Healwell Podcast: 0:33

Hello, and welcome to season three of interdisciplinary Healwell's healthcare podcast. We have a great season shaping up for you featuring several guests who will also be presenters at our social justice and health care conference in October. So that conference is called just care, social justice and health care, and will be October ninth and 10th of 2021. This is an all online conference and we have some great speakers lined up and you'll get to hear from some of them during this season of interdisciplinary. For this first episode, we hope you enjoy this rebroadcast of an episode we recorded in October of 2020. With Ann Blair Kennedy and Kemi Balogun.

Cal Cates: 1:25

As you know, we like to start every show with a pun. And we're getting we're getting off the we're not going to be hemmed in by themes for our puns I've decided, so. So today's pun I actually just finished on Saturday, I finished my six day course that I teach called Opening To The Mystery, which is all about mortality and death and dying and stuff. So. So I wonder if you guys know what a liar does after he dies. He lies still. Lovely. You're welcome. So how do I respond politely? That's the worst joke I've ever heard. So without further ado, let's

Cathy Ryan: 2:13

Yes, yes, please. Let's talk about something else. Yeah.

Cal Cates: 2:19

So ABK Ann Blair Kennedy, you've been with us before so you know that we sort of let you introduce yourself. So we'll let you do that. And then Kemi, I should have asked you your last name is Balogun? Yes, that's correct. Yeah. So we'll let our guests introduce themselves. But we're here to talk about stuff that we know is important to you guys. And as we promise, hopefully make some suggestions about how to help us all move forward. So we'll let you guys armwrestle to decide who introduces themselves first.

Ann Blair Kennedy: 2:53

It's up to my student, I will let her decide who should, if she wants me to go first I will or

Kemi Balogun: 2:58

Dr. Kennedy, you can go ahead

Cal Cates: 3:00

Dr. Kennedy, ooh!

Ann Blair Kennedy: 3:01

All right, so I am Ann Blair Kennedy, I am an assistant professor at the University of South Carolina School of Medicine Greenville. Nice, long name. I've also been

Cal Cates: 3:10

Get your paywalls out of here. No paywalls, no a massage therapist for 21 years and here in South Carolina, and had a practice was had a great successful practice. And then just before I turned 40, went back and got my doctorate of public health. So I don't have a PhD. I have a Dr. Ph. Yeah, it's leadership in public health, and nothing that's important right now at all. And I've also been really active in our massage profession, especially with AMTA and massage therapy foundation. At the AMTA right now, I was president of the South Carolina chapter, all that stuff. Now I am the chair of governance for that association. For the massage therapy Foundation, I've been on the Board of Trustees, a lot of different committees here and there, but I'm also the editor in chief and executive editor of the International Journal of therapeutic massage and bodywork, which is our peer reviewed, open access, free to publish in journal that is supported by the Foundation. And there we have it. paywall, gone. Boom. Thank you.

Kemi Balogun: 4:24

And I'm Kemi Balogun. I'm a fourth year medical student at USC, Greenville. I graduated from Wake Forest University in 2016 with a degree in biology and psychology. I have an interest in women's health as well as mental health. And I'm glad to be here with you all tonight.

Cathy Ryan: 4:46

Thanks for being here.

Cal Cates: 4:48

Before we get into the meat of your paper, that you sort of like you sort of bury the lead for me in the paper. So you sort of like there's this tiny little paragraph about how you guys started talking about race and equity and diversity and you're like and so now here we go. And I wonder if you remember that conversation and sort of how tell us the things.

Ann Blair Kennedy: 5:11

How we get started. This was actually one of the best things for me and I actually said this, Kemi, I said this in a whole meeting on Friday. This is one of the best things that came out of the pandemic for me was this relationship with her. Oh, wow. I said that in a meeting at the school. Yay. So because of the pandemic, I ended up, I was asked to teach this elective that I teach for the school. It's on gender and sexuality in the clinical environment. And they asked me to switch it to an online version, which I did pretty quickly. And Kemi was in my class.

Kemi Balogun: 5:45

Yeah. So that was an elective that I thought would be very useful for my future career. And I was really nervous about it. But I ended up loving it. I thought that Dr. Kennedy conducted it in such a way that myself and my classmates were very comfortable in speaking about taboo subjects. So then I reached out to her after the course ended, and I just kind of sent her a bit of a love letter saying, hey, I really enjoyed the course. And I would love to learn more about your research and how I could get involved. And that's where the relationship started.

Cal Cates: 6:22

Awesome. And so and then you guys started talking about race?

Ann Blair Kennedy: 6:27

We did. Okay, because very like right in that phone call. I mean, in that WebEx call we did right then, because she was asking about the research. That's right when Project Cope get started, which we talked about a while ago, which is still going on. Awesome. And I said to her very explicitly. Now mind you, we got really comfortable talking about some interesting things. In the two weeks. It's just, you, you never know what parents or patients are gonna bring into the room. So you got to be able to do it without squeaking. So we talked about a lot of stuff. So we were already kind of comfortable. Yeah. And I just looked at her, I said, I want you to realize that this entire research team is white. We know we're white. And we recognize we are all white, and we need help. And we want you to be comfortable coming into that environment. Knowing not that you're the diversity person coming in. But saying we need your perspective. Yeah. Yeah. Because that's the team I work with.

