理查德·贝塞尔（Richard Besser）博士：健康公平处方

Jennifer Tescher:
欢迎来到任何地方。我是詹妮弗·特舍尔（Jennifer Tescher），记者变成了财务健康冠军。作为金融健康网络的创始人兼首席执行官，我的职业生涯通雷竞技最新网址过与各个行业的创新者互动来分解筒仓，现在，我与您分享了这些对话。与前瞻性思维领导者挑战现状，并通过与3D的客户，员工和社区见面，从而释放创造性的新方法，以改善财务状况。

的双重危机COVID-19流行和economic downturn that spawned, are maybe the best example yet of the link between physical, mental, and financial health. My guest today is uniquely qualified to explore these intersections. Dr. Richard Besser is a global public health expert and the president and CEO of the Robert Wood Johnson Foundation, the largest private foundation in the country devoted solely to improving the nation’s health.

As a pediatrician and the former acting director of the Centers for Disease Control, Dr. Besser has worked in communities around the globe to ensure families are able to raise healthy children. Today, he is particularly focused on achieving health equity, ensuring that communities of color aren’t left behind. Rich, welcome to EMERGE Everywhere.

Dr. Richard Besser:
谢谢，詹妮弗。来到这里真的很好。

Jennifer Tescher:
因此，在这个节目中，到处都出现的实际上是关于十字路口的。这是关于您的病人，我的工人以及他的学生和她的租房者实际上都是同一个人的想法。我们只是倾向于在筒仓中看到它们。而且，如果有一件事确实为我加强了，那就是一切都相互联系了。绝对一切都相互联系。

你带领罗伯特·伍德·约翰逊基金会和哟ur North star as you’ve said, is to build a culture of health.

Dr. Richard Besser:
是的。

Jennifer Tescher:
I see the culture of health as being all but intersections. So talk to me a little bit about what is a culture of health and why is it so important?

Dr. Richard Besser:
是的。It is absolutely critically important. And as you’re saying, COVID shines a bright light on it. The idea of a culture of health is really a recognition that health is about much more than having access to high quality, comprehensive, affordable health care. You have to have that, but if you have health care, it doesn’t mean that you truly have opportunities for health.

健康是什么发生在社区which we live, where our kids go to school and where they play, where we work. Those are all the settings that play such a role in terms of health. And we don’t talk about the culture of health without talking about the concept of health equity. And by that we mean the idea that everyone has a fair and just opportunity for health and that the barriers to health that are there for so many, related to structural racism, and sexism, and homophobia, and able-ism and classism; you go on and on.

But if you don’t remove those barriers, if you don’t look at those barriers and recognize that for some people in our society, health is the easy option. And for some people in our society, it’s a near impossibility. If you don’t recognize that and move away from this idea, that health is all about individual choice, you will never reach the goal of a culture of health.

Jennifer Tescher:
This idea of a culture of health is not a COVID idea. The foundation was at this pre-COVID, I think even before you came to the foundation in 2017. What does that work look like? How does trying to create a culture of health show up in the grants you made, in the calls to action that you are making out in the world?

Dr. Richard Besser:
是的，我的意思是，我们会谈论很多关于Covid的谈论，因为Covid阐明了我们社会中的不平等和鲜明的光明。当我们想到一种健康文化时，实际上就是一切。因此，对于我们来说，作为授予者，作为慈善事业，我们不得不选择我们认为可以产生最大影响的地区。

因此，我们围绕健康社区以及住房与健康之间的联系做了很多工作。社区发生了什么样的发展？您如何确保人们居住在可以使用负担得起，安全住房和稳定住房的社区中？您如何确保有与人们居住的工作相关的工作和运输系统，以便他们可以工作。那里有很多关注。我们如何发光，让人们看到住房与健康之间的联系？

Last year my president’s message was all about this connection between housing and health. And it’s pretty easy to understand I think, that if someone is spending more than half of their income on housing, it’s hard to have a lot of money left over for healthy food, for all of the things that you know people need to lead a healthy life. If you are in a household where your risk of eviction is very high, it’s pretty hard for you to provide the stable environment you want to for your children. It’s hard if you’re in a household where eviction is a challenge, to have your child in a stable school environment where they can develop the peer relationships that are so important, the educational development that’s so important. There’s clear connections there between housing and health.

