Hello and welcome. I'm Dr. Will Ross, Associate Dean for Diversity and
Professor of Medicine here at the Washington University School of Medicine.
I'm here to talk to you about a subject which you've certainly been exposed to
in your time here Washington University and I think will be quite relevant to
your future practice, and that is the subject of health and health care for
disadvantaged communities in the St. Louis region. What I hope to accomplish
in this lecture is an exposure to the variables that have led to poor
health in certain segments of this population. We will explore the epidemiology
of some of the leading health status indicators in the St. Louis
region. And then I want to explore the unique social political history that led
to adverse health status of these vulnerable populations. We're going to delve
a little bit deeper into some some of the social determinants of health. We'll
give you an explanation, definition of social determinants of health and then I
hope at the conclusion, you'll have a greater appreciation of the
relationships between culturally competent practices and the reduction in
health disparities. Now, I want to take a look at this picture of three
homes in the North St. Louis region. I take our students on the tour and during
the tour, we have an opportunity to get out and look around. And now, you'll see
three homes in various stages of disrepair. You'll see one, to my left –
broken windows, vacant lot – and then you'll see another one, to my right, that seems to be
somewhat improved. Someone purchased a home and and engaged in some significant
improvement. When you assess this situation, this picture of the homes here,
I want you to just use your imagination and ask, if an individual moved into that
home, rehabbed that home, the one on my right, what would his or her life
expectancy be simply by living in this community? Don't answer that yet.
This is just a hypothetical for now. We'll revisit this. Now, what if the
individual moved into this home? Now, let's go back. This home is in St. Louis
City, North St. Louis City, ZIP code 113.
This home is in St. Louis County, actually Clayton, Missouri, 63105. What is
the difference in life expectancy between these two homes, separated by no
more than two or three miles? There's a big difference. We want to talk about why
some neighborhoods are less healthy than others.
What are those social determinants of health that lead to the difference in
health outcomes, and one neighborhood versus another? Why is it so relevant?
Why does ZIP code matter moreso than one's genetic code? A lot of this data
stems from the normal work of Dr. Michael Marmot who's an epidemiologist in
London, who really wrote extensively about the social determinants of health.
These are the social factors in which we live, work, and grow that really affect
our long-term health, our life expectancy. We'll see that some homes, some
neighborhoods, have been under-resourced for decades, in a setting of residential
segregation. There's a disinvestment in educational opportunities,
a disinvestment in in stable housing, and a disinvestment in the infrastructure
surrounding those neighborhoods. As a consequence, you have unstable
neighborhoods, which lead to unstable individuals in those neighborhoods.
Unstable neighborhoods lead to unhealthy neighborhoods and unhealthy individuals.
And so we can speak and work assiduously to improve the health of the individual, but
we can also work assiduously to improve the health of the neighborhood, of the
community. Let's focus on how we can do that. Years ago, an economist at Harvard
posited this concept of the "broken windows theory." This was initially used
to promote a certain type of policing which has been later debunked. We won't
go into this issue of this broken windows policing, but it follows
Michael Marmot's view of social determinants of health. If you remember
that first image of those homes in disrepair, the issue is that simply
living in that community, being exposed to broken
windows, being exposed to vacant lots, can actually lead to adverse health outcomes.
And a simple concept – actually going in, fixing the broken windows, mowing the
lawn, painting the walls – can actually restore a sense of confidence to the
residents of that community. They have a greater sense of empowerment. They feel
better about their neighborhood. They feel better about themselves. And guess
what? Their health indicators improve. Their health status improves. So a real
simple concept, but it follows along the lines of really well-documented evidence
on social determinants of health. Now as we go on with this discussion, I'm
going to introduce a couple of terms. One: health disparities. Another: health equity.
And of course we've already talked about social determinants of health.
Health disparities really relates to a disproportionate burden of disease borne
by a certain group, a certain community, even though they have equal
access to health care. So when one can control access to health care, there
still is this disproportionate burden of disease borne by one group, a minority
group, compared to a reference group of non-minority. So if we look at this slide
showing populations with equal access to health care, on my y-axis you'll see
increasing quality of health care and there is a difference. That's what
we define as disparity when we control for the
clinical purpose of health care. And that disparity is based on systems that are
unfortunately designed to discriminate against certain groups of individuals.
So this is the definition of disparities. Again, the disproportionate burden of
disease borne by a particular group, even when one controls for access to care.