Cal Cates: 7:31

Well, and I would, and I would guess, from what I know, of you, Ann Blair, that, that when you say, we're white like that, you and your team have likely sort of discussed whiteness, and like not, we all have white skin, but like, we are white in all of the ways a person can be white. And we're trying to get our minds around why that matters, and how to sort of bring true equity and diversity into the environment. And yeah, so I just for our listeners, I mean, if that was wrong, I'd certainly want you to be like, No, we didn't talk about that at all. But I think that we, when we think about being white, we really most of us think Oh, of course, I have white skin. It's like no, no, no whiteness goes way deeper than that. And so, okay, so that how did that feel Kemi, to be to be like, Hey, come on in.

Kemi Balogun: 8:22

I found that to be very refreshing. Actually, I thought that that like honesty in very direct and straightforward way of saying, Hey, this is where we are. And this is where we would like to be. I thought it was great. I felt comfortable stepping into that. And like Dr. Kennedy mentioned, it wasn't just about including one black person on the team, it's more about making sure that we have different perspectives represented. And then having someone like me, who can then tap into my own networks, to then bring those voices to the forefront. So I was excited to be a part of the team.

Cal Cates: 9:02

Absolutely. Cool. All right. So then, so you are not a massage therapist, but you are a massage recipient.

Kemi Balogun: 9:11

Right. Exactly.

Cal Cates: 9:13

So, talk about how did you decide that? You know, Equity and Diversity and Inclusion in massage was the thing that I mean, obviously, you you might have been swayed by a someone with a 21 year career in massage. How did that happen?

Kemi Balogun: 9:27

So again, back to that conversation, that Zoom meeting that we had set up, we got to talking about everything. And I was of course talking about the pandemic. And at that time if things had just picked up. And I was talking about how, you know, I wonder when next I'm going to be able to get a massage. And I was a little sheepish about sharing that because at the time, I was like, you know, massage is this thing that is seen as a luxury and I'm a student with no income. And, you know, I'm a little shy about sharing that and she said, Well, I want to challenge that. And that's how that conversation came about.

Cal Cates: 10:09

Yeah, yeah. Okay, just to challenge, yeah for a minute, she sort of stepped out of character and we're kind of like, hey, yeah,

Ann Blair Kennedy: 10:18

well, it was the whole discussion of this is something you are doing, not just for your physical self, but for your mental health and well being. Yeah. And this is part of your wellness routine. And if you honor it that way, and step back from that luxury piece, which so many people fall into, honoring it as part of that wellness and, and health to keep you healthy, I mean good lord medical school. I've never been through medical school, but from what I have seen, it's just stressful. Yeah.

Cathy Ryan: 10:55

Right. Right.

Cal Cates: 10:56

So the paper is called equity, diversity and inclusion in the massage therapy profession. Which is was very exciting to me to even see that that was out there. And then of course, I looked at and I was like, Oh, well, of course, that's who's involved with this craziness. And I? So what's the most useful way, you guys for us to talk about this? Do you want to like, tell us your favorite parts of it? Do you want to? You know, we know that not everybody. Some people just see even the format and they go, I'm not gonna read this whole thing. So what what would like your Cliff's Notes be?

Kemi Balogun: 12:14

So I mean, I can start it off. So and in the brainstorming process, I kind of thought back to how important representation has been for me in medicine. And I said, Well, maybe this could be carried over into massage therapy. So my initial thought was, well, maybe there aren't many black massage therapists, because maybe there aren't many black people receiving massage in the first place. There aren't enough personal experiences with the field. So there may not be this awareness of like, this is a career opportunity for me. This is something that I could pursue as a legitimate career. So that's where I would like to start this discussion, I think there are, in the paper, we broke it down into three main pieces. One being economics. So kind of like how I mentioned earlier in the black community, and not just the black community, but probably more so the black community, massage is seen as a luxury, seen as something that it's only meant for the rich white woman. And therefore, we're not going to allocate funds to something that may be seen as indulgent. So is there a way we can make massage therapy more affordable. So that's number one. Number two, it there also may be this lack of knowledge around the health benefits of massage therapy. So one idea I had was, well, I wonder if primary care providers could talk to patients about massage therapy and offer that as a legitimate modality as a part of their, you know, care? Are people even aware that this does have actual health benefits? So that's another piece of education. And then the last piece is access. So let's say I do have the funds, and I am aware of the health benefits, where can I go to get a massage? Are there franchises and I know, franchises are not the only means of getting massage, but are their franchises in lower income communities? Yeah. So those are just like cliffnotes of some of the key pieces that we discussed them in the editorial.

Cal Cates: 14:52

Yeah. Would you talk a little bit about you were talking about representation and in medicine, and I know that, I mean, we don't have really great data. I mean, you guys reference and we'll talk later about the the Bureau of Labor Statistics and kind of what they've measured in terms of representation, which I, you know, I don't know how, how well that's measured. But when we look at, you know, blacks are way less represented as physicians. So I'm really curious about your, talk, if you would talk about your how, I think you said like representation, sort of as part of how you were like, Oh, wait, this is the direction I want to go in?

Kemi Balogun: 15:30

Yeah, So as of 2018, about 5% of physicians. There are about 5% of physicians who are black practicing in the United States. And the reason why we want to increase representation of black physicians in the workforce is that studies have shown that when patients see physicians who are similar to themselves, they're more likely to seek out preventive care, they spend longer time with their doctors, they report higher satisfaction of the care that they received. So it just leads to better outcomes. And that is supported by research. So that's why it's important to have an increasing representation of minority groups in healthcare. And then a personal piece of it is when you see yourself represented in a group, you're more likely to think you know what that is achievable. I can actually accomplish that. And unfortunately, so many of us, I'm thinking about a classmate who told me that the first time she met a black physician was actually in medical school. And how sad is that. But she just, you know, shared with me that she wished that she had met someone sooner because that grew to be a meaningful relationship for her. So that's why representation is important.

