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WESTERN BUREAU: THE PSYCHIATRIC department at the Cornwall Regional Hospital [CRH] in Montego Bay, St James, kick-started its observance of Mental Health Week with an education campaign targeting patients’ relatives, featuring too opportunities...

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Californians in November will weigh in on a ballot initiative to increase scrutiny over the use of health-care dollars — particularly money from a federal drug discount program — meant to support patient care largely for low-income or indigent people. The revenue is sometimes used to address housing instability and homelessness among vulnerable patient populations.

Voters are being asked whether California should increase accountability in the 340B drug discount program, which provides money for community clinics, safety net hospitals and other nonprofit health-care providers.

The program requires pharmaceutical companies to give drug discounts to these clinics and nonprofit entities, which can bank revenue by charging higher reimbursement rates.

Advocates pushing the measure, Proposition 34, say some entities are using the drug discount program as a slush fund, plowing money into housing and homelessness initiatives that don’t meet basic patient safety standards. Researchers and advocates have called for greater oversight.

“There are 340B entities that are misusing these public dollars,” said Nathan Click, a spokesperson for the pro-Proposition 34 campaign. “The whole point of this program is to use this money to get more low-income people health-care services.”

The initiative wouldn’t bar 340B providers from using health-care funds for housing or homelessness programs. Instead, it targets providers that spend more than $100 million on purposes other than direct patient care over 10 years. It would mandate that 98 percentof 340B revenues go to direct patient care. It also targets 340B providers with health insurer contracts and pharmacy licenses and those serving low-income Medicaid or Medicare patients that have been dinged with at least 500 high-severity housing violations for substandard or unsafe conditions.

That has placed a bull’s eye on the Los Angeles-based AIDS Healthcare Foundation, a nonprofit that provides direct patient care via clinics and pharmacies in California and other states, including Illinois, Texas and New York. It also owns housing for low-income and homeless people.

A Los Angeles Times investigation found that many residents of AIDS Healthcare Foundation properties are living in deplorable, unhealthy conditions.

Michael Weinstein, the foundation’s president, disputes those claims and argues that Proposition 34 proponents, including real estate interests, are going after him for another ballot initiative that seeks to implement rent control in more communities across California.

“It’s a revenge initiative,” Weinstein said, arguing that the deep-pocketed California Apartment Association is targeting his foundation — and its health and housing operations — because it has backed ballot measures pushing rent control across California. “This is a two-pronged attack against us to defeat rent control.”

Weinstein is locked in a feud with the apartment association, the chief sponsor of the initiative, which has contributed handsomely to pass Proposition 34. Opponents argue that the initiative is “a wolf in sheep’s clothing.”

Weinstein acknowledged to KFF Health News that his nonprofit uses money from 340B drug discounts to support its housing initiatives but argued they are helping treat and house some of the most vulnerable people, who would otherwise be homeless.

The apartment association declined several requests for comment. But Proposition 34 backers say they aren’t going after rent control — or Weinstein and his nonprofit.

Supporters argue that “rising health care costs are squeezing millions of Californians” and say that the initiative would “give California patients and taxpayers much needed relief, and lowers state drug costs, while saving California taxpayers billions.”

If the initiative passes and 340B providers do not spend 98 percent of the revenue on direct patient care, they could lose their license to practice health care and their nonprofit status.

This article is not available for syndication due to republishing restrictions. If you have questions about the availability of this or other content for republication, please contact NewsWeb@kff.org.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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In the series finale of the podcast, a confident, outspoken Sikeston teenager shares her feelings in an uncommonly frank conversation with Chief James McMillen, head of Sikeston’s Department of Public Safety, which includes Sikeston police. 

Host Cara Anthony asks what kind of systemic change is possible to reduce the burden of racism on the health of Black Americans. Health equity expert Gail Christopher says it starts with institutional leaders who recognize the problem, measure it, and take concrete steps to change things. 

“It is a process, and it’s not enough to march and get a victory,” Christopher said. “We have to transform the systems of inequity in this country.” 

Host

Cara Anthony
Midwest correspondent, KFF Health News

@CaraRAnthony

Read Cara's stories

Cara is an Edward R. Murrow and National Association of Black Journalists award-winning reporter from East St. Louis, Illinois. Her work has appeared in The New York Times, Time magazine, NPR, and other outlets nationwide. Her reporting trip to the Missouri Bootheel in August 2020 launched the “Silence in Sikeston” project. She is a producer on the documentary and the podcast’s host.

In Conversation With …

Gail Christopher
Public health leader and health equity expert 

click to open the transcript

Transcript: Is There a Cure for Racism?

Editor’s note: If you are able, we encourage you to listen to the audio of “Silence in Sikeston,” which includes emotion and emphasis not found in the transcript. This transcript, generated using transcription software, has been edited for style and clarity. Please use the transcript as a tool but check the corresponding audio before quoting the podcast. 

[Ambient sounds from Sikeston, Missouri’s 2021 Juneteenth celebration — a DJ making an announcement over funky music, people chatting — begin playing.] 

Cara Anthony: It’s 2021. It’s hot and humid. We’re at a park in the heart of Sunset — Sikeston, Missouri’s historically Black neighborhood. 