我们还专注于健康的儿童和家庭的问题。在这里，我们如何确保每个家庭都有他们知道自己的孩子成功的知识？与说：“哇，让我们提供一些教育，让人们知道您应该每天锻炼一个小时，并且您需要适当地吃掉食物金字塔或食物盘。”而且，您如何确保父母拥有他们知道他们需要养育健康，成功的孩子所需的资源？

And a lot of our work focuses on issues of policy, what policies need to be in place, around mindsets of who do we, as a society view as worthy, and who do we not? Where do we yell out for opportunity and where do we not? And more and more, looking at community power; how do we provide resources to those in communities who are closest to the problem who are living these issues every day, who clearly see the solutions for those problems and need resources to help effect the changes that they know are necessary.

We do a lot of investment in leaders. Across our history we’ve had leadership programs, the Robert Wood Johnson Clinical Scholars Program trained people to do health services research. And you’ll find incredible graduates of that program in leadership positions across the country. We have moved away from that to change leadership programs. So how do we provide resources to those in communities who are trying to affect change? And that’s really, really exciting work.

Jennifer Tescher:
It’s one thing to talk to healthcare professionals or administrators or public health professionals about the upstream inputs to health, the social determinants of health, but it’s another to engage with say, employers or big corporations, or folks in community or home builders, who don’t see themselves necessarily as being in the health business.

您如何向他们辩护？我的意思是，对您和我似乎很明显，这是有联系的，但是您如何为这些观众提供理由，这并不是您作为健康基础的传统受众呢？

Dr. Richard Besser:
是的。I’m finding that with the COVID pandemic and the economic crisis in America and the movement for racial justice in America, it’s become easier and easier to make the case for the connection between economic health and overall health. It’s easier to make the connection between structural racism and barriers to health.

If you look at this pandemic, it’s hitting every community in America, but it clearly is not hitting every community, every population at the same level. Black, Latino, Native Americans being infected, being hospitalized, dying at three to five to seven times the rate of white Americans. And it begs the question as to why, and a lot of that comes down to economics. A greater proportion of people of color are paid lower wages, they’re in lower income jobs, have less wealth, have less savings. The idea of staying home and working remotely is not an option if you work in food production, if you’re a frontline healthcare worker, if you work in a transit system. So many of these jobs have a greater proportion of individuals who are people of color. And so you can’t do those jobs remotely.

美国的财富差距很大。The ratio of wealth between whites to blacks is something like 10 to 1. And so the resources that people have to be able to say, “You know, I’m not feeling great today,” or, “I’ve been exposed to somebody who may have COVID. I’m going to stay home and make sure that I’m not spreading this out there.”

Well, if the choice is between going to work with a slight risk so that you can put food on the table and pay the rent, or staying home to follow public health recommendations, well, it’s an easy choice. It’s a rational choice. You have to go to work. And while the federal government puts some resources out there to support people last spring, most of those are gone and the rest of them are gone by the end of December. And the idea that as the wealthiest nation on the planet, we are going to allow tens of millions of people to be evicted in January, in the middle of winter, in the middle of a pandemic, is absolutely criminal.

Jennifer Tescher:
是的。I am very, very concerned about the financial health of Americans. At the same time we see the stock market hit the 30,000 level. There’s such a disconnect between the typical measures that we use as a country to assess our economic health and the economic realities for frankly, the majority of Americans. And certainly if those living at the margins, and it creates a sense of cognitive dissonance to hold those same set of facts in your head at the same time and try to make sense of them.

Dr. Richard Besser:
是的。

Jennifer Tescher:
We’re going to get back to your sort of call to action for the incoming administration. But first, I want to make sure that we continue to unpack a little bit, these intersection between physical, mental, and financial health, because it’s really bi-directional. So healthcare costs can disrupt financial health, but also, financial insecurity impacts health outcomes.

Dr. Richard Besser:
是的。

Jennifer Tescher:
我们尚未谈论的一件事是，压力在造成许多慢性健康状况中所扮演的角色，许多人面临或至少对它们做出了贡献。因此，我们进行了大量的调查工作来评估美国财务状况。我们提出了许多其他问题，包括一堆基本的健康问题，身体健康问题，以便我们可以理解联系。

根据我们的研究,我们responde的43%nts, this is nationally representative. It’s a panel of about 6,000 people. 43% say that their finances are causing them moderate to high stress. 58% of them believe that their financial stress affects their physical health. 65% believe financial stress impacts their mental health. So people are aware, themselves, of the intersection.

