Vayong Moua wears his heart on a T-shirt that reads, "Racism is a Public Health Crisis," his confidence showing through his eccentric exterior.

For Moua, his T-shirt is more than a fashion statement. As a Hmong American refugee, he connects his life experiences and identity to his work at Blue Cross and Blue Shield, fighting to bring awareness to how social factors like race can affect the health system and working to legally classify racism as a public health crisis.

Moua was barely a year old when his parents fled Laos. He grew up surrounded by Hmong culture.

"It really has this deep imprint on my life," Moua said.

His family settled in Eau Claire, Wis., where Moua started school. He attended English-language learners courses with his siblings and helped his parents learn English at home.

Years later, Moua attended St. Olaf, where he studied philosophy, anthropology and Asian studies, much to the surprise of his parents.

"We didn't cross the Mekong River for you to think deeply about being unemployed," they told him. He went on to receive a graduate degree in public health from the University of Wisconsin-Madison.

His mother worked at the public health department in Eau Claire for 25 years, and his father worked at Eau Claire City Hall.

"I was forged out of civic engagement and public health," Moua said.

His views came together by the discrimination he witnessed. When his father, who has a strong Hmong accent, would try to help people find housing, he was told the properties were no longer available.

"I would call in a perfect Midwestern accent, and they would say, 'Oh, you can come by anytime you want.' But if I disclosed my name, they said, 'Oh, sorry, it's taken.' "

Moua said an intentionally designed racist system has led to discrimination. Now as the director of racial and health equity and advocacy at Blue Cross and Blue Shield, he is in a position to help change that.

He said it's important to legally classify racism as a public health crisis. He is working on doing so with Minnesota Reps. Ruth Richardson and Rena Moran, and with Gov. Tim Walz's administration.

Moua discussed the social determinants of a health framework, which says only a small percentage of a person's health is determined by direct health care at a clinic. Another small amount is created by genetics or physical behavior.

"The majority is the social factors, so that's your education, where you live, where you work, your gender, your social experience," he said.

He points to COVID-19 as an example of how race, gender, ZIP code and income affect people's access to health care, saying that it has only escalated existing social inequities.

"For somebody like me who has been deep in this work for a long time, of course this is going to be exacerbated by COVID-19. And if we have pre-health conditions, COVID-19 is going to exacerbate them. The hope is that it shines a sustained, concentrated light on racism, which then will cut across multiple issues, not just health. It's embedded ecologically in our society."

Moua describes how he is often the only person of color involved in key decisionmaking processes and how that must change. There are now more people of color at the table — and creating their own tables, he said.

"We're trying to … say, 'I don't like your rules, I'm not here to fulfill something for you,' " he said. "We're here to decide upon things together."

He leads policies designed to reduce commercial tobacco use and food insecurity and increase physical activity. And when Moua isn't actively calling and meeting with policymakers and community members, he is working on plans to design transportation for everyone in area communities.

Through his upbringing and profession, Moua can distinguish how current racial health system inequities are upheld, and he tailors his work to address them. "It is preventable, avoidable and unjust, and these inequities are not natural," Moua said. "They did not happen out of thin air."