Emory: Today is Juneteenth, baby. 

Cara Anthony: The basketball courts are jumping. And old-school funk is blaring from the speakers. Kids are playing. 

Cara Anthony: [Laughter] Are you enjoying the water?  

Cara Anthony: People are lining up for barbecue. 

I’ve been here reporting on the toll racism and violence can take on a community’s health. But today, I’m hoping to capture a little bit of Sikeston’s joy.  

Taneshia Pulley: When I look out to the crowd of my people, I see strength. I see power. I just see all magic. 

Cara Anthony: I drift over to a tent where people are getting their blood pressure, weight, and height checked … health screenings for free. 

Cara Anthony: I’m a journalist. 

Community Health Worker: Ooooh! Hi! Hi! 

Cara Anthony: The ladies working the booth are excited I’m there to report on the event. 

Cara Anthony: OK, and I’m a health journalist. 

Community health worker: Baby, that’s what I told them. Yeah, she healthy. [Laughter] 

[Dramatic instrumental music plays.] 

Cara Anthony: This Juneteenth gathering is happening a little over a year after Sikeston police officers shot and killed 23-year-old Denzel Taylor. 

We made a documentary about Denzel’s death and the death of another young Black man — also killed in Sikeston. 

Denzel was shot by police. Nearly 80 years earlier, Cleo Wright was lynched by a white mob. 

Both were killed before they got their day in court. 

In these years of reporting, what I’ve found is that many Black families worry that their kids don’t have an equal chance of growing up healthy and safe in Sikeston. 

[Dramatic instrumental ends.] 

Rosemary Owens: Being Black in the Bootheel can get you killed at any age. 

Cara Anthony: That’s Rosemary Owens. She raised her children here in Southeast Missouri. 

Cara Anthony: About 10 Sikeston police officers showed up to Juneteenth — for security and to connect with the community. Some are in uniform; some are in plain clothes. 

Rosemary has her doubts about why they came today. 

Cara Anthony: You see the police chief talking to people. What’s going through your mind as you see them milling about? 

Rosemary Owens: I hope they are real and wanting to close the gap between the African Americans and the white people. 

Anybody can come out and shake hands. But at the end of the day, did you mean what you said? Because things are still going on here in Sikeston, Missouri. 

Cara Anthony: For Rosemary, this brings to mind an encounter with the police from years ago. 

[Slow, minor, instrumental music plays softly.] 

When her son was maybe 16 years old, she says, she and her sister gave their boys the keys to their new cars — told them they could hang out in them. 

Rosemary had gotten her new car for Mother’s Day. 

Rosemary Owens: A brand-new red Dodge Caravan. We, we knew the boys were just going from the van to the car. You know, just showing out — they were boys. They weren’t driving. 

Cara Anthony: Someone nearby saw the boys …  

Rosemary Owens: … called and told the police that two Black men were robbing cars. 

 When the boys saw the police come up, there was three police cars. So they were like, something’s going on. So their intention, they were like, they were trying to run to us. And my brother said, stop. When they looked back, when the police got out of the car, they already had their guns drawn on my son and my nephew.  Cara Anthony: That’s what Rosemary thinks about when she sees Sikeston police at Juneteenth. 

[Slow, minor, instrumental music ends.] 

[“Silence in Sikeston” theme song plays.]  Cara Anthony: In this podcast series, we’ve talked about some of the ways racism makes Black people sick. But Juneteenth has me thinking about how we get free — how we STOP racism from making us sick. 

The public health experts say it’s going to take systemwide, institutional change. 

In this episode, we’re going to examine what that community-level change looks like — or at least what it looks like to make a start. 

From WORLD Channel and KFF Health News, distributed by PRX, this is “Silence in Sikeston.” 

Episode 4 is our final episode: “Is There a Cure for Racism?” 

[“Silence in Sikeston” theme song ends.] 

James McMillen: How you doing? 

Juneteenth celebration attendee: Good. Good.  

James McMillen: Good to see you, man.  

Juneteenth celebration attendee: What’s up? How are you?   

Cara Anthony: When I spot Sikeston’s director of public safety in his cowboy hat, sipping soda from a can, I head over to talk.  James McMillen: Well, you know, I just, I, I’m glad to be … on the inside of this. 

Cara Anthony: James McMillen leads the police department. He says he made it a point to come to Juneteenth. And he encouraged his officers to come, too. 

James McMillen: I remember as being a young officer coming to work here, not knowing anybody, driving by a park and seeing several Black people out there. And I remember feeling, you know, somewhat intimidated by that. And I don’t really know why. 

I hadn’t always been, um, that active in the community. And, um, I, I have been the last several years and I’m just wanting to teach officers to do the same thing. 

Cara Anthony: The chief told me showing up was part of his department’s efforts to repair relations with Sikeston’s Black residents. 

James McMillen: What’s important about this is, being out here and actually knowing people, I think it builds that trust that we need to have to prevent and solve crimes. 

Cara Anthony: A few minutes into our conversation, I notice a teenager and her friend nearby, listening. 

Cara Anthony: Yeah, we have two people who are watching us pretty closely. Come over here. Come over here. Tell us your names. 

Lauren: My name is Lauren. 

Michaiahes: My name is Michaiahes. 