And then of course, what you would expect is true. The healthier you are physically, the more financially healthy you are. Folks who state that they’re in excellent physical health, half of them are financially healthy. Similarly, people who aren’t getting healthcare, it’s because they can’t afford it. And often, we had 17% of consumers say they stopped taking their medication or took less than directed, because they couldn’t afford the costs.

And finally, we look at what are the factors that really drive financial health? When your physical health declines, we find that you experience a three point decline in your financial health. If a financial health score is on a scale of 0 to 100, you’re losing more than three points when your physical health declines. You’re losing more than three points when you have a major medical expense. But when your physical health improves, you gain almost two points.

So, talk to me a little bit about how you see this connection play out in some of the broad changes and transformations that you are trying to affect.

Dr. Richard Besser:
Well, I’m seeing it play out again in the pandemic. If you look at the start of the pandemic, there were 28 million people in America without health insurance. The connection between how we provide health services in this country and finance is clear, given how many people get health insurance through their jobs. And the Affordable Care Act increased the number of people who had health insurance, but it was not the end state that we’re looking for. We believe that we should have universal healthcare. And there are many ways to get there, but everyone deserves access to high quality, comprehensive, affordable healthcare.

And during this pandemic, as millions of people have lost their jobs, millions of people will be losing health insurance and it’s just wrong. With the Affordable Care Act, states have the opportunity to expand Medicaid, but a number of states haven’t. There are 12 states that still haven’t expanded Medicaid. And those are primarily southern states with very large proportions of populations who are African American. So again, you see this connection between structural racism and health.

When I look at the early guidance that CDC was putting out in terms of, well, what do you do if you think you have COVID? They said, “Don’t go to the hospital because there, you can expose healthcare workers or expose yourself. Call your doctor.” Well, if you didn’t have a doctor, what are you going to do? It means that you’re going to delay getting care. You’re going to go to the hospital when you’re sick, and your outcome is going to be worse.

你的评论关于压力是正确的。我们知道in the short-term, a stress reaction is good. You’re outside walking in the woods, you see a bear, your stress reaction kicks in and you get out of there. That’s good. But if the bear is there every day, you leave your house and there’s the bear. You’re walking down the street and there’s the bear. The bear doesn’t go away. That’s really bad for your health. And that’s the impact of stress of all kinds.

我们现在知道，这就是为什么我们看到遭受慢性种族主义的人的健康状况更糟的原因之一。这是那里的影响之一，在这里发挥了作用。当您查看为什么非裔美国人受到这一影响很大的影响时，它的一部分就是暴露。最大的部分是曝光。但其中的一部分也是由于许多慢性疾病的发生率更高。糖尿病，心脏病，肺部疾病，来自社区的环境状况。同样，那里有财务问题，还有红色的衬里。缺乏能够朝着机会和财务机会的能力。但是，在这些社区的空气质量方面也有条件，这可能会使健康恶化。

Jennifer Tescher:
是的。

Dr. Richard Besser:
Finances is definitely a part of it. I see a lot of that connection in terms of our thinking around who has access to high quality, good paying jobs, and who doesn’t. And when I think about it in terms of our work and why we talk about the importance of a living wage. What could that possibly have to do with health? It has everything to do about health, everything.

When we’re saying to people, “Wow, this pandemic would just go away if everyone would just wear their masks and keep apart and wash their hands,” that would help a lot, and that really has to happen over these next few months, next four or five months before we have a vaccine. But if Congress doesn’t step in and do what they need to do, people are going to be hit incredibly hard at the end of December. That’s when we see eviction protection go away. That’s where we see a lot of the financial issues, the pandemic emergency unemployment compensation, those extra 13 weeks goes away, unemployment assistance for gig workers, that goes away, paid family leave for many people goes away.

These things are tied to finance, because if you don’t have money coming in, there’s no way you can follow the CDC recommendations and quarantine and isolate when you think you may have been exposed. It’s just impossible, but yet Congress doesn’t come together and put money back in people’s pockets. It’s wrong morally. It’s wrong from a public health perspective.

