WEBVTT 00:00:00.000 --> 00:00:04.275 align:middle line:90% [MUSIC PLAYING] 00:00:04.275 --> 00:00:07.500 align:middle line:90% 00:00:07.500 --> 00:00:09.500 align:middle line:84% ADITI RAO: Let's first have a look at how global 00:00:09.500 --> 00:00:11.810 align:middle line:84% and national politics may affect health equity 00:00:11.810 --> 00:00:14.450 align:middle line:84% in agenda-setting for public health programs 00:00:14.450 --> 00:00:17.450 align:middle line:84% and its particular impact on the most vulnerable pockets 00:00:17.450 --> 00:00:18.890 align:middle line:90% of disease. 00:00:18.890 --> 00:00:21.470 align:middle line:84% We know communities commonly affected by polio 00:00:21.470 --> 00:00:24.440 align:middle line:84% make up the last 1% in large part because 00:00:24.440 --> 00:00:26.810 align:middle line:90% of political forces in play. 00:00:26.810 --> 00:00:29.810 align:middle line:84% These communities are typically excluded and underserved 00:00:29.810 --> 00:00:32.090 align:middle line:84% by health systems and are in countries 00:00:32.090 --> 00:00:34.940 align:middle line:84% that have serious competing priorities distracting 00:00:34.940 --> 00:00:39.980 align:middle line:84% attention from an eradication program, complicating efforts. 00:00:39.980 --> 00:00:41.870 align:middle line:84% Staying with our example, we know 00:00:41.870 --> 00:00:44.240 align:middle line:84% for some groups in Afghanistan and Pakistan, 00:00:44.240 --> 00:00:47.000 align:middle line:84% health systems are particularly hard to reach. 00:00:47.000 --> 00:00:50.420 align:middle line:84% This picture from 2010 shows a mobile medical team 00:00:50.420 --> 00:00:52.700 align:middle line:84% in Afghanistan reaching a village, which 00:00:52.700 --> 00:00:55.760 align:middle line:84% is a two-hour walk from the nearest road. 00:00:55.760 --> 00:00:58.820 align:middle line:84% People in this village only had access to a qualified health 00:00:58.820 --> 00:01:01.040 align:middle line:90% worker once a month. 00:01:01.040 --> 00:01:04.160 align:middle line:84% The recent decades of conflict in Afghanistan and Pakistan 00:01:04.160 --> 00:01:08.060 align:middle line:84% have had broad impacts on the health of their people. 00:01:08.060 --> 00:01:11.540 align:middle line:84% In Afghanistan, in the long war between the Soviets 00:01:11.540 --> 00:01:14.810 align:middle line:84% and the then US and Pakistani-backed militants, 00:01:14.810 --> 00:01:18.050 align:middle line:84% health facilities were neglected or destroyed. 00:01:18.050 --> 00:01:20.750 align:middle line:84% While militant groups received ample international funds 00:01:20.750 --> 00:01:22.910 align:middle line:84% for war-making, international aid 00:01:22.910 --> 00:01:25.220 align:middle line:84% to rebuild or staff health facilities 00:01:25.220 --> 00:01:28.850 align:middle line:84% in times of relative peace was woefully inadequate. 00:01:28.850 --> 00:01:31.310 align:middle line:84% Displacement and economic insecurity 00:01:31.310 --> 00:01:33.980 align:middle line:84% also took their toll on the Afghani people. 00:01:33.980 --> 00:01:37.520 align:middle line:84% The effects on health were severe and far-reaching. 00:01:37.520 --> 00:01:40.880 align:middle line:84% In 2002, adult life expectancy in Afghanistan 00:01:40.880 --> 00:01:44.720 align:middle line:84% was just 46 years, and infant and child mortality 00:01:44.720 --> 00:01:47.400 align:middle line:84% were among the highest in the world. 00:01:47.400 --> 00:01:50.340 align:middle line:84% Pakistan has a slightly different story, 00:01:50.340 --> 00:01:52.680 align:middle line:84% but its health systems too have been neglected 00:01:52.680 --> 00:01:55.290 align:middle line:90% as a result of militarization. 00:01:55.290 --> 00:01:57.780 align:middle line:84% The government spends less on health than most 00:01:57.780 --> 00:01:59.800 align:middle line:90% other countries in South Asia. 00:01:59.800 --> 00:02:03.510 align:middle line:84% This is, in part, a result of conflict, especially including 00:02:03.510 --> 00:02:07.920 align:middle line:84% Pakistan's ongoing dispute with India over the Kashmir region. 