06/17/18 Malik Burnett

Century of Lies
Malik Burnett
Tim Pate

This week: Dr. Malik Burnett speaking about the social determinants of health, stigma, cultural competency, and medical cannabis; plus Tim Pate performs "Let's All Be Farmers".

Audio file



JUNE 17, 2018

DEAN BECKER: The failure of drug war is glaringly obvious to judges, cops, wardens, prosecutors, and millions more now calling for decriminalization, legalization, the end of prohibition. Let us investigate the Century Of Lies.

DOUG MCVAY: Welcome to Century Of Lies. I'm your host Doug McVay, editor of

Well on June Twelfth, UN Secretary General António Guterres opened the discussion at the United Nations on implementation of the Declaration of Commitment on HIV/AIDS, and the Political Declaration on HIV/AIDS, at the General Assembly's 94th Plenary Meeting. Let's hear Secretary General Guterres.

ANTÓNIO GUTERRES: We are at the halfway point to the 2020 fast track commitments agreed by the General Assembly in 2016. The world is making good progress towards ending the AIDS epidemic by 2030.

More people have access to HIV testing and treatment. Access to anti-retroviral therapy has expanded by more than 20 million people since 1990. As mother-to-child transmission continues to decline, and fewer children are living with HIV, we are moving closer to bringing about an AIDS-free generation.

But progress is uneven and fragile. On all continents, key populations at higher risk of infection continue to be left further and further behind, and young women remain unacceptably vulnerable where prevalence is high. We must empower young people to protect themselves from HIV.

This includes providing a full range of sexual and reproductive health services and rights, harm reduction for people who use drugs, and access to anti-retroviral treatment for young people living with HIV.

Prevention is the key to breaking the cycle of HIV transmission. The Prevention 2020 Roadmap focuses explicitly on adolescent girls, young women, and key populations at risk.

This sharpened focus on human rights, key populations, and gender equality, is essential. Greater leadership and investment must follow suit to remove the social and political barriers that keep so many beyond the reach of necessary services.

The 2020 Agenda for Sustainable Development calls for an integrated approach to development challenges, and our efforts to end HIV are connected to other areas, such as malaria, tuberculosis, access to medicines, and the increasing threat of anti-microbial resistance.

Success will require us to strengthen links across these areas and build resilient and sustainable systems for health, underpinned by principles of human rights and equity.

This year's high level meetings of the General Assembly on tuberculosis and noncommunicable diseases, as the President just mentioned, are key opportunities to inform a new way of thinking and working that moves beyond disease-specific silos of yesterday.

Let us also look ahead to the 2019 high level meeting on universal healthcare to build coherence across the global health landscape on financing, programming, and accountability.

The progress towards ending this epidemic would not have been possible with forceful advocacy, solidarity, and the spirit of shared responsibility. We must maintain this spirit.

This year marks the fifteenth anniversary of one of the more significant commitments to ending the AIDS epidemic, the US President's emergency plan for AIDS relief, or PEPFAR, and we commend the United States of America for its steadfast and generous commitment.

Next month, scientists and advocates from around the world, many of whom are with us today, will gather in Amsterdam for the 22nd International AIDS Conference. From the beginning of the global response, this intersection of science and advocacy has helped to shape policy and expand access to rights-based treatment and support for million around the world.

At this pivotal moment, we must renew our focus and shared commitment to a world free of AIDS. The pandemic is not over, but it can be, and we must all do our part.

Let us move forwards in the bold, new spirit of partnership to overcome the cycle of HIV transmission and delivery health and wellbeing for all. Thank you.

DOUG MCVAY: That was His Excellency António Guterres, United Nations Secretary General, on the implementation of the Declaration of Commitment on HIV/AIDS, speaking before the UN General Assembly. Also speaking at that event was the President of the General Assembly, Miroslav Laj?ák.

MIROSLAV LAJ?ÁK: Excellencies, distinguished delegates, ladies and gentlemen. Welcome to our General Assembly hall. This is our annual debate on HIV and AIDS. It is an opportunity to hear about progress being made, and also about the hurdles we still face in eradicating AIDS from our world.

And I'll make three brief points before handing the floor over to others.

First, I want to say that HIV is still a huge challenge. Yes, there have been success stories, and there has been progress. We have developed better anti-retroviral therapy. HIV positive people now live longer and healthier lives. We have seen less and less mothers die during pregnancy or transmit the virus to their babies, and overall, there has been a 40 percent decline in new infections between 2000 and 2016.

But we need to be clear: we cannot afford to slow down. This virus still has a destructive and deadly impact on people around the world. In 2016, one million people lost their lives to AIDS-related illnesses, and the new drugs and treatments are not available to everyone.