Cara Anthony: Yeah. And what are you all … ? 

James McMillen: I saw you over there. 

Cara Anthony: So, what do you think about all of this?  

Michaiahes: Personally, I don’t even know who this is because I don’t mess with police because, because of what’s happened in the past with the police. But, um … 

Cara Anthony: As she starts to trail off, I encourage her to keep going. 

Cara Anthony: He’s right here. He’s in charge of all of those people. 

Michaiahes: Well, in my opinion, y’all should start caring about the community more. 

Cara Anthony: What are you hearing? She’s speaking from the heart here, Chief. What are you hearing? 

James McMillen: Well, you know what? I agree with everything she said there. 

Cara Anthony: She’s confident now, looking the chief in the eye. 

Michaiahes: And let’s just be honest: Some of these police officers don’t even want to be here today. They’re just here to think they’re doing something for the community. 

James McMillen: Let’s be honest. Some of these are assumptions that y’all are making about police that y’all don’t really know. 

[Subtle propulsive music begins playing.] 

Michaiahes: If we seen you protecting community, if we seen you doing what you supposed to do, then we wouldn’t have these assumptions about you. 

James McMillen: I just want to say that people are individuals. We have supervisors that try to keep them to hold a standard. And you shouldn’t judge the whole department, but, but just don’t judge the whole department off of a few. No more than I should judge the whole community off of a few. 

Cara Anthony: But here’s the thing … in our conversations over the years, Chief McMillen has been candid with me about how, as a rookie cop, he had judged Sikeston’s Black residents based on interactions with just a few. 

James McMillen: Some of, um, my first calls in the Black community were dealing with, obviously, criminals, you know? So if first impressions mean anything, that one set a bad one. I had, um, really unfairly judging the whole community based on the few interactions that I had, again, with majority of criminals. 

Cara Anthony: The chief says he’s moved past that way of thinking and he’s trying to help his officers move past their assumptions. 

And he told me about other things he wants to do …  

Hire more Black officers. Invest in racial-bias awareness education for the department. And open up more lines of communication with the community. 

James McMillen: I know that we are not going to see progress or we’re not going to see success without a little bit of pain and discomfort on our part. 

Cara Anthony: I don’t think I’ve ever heard the chief use the term institutional change, but the promises and the plans he’s making sound like steps in that direction. 

Except … here’s something else the chief says he wants …  

[Subtle propulsive music ends with a flourish.] 

James McMillen: As a police officer, I would like to hear more people talk about, um, just complying with the officer. 

Cara Anthony: That phrase is chilling to me. 

[Quiet, dark music starts playing.] 

When I hear “just comply” … a litany of names cross my mind. 

Philando Castile. 

Sonya Massey. 

Tyre Nichols. 

Cara Anthony: After Denzel Taylor was killed, people felt unsafe. I talked to a lot of residents on the record about them feeling like they didn’t know if they could be next. 

One thing that you told me was, like, well, one thing that people can do is comply with the officers, you know, if they find themselves having an interaction with law enforcement. 

James McMillen: Well, I mean, I think that’s, that’s a good idea to do. 

And if the person is not complying, that officer has got to be thinking, is this person trying to hurt me? So, asking people to comply with the officer’s command — that’s a reasonable statement. 

Cara Anthony: But, it’s well documented: Black Americans are more likely than our white peers to be perceived as dangerous by police. 

That perception increases the chances we’ll be the victim of deadly force. Whether we comply — or not. 

[Quiet, dark music ends.] 

That’s all to say … even with the promise of more Black officers in Sikeston and all the chief’s other plans, I’m not sure institutional change in policing is coming soon to Sikeston. 

[Sparse electronic music starts playing.] 

Cara Anthony: I took that worry to Gail Christopher. She has spent her long career trying to address the causes of institutional racism. 

Cara Anthony: We’ve been calling most of our guests by their first name, but what’s your preference? I don’t want to get in trouble with my mom on this, you know? [Cara laughs.] 

Gail Christopher: If you don’t mind, Dr. Christopher is good. 

Cara Anthony: OK. All right. That sounds good. I’m glad I asked. 

Cara Anthony: Dr. Christopher thinks a lot about the connections between race and health. And she’s executive director of the National Collaborative for Health Equity. Her nonprofit designs strategies for social change. 

She says the way to think about starting to fix structural racism … is to think about the future. 

Gail Christopher: What do you want for your daughter? What do I want for my children? I want them not to have interactions with the police, No. 1, right? 

Uh, so I want them to have safe places to be, to play, to be educated … equal access to the opportunity to be healthy. 

Cara Anthony: But I wonder if that future is even possible. 

[Sparse electronic music ends.] 

Cara Anthony: Is there a cure for racism? And I know it’s not that simple, but is there a cure? 

Gail Christopher: I love the question, right? And my answer to you would be yes. It is a process, and it’s not enough to march and get a victory. We have to transform the systems of inequity in this country. 

Cara Anthony: And Dr. Christopher says it is possible. Because racism is a belief system. 

[Hopeful instrumental music plays.] 

Gail Christopher: There is a methodology that’s grounded in psychological research and social science for altering our beliefs and subsequently altering our behaviors that are driven by those beliefs. 