00:02:07.920 --> 00:02:11.100 align:middle line:84% Pakistan has poured resources into national defense 00:02:11.100 --> 00:02:14.760 align:middle line:84% at the expense of sectors like education and health. 00:02:14.760 --> 00:02:17.190 align:middle line:84% The result is that Pakistan's health indicators 00:02:17.190 --> 00:02:19.710 align:middle line:84% lag behind its South Asian neighbors 00:02:19.710 --> 00:02:21.660 align:middle line:84% and are even worse in border areas 00:02:21.660 --> 00:02:24.840 align:middle line:84% where people often live far from government services. 00:02:24.840 --> 00:02:28.110 align:middle line:84% Most of these deaths are preventable and treatable 00:02:28.110 --> 00:02:31.170 align:middle line:84% from causes such as diarrhea, pneumonia, and relatively 00:02:31.170 --> 00:02:33.660 align:middle line:90% simple birth complications. 00:02:33.660 --> 00:02:36.570 align:middle line:84% The current struggle to end polio in both these countries 00:02:36.570 --> 00:02:39.750 align:middle line:84% is deeply affected by their history. 00:02:39.750 --> 00:02:42.000 align:middle line:84% Let's look at the routine humanization coverage 00:02:42.000 --> 00:02:43.950 align:middle line:90% in both these countries. 00:02:43.950 --> 00:02:46.890 align:middle line:84% Routine immunization, a vital pillar in public health, 00:02:46.890 --> 00:02:49.500 align:middle line:84% is most often lacking in underserved and neglected 00:02:49.500 --> 00:02:51.900 align:middle line:90% areas with weak health systems. 00:02:51.900 --> 00:02:54.900 align:middle line:84% The Independent Monitoring Board for Polio Eradication 00:02:54.900 --> 00:02:59.940 align:middle line:84% reported that 78% of polio cases in Pakistan between 2012 00:02:59.940 --> 00:03:03.240 align:middle line:84% and 2019 did not receive polio vaccine 00:03:03.240 --> 00:03:05.250 align:middle line:90% through routine immunization. 00:03:05.250 --> 00:03:09.690 align:middle line:84% That is, if vaccinated, it was only from campaigns. 00:03:09.690 --> 00:03:12.420 align:middle line:84% If Pakistan and Afghanistan had strong health systems 00:03:12.420 --> 00:03:15.150 align:middle line:84% with good routine immunization coverage, 00:03:15.150 --> 00:03:16.860 align:middle line:84% polio would have long ago disappeared 00:03:16.860 --> 00:03:18.090 align:middle line:90% from these countries. 00:03:18.090 --> 00:03:21.330 align:middle line:84% But because their health systems may fail to reach everyone 00:03:21.330 --> 00:03:24.840 align:middle line:84% with even basic services like childhood vaccines, 00:03:24.840 --> 00:03:27.570 align:middle line:84% especially the poor and marginalized, 00:03:27.570 --> 00:03:30.450 align:middle line:90% polio has gained a foothold. 00:03:30.450 --> 00:03:33.030 align:middle line:84% Another facet of the efforts to stamp out the virus 00:03:33.030 --> 00:03:34.920 align:middle line:84% completely has been the establishment 00:03:34.920 --> 00:03:36.630 align:middle line:84% of an intense program of vaccination 00:03:36.630 --> 00:03:38.490 align:middle line:90% across both countries. 00:03:38.490 --> 00:03:41.070 align:middle line:84% In Afghanistan and Pakistan-- and especially their border 00:03:41.070 --> 00:03:41.610 align:middle line:90% areas-- 00:03:41.610 --> 00:03:44.670 align:middle line:84% houses are visited by vaccinators as many as 10 times 00:03:44.670 --> 00:03:48.300 align:middle line:84% a year, attempting to find and vaccinate every child 00:03:48.300 --> 00:03:50.400 align:middle line:90% under the age of five. 00:03:50.400 --> 00:03:53.670 align:middle line:84% How might this situation reflect on a health equity agenda 00:03:53.670 --> 00:03:55.980 align:middle line:84% when communities who have failed to receive 00:03:55.980 --> 00:03:58.140 align:middle line:84% other basic and essential services 00:03:58.140 --> 00:04:00.120 align:middle line:84% are inundated with polio campaigns 00:04:00.120 --> 00:04:02.970 align:middle line:90% with strong political backing? 