In fact, only 53 percent of people have access to anti-retroviral therapy. That's why we need to work even harder. That's why we have committed to ending the epidemic of AIDS by 2030, and that's why we are here today.

As my second point, I want to say that we can use today's meeting to explore opportunities for even more action, and I want to point two of them in particular.

One is the high level meeting on tuberculosis, which will be held on September 26. This will be the first meeting of its kind, and it will make a big impact on the work we are doing here. People infected with HIV are 20 to 30 times more likely to develop active tuberculosis, and this makes a lethal combination. Without proper treatment, nearly all HIV positive people with tuberculosis will die.

Also in September, the General Assembly will hold its third high level meeting on noncommunicable diseases, and this is another major opportunity because people with HIV have a much higher risk of suffering from NCDs, which is why we need a more integrated approach than ever.

We must use these and other events and platforms to push ahead with our goal of eradication by 2030.

Finally, we cannot forget that what we are doing today ties into our other goals and objectives, and that's my third point. We cannot just think about HIV and AIDS. It is not just about the virus. We also have to look at the context around it, because the fact is, we are not on an even playing field.

It is not the case that everyone has the same chance of contracting HIV. It is not the case that everyone has the same chance of surviving it. And this is not the way things should be.

We cannot continue to leave people behind, and universal healthcare can help to give everyone a chance. It can level the field. We all know that healthcare is crucial to sustainable development. That's why it has its own goal in our Sustainable Development Agenda, SDG Three.

And that's why, as part of it, we are committed to achieving universal health coverage. This will be on the General Assembly's agenda in 2019, and it could accelerate our drive to eradicate AIDS once and for all.

Excellencies, dear colleagues, we are on the -- and so we should be hopeful, but never complacent, so let's keep going. Let's keep fighting this virus, and the stigma that comes with it. Let's speak up louder, in memory of those who have died and in support of those who are living with HIV and AIDS today. I thank you.

DOUG MCVAY: That was Miroslav Laj?ák, General Assembly President, on the implementation of the Declaration of Commitment on HIV AIDS and the Political Declarations on HIV AIDS, speaking before the UN's General Assembly at its 94th Plenary Meeting, 72nd Session, on June 12.

You are listening to Century of Lies. We're a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at I'm your host Doug McVay, editor of

Well May 10 through 12, Patients Out of Time held its National Clinical Conference on Cannabis Therapeutics in Jersey City, New Jersey. The first day of that conference was devoted to an examination of social policy. One of the speakers was Dr. Malik Burnett. He is from DC and Maryland, he is a physician, also has an MBA, and he's very active in medical cannabis. Let's give a listen.

MALIK BURNETT, MD, MBA: For those who are not familiar with the social determinants of health, the social determinants of health are the conditions of health, or the places where people work, grow, live, born -- live, born, and age, and this includes the health system.

And, all these conditions are shaped by the distribution of money, power, resources at the global, national, and local levels, which are influenced by our policy decisions.

You know, they're -- the social determinants of health, and why I want to bring this concept to you all are -- to encourage to think about cannabis policy reform in this context, is because social determinants of health are largely responsible for, you know, a lot of the health inequalities that we have in society today.

So, I want to deconstruct this a little bit, and unfortunately this slide is not projecting very well on there, but I can talk through it pretty well, so, within the social determinants of health there are two major, major buckets.

You know, there are structural determinants and then there are intermediary determinants, and so, when you're defining intermediary determinants, those are the softer sort of life experiences, at the individual and at the family level.

So, you know, your marital circumstances, your behavioral and biological factors, like how your daily life is impacted on a day to day basis, you know, whether or not you're dealing with psychological issues, or if you have, you know, a very tough home environment, you know, and a tough family life, or really good family life and a really privileged and improved sort of home condition. Those are all what are defined as intermediary determinants.

And there's -- there's much more structural and tangible sorts of social determinants, and where we are going to focus broadly in this conversation is on what's defined as socioeconomic and political context, and so this is largely your annals of power, the governance, your policy decisions, your policy makers, all of those sort of buckets are all influential in the overall lives of people day to day.

So, whatever policy decisions that the government is making have direct impact on your day to day lives, and those are all very, very part of the structure that we all define in our livelihood.

Then, you know, there's also the fact of money. Right? So, socioeconomic position in life influences your outcomes, and so your ability to seek an education, your ability to sustain a job, and use the income that you have to better your situation, are all factors that affect your life outcomes, and all play a critical role in what we're defining as the social determinants of health.