Cara Anthony: To get there, she says, institutions need a rigorous commitment to look closely at what they are doing — and the outcomes they’re creating. 

Gail Christopher: Data tracking and monitoring and being accountable for what’s going on. 

We can’t solve a problem if we don’t admit that it exists. 

Cara Anthony: One of her favorite examples of what it looks like to make a start toward systemic change comes from the health care world. 

I know we’ve been talking about policing so far, but — bear with me here — we’re going to pivot to another way institutional bias kills people. 

A few years ago, a team of researchers at the Brigham and Women’s Hospital in Boston reviewed admission records for patients with heart failure. They found that Black and Latinx people were less likely than white patients to be admitted to specialized cardiology units. 

Gail Christopher: Without calling people racist, they saw the absolute data that showed that, wait a minute, we’re sending the white people to get the specialty care and we’re not sending the people of color. 

Cara Anthony: So, Brigham and Women’s launched a pilot program. 

When a doctor requests a bed for a Black or Latinx patient with heart failure, the computer system notifies them that, historically, Black and Latinx patients haven’t had equal access to specialty care. 

The computer system then recommends the patient be admitted to the cardiology unit. It’s still up to the doctor to actually do that. 

The hard data’s not published yet, but we checked in with the hospital, and they say the program seems to be making a difference. 

Gail Christopher: It starts with leadership. Someone in that system has the authority and makes the decision to hold themselves accountable for new results. 

[Hopeful instrumental music ends.] 

Cara Anthony: OK, so it could be working at a hospital. Let’s shift back to policing now. 

Gail Christopher: There should be an accountability board in that community, a citizens’ accountability board, where they are setting measurable and achievable goals and they are holding that police department accountable for achieving those goals. 

Cara Anthony: But, like, do Black people have to participate in this? Because we’re tired. 

Gail Christopher: Listen, do I know that we’re tired! Am I tired? After 50 years? Uh, I think that there is work that all people have to do. This business of learning to see ourselves in one another, to be fully human — it’s all of our work. 

[Warm, optimistic instrumental music plays.] 

Now, does that preclude checking out at times and taking care of yourself? I can’t tell you how many people my age who are no longer alive today, who were my colleagues and friends in the movement. But they died prematurely because of this lack of permission to take care of ourselves. 

Cara Anthony: Rest when you need to, she says, but keep going. 

Gail Christopher: We have to do that because it is our injury. It is our pain. And I think we have the stamina and the desire to see it change. 

Cara Anthony: Yep. Heard. It’s all of our work. 

Dr. Christopher has me thinking about all the Black people in Sikeston who aren’t sitting around waiting for someone else to change the institutions that are hurting them. 

People protested when Denzel Taylor was killed even with all the pressure to stay quiet about it. 

Protesters: Justice for Denzel on 3. 1, 2, 3 … Justice for Denzel! Again! 1, 2, 3 …  Justice for Denzel! 

Cara Anthony: And I’m thinking about the people who were living in the Sunset neighborhood of Sikeston in 1942 when Cleo Wright was lynched. 

Harry Howard: They picked up rocks and bricks and crowbars and just anything to protect our community. 

Cara Anthony: And Sunset did not burn. 

[Warm, optimistic instrumental music begins fading out.] 

[Piano starts warming up.] 

Cara Anthony: After nearly 80 years of mostly staying quiet about Cleo’s lynching, Sikeston residents organized a service to mark what happened to him — and their community. 

Reverend: We are so honored and humbled to be the host church this evening for the remembrance and reconciliation service of Mr. Cleo Wright. 

[Piano plays along with Pershard singing.] 

Pershard Owens: [Singing] It’s been a long, long time coming, but I know a change gonna come, oh yes it will. It’s been too hard a-livin but I’m afraid to die and I don’t know what’s up next, beyond the sky … 

[Pershard singing and piano accompaniment fade out.] 

Cara Anthony: I want to introduce you to that guy who was just singing then. His name is Pershard Owens. 

Remember Rosemary Owens? The woman who told us about someone calling the police on her son and nephew when they were playing with their parents’ new cars? Pershard is Rosemary’s younger son. 

Pershard Owens: Yeah, I definitely remember that. 

Cara Anthony: Even after all this time, other people didn’t want to talk to us about it. We couldn’t find news coverage of the incident. But Pershard remembers. He was in his weekly karate practice when it happened. He was 10 or 11 years old. 

Pershard Owens: My brother and cousin were, like, they were teens. So what do you think people are going to feel about the police when they do that, no questions asked, just guns drawn? 

Cara Anthony: Pershard’s dad works as a police officer on a different police force in the Bootheel. Pershard knows police. But that didn’t make it any less scary for him. 

Pershard Owens: You know, my parents still had to sit us down and talk and be like, “Hey, this is, that’s not OK, but you can’t, you can’t be a victim. You can’t be upset.” That’s how I was taught. So we acknowledge the past. But we don’t, we don’t stay down. 

Cara Anthony: So years later, when Chief James McMillen started a program as a more formal way for people in Sikeston and the police to build better relationships, Pershard signed up. They started meeting in 2020. 

The group is called Police and Community Together, or PACT for short. 

  [Sparse, tentative music begins playing.] 