Cathy Ryan: 17:01

Yeah. And if you, you know, even when you Google these images, right, if you go and google massage, yes. And you look at images, it's white women! Yeah. Right. With flowers in their hair. Yeah. Stones on their body. Yeah. So it looks luxurious.

Cal Cates: 17:18

Right? Well, I'm thinking about, you know, we are on hiatus, unfortunately, on a study that we're doing right now, but working with left ventricular assistive device patients in urban hospital setting, and all of the patients we've seen in the study so far have been black. And I think one of the patients I worked with had previous experience with massage. But when I walk in the jokes about spa, and like, you know, it's my, it's my pedicure day, whatever, like, just start rolling in like this is they're like, Ooh, you know, look at me, I get to, you know, be pampered and, and I'm so glad that that is what I'm actually there to do is to help them I mean, the study is to show if I'm nice to you for a half hour every time you come in for a checkup, does that help you cope with your chronic illness? But you can see how it's also sort of masking discomfort with like, I don't deserve this. I couldn't afford this on the outside. This is not like how is this part of medical care? And you can really see how we are we will be measuring also, did people have access to massage before? Were they using massage, but the story is that this is their first exposure. And it's not something that necessarily will inspire them to seek massage later. It I think it is benefiting them during their treatment, but there's definitely still a disconnect. Yeah, and we have a black massage therapist on our team. So there's also that I wonder how that fits with, if I'm a black patient receiving massage from a white person? How does that also sort of support the like, I don't? Where would I go to get this? You know, maybe some of those questions don't get asked because you go Oh, right. This is whiteness coming to me. And when I'm not in this medical environment, maybe that's not something I can I can do.

Ann Blair Kennedy: 19:12

So a question on your study?

Cal Cates: 19:14

Yes, please.

Ann Blair Kennedy: 19:16

Um, if I'm remembering correctly, you do have some patient engagement type work going on with it, too?

Cal Cates: 19:21

Yes, we do. We do. Yes.

Ann Blair Kennedy: 19:24

Which was, I'm so excited about because that's another line of work. But I guess my question for you would be is at the end of your study, are you giving them a link to resources to massage therapists who are in the community?

Cal Cates: 19:37

We are

Ann Blair Kennedy: 19:38

Who also might look like them? Right? So are you bringing in massage therapists who can help them afterwards?

Cal Cates: 19:45

Yes, and I and I am embarrassed to say that George Floyd had to be murdered for us to go, Hmm, we're in Washington, DC. This is a place where there are black massage therapists. And I mean, we've sort of the people who work with Healwell have just come through our courses, which then, of course, leads us further down the road to why aren't black massage therapists taking end of life hospital based medical minded massage therapy courses? And where is that disconnect? And yeah, I mean, and I don't, I don't have an answer. Certainly representation is probably a big piece of it. The economics of it are another big piece. And how do we, how do we untangle you know, when I think about making massage affordable, that is an important piece of this. And also, it's sort of I feel this sense of like, because we're just going to accept that black people won't have the money. So we better just make this affordable, right? Like, can't we fix also and I mean, we can't as a profession, but it's not enough to just lower the price, sort of, we have to look at access in in more creative ways and really look at how do we lift all the boats and

Ann Blair Kennedy: 20:56

that also, not all black people are low

Cal Cates: 21:00

Right, right, exactly. Yeah. So access isn't all about. Yeah, that that piece of it. So yeah, so many questions.

Ann Blair Kennedy: 21:12

Kemi you look like you've had a thought there for a second one, I jumped in and interrupted.

Kemi Balogun: 21:19

No, I think, in speaking about the education piece, I don't know much about how much it costs to go to, to income either get training in massage therapy. But I wonder if that could also be a barrier. Because I know, in thinking about medical education, the cost of even applying to medical school is astronomical, and just as a significant barrier for black students even pursuing the field. So I wonder if a similar dynamic is present in massage therapy? I don't know.

Cal Cates: 21:56

Yeah, it's it's cheap to apply. In fact, I think it's usually you know, 50 bucks, 100 bucks. Really? Yeah. But, but I do think I mean, I think the cost of massage, and I look forward to the hate mail about this, but I feel like massage attracts people who want sort of a quasi career, in a lot of ways, like, I think that it is an entry point for people who want to help and be sort of healthcare ish. But it doesn't cost the same as PT school, or like medical assistant training, or, you know, so you can get your hands on people and feel like you're doing something meaningful for not so much money. And I mean, I think there's a pretty wide range in terms of what it might cost. Because, you know, every state has different requirements. And schools run very differently. And so, and some schools have, you know, the opportunity for you to do student loans and various sorts of like payment plans and things. But I think that massage therapy, it attracts people who want to do a different kind of study. And I think that here, I know that there has been the average age of massage students has dropped in the last handful of years. And so you have people coming right out of high school, going into massage school, and not really being invited to sort of develop the chops to then be successful when they leave massage school. And I wonder how many people, I mean, across the spectrum, but certainly, if you're sort of pulling up your bootstraps, and saying, I'm going to try massage therapy, and then you go through a training program that doesn't sort of really help you be successful after, I wonder how many black massage students are graduating from massage school, and six months later, they go do some other job because they went out there and they couldn't start their own practice, or, you know, they didn't get the kind of support that they needed, and they didn't have the kind of safety net to be able to ride it out until they could get that established.