So, that's a very sort of, you know, unpacking of the concept, but the real key takeaway here is that, you know, really understanding, you know, health inequalities and poor health outcomes in life, in communities, largely relates to the social and economic factors of education, employment, income, family and social support, and community safety.

And while all those things seem like broad topics, they're all intimately related to cannabis policy.

So, I want to show you guys New Jersey here by the numbers, because the point that I want to make here is that generally, what we have in the state of New Jersey, and in the United States and globally writ large, is a poor distribution of resources. So, within this -- a lot of these numbers are taken from the ACLU report "The War On Marijuana In Black And White" -- right now, this -- these numbers are taken from 2010, but I'm very much sure that they have not changed since then.

Right now, in the state of New Jersey, you are three times more likely to be incarcerated as an African American than you are as a white person in spite of the fact that use is equal across race. As you guys are much more intimately familiar with New Jersey than I am, you can see the counties highlighted in blue here, those counties are the counties where there's disproportion -- the disproportionate impact is greater than three times.

If you look at the second box, the state of New Jersey in 2010 alone spent 127 million dollars on enforcing marijuana possession laws. So, you ask yourself the question, 127 million dollars is a lot of money, and I want to turn your attention to the third slide. In that -- 127 million dollars is actually more money than five counties spent on the total amount of education in the year 2010.

So, for marijuana possession laws, the state of New Jersey spent more money than they allocated to five counties for the education of all of the students in that county for K through 12.

This is a direct sort of concept that is highlighting what I'm trying to identify in cannabis policy and in drug policy writ large, which is the inappropriate distribution of resources.

And so, what we're doing right now, broadly, is spending an overwhelmingly large amount of money on law enforcement and criminal justice in certain communities, in communities of color predominantly, and under-resourcing those same communities with things that would actually improve the life outcomes of the people in the community: education, social services, the like.

So that -- that's one concept. Then the second concept that's intimately related to the social determinants of health, and very much related to some conversations that we're going to have here, is the concept of stigma, and you know, there are some stigmas -- there are a lot of stigmas in cannabis, and some of them are, you know, quasi-funny, like, you know, cannabis, labeling -- this breaks, this first graph breaks down stigma into four buckets: labeling, stereotyping, prejudice, and discrimination.

You know, in cannabis, labeling people, you know, say, cannabis users are stoners, or, you know, in a stereotyping way, cannabis users are, you know, lazy and, you know, or they have the munchies, or, you know, a whole host of different sort of labels and stereotypes that get applied to cannabis.

And, you know, if you look at the lower half of that slide there, there are more pernicious sorts of stigmas that are associated with cannabis as well. So, you are -- you do get prejudice and discrimination as soon as you are incarcerated for cannabis, and the collateral consequences of your incarceration are what lead to prejudice and discrimination relative to your life outcomes, so you are then looked at in a negative way for employment, and a whole host of issues.

And I know one of our other panelists are going to talk about all of the relevant collateral consequences around education, employment, social services, and the like, so I just wanted to show you that as a -- and ask you to put a pin in that because I know one of the other panelists is going to talk in greater detail about that. But it's all very much intimately related.

So, that is the, you know, the downside, and so the question becomes in -- from a policy context, how exactly do we use cannabis policy to improve the social determinants for individuals, and, you know, it is best captured around the idea of cultural competency and, you know, as it says on the slide here, cultural competency is a set of congruent behaviors, attitudes, and policies, that come together in a system, agency, or amongst professionals, and enables that system, agency, or those professionals to work effectively across cross-cultural situations.

And so, you know, what we're looking to do now, as we move forward in creating effective cannabis policy, is to, you know, create policy that actually has cultural competency, and so, that's a very, you know, broad sort of definition, but you're actively looking in here, I've highlighted in blue, actively looking to dismantle systematic and institutionalized policies, methods, and frameworks that contradict the ability for effective cross cultural situations to occur.

And, you know, that's a very technical sort of thing, but, it all exists across the continuum, and so, cultural competency as a context, there's grades -- there's levels to it, if you will, to use a common euphemism for today.

There's, you know, cultural destructiveness, which is kind of at the bottom end of the cultural competency spectrum. Then, incapacity and blindness, which is further along. Then you're at the stage where you're kind of pre-culturally competent, culturally competent, and cultural proficient, and all those are the continuum, and what I'm about to do is kind of show you how cannabis policy fits into this cultural competency continuum.

So, we can all agree that cannabis prohibition leads to cultural destructiveness, it divides families, it, you know, creates, you know, subjugation under certain rules and correctional control. It ultimately, you know, undermines the cultural ethos of, particularly, communities of color.