Pershard Owens: It was a little tense that first couple of meetings because nobody knew what it was going to be. 

Cara Anthony: This was only five months after Sikeston police killed Denzel Taylor. 

PACT is not a citizens’ accountability board. The police don’t have to answer to it. 

The committee met every month. For a while. But they haven’t met in over a year now. 

Pershard Owens: We would have steps forward and then we would have three steps back. 

Cara Anthony: People have different accounts for why that is. Busy schedules. Mutual suspicion. Other things police officers have done that shook the trust of Black residents in Sikeston. 

Pershard Owens: And people were like, bro, like, how can you work with these people? 

The community is like, I can’t fully get behind it because I know what you did to my little cousin and them. Like, I know what the department did back in, you know, 15 years ago, and it’s hard to get past that. 

So, I mean, I’m getting both sides, like, constantly, and listen, that is, that is tough. 

[Sparse, tentative music ends.] 

Cara Anthony: But Pershard says something important changed because he started working with PACT. 

Pershard Owens: Chief did not like me at first [Pershard laughs]. He did not. 

Chief didn’t … me and Chief did not see eye to eye. Because he had heard things about me and he — people had told him that I was, I was anti-police and hated police officers, and he came in with a defense up. 

So, it took a minute for me and him to, like, start seeing each other in a different way. But it all happened when we sat down and had a conversation. 

[Slow instrumental music begins playing.] 

Cara Anthony: Just have a conversation. It sounds so simple; you’re probably rolling your eyes right now hearing it. 

But Pershard says … it could be meaningful. 

Pershard Owens: I truly want and believe that we can be together and we can work together and we can have a positive relationship where you see police and y’all dap each other up and y’all legit mean it. I think that can happen, but a lot of people have to change their mindsets. 

Cara Anthony: That’s a challenge Pershard is offering to police AND community members: Have a conversation with someone different from you. See if that changes the way you think about the person you’re talking to. See if it changes your beliefs. 

The more people do that, the more systems can change. 

Pershard Owens: We got to look in the mirror and say, “Am I doing what I can to try and change the dynamic of Sikeston, even if it does hurt?” 

Cara Anthony: Pershard says he’s going to keep putting himself out there. He ran for City Council in 2021. And even though he lost, he says he doesn’t regret it. 

Pershard Owens: When you’re dealing with a place like Sikeston, it’s not going to change overnight. 

Cara Anthony: And he’s glad he worked with PACT. Even if the community dialogue has fizzled for now, he’s pleased with the new relationship he built with Chief McMillen. And all of this has broadened his view of what kind of change is possible. 

[Slow instrumental music ends.] 

Pershard Owens: If you want something that has never been done, you have to go places that you’ve never been. 

[“Silence in Sikeston” theme music plays.] 

Cara Anthony: Places that you’ve never been … stories that you’ve never told out loud … maybe all of that helps build a Sikeston where Black residents can feel safer. Where Black people can live healthier lives. 

A world you might not be able to imagine yet, but one that could exist for the next generation. 

[“Silence in Sikeston” theme music ends.] 

[Upbeat instrumental music plays.] 

Cara Anthony: Thanks for listening to “Silence in Sikeston.” 

Next, go watch the documentary — it’s a joint production from Retro Report and KFF Health News, presented in partnership with WORLD. 

Subscribe to WORLD Channel on YouTube. That’s where you can find the film “Silence in Sikeston,” a Local, USA special. 

If you made it this far, thank you. Let me know how you’re feeling. 

I’d love to hear more about the conversations this podcast has sparked in your life. Leave us a voicemail at (202) 654-1366. 

And thanks to everyone in Sikeston for sharing your stories with us. 

This podcast is a co-production of WORLD Channel and KFF Health News and distributed by PRX. 

It was produced with support from PRX and made possible in part by a grant from the John S. and James L. Knight Foundation. 

This audio series was reported and hosted by me, Cara Anthony. 

Audio production by me, Zach Dyer. And me, Taylor Cook. 

Editing by me, Simone Popperl. 

And me, managing editor Taunya English. 

Sound design, mixing, and original music by me, Lonnie Ro. 

Podcast art design by Colin Mahoney and Tania Castro-Daunais. 

Tarena Lofton and Hannah Norman are engagement and social media producers for the show. 

Oona Zenda and Lydia Zuraw are the landing page designers. 

Lynne Shallcross is the photo editor, with photography from Michael B. Thomas. 

Thank you to vocal coach Viki Merrick. 

And thank you to my parents for all their support over the four years of this project. 

Music in this episode is from Epidemic Sound and Blue Dot Sessions. 

Some of the audio you heard across the podcast is also in the film. 

For that, special thanks to Adam Zletz, Matt Gettemeier, Roger Herr, and Philip Geyelin. 

Kyra Darnton is executive producer at Retro Report. 

I was a producer on the film. 

Jill Rosenbaum directed the documentary. 

Kytja Weir is national editor at KFF Health News. 

WORLD Channel’s editor-in-chief and executive producer is Chris Hastings. 

Help us get the word out about “Silence in Sikeston.” Write a review or give us a quick rating wherever you listen to this podcast. 

Thank you! It makes a difference. 

Oh yeah! And tell your friends in real life too!  