00:04:02.970 --> 00:04:05.670 align:middle line:84% For some communities, polio vaccination campaigns 00:04:05.670 --> 00:04:08.400 align:middle line:84% was the only health service received. 00:04:08.400 --> 00:04:10.200 align:middle line:84% As one can imagine, this can frustrate 00:04:10.200 --> 00:04:12.060 align:middle line:84% families who may desperately need 00:04:12.060 --> 00:04:15.330 align:middle line:84% obstetric care for high-risk pregnancy or medicine 00:04:15.330 --> 00:04:18.149 align:middle line:84% for someone dying of tuberculosis. 00:04:18.149 --> 00:04:20.730 align:middle line:84% While it is difficult to get these services from neglected 00:04:20.730 --> 00:04:23.770 align:middle line:84% government health facilities, particularly along the border, 00:04:23.770 --> 00:04:25.830 align:middle line:84% which are highly contested areas, 00:04:25.830 --> 00:04:27.390 align:middle line:84% the same government health system 00:04:27.390 --> 00:04:30.000 align:middle line:84% is able to bring polio vaccinators repeatedly 00:04:30.000 --> 00:04:31.920 align:middle line:90% to their doorstep. 00:04:31.920 --> 00:04:34.140 align:middle line:84% The stark difference between polio services 00:04:34.140 --> 00:04:35.970 align:middle line:84% received and other health services 00:04:35.970 --> 00:04:38.230 align:middle line:90% received has two causes. 00:04:38.230 --> 00:04:40.800 align:middle line:84% One is the low levels of government funding for health 00:04:40.800 --> 00:04:44.190 align:middle line:84% programs, and the other is the heavy international focus 00:04:44.190 --> 00:04:47.880 align:middle line:84% on polio which invests hundreds of millions of dollars a year 00:04:47.880 --> 00:04:50.730 align:middle line:84% in separate streams of International funding. 00:04:50.730 --> 00:04:52.230 align:middle line:84% International actors are committed 00:04:52.230 --> 00:04:55.050 align:middle line:84% to polio eradication as the prospect of being 00:04:55.050 --> 00:04:56.700 align:middle line:90% part of a historic initiative. 00:04:56.700 --> 00:05:00.570 align:middle line:84% Ending a disease forever is a significant motivator, 00:05:00.570 --> 00:05:03.690 align:middle line:84% and eradicating polio would also mean that governments 00:05:03.690 --> 00:05:05.250 align:middle line:84% could eventually stop vaccinating 00:05:05.250 --> 00:05:07.680 align:middle line:84% their own populations against the disease, 00:05:07.680 --> 00:05:11.360 align:middle line:84% resulting in long-term financial benefits. 00:05:11.360 --> 00:05:14.950 align:middle line:84% Refusals have remained a key issue in this region. 00:05:14.950 --> 00:05:17.930 align:middle line:84% Now given the fact, as we just discussed on repeated polio 00:05:17.930 --> 00:05:21.470 align:middle line:84% campaigns and an unequal focus in health services delivered, 00:05:21.470 --> 00:05:23.960 align:middle line:84% some communities, who are well aware of these dynamics, 00:05:23.960 --> 00:05:26.780 align:middle line:84% may reject the polio campaign and vaccine, 00:05:26.780 --> 00:05:28.760 align:middle line:84% which they know that international agencies 00:05:28.760 --> 00:05:31.550 align:middle line:84% and their government want them to accept as a way of drawing 00:05:31.550 --> 00:05:33.650 align:middle line:90% attention to other needs. 00:05:33.650 --> 00:05:36.890 align:middle line:84% Here's an example of one of these demand refusals 00:05:36.890 --> 00:05:39.830 align:middle line:84% highlighted in the 17th report of the Independent Monitoring 00:05:39.830 --> 00:05:42.470 align:middle line:84% Board for Poverty Eradication describing 00:05:42.470 --> 00:05:45.830 align:middle line:84% the situation in Bannu, an area on the Pakistan side 00:05:45.830 --> 00:05:47.510 align:middle line:84% of the Pakistan-Afghanistan border, 00:05:47.510 --> 00:05:51.320 align:middle line:84% which had 23 cases of polio in 2019. 