Cathy Ryan: 24:01

Well, I wonder too, and Kemi, perhaps you can speak to this, you have a background in psychology as well, culturally, perceptions around touch? And how does that tie in in terms of various populations, people of color, you know, versus, you know, people who are not, is that potentially one of those barriers, or one of those issues to be looked at with regard to both individuals seeking out massage therapy as well as people who might take an interest in massage therapy as a profession?

Kemi Balogun: 24:42

That's a really interesting question. I certainly cannot speak for all black people, but my mom comes to mind. So I love massage. Big fan. My mom, on the other hand, is very hesitant because of the touching aspect. So born and raised in Nigeria, moved to the United States as an adult, the idea of undressing in front of a stranger and then having that stranger have access to, you know, the body, that seems to make her uncomfortable. So I know that to be true for my mother. And I don't know if it's true for other members of the black community, but that's a that's an interesting thought for sure. Yeah,

Ann Blair Kennedy: 25:42

I know there was a study done on proximity and amount of touching that different cultures do, right, but I do not remember if they talked about any African American or American, black Americans in any way in that study, so I know they looked at Americans, they looked at British people, and they looked at Latin Americans, I believe is how the study went. And when you look at the number of times, like if you were what, sitting at a cafe, they would watch couples, would, and they would come in, and then sit and watch to see how close they sound to each other, and how much they touched each other. And I think, if I'm remember, this is long time ago that I remember reading this thing. So I can't tell you who wrote it or anything. I'm like, nothing, I'm just remembering barely some things. In Latin Americans, individuals touch the most. So they would get very close to each other. And they would there'd be a lot of touching. Americans are actually kind of in the middle. And in the British, they were like, farther apart, they didn't touch each other hardly at all, if I'm remembering how things were going. So it was just kind of interesting, but I do not remember if they discussed race and ethnicity within that at all. And then what is that structural? You know, would we, if we really need to think about, we cannot talk about diversity, equity and inclusion in any profession, without talking about the structural racism that leads up to those conversations. And why that might be, yes, we talk about equity, and about access and education and all of these other pieces. But we have to look at the underlying structures that lead to these conversations. Why do we have to have these? Because there's structural racism within our society. Yeah, that puts whiteness more important than anything else.

Cal Cates: 27:42

And if we don't, everything we do is a band aid.

Ann Blair Kennedy: 27:45

Yes, yeah. So we can't have those conversations without having those discussions about why it came that way. Yeah. And I mean, it still goes into that piece of I just always go to the images, the Google Images, the thing, just, it just, it floors me. I mean, that's just one place where I will go like, I do this one on, we talked about leadership, too. It's gotten a little better. However, you used to go search the word leadership, or leader, and all you would get would be men.

Cal Cates: 28:16

White dudes. Yep. Yep. Yeah.

Cathy Ryan: 28:21

Like googling massage therapist? Yes.

Cal Cates: 28:25

Did you get skinny too? Yeah.

Ann Blair Kennedy: 28:27

There's very little body diversity.

Cal Cates: 28:29

Yeah. Yeah.

Ann Blair Kennedy: 28:33

And so that just should show you the things that are influencing us along the ways. So as she's, as Kemi mentioned, if black teenagers don't know that this is a profession, right. And they're also not given the keys to success to succeed in the profession, as you've you've mentioned. Yeah. And maybe they're not getting hired. Right. The franchises right. Because of structural racism.

Cal Cates: 29:03

Yeah. Right. Yeah.

Ann Blair Kennedy: 29:05

It wouldn't fit with our clientele.

Cal Cates: 29:07

Yeah, yeah. Or you get hired and people just don't don't see you. And so it just doesn't work out. Right.

Ann Blair Kennedy: 29:13

Yeah, whatever those things might be. Yeah. So we have to look at all of those pieces in this profession, to make sure that not only do we have diversity, but we have inclusion. So we have to bring in those pieces and make all the individuals comfortable to be a part of this profession. Definitely. Because we don't necessarily do that

Cal Cates: 29:35

No. Well, and we're great at tokenism as well. We well. think of inclusion, we think of tokenism as inclusion that like, look, we have a black person, we have a Latin X person. And if that person's voice is not included, you have not achieved any degree of inclusion. But their their mere presence doesn't change the conversation.

Kemi Balogun: 30:00

Yeah, so um, I love what you just said. And I saw a quote that that tokenism is, is diversity without the inclusion. I don't know who said that. But I that really, that really spoke to me because I think it really gets at the essence of like, where we sort of falter. It's not enough just to invite minority groups to the conversation, or, you know, increase the number of black students that you accept into a medical school, but you then have to say, okay, is this environment set up in such a way that all students can succeed? Yeah. So one, one example from medical education is, you know, are there mentors who look like the students that we've recruited? Do they feel safe? Do they have safe spaces on campus? All of these things will contribute to whether or not they thrive, you know whether or not they come out of this, and are able to truly contribute to medicine. Right? So it's not enough just to say, Okay, you're here, but like, how can we see through it? How can we support you through it? That's true inclusion.

Cal Cates: 31:14

Yeah. Well, and I think that that speaks back to what you were saying, Dr. Kennedy, that, that we have to, we have to understand our role in structural racism. And that, you know, I'm thinking about when I've, when I've listened in on conversations about sort of, exactly what Kemi just talked about, like, what do we need to adjust about our curriculum about our school environment to support students coming from black communities? And, and that there's this, there's this whiteness of like, well, what because they can't do the coursework, I have to blahdy blahdy blah, and it's like, so let's go back a couple 100 years and look at how we set this up. This is the least we can do to help these people get back onto an even playing field, we made the playing field uneven. This is actually it's just time to pay your dues. And but I think that there's a real, I mean, when the government puts out an executive order that says no government employee or contractor can teach about racism, while including unconscious bias, or the structural nature of racism, we have a really big problem. So

Ann Blair Kennedy: 32:29

I yelled in my car. Yeah, yeah, I seriously screamed in my car, I just dropped off my children.