Jennifer Tescher:
Let’s use this as a jumping off point though, to talk about the role of employers. Because given the lack of a sufficient response by the government, you’ve seen a lot of corporate leaders not just speak up on these kinds of issues, but have to take more significant stances and play a bigger role in helping to prop up their workers.

Unfortunately, we’ve seen a lot of big companies pull back, dial back on some of the policies that they put in place. For instance, the extra COVID pay for emergency or frontline workers, paid leave; we’ve seen some of that get pulled back at the same time that we’re now hearing potentially about a double dip recession.

Dr. Richard Besser:
是的。

Jennifer Tescher:
And so whether or not there’s healthcare for all, it seems to me at least, that employers are going to continue to be a really important locus for not just health insurance and healthcare issues, but all kinds of other financial issues and issues around good jobs. And it’s kind of interesting in a way, because if I understand the history right, the creator of the foundation, Robert Wood Johnson, II really got started here by working with his employees and the community to help them through the great depression.

Dr. Richard Besser:
是的。

Jennifer Tescher:
And I regularly say to employers, if you’re really focusing on the health of your workforce, because you want to reduce your insurance costs, and you’re not thinking about the financial health of your workforce, you’re just bailing a leaky boat, because they’re so connected.

So I’d love to hear you talk a little bit more about if we are to move to healthcare for all, what role do you continue to see for employers? How important are they? Do they give us enough coverage, given that they’re plenty of people who are not in a traditional workforce? How do you see their role?

Dr. Richard Besser:
I think employers, in particular, large employers, could play a really important role. This summer, I spoke to the Business Roundtable, and there was a lot of focus and interest and I think real interest, in saying, what can the corporate community do to address issues of structural racism in America?

Jennifer Tescher:
是的。

Dr. Richard Besser:
And the question to me was, “How does this connect to health? What can be done?” And I said, “Well, first is, you can pay a living wage and make sure that every employee is paid a living wage. The second thing is you can look at your sick leave and family medical leave policies. Because if someone is exposed to COVID and the choice, as I was saying before, and the choice is between staying home for 14 days, because that’s the recommendation, but there’s no leave or someone could lose their job, they’re going to come to work and they’re going to infect your other employees and they’re going to infect your customers. And that’s a really bad thing.”

So whether it’s out of corporate self-interest or because it’s absolutely the right thing to do, everyone in America should have sick leave. Everyone in America should be paid a living wage. It seems like it’s a no brainer, but you see time and time again, when efforts are made to increase the minimum wage, that there’s real pushback on that, when it’s the right thing to do from an equity standpoint and from a justice standpoint, and it has a direct tie in to health.

Jennifer Tescher:
是的。It’ll be very interesting to see in the new administration, how much progress can be made. It’ll depend in part on who wins those two Senate races in Georgia. But there’s been quite a bit of work at the state level and the municipal level on some of these issues. And I think whether it ends up being a state’s game or a federal game, it’ll all depend on what we see in January.

我认为许多人知道您是CDC的代理总监。在此之前，您负责公共卫生应急准备和应急响应。因此，我觉得我们的很多听众都希望听到您的疫苗或疫苗的消息，我应该说，我们正在听到。但是适合这次对话，我很想听听您谈论您认为我们如何使用疫苗分配来促进健康平等。是否应该有公平考虑因素来指导围绕谁获得的决定，他们如何获得决定？我很想听听您谈论这一点。

Dr. Richard Besser:
是的。我从来没有比现在对流行病及其过程更乐观，但是我也从未更担心这种情况。我担心这种情况，因为所有这些令人兴奋的疫苗新闻是我认为，给人们一个误解，以至于已经完成了，我们可以摘下面具并拥抱我们的亲人。让我们聚在一起，举办大型聚会并庆祝。事实并非如此。这个冬天是呼吸道病毒的野外日，病毒热爱冬天。他们喜欢冷空气。他们喜欢低湿度。当我们在室内和彼此附近时，他们会喜欢，因为病毒然后可以从一个人跳到一个人。

And if we can come together as a nation and get the politics out of this, so that wearing a mask doesn’t say something about your political leanings, it says something about your approach to public health, that you care about your own health and the health of your family and the health of people around you. If we can do that and double down and buckle down over the next three, four months, then yes, the end is in sight.