Now, there is abundant data chronicling the extent of disparities
that are based on race and ethnicity, and a lot of that data was promoted in this
seminal study, Unequal Treatment, published by the Institute of Medicine,
The National Academies, in 2002. And in this book, Unequal Treatment –
Confronting Racial and Ethnic Disparities in Health Care, the authors
posited that racial and ethnic disparities in health care in the
context of broad historic and social and economic inequality and
there's evidence of persistent racial and ethnic discrimination in various
sectors of American life. So let's talk a little more about health equity. I gave the
definition of health disparities but my colleagues
in Europe prefer to use the term health equity. And I think they're probably a
little bit more on task with that, because when we speak of health equity,
we're stating that every person has the opportunity to attain his or her full
health potential. So, I could provide tickets
to a group of kids to go and visit a soccer stadium,
but they may not be able to view the stadium
because of the difference in their ableness. However, if I provide opportunities for
them to have equal access to seeing that soccer game, then I'm
promoting equity. They've attained their potential to witness that
soccer game and we want to make sure that everyone has attained his
or her full potential to have the greatest health possible. Now, let's
switch gears and talk about Missouri, and then we're going to drill down and look
more at St. Louis, and then we're going to talk even more about what's going on at
the ZIP code level and the neighborhood level here in St. Louis. Missouri, like
most states in this country, is witnessing an increase in the Latino
population and other populations. This is a changing demographics of all regions
in the United States and we're certainly not an outlier. What a significant
increase in the Hispanic population between the time period 1995 and 2025.
In fact, since 2000, we've witnessed an 80% increase in the
Latino population in St. Louis; rather in Missouri, mostly in St. Louis.
In a similar vein, because the St. Louis region is designated as an immigrant and
refugee resettlement area, we've had a number of refugees processed here in St. Louis.
Starting back from the Balkan war in the early 1990s,
we now have over 80,000 Bosnians, but we similarly have a
significant number of refugees from Bhutan, Iraq, from Myanmar, and most
recently from Nepal. These groups are coming in without access to normal
health services, and as a consequence, they will have a great burden of disease.
And this is typically a first generation phenomenon, but it's a phenomenon that
really requires our attention. But there's another demographic which
requires our attention. Remember, I gave you the definition of health equity.
You know, everyone should have the opportunity to reach his or her fullest
health potential. We're seeing that a unique population in
not just in Missouri, but the United States, it's not reaching his or her
potential and it is young, low-income whites. Well, we saw that phenomenon in
this past year and unfortunate wasn't given the attention necessary and,
as a consequence, we're seeing an increased number of deaths due to
diseases of despair. I would rather call these deaths of disparities, due to
exposure to heroin and the unfortunate hope your academic and certainly is
we've realized that here in St. Louis who we may be ground zero for the opioid
epidemic and in this graphic you can see the remarkable increase in white death
rates between 2000 and 2014, while African American and Hispanic death rates are
certainly higher proportionately than white death rates, that burden,
disproportionate burden, that disparity persists. We're clearly seeing an
increase in overall death rates among whites. And so when we talk about
disparities, let's recognize there are many groups who are not reaching their
full health potential. So why is this
happening? There are certain challenges in Missouri that we should be cognizant
of. We have low per capita rates of funding for public health. In fact, among
the laws in the country, we have inadequate access to affordable health
care to affordable housing. We're in the midst of this opioid epidemic. We're in
the midst of this epidemic of violence and we have a fraying social safety net
among other challenges. Missouri certainly is not homogeneous in terms of
where those challenges reside. If you look at the the counties in Missouri and
actually look at the health expectancy based on those counties, based on the
regions, you'll see within our bootheel, there's an even lower life expectancy. If
we look at Pima Scott County and others, we're seeing they have the lowest life
expectancy and so they're still there there's a significant burden of disease
one by that population that we should be aware of. We're gonna talk mostly about
what's going on here in St. Louis and why do we see these health disparities
and what can we do to ameliorate these disparities. So what are the challenges
here in St. Louis? We are also not surprised unfortunately there's a
significant amount of racial animus in St. Louis. We turn on our news going
certainly predating of the the events in Ferguson in 2014, we know that we have
needs we have challenges and unfortunately beginning to address this
but necessarily led to a reduced likelihood of one group
african-americans being able to receive the amount of health commensurate with
their overall need and therefore there's a disparity there. We don't have the
these the proportion funding to address health needs that we see in other areas
of the country. We don't have the coordination. We have substandard
information systems and and our urban core is old in this decaying these all
will contribute to imparied health and access to health. We also are very
fragmented within the city of St. Louis a population of now only 300 and perhaps
15,000 we have 28 wards serving that small population, and in St. Louis
County, we have over 90 municipalities serving a population less than a million.