Cal Cates: 32:36

Yeah. I mean, don't bother teaching about it, if you're not going to talk about unconscious bias and the structural nature of it, but but that keeps the white people in power. So obviously, that's the goal. So what, how do we continue to understand that, because those things won't take hold, and be effective, unless more of the stakeholders really are willing to say, woo we are at a deficit here, we as white people are at a deficit, because there's a whole sector of the population who is struggling to succeed because of systems we've created.

Cathy Ryan: 33:11

Well, and I think, you know, for me, in this process, there was a moment of just recognition that I've not really considered my whiteness, because I live in the world where I've had the luxury of not having to, for such a long time. So in that moment, when that it's kind of like, whoa, I've never really considered what it means to be white. Whereas I don't think that that's necessarily the case for people of color, you know, because of the way our world has been structured. And the way that that has, you know, is thrown at them on a daily basis. So I think for me, that was kind of a real moment of awakening. In my, in my process, you know, and certainly here in Canada, and I've mentioned this before, on the podcast. Right now in Canada, a lot of what we're seeing in our media is with regard to indigenous people here in Canada, and colonization. And we keep hearing words like decolonize, and reconciliation. But the process by which our political people are going about reconciliation is from a white colonial lens. So it's kind of like, how are we going to reconcile this? How are we going to create or push some difference? If it's largely white men sitting in the room trying to come up with solutions for this, quote, unquote, problem, without the inclusion and respectful inclusion and respectful engagement of the people who this is impacting the most.

Ann Blair Kennedy: 35:00

And actually listening to the people who it's impacting and hearing their thoughts and asking their opinions.

Cathy Ryan: 35:08

Yeah, precisely.

Kemi Balogun: 35:12

Cathy, I would like to touch on something that you mentioned that you had never really thought about your whiteness, really. Whereas, for me my experience, especially in you know, formal education, Wake Forest, med school, there isn't a moment where I'm not thinking about my blackness. In every space, I enter I, there are thoughts of, you know, I have to prove myself, you know, I have to show that this wasn't a mistake, that that I was a worthy investment. So in everything, and I know this may sound dramatic, but truly in every encounter there's that voice in the back of my head. Because I'm always aware of my race.

Ann Blair Kennedy: 36:09

And that pulls us also into this place of, so I'm about to be 48 years old next month.

Cathy Ryan: 36:19

A youngster

Ann Blair Kennedy: 36:21

But I was raised during that colorblind time. Yeah, we don't see race. Right? Right. I mean, we don't, we don't talk about it. I was raised kind of all over. My mother's from New York, my daddy's from Kansas. But I was raised in the south, quite a bit, but also California, and then the southwest and Texas. But I got that we don't talk about this, and we don't recognize it. So, you know, we get the fight of the South too. And so then we have that piece of how demoralizing that can be to not recognize somebody's experience. Yeah. And then this goes into kind of the final part of this paper that I really want to kind of hit home on. Because this is one of the things as a scientist, that makes me want to fling my glasses across the room.

Cal Cates: 37:11

I'm so glad you're gonna talk about it.

Ann Blair Kennedy: 37:15

So before, we can't talk about race and everything, unless we talk about structural racism. But also we have to talk about the fact of white people having the privilege of saying, when asked the race question, oh, but there is only one race, the human race. And you just read that so dramatically. And it's like, really? Come on. I can't tell if my things are going to have an effect if I tried to make policy changes. If you don't tell me and allow me to consider what that might mean. Yeah, I get it, that you're trying to tell me that you're colorblind, and everybody matters and all of this important things. But you're making me mess. You're messing up my science. Yeah. And you're making me crazy. And you are disrespecting people. Yeah. I think that's the biggest piece is not understanding that by answering that question in that way. It is disrespectful. Yeah, it is rude. And it takes away from their experience. Now let's just be getting a little bit hot and heavy under the science. And Kemi can tell me if I'm wrong or not.

Kemi Balogun: 38:18

But no, no, you're absolutely right. It's almost as if acknowledging my blackness, it makes you so uncomfortable. Like why why? Why are you colorblind? No. Yeah, and like I said, it's when you are in a majority white space, it's hard not to think about your identity. You know, it's hard not to think about trying to defend your credentials. So you're right, it is disrespectful, because my identity is very much so, it shapes my experience. Absolutely.

Cal Cates: 38:57

Well, and I think this is the shortcut that we love to do when we when we want to feel woke, is, you know, we say oh, you know, we made race, so it doesn't count. No, no, we did make it. It's deeply imaginary and totally real. Absolutely. And I know that's hard to understand. But we have made it so real, that it now matters to demographics to health research, like you have to say, What would society call you? And that sucks and feels crappy. Like, but that's the question I'm asking you is what social and political forces have acted on your life. And when you're checking that box, that's what you're checking is like by, you're actually being more of an activist by checking the box than by writing your sort of subversive statement in the blank space.

Ann Blair Kennedy: 39:49

Yeah, it kind of sets me up. And I've had that happen over a course of several studies that I've worked with massage therapists on send out Yeah.