[Upbeat instrumental music ends.] 

Credits

Taunya English
Managing editor

@TaunyaEnglish

Taunya is deputy managing editor for broadcast at KFF Health News, where she leads enterprise audio projects.

Simone Popperl
Line editor

@simoneppprl

Simone is broadcast editor at KFF Health News, where she shapes stories that air on Marketplace, NPR, and CBS News Radio, and she co-manages a national reporting collaborative.

Zach Dyer
Senior producer

@zkdyer

Zach is senior producer for audio with KFF Health News, where he supervises all levels of podcast production.

Taylor Cook
Associate producer

@taylormcook7

Taylor is an independent producer who does research, books guests, contributes writing, and fact-checks episodes for several KFF Health News podcasts.

Lonnie Ro
Sound designer

@lonnielibrary

Lonnie Ro is an audio engineer and a composer who brings audio stories to life through original music and expert sound design for platforms like Spotify, Audible, and KFF Health News.

Additional Newsroom Support

Lynne Shallcross, photo editorOona Zenda, illustrator and web producerLydia Zuraw, web producerTarena Lofton, audience engagement producer Hannah Norman, video producer and visual reporter Chaseedaw Giles, audience engagement editor and digital strategistKytja Weir, national editor Mary Agnes Carey, managing editor Alex Wayne, executive editorDavid Rousseau, publisher Terry Byrne, copy chief Gabe Brison-Trezise, deputy copy chief Tammie Smith, communications officer 

The “Silence in Sikeston” podcast is a production of KFF Health News and WORLD. Distributed by PRX. Subscribe and listen on Apple Podcasts, Spotify, Amazon Music, iHeart, or wherever you get your podcasts.

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HCC will be spotlighting Caribbean NCD leaders leading up to the 4th UN High Level Meeting on NCDs (HLM4) to be held during the United Nations General Assembly in September 2025.

The HLM4 is a global milestone and stocktaking moment for the international NCD Community to pause and reflect on where we are and what needs to be done to accelerate action as we move towards achieving the 2030 SDGs.

Under the umbrella of the NCD Alliance, the global NCD civil society community will be galvanising over the next 12 months under the banner – Time to Lead. The NCDA Global Week of Action, 15-22 October 2024, will kick off this global campaign which calls on leaders worldwide to step forward and champion efforts to reduce the impact of NCDs on communities.

Despite uneven NCD progress regionally and globally, CARICOM has and continues to show tremendous leadership. Individuals and organisations have stepped up and shown bold unwavering leadership in their communities and countries.

As we look towards the HLM4, uniting around the theme – TIME TO LEAD, the HCC is seeking to recognise and showcase NCD champions – individuals and organisations who have shown exemplary leadership in NCD prevention and control in the Caribbean.

We are inviting our constituents to submit nominations of Caribbean NCD Leaders – individuals and organisations who you believe should be celebrated for their acts – small or large – which have changed the trajectory of the NCD response in your communities or countries.

Who is eligible to be an HCC Caribbean NCD Leader? Individuals (representing civil society, academia and the public sector) and Civil Society Organisations (CSOs) working in the Caribbean.

How do you nominate Caribbean NCD Leaders? Use the google form to nominate the names of Individuals (representing civil society, academia and the public sector) or Civil Society Organisations (CSOs).

The google form includes a series of prompts including describing the reason you are nominating this person/organisation, 2-3 key contributions/achievements which merit recognition as a NCD Leader and submitting a quote from the nominee in response to this question: What should CARICOM policymakers be prioritizing to accelerate action on NCDs?

The HCC looks forward to your submissions.

Submit Your Nomination Here

Debisette Consulting Empowerment Organization

Debisette Consulting Empowerment Organization is a non profit organization dedicated to empowering youth and communities through mentorship, youth development, and conflict resolution. Adults also receive individual motivational interviewing session where they gain self esteem and career goals to become more self sufficient. Many people can not afford therapy and they should not be deprived of that service. We all need someone who we can trust and be non judgemental to talk to.Read more
Debisette Consulting Empowerment Organization Achievements

Debisette Consulting Empowerment Organization (DCEO) stands at the forefront of Non-Communicable Disease (NCD) prevention, driving transformative change through innovative programs and personalized interventions. The organization’s targeted youth mentorship programs equip participants with critical life skills and knowledge, empowering them to embrace healthier lifestyles and reduce their risk of developing NCDs. Through comprehensive substance abuse counselling, DCEO addresses a leading risk factor for chronic illnesses, fostering recovery and overall wellness.

Additionally, DCEO integrates conflict resolution training to promote effective stress management, a cornerstone in preventing hypertension and related conditions. A cornerstone of its approach is Motivational Interviewing (MI), which supports individuals facing socioeconomic barriers in making sustainable lifestyle changes. By empowering participants to take ownership of their health decisions, MI significantly increases the likelihood of sustained improvements.

These initiatives underscore DCEO’s unwavering dedication to building healthier, more resilient communities while bridging the gap in health equity.

What should CARICOM policymakers be prioritizing to accelerate action on NCDs?

Addressing socioeconomic inequalities: Lower income populations often face higher NCD risk due to limited access to healthy food, health care, and safe space for exercise. Policies that address these inequalities such as subsidies for healthy food, health education in schools .

