Public Health in Action – Anchored Upstream

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Public Health River Metaphor

A man was fishing in the river when he noticed someone was drowning. He pulled them out and attempted to resuscitate them. Shortly afterwards, he noticed another person in the river and saved them too. He then noticed another, and another and another. Soon he was exhausted and realized he would not be able save all of the drowning people.

He went further upstream to find out why all these people were falling into the river.

On arriving further upstream, he discovered a broken bridge was causing people to fall into the river and end up drowning where he had been fishing.  He decided he would fix the bridge to stop them falling in, instead of fishing them out after they were already drowning.

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There’s a radio ad campaign for the Powerball Lottery in my local area, Raleigh-Durham, North Carolina that has stood out to me more than the hundreds of others I hear on the radio. In the ad,’Wolfman’ (picture Michael J. Fox in the Teen Wolf movie) visits the barber shop for his regular hair cut. ‘Wolfman’ throws out a few ideas – maybe I should shave it all off? “Or maybe a mullet?” His barber asks why the sudden change from his usual cut. ‘Wolfman’ described that his life was so monotonous lately and he wanted to change things up a bit. The barber then responds by recommending that ‘Wolfman’ purchase a Powerball ticket because every jackpot is worth at least $40 million – a life-changing amount; a change that  coincidentally ‘Wolfman’ was looking for. A disclaimer followed in the final seconds stating the odds of winning a Powerball jackpot, which was a measly 1/292 million. Ads, like this one, that tap into our well of emotions leave us particularly susceptible to any product that marketers are hawking, despite the impossible odds or practical necessity in one’s life.

While 1/292 million are nearly impossible odds, 1/4 seems almost certain in comparison. A recent article from the Atlantic highlighted results from Urban Institute’s study on medical debt. 23.8% of adults under 65 in the US has medical debt. Southern states, like Mississippi and Arkansas, have higher rates of medical debt – both over 35%. Furthermore, insurance coverage had a minimal positive effect: 23% of adults with health insurance still had medical debt compared to 31% of uninsured. As mentioned in the article, this has been a common criticism of the Affordable Care Act, aka Obamacare: that expanding health insurance does little to reduce high costs of health care for individuals (out-of-pocket costs) as well as the healthcare system as a whole.

Health policy in most recent years have been focused primarily on health insurance and affordable access to healthcare services. In the river metaphor above, focusing on health insurance would be akin to pulling people out of the river while they were drowning – providing them healthcare when they were sick, rather than figuring out how to prevent, or at least greatly reduce the risk of, illness. In public health and health care lingo this is what’s referred to as “looking upstream.”

In my interview below, Dr. James Leone, professor at Bridgewater State University, describes his career in “looking upstream.” Other upstream heroes of mine include:

Dr. Rishi Manchanda

Dr. Camara Jones

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Me: How did you end up doing the work that you’re currently doing?  Describe your journey to your current role as professor at Bridgewater State University.  Describe why you’re passionate about Improving men’s health…why others should care about the health disparities between genders.

James Leone: My journey into public health education and higher education was a bit random/arbitrary. I began in clinical practice serving as a certified athletic trainer (ATC) where I worked in various settings including: professional with the New England Patriots, clinical outreach at high school, collegiate and physical therapy clinics. I also worked with coordinating rehabilitation clinics and strength and conditioning services in a variety of settings. Not too long into my clinical practice, I received an offer to teach sports medicine/athletic training at Southern Illinois University Carbondale, which was a new challenge for me professionally. I continued to teach and clinically practice, but my love of education rose to the top of my priorities, so I pursued a PhD in public health education. I saw value in what I could contribute on an individual level with people, however, my brain has always been geared towards the “bigger picture” – I guess you can say I embrace an upstream mentality/approach. This was my entry into health promotion and public health studies. I made my way up to Bridgewater State University (BSU) after serving on faculty at Southern Illinois University Carbondale, Northeastern University, and The George Washington University (GWU). Additionally, I currently serve as an adjunct professor at Northeastern University where I have taught courses in athletic training, physical therapy, physician assistant studies, and recently in the master of public health program.