Cal Cates: 39:58

Well, we're totally immune as massage therapists, because we're super caring and compassionate. Yeah, you get it? Well, and I love that in the paper, you guys. I can't, let me see if I can find it real quick. You said something about. And I love this because nobody gets to escape, like the profession, from researchers to educators, practitioners and associations need to work to improve the landscape. And that every single one of us whatever our role is in the profession, even as consumers, we have a role to play in shifting this and really asking, thinking critically about what it is that we can do to change the balance. Now, I do have one question, because one question like this is the only question I've asked, Are you ready? I had my one question. But so the Bureau of Labor Statistics, I don't know that I trust them to collect useful data about our profession because we're such a weird profession and we practice in all kinds of pockets. But if their data is to be believed, it's roughly a 70/30 split, which is actually more than black representation in the main population. So how do you, talk? Can you guys talk about that?

Ann Blair Kennedy: 41:14

There? No, no, it's not 70/30 it's with looking at Black or African American are only 8%. So then you also have to look at Asian American, Hispanic and Latinos. So yeah, 72.3% white. Yeah. And then 8.8% Black or African American, 13.1% Asian and 11.1% Hispanic. If I'm looking at the chart, the

Cal Cates: 41:50

Yeah, I see really the graph. Yeah, that makes sense.

Ann Blair Kennedy: 41:53

Yeah. But here's the other piece in here.

Cal Cates: 41:55

Yeah, please.

Ann Blair Kennedy: 41:58

Who's considered white?

Cal Cates: 42:00

Well, yeah.

Ann Blair Kennedy: 42:02

So Arab Americans. You know, we don't ask this question well. Recently, we've, I know with Project Cope, we did go in and change it to try to make it even more, bring in more categories. Because I started working with, we brought on a an Arab American woman who's on our team now as well. She's amazing. She's taking care of our social media. That's Hanna. And then also, I work with another individual on another project on my patient engagement work. And he's from Lebanon. He's like, and he we've had this discussion, he goes "I have no idea what, they just told me to check white, because I'm not white, I'm from Lebanon."

Cal Cates: 42:46

Yeah. Wow. Right. Right.

Ann Blair Kennedy: 42:48

So, who's lumped in? To white?

Cal Cates: 42:51

Yeah. You're too messy. We don't know where to put you.

Ann Blair Kennedy: 42:54

Exactly.

Cal Cates: 42:55

Yeah.

Ann Blair Kennedy: 42:56

So that negates their experience as well. And what does that do?

Cal Cates: 42:59

Yeah. So I think it's probably my mathematical ineptitude. And I'll look forward to you helping me with that. So there's a section where you say the US Bureau of Labor Statistics provide some information about the state of massage therapy indicating that 83.6 of the profession are women and over 70% white. So So I guess it's the it's that remaining 30% is like you're saying, not African American, it's everybody who's not white. And that's a whole lot of people. Yeah, okay.

Ann Blair Kennedy: 43:31

Yeah. And I don't know how much I trust those statistics, either. Right, right. I mean, because you will see the gender breakdown anywhere from like, low 80s here, all the way up to almost 90%. Yeah. So we don't have a necessarily great measure of race ethnicity. Because at least from the profession standpoint, the professional associations, I don't see them asking that question, right. Yet. I keep

Cal Cates: 43:58

Yeah, there's been there's been some resistance to

Ann Blair Kennedy: 44:00

No, no, actually not. They've done it in asking that question. the past. And I think it's just one of those things that every now and then I just have to remind like, yeah, like, can we please ask this question?

Cal Cates: 44:11

Yeah. Um, you have to move away from from it being a taboo question, like I think Kemi was talking about in the very beginning, like, to be afraid to ask the question, really exposes your beliefs in a way, you know, this is, this is useful information that helps us operate within the profession and advance the profession. So it shouldn't be a question that we're going out on a limb by asking.

Cathy Ryan: 44:37

But no make the point that it is an issue, or is something that needs to be looked at and considered and how do we change that? Because if we just gloss over it, or just ignore it, then again, it's like, myself for a number of years, and I'm gonna have to consider my whiteness. Yeah.

Ann Blair Kennedy: 44:59

And, you know, the interesting piece here Yeah, you know. is that we haven't even delved into the intersection. the intersectionality of it all, right. I mean, oh, yeah. We were we could talk about Benny Vaughn, one of the bigger names of as being a black man in massage therapy. Right. Yeah. I mean, you unicorn. Right. Right. And being very successful. I mean, he is very successful. Yes. Yeah. He, He is amazing. Yes. But how many others? How many other black men in massage therapy? Can you name?

Cal Cates: 45:35

Yeah, well, and his clients aren't black.

Ann Blair Kennedy: 45:39

No, not not many. Right. Right.

Cal Cates: 45:40

So well, and that leads me I wonder, and there's, I'm sure there's no data on this. But I think as we consider, you know, when black people dip their toe into the world of massage as as consumers, and they interact with a white therapist, who is perhaps coming from a place of unconscious bias where you think that that this person experiences pain differently that maybe they have musculature, I mean, all of the crazy assumptions that have been carried over the centuries that then you get a not great massage because this person didn't even know they were telling all these stories about your body and your lifestyle and all of this stuff, and then you go now that's not for me.

Ann Blair Kennedy: 46:21

Yep. Yeah. Are we even talking about it?

Cathy Ryan: 46:25

I was gobsmacked by that. Because I had never I over the course of my massage therapy career, I'd never heard that. And then I believe was on the podcast with, who was who was the podcast with that it was brought up about in medical texts that

Cal Cates: 46:42

Oh, with Dr. J. Pop,?