And so we don't have the ability to really coalesce around a health
strategic plan that will address the health indicators and reduce disparities
across our region. And so this is really a political impediment that we can
address in order to improve health equity our safety net system. The healthcare
that we that we provide for the medically indigent – those who are on
Medicaid. It's certainly also substandard we're not a Medicaid expansion state.
We're only aware of that the last public hospital in St. Louis closed in 1987 – St.
Louis Regional Hospital. And we've just had a history of poor collaboration
among hospital systems here. Our primary and specialty hospital care really takes
place in separate locations and there's a greater need to provide more
community-based care. As you can see, our safety net is indeed afraid. Now let's
now talk a bit more about St. Louis and the demographics. I've put this slide up
because I just love the images of what we have here the wonderful in St. Louis
the climate of Forest Park and of course our lovely baseball stadium for
the Cardinals. But turn to this image here – this is not a Rorschach test, this
is actual a image from the 2010 U.S. Census of the St. Louis region. Just to
give you a highlight, give you a reference, in the middle of this image is
a white line that that white dividing line is actually Mississippi River. St.
Louis is to my left, Illinois to my right. Each dot represents 25 individuals. The
red dots, caucasians; the blue dots represent
African-Americans. You can clearly see there is a distinction here and where
those dots are a place where they reside and there is a remarkable demarcation in
the north of St. Louis along Delmar Boulevard so said north of Delmar
Boulevard the region is almost 90, 95% African-American.
South of Delmar Boulevard the region is about 80% white. The Delmar Divide
is such a such a graphic indicator of a secret of of segregation that is so
stark that actually gained the attention of investigators from the BBC who were
here to conduct the study on the Delmar Divide and in the divide as evidence.
Here in its graphic they noted that north of Delmar it's just pretty
remarkable as you can see the 99% African-American north of Delmar and
70% white south to Delmar and you can see that the disparities and
differences in an educational attainment in household income and of course we'll
talk about the disparity in in life expectancy and based solely on racial
segregation patterns that are persisted for decades here at St. Louis. So what
are those disparities? Let's kind of go into a little more detail here. The
Regional Health Commission in 2003 actually developed a series of geocoding
charts to really highlight the depth of the disparities in St. Louis region with
regards to race, socioeconomic status, and a number of health indicators and from
Attalla t cancer and you can see from this graphic which is really looking at
poverty and the highest rates of poverty are coded red. You can clearly see the
distinction that the the significant amount of poverty is localized north of
the Delmar Boulevard and North st. Louis you'll see a crescent shape of red
extending along the Mississippi River that really
reflects the new immigrant population that we alluded to earlier but for the
most part poverty in st. Louis is a North Side of phenomenon within North
st. Louis there are several dip dip codes which
even more likely be associated with adverse outcomes and these we call
critical zip codes there I want you to focus on one in particular sixty one one
three in North st. Louis a region characterized by some of the highest
maternal child risks the highest sexual risks some of the worst indicators in
terms of life expectancy and then poor a health care access indicators now let's
contrast six three one one three if you remember the first graphic that I
showed to three homes in North st. Louis they were in neighborhood 631 1/3 the
second home I displayed was in zip code 6-3 105 and Clayton let's look a little
carefully at those two zip codes and what you'll see there are two separate
and unequal zip codes that are separated by less than 10 miles and 61 1 3 the
individuals are born live births without first trimester prenatal care are
tenfold higher in North st. Louis 6 we won't 1/3 compared to Clayton Missouri
low birth weight is three times higher in 61 and 3 compared to Clayton lead
poisoning rates again three to four times higher in North st. Louis compared
to Clayton and in the final analysis I asked oppose the question what is the
life expectancy between an individual born in that home and 61 1 3 versus 61 1
5 and you can see the answer there's a remarkable disparity 66 years life
expectancy in 61 1 3 compared to almost a three years to 630 105 Clayton just
remarkable we can map perhaps every health care in the
to st. Louis region and and and and it coincides the these indicators coincide
with the 6-3 1 6 3 1 1 3 and other ZIP codes in North st. Louis here we've
mapped homicides in 2017 and you can see graphically where those homicides are
mostly occurring in North St. Louis. So with this being stated, I think we now
can understand that this our region is is racially stratified – segmented – and
there are remarkable differences in health care indicators between North St.
