Margot Kushel MD Profile picture
May 10, 2019 16 tweets 6 min read Read on X
Anti racism in action: name racism (it’s not race it’s racism) & interrogate mechanism. Racism creates opened & closed signs in our society. It is difficult to recognize a system of inequity that privileges us Dr @CamaraJones #SGIM19 recognize the 2 sides of the sign! ImageImageImage
Racism exists even if we don’t see it. Racism is a SYSTEM of power to structure opportunity & assign value. Based on social interpretation of how one looks Image
Racism unfairly disadvantages individuals & communities & unfairly advantages others & saps strength of whole society Image
3 levels of racism: institutionalized, personally mediated & internalizes Image
Institutionalized racism is differential access to the good, services and opportunities by “race” (ie housing, education, medical facilities, clean environment, info, resources & voice) #SGIM19 Image
Institutionalized racism is WHY we have differences in social class by race (it’s racism, not social class)
Personally-mediated racism is differential assumptions re abilities, motives & intents of others by “race”. Can be unintentional Image
Internalized racism by stigmatized “races” of negative messages about own abilities & intrinsic worth (whole thread Dr @CamaraJones ) #SGIM19 Image
If you haven’t had the honor of hearing Dr @CamaraJones speak, google her telling the Gardener’s Tale. Please do this! Image
Addressing the institutionalized racism will address internalized racism & may address personalized racism. The “gardener” has power to decide, act & control of resources. Dangerous when allied w one group Image
And dangerous when gardener not concerned w equity. We have to talk about history & agency!
We must identify mechanism of racism: structures, policies, practices and values Image
Barriers to social equity: narrow focus on individual, A-historical stance, myth of meritocracy. Image
Other barriers: myth of zero sum game & short sighted vision Image
Our power is in our collective action. Name racism. By not naming it we are complicit in it. We need to become actively anti racist.
Dismantling racism is our urgent task in these turbulent times. Much gratitude to @SocietyGIM @gcsmd & Dr @CamaraJones #SGIM19

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More from @MKushel

Mar 25, 2022
Housing First works. We have tons of evidence to support it. The problem is--we don't have the housing. The soln: we need to preserve, protect, produce housing for the lowest income renters. Happy to talk to @BigadShaban @nbcbayarea about the evidence. 1/x
Discussed our eval study w @mravenEM @DSTNHome @SCCgov @abode_services @ucsfbhhi which showed that even the "hardest to house" ppl could be housed FOR YEARS w/o preconditions 2/x

hsr.org/node/664701
We gave Abode, SCC a list of the folks who were homeless who faced the most challenges (⬆️use of hospitals, ED, jail, psych, etc)--and randomly assigned folks to Housing First Permanent Supportive Housing w "intensive case management"--a master's trained counselor (e.g. LCSW) 3/x
Read 16 tweets
Jul 14, 2021
A🧵about #COVID vaccines. The @ucsfbhhi has spent last several mos working w great partners to provide vax to folks in the Tenderloin--including those who are homeless/formerly homeless. After providing 2500+vax to folks who face many barriers to vaccines--some thoughts: 1/x Bright mural on wall, tree holding homes with inscription: E
We talk alot about vax "hesitancy" but--we found, access>>>hesitancy. We had small, local sites (@GLIDEsf & Boeddeker Park)--with great outreach/ no appts needed. Helpful for those who couldn't get to mass vax sites. Reached 100s of folx, but not enough: So, what worked? 2/X Sunny day, blue topped tends on city street with ppl in them
Mobile teams! Teams, led by the incredible @codetenderloin --ppl w deep roots in community, lived expertise--w MD/NP or RN & "scribe." Teams walked around neighborhood and vaccinated folks wherever we found them. We answered ?s, supported ppls' choices--& when ready--vaxxed 3/X Ppl. casually dressed, masks--cart with bright pink sign &qu
Read 9 tweets
Oct 19, 2020
This policy change is v problematic. Don't be fooled by talk of ⬆️mental health. The reason homelessness has ⬆️ is bc the fundamental drivers of homelessness: income inequality, lack of deeply affordable ("ELI") housing & racism-- have worsened. A 🧵 1/x
bit.ly/3dF5Sdn
Housing First has a strong evidence base. Our recent study showed it successfully housed 86% of the "most difficult" to house chronically homeless ppl w high rates of substance use and mental health disabilities. hsr.org/node/664701 2/x
Read 12 tweets
Sep 25, 2020
Our paper, RCT on PSH for the highest user of healthcare is out @HSR_HRET. PSH w/ intensive case management ends homelessness for 86% of the highest users of multiple services. A lot of subtlety here. A 🧵@mravenEM @ucsfcvp @ucsfbhhi @ucsf onlinelibrary.wiley.com/doi/full/10.11… 1/x
Multi-year RCT comparing PSH (subsidized housing, mostly scattered site; ICM 1:15 master’s trained led team by @abode_services) vs usual care for chronically homeless ppl who were highest users of acute healthcare/jail in @sccgov 423 participants (199 intervent/224 control). 2x
Inclusions: chronic homelessness; highest users of services. Ineligible: engagement other program, req nursing home, hospice eligible. We created risk score/triage tool to calculate highest users (mult criteria). Triage tool calculated continuously & flagged in records. 3/x
Read 20 tweets
Jul 7, 2020
Thrilled to be listening to @nhannahjones & Marla Newman, Chair BOD @NLIHC on #RacialEquityAndCOVID from lens of housing/homelessness!
Image
& @nhannahjones spelling out how control of housing was mechanism of social control in North (racial covenants, redlining)."You don't have to pass laws saying Black ppl couldn't go to school with White ppl if you control where they live--& create neighborhood schools"
Read 26 tweets
May 15, 2020
Must read editorial in @nytimes on #homelessness that lays out the problem, where blame lays, & solution--"The fed govt could render homelessness rare, brief & nonrecurring. The cure for homelessness is housing." (YES!) A thread 1/x @BCAppelbaum

nytimes.com/2020/05/15/opi…
1. Problem is housing (not individual vulnerabilities) 2. Federal govt (& realistically, only Fed) could solve it 3. Instead, feds heavily subsidize wealthy homeowners, instead of low-income (mortgage interest tax deduction means homeowners live in deeply subsidized housing) 2/x
4. We spend $12 Billion a yr on shelters (shelters are dangerous, difficult places (#COVID19 has made this more evident cdc.gov/mmwr/volumes/6… , but as CA Gov @GavinNewsom says: "shelters solve sleep, housing solves homelessness) & 1/3 (in CA 2/3) unsheltered) despite $12B 3/x
Read 12 tweets

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