Cathy Ryan: 46:43

Dr. J. Pop, where black people experienced differently than then white people. And I'm like, I'm like, what? Yeah, that's in medical literature. How can I thought, but I'm like

Cal Cates: 46:57

2016. Yeah, right.

Cathy Ryan: 46:59

What?

Kemi Balogun: 47:00

I think they surveyed a group of medical students. I don't remember how long ago this was, but not too long ago.

Cal Cates: 47:07

Long ago enough. Yeah. 2016.

Ann Blair Kennedy: 47:09

It was 2016. And it was residents too.

Kemi Balogun: 47:10

Residents as well. And a significant number of them reported that black people have thicker skin, less sensitivity to pain. And these are people who are in medicine. Right? How scary is that?

Cal Cates: 47:26

How scary is that? Yeah. And now, and as residents, that means that, technically, they've sort of their past the place where they're going to learn that that's not a thing. Like, they're now providing care to people. The ship has sailed, Oh, so good. Yes.

Ann Blair Kennedy: 47:38

Especially if we can't provide Diversity, That was written by a medical student, Equity and Inclusion continuing education in any way, shape, or who said, I'm just gonna have to go publish a book on this. form. Right. But then, you know, this summer, so I do see pockets of light. So let's pull back. Let's do it. This whole project Because everything, it does not look like that on my skin. Yeah. is like the best part of the pandemic for me, because I got Kemi in my life. Yeah. Is this summer this past summer, a book So we need to be looking at these things in different ways. was published. A medical student in England realized that, you know, when you look at anything talking about rashes, or Yeah. Well, so what's that doing massage texts? So how are my anything on the skin, that book book, yep. what's it going on? In our massage texts? Yeah. And in other pieces. So my one small little piece that I'm working on at the journal, at least, for the IJTMB. Is when so I don't create the photos that go with the articles. Okay. But I'll review them. And I now have the person who's creating them thinking about these things like, who are we putting in these pictures? Yeah. And so just start to look at that when the IJTMB comes out. I mean, this is a piece that we are truly trying to consider. Yeah. To change slowly, some of these pieces. Yeah. Are we going to get it right every time? Absolutely not. Yeah. Are we gonna mess up? Yep. Do I mess up? Oh, yeah. But it's to humbly step back and have those conversations and then say, I acknowledge that. Yeah, I'm going to do better. I'm going to acknowledge this and do what I can. And I am very sorry, that was never my intent. But I can recognize the impact on you, or whoever the you is. Yeah. And how can we do better? Yeah.

Cal Cates: 49:46

Yeah. And I think that that I mean, every episode I feel like so at some point, we come back to humility and the willingness to mess up no matter what topic we're talking about. And I think I'm I was thinking about ABMP, just recently did a CE Summit. And their keynote speaker was Dr. Nicola Finley, and she was talking about health disparities and racial inequity. And she talked about when her own daughter was born, she was jaundiced, and they knew she was jaundice, because they did the bilirubin test at birth, but they couldn't see that she was jaundiced. And so two or three days later, they were ready to release her. And because she was a physician, she's like, You didn't draw her blood again, you didn't like let's just check the levels because she's like I, you know, we have no reason to believe that this has resolved. And actually her numbers had gone up. And she said, you know, they would have sent me home and she could have been deaf. She could have had defects. She could have had all kinds of like, lifelong repercussions. And what I love is that she was so clear to say, these were good doctors. The people treating me are not bad people who were giving me bad care because I was black. They just didn't realize that you can't see yellow on a black baby. And so they thought, well, your eyes aren't yellow. Off you go. And I think that that is one of the biggest things that we just keep trying to reinforce is when you do what you just described, and you say, Gosh, that's I didn't mean to do that. You don't then crawl into the shame spiral and hole of death and say, I'm the worst person ever, you go, Wow, gosh, I didn't know that was in there. You know, and, and maybe you call your friend ABK, and you'd be like, you're not going to believe the stupid crap I just said. But then hopefully you don't say it again. Or you tell somebody else that you did say it, and you go, Oh, here's this thing. I didn't totally by accident and go, Oh, my God, I would have done that. And then maybe that person doesn't do it. But we have to be willing to, to Yeah, when you stick your neck out there, you're going to do it wrong. And you'd be like, Oh, that was messed up. And you have to be willing.

Cathy Ryan: 51:46

Well, and seize it as an opportunity to inform yourself.

Cal Cates: 51:49

Yeah, definitely. Go ahead, Kemi,

Kemi Balogun: 51:52

I was just gonna say you have to be willing to be a bit uncomfortable. As you're acknowledging things that you were once ignorant about and then saying, Hey, we can change it. So it's learning to be comfortable in that discomfort.

Cathy Ryan: 52:06

Yes.

Cal Cates: 52:08

We did not pay them to say that I swear, the two of them just you played right into it. We're always talking about that.

Cathy Ryan: 52:15

Isn't that a Healwell T-shirt? To be comfortable in your discomfort?

Cal Cates: 52:19

Yes. Are you uncomfortable? Good. Our work is done

Cathy Ryan: 52:24

Good. You're doing a good job.

Cal Cates: 52:26

That's right. So so we can't hold you guys hostage for hours. I know, well, we can stay on and you know, talk. But we'd like to, we would like to what What didn't we talk about? What do you, we were going to tell everybody that they need to go read this paper. It's super readable. It's written in normal English, that you can understand, it doesn't have a lot of crazy data that you're gonna have to analyze. It's really spelled out clearly, it's like a maybe eight minute read, you totally have time to read this paper. In fact, you don't have time to not read this paper. But let's say that people don't read it. What should What did we cover? What should they what's the takeaway, or takeaways?

