Exercise developed and produced by:

Johns Hopkins Center for Civilian Biodefense Studies

National Memorial Institute for the Prevention of Terrorism

Office of Justice Programs, National Institutes of Justice, U.S. Department of Justice

The Alfred P. Sloan Foundation

The Value of Culture and Social Capital in National Defense and Bioterrorism Preparedness

Transcript  [Listen to this talk]

DR. SCHOCH-SPANA: It's my pleasure to introduce our second speaker, Kathleen Rand Reed.  It was another moment of planets aligning.  There are very few anthropologists who work on biodefense issues, so when we bump into each other, we cling together, such as the old ladies in Myrna's talk.  And—I shouldn't have—I think I made an age-ist remark.  Excuse me.

You'll note in Kathleen's biography that she has interdisciplinary training in biology, behavioral science and broadcast electronic arts.  And I think it's the merging of those three fields, which will bring us many answers to how to deal with the complex problem like bioterrorism.  She has numerous research accomplishments that touch on the social and ethical dimensions of clinical trials.

She's more than an educator who reaches out to diverse public, teaching them how to plug into medical and public health assets in the United States, she's an educator of genetic scientists, clinicians, and public health officials of the value of reaching out to all sectors of our society.  Thank you very much.  Kathleen.

MS. REED: Good morning.  I'd like to say that there's a certain point in your life as a woman when—I'm sure you've all heard about the book that said, you know, Women Who Run With Wolves.  And I always like to say there's a time in our lives when women are wolves.

First of all, let me say thank you to Monica, to Tara O'Toole, especially to Andrea Lapp because I know how rough it is to do this kind of work.  And more importantly, to the young ladies that are out “manning” the desk outside, or “personing” the desk outside who don't get a chance to be in here, but who have done a lot of the work that allows us to be here today.

The second bit of housekeeping for me is a moment of silence for the seven souls that were lost on the Columbia, and a moment of joy for the 90th birthday of Rosa Parks today, so this is a wonderful time.

Let me explain a little bit about segmented targeted marketing.  Monica mentioned ethnomarketing.  That goes back to say the late 60s or early 70s.  I always laugh and say it's during that time when people discovered that people of color had money, and decided that they wanted some of it.  And, of course, that's when ethnomarketing was born> Because, again the joke is that there was an argument between Billy Bob and Bubba, and Bubba said in the Trent Lott way, you know, get them out of here.  And Billy Bob said, ”Oh no, that's market share!  So it's in that spirit that I say to you that I've been able to take an ethnomarketing background, add radio/TV, and then I got interested in health care.  In health care policy, especially in the early 1990s in transplantation, people were talking about not enough minority donors, but they were couching it in the aspect of,  “If you give, then you get.” 

And, of course, now we know that that's a little bit different when you start talking about, the human genome project, genes, haplotypes, et cetera.  So we've moved forward. 

Lately, I'd say the last few years, I've been very much involved with genetic education and the public, and a dear colleague, Michelle Puryear, who is the Genetic Services Branch Chief at HRSA (Health Resources and Services Administration); we're beginning to see a lot of good moves in terms of some of the programs where the public is, you know, being involved.  What I am thrilled about is the opportunity to be on the cutting edge and sort of  leapfrog ahead.  That is, take the lessons learned, as people say, and come to this arena of biodefense, terrorism, and emergency preparedness, and actually take some of these issues and move forward.  I might also say that I spent 26 years in Silicon Valley, and I go back and forth between the two coasts.

Let me just say one thing.  I said it to Jack Simms the other night; and that is, Silicon Valley thinking is different thinking.  Some people say “out of the box”.  People in Silicon Valley say “out of the sphere”, “out of the cylinder”.  Sometimes it isn't even the box; it's just different thinking all together.  And one of the things that we learned, I was reminded of it with Neil Cohen when he was talking about “in government” and “out of government”; and that is, that it's very interesting for me to see out of private industry governmental thinking of CYA.  And what that turns out to be is, in Silicon Valley people think of failing early, getting failure out of the way, because it's cheaper on the front-end, and you fall on your face as many times as you can, so you can get to the right answer, because the feeling is that failure is the predecessor to success.

That is what comes with an innovative creative spirit, and so I would say to people who are moving in this new direction, “think out of the cylinder”, you know, “think out of the sphere”.  Don't always put it in a box.  That's a very Cartesian way of doing it sometimes, you know, and sometimes you can get stuck on the corners too.  But at any rate, the title: "The Value Of Culture And Social Capital In National Defense And Bioterrorism Preparedness".  I came here with a sense of the practical, because I talked to a colleague in public health not too long ago, who said at one of the academic meetings—he said,  “This is wonderful.  This is great stuff.”  He said,  “but you know when I go back home, I've got to deal with local diseases, poverty, drug abuse, infant mortality, and real world issues.  I mean this is great. 

