straddle the fence between the spiritual realm and the health realm, or the spiritual realm, and the academic realm, it took me a long time to figure this out. But I, someone said to me, my wife in particular said that you should do both, you should stop trying to decide and choose one, then integrate them. And so part of the work that I’ve been doing even this whole idea of integration, generational stress, well, you also have a think about what are the intergenerational buffers that that may offset some of the challenges that that come along with living in stressful environments, because if you look at how African-Americans in particular, but particularly poor African-Americans live in a highly stressful environment, we don’t often think about the stress that comes with not being able to pay your bills, don’t think about that. Many of us who, who have done well in life, you know, we just say, Okay, due date comes write the check or click on the mouse and the bills paid. So, when it comes down to whether you stay in a residence or not, that’s a hugely stressful thing, that but you know, to get the eviction, you know, to get the calls from bill collectors, or someone sliding a letter under your door, saying, if you don’t, if you don’t pay, by this day, we’re gonna put your stuff out in the street. That’s highly stressful, and that has huge implications for how you how you think about yourself, how you communicate with others, all of that, well, there has to be something that’s offsetting that somewhere, it has to be because if folk were under that kind of pressure all the time, then you see a lot more explosions, in many ways. And what I mean by that is, you’d see higher rates of suicide, you’d see higher rates of violence against others, you’d see just the level of stress that’s operating, so something must be going on to buffer that. And so, among African Americans, particularly African Americans in the south, the church has been there, and  the lessons of the church, so even if a person may not be religious, per se, somewhere down the line, they come in contact with their own spirituality. And so, they may pray, they may meditate, they may do these things. Well, part of where my work is going is looking at the beneficial aspects of it. Let’s see, the degree to which religiosity, spirituality is beneficial to oneself. Now, I’ve done some of the studies that looked at attending worship services, there’s, uh, you know, quite a few studies that have shown that attending  worship service on a regular basis can be beneficial to mortality, or, or lower the odds of mortality or someone dying. And we’ve actually, we have a study that’s under review right now that shows that people with chronic kidney disease, if they’re able to attend church regularly, they have better health outcomes, they tend to live longer.

Fred Goldstein  24:04  Wow.

Marino A. Bruce  24:04  Which is something of significance, but the question becomes, what is it about going to worship service? What is it, we still have many more questions to pose, and I’m interested in being the one to pose them because I see not only just being in the looking at the social support aspect of it, but there’s a theological aspect to churches or that undergirds whatever church, synagogue, mosque that you go to,

Fred Goldstein  24:33  right.

Marino A. Bruce  24:33  And so I would argue that those theological underpinnings and shape folks’ worldviews, and that can have an impact on health behaviors, attitudes, perceptions about themselves and others, that can have implications for health.

Fred Goldstein  24:50  That’s fantastic. So, we’ve got just a little bit of time here. I got two quick questions for you, Marino.

Marino A. Bruce  24:55  Sure

Fred Goldstein  24:56  the first one, given what’s going on right now. The BLM George Floyd COVID disparities, what can an individual do? What should they use?

Marino A. Bruce  25:07  Well, I would say is, if you don’t know, if you’re not sure what to do, then the first thing I would say is consult sources about what it is that you want to engage in. So, if, if it’s dismantling racism, first, the thing is, if you’re not sure about what racism is, you know, read a few things about that, read a few things about racism, talk to trusted people, about this. People that you can trust about it. Here’s why. If you just talk to folks that you are just acquainting, you know, that may be acquaintances of yours, or colleagues of yours at work, they may be processing their own stuff. And so, they may not be be ready to have that type of conversation. So, it’s best to start with folks that you trust, and folks that may be a little bit more knowledgeable than you about that. And then you can figure out where is it that you’re best suited to, if you’re if you’re committed to dismantling racism, then the first thing is, you know, where are you most comfortable in operating in that space with that mission. So, if it’s at work, then it’s it could be advocating for greater diversity, more inclusion, if that’s it. If it’s, you know, in a retail space, it may be organizing boycotts and demonstrations, it all depends on you know, you everybody has a lane to, to be in, so find what’s comfortable for you. Because the pushback is coming. It comes. So, you have to be in a comfortable space, a confident space to deal with the pushback, don’t do not assume that, well, you know what, I’m on the right side of history, this is going to go. No, we have enough history in this country to say that a pushback is coming in. So, it’s better to be in a space that you are comfortable, confident in to deal with it when it comes because it’s coming. One of the things about this is that what I would classify as folks that are on fire and knew that this is going to this is going to take some work to do and that that initial fire is great. But one of the things I tell anyone, if you if you’re on this mission, read about what has happened to those who were on the field before you that that’s really important to understand how long and how hard this is. Is it noble? It absolutely is. But does it have cost? It absolutely does.

Fred Goldstein  26:22  right,  Well, I want to thank you so much, Marina, we couldn’t get to the second question. So, we’re gonna have to get back to you for another one. But thank you so much for coming on pop house week. It’s been fantastic listening to you.

Marino A. Bruce  27:36  Sure. It’s been a pleasure. Thank you so much for the opportunity.

Fred Goldstein  27:39  And with that, I’ll turn it back over to you, Greg.

Gregg Masters  27:41  Thank you, Fred. That is the last word on today’s program. I do want to thank Dr. Marino Bruce, the Director of the Program for Research on Faith, Health and Justice in the department of Population Health Science at the University of Mississippi Medical Center for his time and generous insights today, for more information on Mississippi’s only academic Medical Center’s mission and services go to www.umc.edu and do follow their work on Twitter via @ummcnews for the Dean of the School of Medicine Dr. LouAnn Woodward via @ LAWoodwardMD for PopHealth Week my colleague Fred Goldstein and HealthcareNOW radio This is Gregg Masters saying bye now.