As previously mentioned I have embraced a more “upstreamist” approach in my world and professional view. That said, I realized that male health always seemed to be lacking whether from personal experience or reviewing study after study and large data sets. I always have championed efforts to advocate for groups, be it my athletes or gender (in this case). Also, in 2007 I was approached by my former Chairperson at GWU to offer a class in men’s health, which I quickly embraced since my thought process was already in-tune with this topic. I quickly realized that evidence was lacking in terms of “why” men live sicker and die sooner than women. Also, there were few academic resources (i.e. books) from which to facilitate the topic. I set out consuming as much as I could to develop my course and my knowledge in this area of research. This journey led me to propose a textbook on male health (published in 2012) as well as develop two courses on male health (one at GWU and the other at BSU, presently). I am currently pursuing opportunities to develop male health curricula further so that beyond greater awareness of the topic and issues, we can move dialogue into action and advocacy by training public health professionals and providers on gender-specific needs of men and boys.

So, why do I care about male health topics? I have always been an advocate for people, ethics, and basic human rights. Poor health outcomes in males challenges these aforementioned principles, negatively impacting overall population health. From the public health perspective, we are morally and professionally obligated to help right these wrongs so as to create a more equitable society aimed at a “true public health for all.” I believe Sir Geoffrey Vickers captured it best in his quote, “public health consists of “a successive re-defining of the unacceptable.” I believe gender disparities, particularly those affecting men have been “unacceptable” and warrant our full and undivided attention at present times.

Me: What inspires you on a daily basis, especially when things get hard?

JL: My commitment is based on my ethics and morals, which guide my actions. My intolerance for average often guides my “drive” to improve most things in my personal life and professional practice. Knowing that I do work that directly corresponds to people’s health and experiences is more than enriching for me on a daily basis. When times get rough I often remain mindful of the transient nature of life and experiences – the viewpoint “nothing is guaranteed in life” often helps me to keep my life and work perspectives in check most days.

Me: I saw your presentation at this year’s American Public Health Association (APHA) conference on men’s health as a national security concern.  Can you describe your perspective on this issue?

JL: I was in a graduate school lecture discussing public health initiatives and Harry Truman’s 1946 speech was referenced in the talk. As part of that talk, Truman commented on the nature of the military and investing in the health of the youth to strengthen the defense system of the U.S. Of course, at the time, the vast majority of the military were younger men whose overall health and qualifications for military service were being called into question. The latter point got me thinking as to what it would be today; likely, things have gotten worse with rising overweight and obesity issues nationally. This perspective motivated my presentation at APHA in November. Overall, I think this is an incredibly important issue for two main reasons: 1. Of course we want to a strong system of defense if called upon, and 2. And perhaps most importantly, poor men’s health brings to light the overall issues in male health in the U.S. When we are able to gain the attention of the Department of Justice and Department of Defense, we might actually see Congress move on some of the issues in men’s health that we have been advocating for over the past few decades.

Me: What made you decide to be involved in the men’s health movement and the American Public Health Association Men’s Health Caucus (MHC)?

JL: I saw the APHA MHC as a strong platform from which to pool my energies and resources on advancing male health. I value like-minded people, but also, I am challenged by various ways of thinking and working towards solutions in these groups. I have learned that even though there is a shared value and perspective, we all have something unique to contribute to the conversation over men’s health. The men’s health movement attracts me simply because we as a society must look upstream to the issues that we generalize and deal with downstream. We have grown too normalized with poor men’s health and the forces that drive it. I think working with Men’s Health Network, MHC, and APHA can embolden an area that has gone largely unnoticed even at the detriment of society.

Me: What are the current needs in the Boston metro area (or focus in on the city you live in) as they relate to social determinants of health (i.e SES, poverty, access to care, transportation, safety, etc.)?

JL: I consider Boston and the surrounding areas as “lucky” because we have so much access to health, healthcare, education, and most of the social determinants that can positively affect population health. However, when we look below the generalized population data, we still see a consistent and stark contrast in the health of the privileged and the socially marginalized as with most other major cities. Boston struggles to meet the needs of harder to reach populations and men just like most other major cities in the U.S. We do have some excellent and progressive programming such as the Men’s Health Center (Whittier Street) in Roxbury and the men’s health program through Cambridge, however, the salient question is always: are we meeting the needs of the most vulnerable at the right moments so as to promote long-term individual and population health – I guess time and statistics will tell that story.