So, we can all agree, what that policy decision leads to the outcome of as it relates to culture.

The second, and most cannabis policy writ large actually falls into a bucket between cultural blindness and cultural incapacity, and so, you know, most cannabis policy falls -- is not considerate at all, which is what it means to be culturally blind. Not considerate of the historical impacts as it relates to what cannabis prohibition has caused in the past, and is trying to superimpose a new system without taking into account all of the previous policy that has occurred in the past.

And so its defined as culturally blind, or, it in fact is cultural incapacity. So there are provisions that are included like, you know, prohibiting those individuals who have had previous, you know, criminal records, from being able to participate in the new cannabis industry because of their previous drug convictions. So, like, you know, barring out things that you are now making -- barring individuals who have committed crimes when things were illegal from participating in things that you're now deeming legal.

A lot of states have policies around that, and that in and of itself is by definition cultural incapacity, or cultural blindness, where there's no consideration for these issues at all.

I would say social equity programs are at a stage of, you know, cultural pre-competence, right, so they are largely, if you look at the meat and potatoes of the policy, issue -- policy strategies that, you know, begin to take note of the diversity inside of the industry, and require companies to report on diversity, and, you know, encourage people to hire individuals who are a diverse background.

And so they're beginning to explore the issues in a very superficial level, and, you know, basically the jury is still out on the effectiveness of social equity programs, because, as you know, or as you all are well aware, it is very much possible to, you know, game the system relative to what you're defining as social equity in certain groups that may not actually be as disadvantaged are able to fall under the definitions of what you're looking for from a participation standpoint in terms of your programs, as it relates to cannabis.

But, you know, what we're looking to do, restorative justice policy, is where you actually move into the, you know, cultural competence and cultural proficiency realm. And so, what is restorative justice policy? Restorative justice policy is, you know, beyond the brick and mortar policy that sets up cannabis programs and creates dispensaries, cultivation centers, and production facilities.

This is, you know, being intentional about using the tax revenue that you're generating from the economic activity here, and siphoning it, or channeling it, into those same communities that are harmed by the war on drugs. This is, you know, being active in requiring companies to have diversity plans in hiring individuals, or significant numbers of individuals who have previous criminal records around drug policy to be able to participate in the industry.

This is being intentional about seeking out those individuals who are actively participating in the gray market and finding ways for them to be brought into the new legalized system. You know, it's a very much more intentional sort of approach to the policy, which is what you're actively recognizing the historical harms that have been done, and then choosing as a matter of policy to correct them when you're bringing on cannabis legalization.

And so, I will stop there, and I'm sure that my fellow panelists will dig in greater depth into all of the things that I have highlighted here, and so, thank you guys for your time.

DOUG MCVAY: That was Doctor Malik Burnett speaking at the Patients Out of Time National Clinical Conference on Cannabis Therapeutics on May Tenth in Jersey City, New Jersey. Full disclosure: I do work with Patients Out of Time doing social media and website development.

Now, while we have time, coming up August 17, 18, and 19, it's Seattle Hempfest, the world's largest protestival. It's happening right up there in Seattle, Washington, along the Sound, Myrtle Edwards Park. Every year, my good friend Tim Pate opens the Seattle Hempfest by performing his song "Let's All Be Farmers" from main stage, there at the Hempfest. Let's give a listen.

TIM PATE: [MUSIC: "Let's All Be Farmers"]

DOUG MCVAY: That was my good friend Timothy Pate, he is a musician, and an entrepreneur, and a lot of stuff, a political activist, a good friend, he is a long time social justice activist and hemp activist, marijuana legalizer, working with Hempfest in core crew for many years. He opens the main stage each year with that anthem, Let's All Be Farmers. That audio came to us courtesy of Hempfest.

And that's it for this week. I want to thank you for joining us. You have been listening to Century of Lies. We're a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at I’m your host Doug McVay, editor of

The executive producer of the Drug Truth Network is Dean Becker. Drug Truth Network programs are available via podcast, the URLs to subscribe are on the network home page at

The Drug Truth Network is on Facebook, please give its page a like. Drug War Facts is on Facebook too, give its page a like and share it with friends. Remember: Knowledge is power. Follow me on Twitter, I'm @DougMcVay and of course also @DrugPolicyFacts.

We'll be back next week with thirty more minutes of news and information about drug policy reform and the drug war. For now, for the Drug Truth Network, this is Doug McVay saying so long. So long!

DOUG MCVAY: For the Drug Truth Network, this is Doug McVay asking you to examine our policy of drug prohibition: the century of lies. Drug Truth Network programs archived at the James A. Baker III Institute for Public Policy.