当涉及疫苗和FDA时，必须允许他们在不加入政治的情况下进行批准过程，或者没有人希望遇到另一端的疫苗。这将是最终的悲剧，要拥有安全有效的疫苗，而且没人想要它们，因为我们不认为科学做得正确。

But you have to have equity considerations in this. When you look at who is being hit hardest by the pandemic, that has to factor in. And I’m seeing it factoring in, in a number of ways that I think are on target, but we’ll have to see how it plays out. In a public health crisis, you don’t want someone’s income or social connections to drive their access and where they are in line for prevention measure.

在这里，确定优先级列表的方式，FDA决定是否批准了疫苗。然后，CDC从其联邦咨询委员会，即免疫实践咨询委员会获得建议。And what they’re looking at in terms of priority order, and this factors in issues of justice, factors in issues of equity, issues of maximizing benefits and minimizing harm, and it factors in the issues of transparency, so people know how the systems should work.

Their recommendation is frontline health workers get it first. And that makes sense because they’re taking care of all of us when we get sick. And if you look there in terms of equity issues, there is a high proportion of people of color who work as frontline healthcare workers. Second line are other essential workers. And again, high proportions of people of color are out there doing the work to keep society going. That’s important. The next group are those with underlying medical conditions and a great report and people of color have those conditions. And then the next group are people over 65. There you see actually a lower proportion of people of color.
And so we’ll need to see as this goes forward, but people over 65 are a high risk group, whereas we’ve seen devastating impact in nursing homes. It’s going to be really important that public health work with trusted leaders in communities. The surveys right now are showing that fewer than 20% of African-Americans trust that a vaccine coming forward is going to be safe and that they want to get it. Nationally, it’s less than 60% of people say that they’re going to trust this.

So a lot of work has to be done, and it’s not simply saying, “Oh, yes, it’s safe and effective,” it’s looking to see how do you overcome the history of how communities of color, how our African-American communities have been treated by public health? There’s a long history of experimentation and that needs to be dealt with by dealing with trusted voices in communities.

值得庆幸的是，已经进行的疫苗试验努力招募非常多样化的研究科目，以便将有关于种族和种族的安全性和有效性的数据，并希望这将有助于解决一些信任问题。但是每个州都应提供透明度并表明谁正在获取疫苗。按位置显示，按种族，种族，收入，性别展示。这里有很多因素非常重要，因此我们可以以公平的方式完成并会产生影响感到舒适。

Jennifer Tescher:
知道了。我想谈论您作为领导者的问题，因为我们在这个播客上谈论的另一件事是同理心在真正看到3D的人，真正看到所有人，从而能够在这些交叉点上工作的重要性。而且您有一个非常有趣的个人旅程。你是医生。您是公共卫生专家。您参与了世界各地的埃博拉病毒和H1N1等公共卫生问题。您来自一个似乎非常专注于回馈的家庭，尤其是在医疗领域。而且我倾向于发现，最好和最善解人意的领导者有一些个人经验或个人故事，与他们的激情联系在一起，并与他们的领导联系起来。

So tell us about you. Sort of, how did you get on this journey? Did you always know you wanted to be a doctor?

Dr. Richard Besser:
I think I did know I wanted to be a doctor. I grew up in a household of doctors. My father is an obstetrician and gynecologist. My mom’s a social worker. My dad’s parents, who I was really close to, my grandfather was a family doctor in Philadelphia and my grandmother was the nurse at his practice and their office was in the basement of a kind of a brownstone in Philly. And I just saw the lives that they were able to live and the joy that they got in being able to be in a career of service. And my parents also believed in giving back. Each summer we would spend several weeks out on the Navajo Reservation out in Arizona. And I went out with them and enjoyed that experience.

因此，我有某种感觉要去医学，但是我认为我不想做与他们所做的相同的药物方法。我对全球健康真的很感兴趣。我在澳大利亚是一名交流学生。我以为我会花在世界各地的职业生涯。我在大学旅行后花了一年。我曾担任调酒师，赚钱，然后起飞。对我来说，这可能是最重要的岁月之一，能够看到许多低收入国家的人们的条件。因此，我决定我想要一个专注于公共卫生并走上那条路的职业。

But I’m still a pediatrician. And at heart, in terms of my identity, I view myself as a pediatrician. And I’ve been fortunate that I’ve been able to continue practicing pediatrics in all my jobs as a volunteer in community clinics. And that experience of being with families in community clinics has really grounded me in all my other work, because I see the challenges that so many people face in trying to lead healthy lives and trying to provide the best for their children.