Data collection and monitoring is also needed, there is a need for accurate and up to date health data.

Priscilla Prevost

Mrs. Priscilla Prevost, a Family Nurse Practitioner, has been a champion for NCD prevention and management since 1990.
Her prominence as a health professional in Dominica is evidenced by her passion for the wellbeing of people as she advocates for and provides services across the Public, Private and Civil Society sectors. She has worked tirelessly from 1990 when she coordinated the first health expo in Dominica in collaboration with ADRA to present as she conducts screening, self-management training and food demonstrations within communities and schools on the island.

Read moreNurse Prevost connects with the wider population with a weekly radio Healthy Living Broadcast and Morning Breakfast Show along with health tips five days per alternate week.

She is a strong supporter of Dominica Diabetes Association and the Dominica Cancer Society and serves as Health Director for the East Caribbean Conference of Seventh Day Adventists for Barbados and Dominica.

Priscilla Prevost Achievements

In 1995, Mrs Prevost conducted a six-week programme titled “Lifestyle Intervention for Chronic Disease” in all the communities within the St. Joseph Health District. For this she received a nutrition award from CFNI (Caribbean Food and Nutrition Institute)

In 2001 she launched the Healthy Lifestyle and corporate Wellness Services, a private business aimed to identify and reduce risk factors for non-communicable diseases.

1n 2003 she began an employee wellness programme with utility companies and banks in Dominica. Where 75-80% of staff were screened annually until 2017. The companies concerned attributed a decrease in absenteeism and increased staff morale as positive outcomes of the programme.

What should CARICOM policymakers be prioritizing to accelerate action on NCDs?

At the 75th World Assembly in 2022 member states adopted new recommendations for prevention and management of obesity and endorsed the WHO accelerated plan to stop obesity (WHO,2022).

Obesity, a disease as well as a risk factor, is one of the major contributing factors to diabetes, cardiovascular disease and cancer. It is noticeable that enough is not being done from a policy maker and also from a service delivery standpoint. I am therefore strongly recommending that accelerated action be taken to develop policies prohibiting the promotion and sale of unhealthy foods on and around school compounds and at school sponsored events.

Additionally, policies regarding the creation or allocation of safe spaces for physical activity in every community should be prioritized.

Abi Begho

Abi Begho is an inspirational leader in public health and the founder and director of Lake Health and Wellbeing, a public health NGO in St. Kitts and Nevis. Abi is a fearless advocate who has amplified the voices of vulnerable groups, ensuring they are heard and supported. Among her many accomplishments, she: spearheaded the SKN Disability Working Group, advocating for greater inclusivity across all sectors, launched the EmpowHer program to empower women living with chronic diseases, and developed the Menstrual Health Education program to equip young girls with essential knowledge about their periods and how to identify signs of reproductive conditions such as fibroids.

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Some of Abi’s Achievements

• Created the opportunity for the youth perspective to be integrated into the public health space through the Youth Health Advocates program.
• Created the You’re Sweet Enough Campaign which has garnered local, regional, and international attention and awareness of the need for sugar-sweetened beverage policies, school nutrition policies, and front of package warning labels.
• Spearheaded the creation of the St. Kitts and Nevis NCD Alliance and its recent full membership with the global NCD Alliance.

What should CARICOM policymakers be prioritising to accelerate action on NCDs?

NCDs are the leading cause of death in the Caribbean, and urgent action is needed from CARICOM leaders. We urge our leaders to unite to accelerate the development and implementation of policies that focus on preventing, detecting, and managing NCDs. Prevention offers the greatest potential for impact, so we call on all CARICOM leaders to focus on healthy food policies, (such as SSB taxes, trans fat elimination, salt reduction and front-of-package labelling), promoting physical activity, tackling pollution and expanding NCD screening. Our leaders must make health a priority to avoid the premature loss of our loved ones from preventable NCDs.

Breast Friends

A very long time ago Carolyn Aziz had a dream. Long before the word Cancer was actually mentioned in polite conversation, she was afflicted with breast cancer. She advocated single handedly and brought others on board.  She wanted to share her story so that others would understand that there was no shame in having Cancer and to let others know that fear could only kill.

At the time, it was a diagnosis associated with doom and gloom. She wanted to change that for Antiguans. She wanted to share a message of hope.

She continued as long as she could and laid the foundation. Then Ms. Bird joined the fight.

Read moreToday Breast Friends (Women in Touch ) has led the way. When no one was organizing talks about cancer, they were.  When no one cared to care, they did. When there was little money to be made by the pharmaceutical world in this part of the world, Breast Friends walked, Breast Friends talked.

Breast Friends also helped neighbouring Anguilla and Montserrat. When politicians were not talking about Cancer but were lobbying for NCDs thanks to the Nassau and P.O.S declarations, Breast Friends were advocating.

So you see, for Breast Friends it wasn’t a fad, it wasn’t a fate, it wasn’t just an October month fashion. T’was a group of women along with their families helping to change the stereotype, one small step at a time.

What should CARICOM policymakers be prioritizing to accelerate action on NCDs?