Louis and the rest of the region. So it really should come as no surprise that
individuals living in these communities would scream for help under the under
the heavy burden of living with poor disease, in poor health, over years. And so
Ferguson, to me, was not some epiphenomenon. It was a similar event
that should have been predicted because Ferguson had less to do with the death
of Michael Brown, the African-American teenager – unarmed teenager – shot by a
white officer, and more with the circumstances in which Michael Brown and
so many lives, circumstances are highlighted by high rates of poverty,
high rates of infant mortality, high rates of unemployment, and and less
educational attainment. And so when you take those factors, and then when you
layer on police brutality, racial profiling, discrimination in municipal
courts, then you can understand why Ferguson occurred and why Ferguson can't
occur again in another part of our region. So how did we get this way? What happened?
this let's delve into this a little more detail, and I want to give you a brief
history of St. Louis. I think you get a better sense of why we're this way and
how can we then find ourselves out; how can we find a passport. The same
rule started as a very wealthy city. I've found about French fur traders there was
significant commerce in the Mississippi River. And so the city was bustling at
the turn of the century. I love this image of the Eads Bridge connecting St.
Louis to East St. Louis. What a remarkable industry, on both sides, and
this moving back and forth between St. Louis and East St. Louis. East St. Louis
and that area had a lot more nightlife and I think that kind of led to a lot more
excitement on the east side of the river, but they were they were still
viewed as a region, together. But something happened. Landowners the
reigning gentry, business leaders, recognized that their economic interests
were not served by subsidizing the expansion of infrastructure to the to
the rural areas – what would would be in the future, St. Louis County. And so they
wanted to keep the the largesse of spending in St. Louis City proper.
And through a very narrow decision in 1876, the city decided to to divorce from
the county, and the city actually seceded from the county. So Howard Baer,
in 1978, concluded that this action was roughly the equivalent of England giving
up to 13 colonies; only the city did it from choice, whereas Great Britain at
least had good sense of struggle if but half-heartedly against the separation. So
St. Louis was wealthy and the we hear about the St. Louis World's Fair in 1904.
We think, my goodness his name is 2018 while we still talking about the St.
Louis World's Fair in 1904. It really was an opportunity to showcase now the
the wealth the operas in this city to the world we were proud of that and
there are many others, particularly health professionals, who were proud of
the of the Enlightenment that was occurring in St. Louis at the turn of
the century. John Green, who was president of the St. Louis Medical Society stated
that if we have these resources and Louis, if we have the spirit of
enlightenment, can we not extend this to a medical enlightenment? Can we then
create a hospital system which will benefit our less fortunate citizens and
who and will this actually provide instruction to an in medicine to
undergraduate students? He was really appreciate in saying that
we can provide a system of care that will uplift the entire region and
unfortunately his advocacy was not realized by those who were structuring
the health care system the first haas city hospital the second city Osmo
actually the first one opened in 1846 and was struck by cyclone. But the
first major city hospital opened in 1906 and unfortunately it opened as a
segregated facility. African-American physicians were not invited to the
hospital. They were not extended privileges and African-American patients
were relegated to residing in a back part of the hospital. This was a time
when Plessy vs. Ferguson was the law of the land; separate but equal. Now St. Louis
still even in the setting of Plessy vs. Ferguson was a relatively
progressive region. St. Louis is mostly southern. Let's be honest, and there are
some southern mores which still are here. But as you can see by this
integrated swimming pool that there were certain practices that
were really tolerated in St. Louis. However. something changed. And what
changed was the remarkable migration of African-Americans from the deep south
between 1915 and 1917. This is what Isabel Wilkerson wrote extensively in
her book, The Warmth of Other Suns. She chronicled the epic migration of
African-Americans seeking greater economic opportunities after
after being oppressed in the south for hundreds of years
moving into communities that provide what there hopefully provides those
opportunities but this was at a time in another world war one when our economy
was unfortunately doing less well and families lat
this one arriving in Chicago found themselves when they were seeking in
poor employment pitted against white low-income workers
who found them to be a significant threat an academic threat and st. Louis
in particularly in East st. Louis this all reached ahead in 1917 when
african-american workers were trying to find jobs at the aluminum or contra
company in East st. Louis while white workers were boycotting they were
striking seeing the african-american workers arrive unfortunately tension
some brood and they boiled over and culminated in one of the worst race
riots in the history of the United States in 1917 you can see on one image