But I don't have the time to be able to talk about the esoteric and the studies.”  So I came here to give some information that I think is practical, and a model for the cultural context for social change in bioterrorism and national defense.

I also came bearing in mind that there are budget cuts in public health.  There's a recession and state and local budgets are slashed, if at all.  There are demographic changes in terms of immigrant populations and their customs and needs. 

And just as a short aside to that, you know there was a time when you could talk about Black people, and people pretty much knew what you meant by that, when you said Black people or African-descended. 

Now we're in a situation after the Immigration Act of 1965, where when you talk about African-descended or Black people, you could be talking about Dominicans.  There are places in Oaxaca and Guerrero and Vera Cruz, Mexico where people look like they're from Cleveland, you know.  There’s the Sudan, Ghana, Nigeria, as well as U.S. African Americans.  So you know, we're talking about diversity within diversity now.  And so I know that most of the people in public health are dealing with these issues, so bear in mind when I talk about African Americans or Black people, I'm bearing in mind that there are these variations on a theme.  And the other part is immediacy in use.  In other words, you need things that can hit the ground and—where you can hit the ground running.

The two models that I'd like to talk about briefly is STEWARTTM, and that means Segmented Targeted Environmental Web Articulated Relative Territories, that's a mouthful.  And at another time, in another life perhaps we'll get a chance to talk about that.  But what it takes into consideration is the idea that there are a lot of different disciplines that overlap, but it's been my experience that many people have their narrow niched fields.  And remember, I'm talking about segmented marketing and niches.  People go into their fields, and sometimes they put these blinders on, and they don't look to the left, and they don't look to the right.  But in many cases in public health, and especially in medicine and public health now that genomics is coming aboard, ethnohistory is just as important as understanding contagious disease.  Understanding pre-migration families of origin, may be just as instrumental in how you plan a program, or in this particular case, approach biodefense.  So the idea is to use segmented targeted marketing, in other words, if you have a zip code you need to know what you've got in it.  That means to profile communities, not just profile them where product development was years ago, but actually profile based on what you've got in your zip code as to ethnicity, demographics, lifestyle analysis, how people do things, what they do, et cetera.

There’s a reason that's important, and I'll get to that in just a second.   There are five sources that actually are the best sources to begin to do this.  Number one, the Dictionary of Occupational Titles.  Second, what used to be the old SIC, Standard Industrial Classification Code.  Now it's called NAICS, (nākes) the North American Industrial Classification System.  Gales Encyclopedia of Associations is a mainstay.  The Library of Congress system and getting very facile and very comfortable with that.  And lastly, a tool that we use as anthropologists called the Human Relations Area Files.  And what that does is: HRAF is where all of the various and sundry aspects of life and living is catalogued.  As a way of looking, let's say, how do people look at adornment?  How do people look at creation of identity, and the list goes on.  But it's an anthropological tool.  Those five sources become very important and will help quite a bit.

The reason I bring all of that up is that if you profile your populations and do what we call a culture audit, you will find that epidemiology is interesting, and that's a part of it, but you really need to get down to the beliefs and customs.  It's the both/ands.  It's the beliefs, and customs, and systems of the populations that you're serving.  Let me give you an example of how important that is.

I was once giving a talk before the National Medical Association, and I asked some of the doctors that were there, “How many of you are from Mississippi; how many are from Tennessee; how many are from Illinois, especially East St. Louis; how many are from Missouri and Chicago?  And, you know, various hands went up in the audience.  I said, “Do you talk to one another?  They said, “Yeah, every now and then, you know.  We get together maybe for a drink or something, you know, at a conference.”  I asked, “But are you talking to one another constantly?  Do you have a setup, a loop, if you will?  And they said no.
Well, that's interesting because anyone who really knows ethnohistory and migration in the country, knows that the people in Yazoo in Holmes County, Mississippi are the same people that are in Memphis, Tennessee, are the same people that are in East St. Louis, St. Louis and Chicago on a certain side of town.

That has aspects of not only getting the message out, but also in this particular case we were talking about what's called geophagy or clay eating.  And in Chicago, if a Black woman,—I don't know about some of the other groups, but certainly African-descended people—if she's pregnant she's either eating clay or she's got an Argo box of starch that she's working with, because it's a West African practice of geophagy that is going on at that time, and you need to know that in terms of fetal development, et cetera.  I point that out because in cases like in the District of Columbia, I've got a principal investigator that's got a sarcoidosis trial, and he's having a dickens of a time finding people for that trial.  What we began to talk about was the fact that most of the people that he wants in that particular trial, their families are in North and South Carolina, because that's the pre-migration locale for many of the people in Wards 7 and 8.  So it's that linkage that begins to become important as to how you deal with—in terms of biodefense—how you deal with your population.