Public Health in Action – Linked Up/In

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“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” –Margaret Mead

Margaret Mead’s quote eloquently describes what I see on a regular basis living and working in Durham, North Carolina. Since moving south from Washington, D.C. two years ago, I’m consistently humbled and inspired to hear what various groups are doing to improve the local community.

I recently attended a meeting hosted by the North Carolina Chapter of the B Corporation and heard a brief presentation from local B Corp Seth Gross, owner of Durham-based brewpub, Bull City Burger. In his remarks, he described how he opened Bull City Burger in 2011 and noticed a significant turnover in staff he had during his first year. After thoughtful consideration, he decided to focus more time, effort and resources on creating a work environment that was conducive to staff retention and a greater community impact. Bull City Burger was one of the, if not the, first restaurant to become certified as a B Corp in 2014. His leadership, willingness to share his story and advice to other restaurateurs and business owners have inspired countless others. North Carolina boasts 37 certified B Corps throughout the state.

Seth’s story with Bull City Burger is just one story among so many others that reflect the city’s level of community engagement.

My interview with Rob Shields, below, takes a deeper dive into the non-profit organization ReCity and its role in “rewriting the story” of Durham.

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“Durham incubator works to aid youth employment” local ABC news clip: http://abc11.com/video/embed/?pid=1722793

Rob Shields, Executive Director of ReCity

Me: How did you end up doing the work that you’re currently doing?  Describe your journey to your current role as Executive Director of ReCity.  Describe why you’re passionate about addressing youth disconnection…why others should care about the work you’re doing.

Rob Shields: I’ve been in the youth development space for my whole career – sports coach to a campus-based youth ministry Fellowship of Christian Athletes (FCA) to my current role as Executive Director at ReCity – and although my roles have differed, my professional interests have been in serving youth.

Through the years, I became more aware of division within communities. It really opened my eyes to the reality that communities of color experienced in daily life. The gap between rich and poor was huge and I became discontent with structures and systems that reinforced widening of that gap. From there I wanted to focus on community development and envisioned a thriving community where all individuals had opportunities to succeed. And that’s what attracted me to this role at ReCity. I wondered if this model could this be the solution to magnify programs that were already working and facilitate connections to foster collaboration between those programs. We aren’t trying to compete or reinvent the wheel, but our driving force is how best to serve the community.

I have a strong conviction and belief that talent is equally distributed but opportunity isn’t. And this bothers me. Everyone has dignity and we all have God-given skills and abilities and I want to be part of a city that has opportunities for all to find their way. The gap between rich and poor is too wide and ReCity would ideally play a role in creating the city as it should be.

Me: What inspires you on a daily basis, especially when things get hard?

RS: I draw a lot of inspiration from my Christian faith. My belief in serving a god that is redemptive and restorative in nature. I’m inspired to follow in his example of being involved in work that restores and I feel called to do so. My wife and kids are another source of inspiration and perspective. The startup world is tough and it’s so easy to lose one’s identity in work. My family provides me a constant reminder that I have other priorities that I’m responsible for. They bring balance by slowing me down to a marathon pace when I’m normally sprinting.

Me: Can you tell us more about ReCity and your vision for the next 5 or 10 years?

RS: ReCity is a co-working space for nonprofits and mission-driven organizations committed to restoring opportunities for disconnected youth and their families in Durham. Our space empowers our partner organizations to work alongside each other to close the opportunity gaps in our community through strengthening collaboration and pooling resources as well as social capital to achieve collective impact.

In five years we envision ReCity playing a role in rallying the city to act collectively to address social issues like youth disconnection. And since youth disconnection is a complex mix of underlying core social issues, a focus on youth disconnection specifically would simultaneously address disparities and injustices in other areas like education, housing, and transportation among others. We hope to provide a path to stable employment to 1,000 youth by our third year.

In 10 years, I can see our model as a template to address any complex social issue in any city. The beauty in our model is its simplicity. Living out shared values together in a shared space can accelerate the collaboration needed to solve complex problems plaguing cities nationwide. At the core, these issues are not unique to Durham and we hope that others can find value in what we’re doing.