And so little of it has to do with lack of knowledge, yet we continue to approach every single problem that, “Oh, wow, just hit it with an ad campaign. If people just knew what to do, they would change their behavior.” Instead of doing what we are doing at the Robert Wood Johnson Foundation, which is saying, “Okay, how do we address the structures that allow this to continue?”

而且不只是说,“哇,这个人是abo血型ut to have their utilities shut off. Let’s connect them to an attorney so their utilities aren’t shut off. This person’s hungry, let’s connect them to a food bank.” It’s saying, why are people stuck in communities where there’s little opportunity? Why are they stuck in communities where they’re having to pay such a high proportion of their money on rent? Why are they stuck in jobs that don’t pay them enough to feed their family without going to a food bank? And it’s very different.

So when we talk about social determinants of health, we want to go upstream and look and say, what is it about the fundamental nature of our economy? What is it about the fundamental nature of our society that says that some people are worthy and some people are not, some people lack opportunity, and some people are lifted up and it’s pretty hard not to succeed. We want to address those fundamental issues.

And it speaks to my passion around social justice. And this is about justice. These are justice issues, and I’ve been very fortunate that I’ve been able to work in public health in many different ways. And in each one, I see a different set of tools to come at the problem. So governmental public health and academic public health, and then practicing public health on the air at ABC, and now at a philanthropy. We all come at these issues from different perspectives, but they all I think, are really valuable and contribute to the solutions.

Jennifer Tescher:
Yeah, well, you and I, it sounds like we have a few things in common. Because for me, as a former journalist, I’m a question asker. And I think the most powerful question you can ask is why.

Dr. Richard Besser:
是的。

Jennifer Tescher:
And it’s important to understand the details and to get into the details, but in financial services, as an example, the question why is often, “Well, because that’s how it’s done.” I expect that is often the case in medicine and frankly, it’s often the case in many fields and it relates in part to the importance of continued innovation and connecting that innovation to what’s actually happening in the world. So I think asking good questions is something that I think we both find to be a powerful tool.

The other thing it sounds like we have in common, is that we are frequently having to tell people that it’s not about education. Because often, the very first thing that you hear when you talk about challenges in pure financial services is, “Let’s teach them how to budget.” I can tell you people who barely make enough money to make ends meet, are better budgeters than anybody, because they know how to stretch a dollar.

Dr. Richard Besser:
是的。

Jennifer Tescher:
I often talk about the know do gap, right? We all know we should save, but it’s hard. And frankly, some of it is just the way that our brains are wired from a behavioral economics perspective. We all know we should eat healthy. I’m the person who cuts the donut in half and then I go back for the other half a donut, right?

Dr. Richard Besser:
Right.

Jennifer Tescher:
So we all know we shouldn’t overspend and then we spend. So that’s not about knowledge, that’s about behavior. And I think one of the most challenging aspects of the equity conversation that we’re having today is recognizing that so much of behavior is predicated on systems and on past history. And that there’s a deep connection between what appears to be a choice. You have to consider what the choice set was in the first place.

Dr. Richard Besser:
Right. We talk about that a lot in our work, that yes, the choices people make matter in terms of health, but the choices you make depend on the choices you have. And for too many people in our country, healthy choices are just not an option, or they’re not an easy option. And we want to work towards a day when everyone has those healthy options as the easy way, as the default.

Jennifer Tescher:
确切地。

Dr. Richard Besser:
We have a long way to go. But I am optimistic that the existence of this pandemic, and the economic downturn, and the movement for racial justice could represent a real inflection point. And as a society, we have the opportunity to say, “Is this the society we want to have? Is this as good as it can get?” And if not, we have to make some fundamental changes in America.

Jennifer Tescher:
Rich, thanks so much for joining us on EMERGE Everywhere.

Dr. Richard Besser:
Thanks so much for having me. I really enjoyed the conversation.

Jennifer Tescher:
This has been EMERGE Everywhere, a Financial Health Network production. I’m Jennifer Tescher, and I’d love to hear your ideas for future guests and your reactions to the show. You can connect with me on Twitter@Jentescher。If you liked this episode, please review the show and subscribe wherever you get your podcasts. To learn more about the work and research we do, please visitemerge.www.hamroaawaz.com。See you next time.