Let me move forward quickly.  Let me just say this too. We are now beginning to forge new relationships.  As I say, I lived on the West Coast, and I would say to someone in some instances leave the church alone.  Some people want to go to church on Sunday and just go to church on Sunday and pray.  The Black church has been overworked.  People are having church fatigue. 

I always say that it's a comfort zone because it's where people don't have to worry about whether African Americans are going to be violent because, of course, they're in their Sunday-go-to-meeting best clothes, and it's a comfort zone for people to go and meet, but there are new places.  The hip-hop generation is really, as the brothers say, “got it going on.”  And there needs to be forays into that generation because of the aspect of popular culture, and getting messages out in particular ways.

The other thing is, African American women and outreach means that we need to talk to the Vietnamese community.  Many of the African American women are a captured audience for 45 minutes as they get a “cut down and a fill” in the nail salon.  And the linkage between the Asian community and the Vietnamese and African American women's community, these are sites. 

And I just—you know, I'm bringing this up, and I know I'm throwing a lot out, but I'm bringing it up because these are sites that are often overlooked unless you understand how to profile your community and where they come together.

Now here's probably the most important thing that I would say for me, you can write this down, and that is Ashby's Law of Requisite Variety.  Ashby's Law of Requisite Variety comes out of W. Ross Ashby who is a cybernetician, He dealt with feedback loops and systems analysis.  And what he gives us, and I think it's, to this particular audience, is a rule. 

And that rule is that, “In order to control a system, the governor of a system has to match or exceed its variety.”  And this goes to what Lee was talking about, command and control, or what I call the “mommy mode” of biodefense.  Do what I tell you to do or else.

And, you know, the idea is that we can no longer match the variety of any system.  It's just too much.  In fact, variability and variety is profitable.  So the idea of matching a system: you have to get inside those populations and those critical social networks, and that social capital and allow that social capital to come out.  That means that you've got to disempower yourself as officials and policymakers so that that little old lady at the church with that big hat, she's got credentials behind her name too, and that is MVP, most valuable player in the community.

I know physicians and public health officials that have enough degrees to bake a cake, but the bottom line is when it comes to going in those communities and disempowering, and taking the white coat off, and really understanding that they really don't know what they're doing, and it's okay, those are sorely lacking.

Let me cut right to the chase.  Let me move on.  You know, how you always over-write. You know, this is wonderful, but let me give you just a laundry list of what I saw at Brentwood, because I think that's one of the things that we came up. 

Number one, legal issues aside.  That'll be adjudicated in a courtroom, but what I saw at a community meeting was this.  Five or six white middle-aged guys sitting on a stage—talking heads—telling everyone what they were supposed to know about what they were doing.  Dana Briscoe, who happened to be the president of Brentwood Exposed, was in the audience with a lot of other postal workers, and basically there was no representation on that stage of the postal workers.  Their agency was stolen.  There was no voice in terms of the postal workers at that meeting except, you know, outside the official realm.
The antagonism is usually framed that it's the postal workers union versus the postal management.  But a lot of people rarely review the antagonism between the labor management and the rank and file, and that's an internal struggle.  So while a lot of people thought that their union was representing the postal workers, they didn't understand the antagonism between the labor management and the rank and file, and that's a real issue.

Lastly, the postal workers were aggregated as "the postal workers".  And all throughout this entire thing, that's against human research protections.  I sit on an IRB (institutional review board), and I can tell you that it's each individual postal worker.  Now, if they aggregate, they aggregate out of their own agency, but they do not aggregate because they are "the postal workers".  That has some stigmatization issues surrounding it.

Last thing.  A young man approached the microphone to ask about sending an animal into the facility.  That was his own indigenous scientific knowledge.  That was all he knew to ask to do.   “If you send something else that's living in there and it survives, you know, and it comes out and a week later it's still alive, maybe that might work for us.”

The gentleman that was on the stage who will remain nameless said,  “Oh, we don't do that any more”, and he dismissed him.  “We have scientific instruments.”  Well, I must tell you, it is that very scientific community that many African Americans are afraid of, because they've watched those kinds of things be used on them.  So as regards his other ideas he felt dejected and he walked away.  And I said to some of the officials, and I will say it here openly, and no offense, and no disparagement meant in terms of culture and people.  But I said, “You know, before it's over, you may have to bring the Shaka-Shaka man in to send the spirits out.  You don't know what you're going to have to do to get people to come back in there and work.  But the bottom line is you've got to be open to allow people to be where they are, and to let you know what they need, as opposed to you telling them what you're going to tell them.”
I've been told to stop, and I thank you very much for the opportunity to allow me to give you some information.  Thank you.

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