white bullying African Americans out of a streetcar and on the right side you
can see homes African homes or simply burn to the foundations this was really
a horrific time in the history of st. Louis even before then white landowners
had written into law restrictive covenants which prohibited white White's
from either renting or or selling homes to African Americans this was these were
written into law in 1916 although they were declared unconstitutional by the
Supreme Court frankly they continued unabated for decades
well into the 50s and 60s and after the East st. Louis ride 1917 African
Americans fleeing for their homes for the safety and he st. Louis came across
the East bridge looking for refuge and they were told that if they want to be
in st. Louis and we're not in st. Louis they could not live south of Delmar
Boulevard there were just harsh restrictions and if so this is a map of
restrictive covenants shortly after these easing was riot and there's a
certain phenomenon that hasn't changed here not only where blacks relegated to
living north of my Boulevard if you were Italian you had to live
the hill and if you were Jewish you had to live in a the Kingsborough university
city and if you were german you were pushed uptown a brother up north near to
baden river view we're at 2018 and frankly some of these housing patterns
have not changed well here's an image of the of an attempt to really explode and
just just collapse that entrench segregation the collapse of the
pruitt-igoe housing development in 1972 hopefully this was to be the sign of
progress for st. Louis as we move beyond entrenched segregated housing to
providing mixed uncle income housing across the region unfortunately that did
not come to fruition the residents of pruitt-igoe were
similarly push a further north into North County syrup suburbs also and
housing patterns remain segregated let's talk now about health care in st. Louis
since we've had that type of history about you know the political is social
cultural events so here's a here's a picture of our Hospital Barnes Hospital
around 1815 and there's this beautiful structure there are in the foreground
two smaller frame houses these were the hospitals for at four Negro patients at
the time african-american patients this was to the embarrassment of a lot of the
trustees at barnes-jewish hospital around at that time and so those
facilities were dismantled shortly after this picture was taken but frankly
African Americans still resided in the basement of Boren's hospital for care of
well into the 1960s african-americans were were pushing for their own Hospital
not wanting to live under in the basement or not not having a place where
they can receive equitable health care the city number two was in a short
timeframe woefully inadequate to meet the the needs of the african-american
community and so an attorney in st. Louis Hamdi flipz hospital became the
the main advocate for a larger facility for African Americans
and he was successful and in winning a significant award from his Department of
Interior along with significant bond - to build up a city hospital for
african-americans unfortunate homophobes was assassinated before his vision was
actualized by and misra still to this date but his legacy was the hamaji
Phillips hospital which was constructed in 1937 and was widely heralded as the
largest single Hospital in the world it was a beautiful sight it really was the
largest echo Hospital in the country if not the world and between the days of
operation from 1937 to 1979 one out of three african-americans
completed their residences in this hospital
it really was state-of-the-art in every respect in terms of this infrastructure
the the training in conjunction with Washington versity as well as a
high-quality care delivered in that hospital toward the 1960s the city of
st. Louis population declined peaking in 1950s and declining the city was unable
to to support two public hospitals City number one and City number two the mayor
at the time actually charged two Commission's to look into whether or not
which to look into which one of these two hospitals could connect to remain
solvent recognizing that the tax base was not there to support both both
commissions agreed to greet that harmony Phillips hospital was the better
Hospital in terms of his physical structure and its overall quality of
care nonetheless Hammadi Phillips Hospital the predominately African
Oregon Hospital was the one that closed 1979 under remarkable protest it was a
dark day in the history of st. Louis and it's a memory that's really fully carved
in in the mind of those individuals of color in this city to this day
unfortunate with that history we continue to see a decline in st. Louis
City population from its peak in the 1950s to current of about three hundred
and fifteen thousand individuals the last public hospital was st. Louis
Regional Medical Center I had the honor of serving as chief medical officer and
now I seeing that history really allowed me to be able to speak I really candidly
haven't spoken to the physicians and nurses who actually live through those
those wonderful and tumultuous years of home eg Phillips hospital now so I've
given that history and I don't want anyone to leave here thinking my
goodness all this all this is poor woe unto us some things are beginning to
improve and through the collective efforts of the st. Louis Regional Health
Commission which was chartered in 2002 we have seen health indicators improve
the region Health Commission actually began to look at errors in North st.