• Caricom leaders must prioritize the war on tobacco and Green spaces (safe and clean). Incentivize exercise in the workplace. Antigua has exercises in the 39ers Square at the Ministry of Health three times weekly for free. In Dominica, the public workday was made shorter to facilitate those who want to exercise.
• Advertisements are needed to promote less alcohol abuse and encourage  eating ground provisions and healthy foods as part of a healthy diet. 
• Stress and psychosocial determinants of Health must be taken more seriously. 

Together we can,  Together we will!

Professor Rohan Maharaj

Professor Maharaj is a beacon in research, medical education and scholarly research in the areas of NCDs, Alcohol reduction, Mental Health Issues and many others. He has contributed immensely during the last 20 years to the sensitisation and education of the population on the harmful effects of alcohol and has lobbied tirelessly for its regulation and control in order to reduce the burden on NCDs. He has provided yeoman clinical services in both the public and private sectors in relation to health promotion, NCD prevention and treatment of NCDs. He is currently an active member of the HCC and led the local efforts for the 2023 Caribbean Alcohol Reduction Day. He is on the cusp of publishing his latest book entitled Rum Songs and Other Alcohol Issues in the English Speaking Caribbean.

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Dr Professor Maharaj’s Achievements

1. Prolific researcher on NCDs and other risk factors associated with NCDs
2. Principal Investigator of ECHORN- Eastern Caribbean Health Outcomes Research Network
   with NCD publications on Consumption of sugar-sweetened beverages and T2D diabetes in the Eastern Caribbean, Risk factors for household food insecurity in the Eastern Caribbean Health Outcomes Research Network cohort study and Egocentric Health Networks and Cardiovascular Risk Factors in the ECHORN Cohort Study.
3. Key actor in the quest for alcohol regulation locally and regionally.

What should CARICOM policymakers be prioritizing to accelerate action on NCDs?

Alcohol contributes to cardiovascular disease through its effect of elevating blood pressure, and pericardial disease among others; alcohol is a Class I carcinogen, alcohol contributes to breast, liver, and oropharyngeal cancers; alcohol contributes to mental health issues and is often a co-diagnosis to bipolar, personality and mood disorders. CARICOM and regional governments recognize the fact that alcohol contributes to NCDs. Yet there has been little effort to address this. The WHO recommends 3 ‘Best Buys’ (simple, acceptable, and cost-effective interventions) to tackle alcohol in under-resourced settings- 1. Ban the marketing and advertising of alcohol and its products; 2. Implement price measures, such as taxation, Minimum Unit Pricing, and linking alcohol prices to inflation; and 3. Addressing availability, such as hours of sale and outlet density.

CARICOM policymakers should be working in these areas to reduce the harmful impact of alcohol on our Caribbean communities.

Dr. Asante Le Blanc

Dr, LeBlanc is an exceptional and dedicated leader in public health. As the former Chairman and current Director of the Trinidad and Tobago Cancer Society, Dr. Le Blanc has led with vision and impact, steering initiatives focused on cancer prevention and education. Her commitment to public education has been pivotal in raising awareness about the importance of lifestyle changes to reduce the risks of non-communicable diseases, especially cancer. Through her leadership and advocacy, she continues to make a significant difference in empowering individuals and communities to make healthier choices for long-term well-being.

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Dr Le Blanc’s Achievements

Dr. Asante Le Blanc merits recognition as an NCD Leader for her impactful work in two key areas. First, she spearheaded the implementation of an Anti-Smoking/Vaping Campaign in high schools nationwide, educating youth on the harmful effects of these habits. Her efforts aim to reduce the early adoption of smoking and vaping, fostering healthier future generations. Secondly, through the Trinidad and Tobago Cancer Society’s Cancer Survivors Network, Dr. Le Blanc works closely with patients and survivors, empowering them to advocate for early detection. This initiative not only provides emotional support but also inspires others to undergo screening, promoting early diagnosis and better outcomes.

What should CARICOM policymakers be prioritizing to accelerate action on NCDs?

Dr. Asante Le Blanc merits recognition as an NCD Leader for her impactful work in two key areas. First, she spearheaded the implementation of an Anti-Smoking/Vaping Campaign in high schools nationwide, educating youth on the harmful effects of these habits. Her efforts aim to reduce the early adoption of smoking and vaping, fostering healthier future generations. Secondly, through the Trinidad and Tobago Cancer Society’s Cancer Survivors Network, Dr. Le Blanc works closely with patients and survivors, empowering them to advocate for early detection. This initiative not only provides emotional support but also inspires others to undergo screening, promoting early diagnosis and better outcomes.

CARICOM policymakers should prioritize three key areas to accelerate action on NCDs;

• Strengthening Public Education and Prevention Campaigns Greater emphasis is needed on awareness campaigns, particularly targeting youth, to promote healthy lifestyle choices and reduce risk factors such as smoking, vaping, poor nutrition, and inactivity.
• Expanding Access to Screening and Early Detection Services Policymakers must invest in accessible, affordable screening programs to enable early diagnosis and timely intervention, improving health outcomes for chronic diseases like cancer.
• Implementing Stronger Policy Frameworks and Regulations. This includes enacting stricter tobacco and sugary drink regulations, promoting healthy school environments, and ensuring that health policies are integrated across all sectors for a whole-of-society approach

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