00:05:51.320 --> 00:05:53.820 align:middle line:84% The report stated, earlier in the year, 00:05:53.820 --> 00:05:56.150 align:middle line:84% it was announced that every member of the Bannu 00:05:56.150 --> 00:05:59.090 align:middle line:84% Chamber of Commerce and Industry would be boycotting the polio 00:05:59.090 --> 00:06:03.200 align:middle line:84% vaccination drive, resulting in thousands of refusals. 00:06:03.200 --> 00:06:06.350 align:middle line:84% The organization demanded that the newly elected Pakistan 00:06:06.350 --> 00:06:09.650 align:middle line:84% government withdraw a slew of new taxes that were, they say, 00:06:09.650 --> 00:06:12.590 align:middle line:84% crippling their ability to survive. 00:06:12.590 --> 00:06:15.410 align:middle line:84% The spokesperson for the Chamber of Commerce and Industry 00:06:15.410 --> 00:06:18.590 align:middle line:84% said it was the only way to get the government to listen. 00:06:18.590 --> 00:06:21.290 align:middle line:84% He also said that he has no doubts about the effectiveness 00:06:21.290 --> 00:06:24.290 align:middle line:84% of the vaccine and is also aware of the dangers of creating 00:06:24.290 --> 00:06:27.500 align:middle line:84% a gap in the herd immunity that full coverage of the vaccine 00:06:27.500 --> 00:06:30.800 align:middle line:84% offers, but that he and members of the community 00:06:30.800 --> 00:06:33.200 align:middle line:90% felt they had no choice. 00:06:33.200 --> 00:06:35.210 align:middle line:84% Take a minute and think about what you 00:06:35.210 --> 00:06:37.310 align:middle line:90% might do in such a situation. 00:06:37.310 --> 00:06:40.910 align:middle line:84% And do you think this issue is related to health equity? 00:06:40.910 --> 00:06:41.420 align:middle line:90% How so? 00:06:41.420 --> 00:06:51.890 align:middle line:90% 00:06:51.890 --> 00:06:53.840 align:middle line:84% One strategy developed in Afghanistan 00:06:53.840 --> 00:06:55.880 align:middle line:84% to address these barriers was to begin 00:06:55.880 --> 00:06:58.250 align:middle line:84% offering additional services to the communities 00:06:58.250 --> 00:07:00.050 align:middle line:90% during campaigns. 00:07:00.050 --> 00:07:03.260 align:middle line:84% Integration of services, such as the distribution of bed nets 00:07:03.260 --> 00:07:06.080 align:middle line:84% and nutrition video during vaccination campaigns, 00:07:06.080 --> 00:07:08.930 align:middle line:84% can provide the necessary motivation for families 00:07:08.930 --> 00:07:11.940 align:middle line:84% to bring their children for vaccination. 00:07:11.940 --> 00:07:14.790 align:middle line:84% Similarly, in Pakistan, the polio program 00:07:14.790 --> 00:07:17.460 align:middle line:84% evolved into a PolioPlus program, 00:07:17.460 --> 00:07:20.370 align:middle line:84% offering additional services as well as providing support 00:07:20.370 --> 00:07:22.492 align:middle line:90% to routine immunization. 00:07:22.492 --> 00:07:25.860 align:middle line:84% Here's a table from Polio Eradication in Afghanistan 00:07:25.860 --> 00:07:29.500 align:middle line:84% laying out possible strategies based on different scenarios. 00:07:29.500 --> 00:07:31.530 align:middle line:84% Especially in the South and Southeast region 00:07:31.530 --> 00:07:35.100 align:middle line:84% of Afghanistan, door-to-door coverage was often not allowed. 00:07:35.100 --> 00:07:38.640 align:middle line:84% While in the Northern region, it was only partially allowed 00:07:38.640 --> 00:07:40.700 align:middle line:84% based on such restrictions the program 00:07:40.700 --> 00:07:44.370 align:middle line:84% would develop alternate implementation plans. 00:07:44.370 --> 00:07:46.290 align:middle line:84% The first column on the left lists 00:07:46.290 --> 00:07:49.440 align:middle line:84% strategies such as conducting supplementary immunization 00:07:49.440 --> 00:07:52.680 align:middle line:84% activities or integrating polio vaccination 00:07:52.680 --> 00:07:56.290 align:middle line:84% with routine immunization in high-risk areas. 