Kemi Balogun: 53:11

I think we covered just about the highlights really, like I said, we have to think about who is being left out of the picture, left out of the discussion. And try our best to reach out to people who aren't included. So reach out to communities that you don't often see. Find ways to educate people, find ways to sponsor people. This is how we change. This is how we increase representation.

Ann Blair Kennedy: 53:48

Yeah, she's a great student.

Cal Cates: 53:53

Oh, I forgot one question I do have, and I think we can do it quickly. But, um, when we talk about access, I actually use your paper for my column in massage & bodywork magazine, which will come out in a month or two, because I want to talk about access. And I think that when we talk about what we're talking about is more trained hands on people. So we're not necessarily talking about more people able to walk into a massage studio. We might be but part of what we are members of the coalition to transform advanced care. And we've been working and we're now working with MedStar, the same hospital who's doing the LVAD study, to participate in a three year community based palliative care program in DC. So we're going to be working with primarily upwards of 85% of the patients in this program are going to be African American. In the city, we're going to have massage therapists going into their homes, helping them to manage chronic and serious illness. So they're not going to go to Massage Envy or to my office, we are actually going to bring massage to them. And I feel like that is still success. You know if we can get into the home of a person who has never had massage before, and then because it's it's primarily a telehealth program, we're sort of like the telehealth plus piece of it. But that people will be able to ask their telehealth nurse practitioner, hey, that massage therapist came last week, I'm having that pain, I'm having that whatever again, could that person come out? And I think that we can really get a lot more creative about how we bring massage to people who haven't traditionally accessed it. I think that's one of the ways and working with Medicare and Medicaid and making it certainly a more primary part of healthcare that is a reimbursable investment in your health. Is that crazy?

Ann Blair Kennedy: 55:49

No, no, no, not not at all. But first I had to revisit one thing real quick. I said she's a great student. That does not mean that she learned all of that for me. She has a lot of that in her own, I am not going to claim all of that myself. So I need to take a step back because I realized that sounded kind of like, oh, how do my part? No. No. I think that bringing that access into whatever way it would be possible. I think that's fantastic. But here's one thing you might not have considered yet. What are you going to do for your rural communities?

Cal Cates: 56:23

Yeah,

Ann Blair Kennedy: 56:23

So we live in a rural. I'm down here in a rural state. That's where my practice was when I was in practice. I was in little, tiny, tiny Lawrence County, Lawrence County is special. It's a special place to be. Yeah. And don't even get me. This is. Okay. I know we're trying to get done with this thing. My office was a block and a half from the only KKK Museum in the United States. Wow. Yes. That held rallies. Wow. Yes. In the 2000s. Wow. So there's a movie that's been made with Forest Whitaker called Burden, which it hasn't like been widely released. But that's all about this museum, and the redneck shop in my little town, which was a block and a half from my massage practice. Wow. Okay. Rural, rural South Carolina. Very poor, very low levels of education. Yeah, but I was very successful for a very long time before I went back to school. And while I think it's great to go out to people's homes, where will that not work? Yeah. And that is just that other piece we have to consider, especially when you look at the evidence of all the rural hospitals closing down in those states, where Medicare was not expanded. Yeah. So you're already seeing this limitation. And I'm not saying it's crazy. It's excellent. This is amazing.

Cal Cates: 57:49

And it's but it's one thing. I mean, yeah. Yeah, absolutely.

Ann Blair Kennedy: 57:58

So it's a lot. It is messy,

Cal Cates: 58:01

but it's worth doing.

Ann Blair Kennedy: 58:03

It is. Yeah. And each person can make those steps, even if it's just answering the question on the survey the right way.

Cal Cates: 58:11

Yeah

Ann Blair Kennedy: 58:12

It's a start.

Cal Cates: 58:13

It is a start.

Ann Blair Kennedy: 58:15

And just start, a pick, just like Kemi said, who's at the table? Who isn't?

Cal Cates: 58:20

Yeah.

Ann Blair Kennedy: 58:21

Because of representation matters. Yeah. Absolutely.

Cal Cates: 58:28

Well, thank you both for, for helping us continue this conversation. It's funny that you mentioned the skinny white men when you look up leadership, because we're actually going to have some guests on really soon to talk about health ism and weight ism, and just how that plays into it's yet another it's sort of like the last acceptable racism that you can still judge people by their weight and you know, all the things that go into that.

Ann Blair Kennedy: 58:55

So I have another paper under review, that's on that, that's just

Cal Cates: 58:58

Enough, enough with the production, just enough. Take a nap, have a snack? I don't know something. Well, thank you both for being with us. I suspect we'll we'll have you back at some point. I mean, that tends to happen around here. Cathy, anything?

Cathy Ryan: 59:16

Other than as always, I'm just feel so grateful that I get to be part of this podcast where we get to sit down and have really meaningful conversations with super fancy informed and extraordinary guests who are out there doing great work. So thank you both.

Cal Cates: 59:36

Absolutely. Thank you guys.

Kemi Balogun: 59:38

Thank you for having us.

Healwell Podcast: 59:41

If you like this podcast, please write us a review. It helps us a whole lot to actually write words in the review. Send us an email, send us some love on the social media. And we always want to hear from you. You can email us at podcast@healwell.org. Enjoy the season. Interdisciplinary is produced by Healwell. Our theme music is by Harry Pickens. New episodes are available weekly on your favorite podcast outlets. Again you can send us an email at podcast@healwell.org. Podcast@Healwell.org. Thanks for listening