Louis I mentioned those zip codes 61 1 3 among others and recognize that that we
could do a better job of coordinating care among the the federally qualified
health centers and that those zip codes as a consequence of that and the
creation of the integrated health network we have began to witness some
improvement in the health care across the region particularly North Side as
you can see that we've seen we've you know in the period of 2000 2010 we we
saw a 29% reduction in heart disease mortality diabetes mortality filled by a
similar rate as did stroke mortality and even lead poisoning however for young
people who are less likely to access care particularly young
african-americans who let's let's likely access care dead population was
unfortunately characterized by the latter rate and increase in sexually
transmitted infections and unfortunate increase in homicides so why don't we
what if what if we shared so far so far we've talked about two communities one
black one white separate and unequal that was a finding of the colonel
commissioner by Otto Kerner and the 60s after the the their the rat the
rut civil rights riots in watts in Detroit but we can say the same thing
about here our own region in 2018 separate but unequal we have communities
of opportunity and we have communities health disparities low-income
communities and and those communities are basically can be stratified based on
the collective number of goods and services the social determinants of
health that we look to earlier the access to transportation and grocery
stores and financial institutions umbrella performing schools will give
rise to community of communities of opportunity whereas in concert
distinction poor performing school limited public transportation food
deserts are associated with our low-income communities and thus poor
health status compared to the communities of opportunity with their
excellent health status well we've we've also talked about the social
determinants of health that our health status is really undergirded by access
to to affordable homes living wage jobs ability to obtain an education the bill
to live above the poverty line these are factors which are really are more
responsible for overall health than health care that I can deliver as the
clinician in my office lastly I hope that this presentation allows us to
recognize that these disparities persist based on social cultural phenomenon in
this graphic and I tend white practitioners believe that disparities
and how people are treated within a healthcare system rarely or never happen
based on such factors such as English fluency or racial background and when
they do acknowledge racial disparities physicians that will say well well these
disparities our care in the US healthcare system but they don't occur
in my hospital or my clinic and even more disheartening are these beliefs
that persist among US residents medical residents it is and medical students
even now quarter and in medical schools will believe that
african-americans have thicker skin than white and their other false beliefs that
are perpetuated in our medical system and so because of all these factors is
really in coming upon us to delve deep into this history to recognize that in
order to understand health disparities and communities of color we must get out
of our comfort zone we must get civically engaged and we have to have a
greater sense of how do we train ourselves to mitigate the bias that we
all have and to become more aware of these disparities how do we incorporate
questions on social determinants of health in our medical histories and how
do we recognize that individuals living in north these certain zip codes North
st. Louis who live on a daily trauma and high stress how do we begin to deliver
care that asks what happened to you rather than what's wrong how do we
deliver trauma-informed care these are things that we must do now we have to do
if we really are sincere about wanting to reduce disparities and ensure that
every st. Louis enhance opportunity to reach their full health potential there
are opportunities for residents there are opportunities for students and in my
final statement I would say a lot of this is not based on given a certain
level of understanding about disparities other than giving a certain level of
understanding about how do we treat people how do we treat our patients and
I think Francis Peabody had the most salient statement we stated in 1927 one
of the essential qualities of the clinician is interest in humanity
interesting in caring for the secret of the care the patient is caring for the
patient our learners all to care for the patients in our region where those
patients are from North st. Louis and South st. Louis where they are from
LeDoux or whether they're from downtown st. Louis whether they're
african-american or we're not they're white we're not they're Muslim or ornate
or or Latino now we're all saying Louis and when we all
are really supported around the sense of caring about uplifting the entire
community then we will have opportunity to see all of us reach our health
potential and then we will see the demise of crippling health disparities
thank you
For more infomation >> Liam Payne & Rita Ora - For You (Live - Echo 2018) - Duration: 1:54. 
For more infomation >> NoCopyrightSounds 1 Hour Long Mix for Gaming! Electronic Music - Duration: 1:15:41. 
Không có nhận xét nào:
Đăng nhận xét