00:07:56.290 --> 00:07:58.860 align:middle line:84% The green column is for accessible areas, 00:07:58.860 --> 00:08:02.600 align:middle line:84% while the red column is for areas with bans on vaccination. 00:08:02.600 --> 00:08:06.300 align:middle line:84% And the column on the far right indicates resource availability 00:08:06.300 --> 00:08:08.490 align:middle line:84% for implementing each of these strategies 00:08:08.490 --> 00:08:10.650 align:middle line:90% in various combinations. 00:08:10.650 --> 00:08:12.600 align:middle line:84% As we can see, certain strategies 00:08:12.600 --> 00:08:15.060 align:middle line:84% are equally possible and necessary 00:08:15.060 --> 00:08:18.000 align:middle line:84% in all three scenarios such as surveillance, 00:08:18.000 --> 00:08:20.940 align:middle line:84% while other strategies are more essential to one scenario 00:08:20.940 --> 00:08:23.610 align:middle line:84% such as putting in place special teams where vaccination 00:08:23.610 --> 00:08:25.620 align:middle line:90% is otherwise banned. 00:08:25.620 --> 00:08:28.200 align:middle line:84% Take a moment again to look through the table 00:08:28.200 --> 00:08:30.630 align:middle line:84% and think about how these strategies in the given 00:08:30.630 --> 00:08:34.049 align:middle line:84% scenarios link to equitable delivery of the program 00:08:34.049 --> 00:08:37.470 align:middle line:84% and which strategies you think might increase equity the most. 00:08:37.470 --> 00:08:48.160 align:middle line:90% 00:08:48.160 --> 00:08:50.080 align:middle line:84% Thinking specifically of strategies 00:08:50.080 --> 00:08:52.190 align:middle line:84% in areas of conflict and insecurity, 00:08:52.190 --> 00:08:54.910 align:middle line:84% which are hard to penetrate safely, in order 00:08:54.910 --> 00:08:57.430 align:middle line:84% to reach these pockets, polio staff calmly 00:08:57.430 --> 00:08:58.930 align:middle line:84% coordinate with different opposition 00:08:58.930 --> 00:09:02.380 align:middle line:84% groups and military forces to negotiate peaceful days 00:09:02.380 --> 00:09:05.470 align:middle line:90% and gain access to unsafe areas. 00:09:05.470 --> 00:09:07.960 align:middle line:84% This includes coordination with insurgent groups 00:09:07.960 --> 00:09:10.150 align:middle line:90% such as the Taliban. 00:09:10.150 --> 00:09:11.710 align:middle line:84% You may also remember from the map 00:09:11.710 --> 00:09:14.460 align:middle line:84% we saw earlier a significant portion of cases 00:09:14.460 --> 00:09:16.870 align:middle line:84% are present in areas where the two countries border 00:09:16.870 --> 00:09:21.070 align:middle line:84% each other where populations are particularly mobile. 00:09:21.070 --> 00:09:22.960 align:middle line:84% Knowing this has allowed the program 00:09:22.960 --> 00:09:25.360 align:middle line:84% to establish special vaccination costs 00:09:25.360 --> 00:09:28.300 align:middle line:84% at formal and informal crossing points mapped 00:09:28.300 --> 00:09:31.840 align:middle line:84% between Afghanistan and Pakistan wherein vaccination 00:09:31.840 --> 00:09:34.060 align:middle line:84% teams deployed are able to reach thousands 00:09:34.060 --> 00:09:36.190 align:middle line:90% of children on the move. 00:09:36.190 --> 00:09:39.580 align:middle line:84% Important to note is also that the two countries synchronize 00:09:39.580 --> 00:09:41.930 align:middle line:90% their cross-border activities. 00:09:41.930 --> 00:09:43.930 align:middle line:84% The programs in Afghanistan and Pakistan 00:09:43.930 --> 00:09:46.430 align:middle line:84% maintain close coordination with each other, 00:09:46.430 --> 00:09:49.450 align:middle line:84% particularly in three corridors to increase access 00:09:49.450 --> 00:09:52.510 align:middle line:90% to high-risk mobile populations. 00:09:52.510 --> 00:09:55.090 align:middle line:84% Additionally, to reach nomadic groups 00:09:55.090 --> 00:09:57.940 align:middle line:84% specific supplementary immunization activities 00:09:57.940 --> 00:10:00.250 align:middle line:84% are conducted in the Southeast region 00:10:00.250 --> 00:10:04.390 align:middle line:84% upon entry to Afghanistan, and prominent transition teams 00:10:04.390 --> 00:10:07.420 align:middle line:84% are deployed in movement routes in the Southern and Western 00:10:07.420 --> 00:10:09.230 align:middle line:90% regions. 00:10:09.230 --> 00:10:11.210 align:middle line:84% Over the years, the goal of eradication 00:10:11.210 --> 00:10:13.340 align:middle line:84% has sparked great discussions and debates 00:10:13.340 --> 00:10:16.280 align:middle line:84% in the global health community, particularly when 00:10:16.280 --> 00:10:20.060 align:middle line:84% thinking about politics and public health agenda-setting. 00:10:20.060 --> 00:10:21.980 align:middle line:90% So let's consider this question. 00:10:21.980 --> 00:10:25.520 align:middle line:84% Does polio eradication or other similar global programs 00:10:25.520 --> 00:10:27.680 align:middle line:90% contribute to health equity? 00:10:27.680 --> 00:10:29.060 align:middle line:84% Take a moment to think about what 00:10:29.060 --> 00:10:31.023 align:middle line:84% arguments you might make on either 00:10:31.023 --> 00:10:32.190 align:middle line:90% of both sides of the debate. 00:10:32.190 --> 00:10:42.550 align:middle line:90% 00:10:42.550 --> 00:10:45.620 align:middle line:84% Now that you've had a chance to think about this, 00:10:45.620 --> 00:10:47.890 align:middle line:90% let's go over some examples. 00:10:47.890 --> 00:10:51.070 align:middle line:84% Examples of arguments to support the notion that the polio 00:10:51.070 --> 00:10:53.830 align:middle line:84% eradication program has contributed to health equity 00:10:53.830 --> 00:10:56.080 align:middle line:84% may include the goal of eradication 00:10:56.080 --> 00:10:59.200 align:middle line:84% inherently means that every last person will be reached, 00:10:59.200 --> 00:11:02.260 align:middle line:84% and everyone will benefit when the goal is achieved. 00:11:02.260 --> 00:11:05.110 align:middle line:84% The GPI has made special efforts to reach 00:11:05.110 --> 00:11:08.180 align:middle line:84% the hardest-to-reach populations and perhaps allowed 00:11:08.180 --> 00:11:10.540 align:middle line:84% other programs to launch from it or piggyback 00:11:10.540 --> 00:11:13.300 align:middle line:84% onto their efforts, essentially opening doors 00:11:13.300 --> 00:11:15.820 align:middle line:84% to a more holistic care provision. 00:11:15.820 --> 00:11:18.970 align:middle line:84% And the GPI has particularly recently 00:11:18.970 --> 00:11:21.490 align:middle line:84% also worked to integrate with other health services 00:11:21.490 --> 00:11:23.650 align:middle line:84% and ensure that all populations also 00:11:23.650 --> 00:11:27.910 align:middle line:84% receive essential services, and that the overall systems are 00:11:27.910 --> 00:11:29.530 align:middle line:90% standard. 00:11:29.530 --> 00:11:34.370 align:middle line:84% On the other hand, here are some arguments to refute the notion. 00:11:34.370 --> 00:11:36.620 align:middle line:84% Large amounts of money have been expended 00:11:36.620 --> 00:11:40.040 align:middle line:84% and health systems distorted in trying to reach this one 00:11:40.040 --> 00:11:42.200 align:middle line:90% often isolated goal. 00:11:42.200 --> 00:11:45.050 align:middle line:84% Other health services have been neglected due to the singular 00:11:45.050 --> 00:11:48.980 align:middle line:84% focus of GPI in some contexts, and the burden 00:11:48.980 --> 00:11:51.140 align:middle line:84% on populations where polio remains, 00:11:51.140 --> 00:11:53.300 align:middle line:84% such as repeated immunization campaigns, 00:11:53.300 --> 00:11:57.350 align:middle line:84% is disproportionately on disadvantaged groups. 00:11:57.350 --> 00:11:59.363 align:middle line:84% And, of course, you may come up with any number 00:11:59.363 --> 00:12:01.280 align:middle line:84% of other reasons on either side of the debate. 00:12:01.280 --> 00:12:07.280 align:middle line:90% 00:12:07.280 --> 00:12:11.530 align:middle line:90% [MUSIC PLAYING] 00:12:11.530 --> 00:12:14.000 align:middle line:90%