Me: What role does the community have in addressing social issues like youth disconnection, poverty, unemployment, etc.?

RS: Community leaders are vital in shaping our work. We fully recognize that it’s their community; they are the most invested and are the key stakeholders, which is why we follow their lead when it comes to planning and decision-making. ReCity’s role in addressing youth disconnection in Durham has evolved since our inception because of their unwavering support, input and feedback.

Leaders in the community have the biggest voice in addressing social issues, and since ReCity doesn’t provide direct programs like many non-profits, we have to be very selective in working with organizations that are well-respected in the greater Durham community. These organizations must use appropriate methods when addressing core issues, with a focus on personal and professional development over reinforcing the need for ongoing services. Durham’s population is culturally diverse, therefore the youth we serve are equally diverse. 56% of ReCity partner organizations are minority-led, which is critical for us because one our driving core values as an organization is to reflect the diversity of the community we serve.

Me: What are the current needs in the Raleigh-Durham metro area (or focus in on the city you live in) as they relate to social determinants of health (i.e SES, poverty, access to care, transportation, safety, etc.)?

RS: Affordable housing is a huge concern, which is why I’m excited our network has added partners doing amazing work in this area like Housing for New Hope and Jubilee Home. Providing shelter is only one aspect, but creating paths to social mobility and wealth creation through home-ownership is the key. If we can make progress in raising rates of home-ownership, there’s potential to break generational cycles of systemic injustice and poverty.

Access to regular, reliable transportation is another issue, especially for the youth that our network serves. ReCity has started to consolidate services and resources among our partner organizations and we hope to one day be a “one-stop shop” for every type of resource needed to serve children and families more efficiently and holistically. We also hope innovative partnerships can help improve access to regular, reliable transportation. Private companies already have the vehicles and drivers – it’s a matter of reallocating funds to local transportation companies like Uber or Lyft to serve our target populations. Often times, the highest impact isn’t a result of new programs being created, but from intentionally re-purposing or redirecting the resources that are already in place. And that’s what ReCity is all about.

Public Health in Action – Seas of Change

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We’re nine days into the new year. Nine days into a fresh start, a clean slate. Many shared in eager anticipation and relief for 2016 to be over and done with in both mainstream and social media. But even though we’ve entered 2017, a magic reset button wasn’t pressed. The same issues we faced 10 days ago will still be the same issues we face this year and for many years after.

I imagine that Jason Roberts faced the same realization over a decade ago. Issues do carry over, year after year, unless something or someone shook things up. Earlier today, I watched Jason’s story as a regular citizen in a neighborhood of Dallas, Texas. His curiosity led to endless questions. The single most important question that kept popping up was “why not?” Why can’t things be different? With a mix of curiosity, resourcefulness, creativity, determination and passion, he made significant, long-lasting impacts that improved the quality of life in those Dallas neighborhoods, block by block.

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I was born in 1983 and I spent most of my childhood before the internet ever existed. I grew up playing sports outside, trading sports cards, playing video games and reading comic books. I was even caught up in that Pog epidemic of the 90s – try explaining Pogs to a teenager nowadays and they’d probably tell you “there’s an app for that”.

Terry and Justin Raimey grew up on comics too, and they were also passionate about food. Their passions fused when they co-founded Black Streak Kitchen.

Terry shares a snapshot of their story below.

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Me: How did you end up doing the work that you’re currently doing?  Describe your journey to your current roles as co-founders of Black Streak Kitchen (BSK).  Describe why you’re passionate about improving health behaviors in youth through nutrition education…why others should care about the work you’re doing.

Terry L. Raimey: Justin and I have always had an interest in health, wellness and cooking. Our mom and dad cooked everyday when we were kids, so we never really ate out. When we moved out of our parents’ home, we carried on the tradition of cooking for ourselves – creating new dishes by combining fresh meats, vegetables, fruits, grains and spices.

I am a writer and Justin is the artist and graphic designer of everything Black Streak Entertainment (Black Streak Kitchen’s parent company). We wanted to do something new and unique with our stories and artwork, something no one else in the comics and animation industry had ever done.

One day, I saw an ad for one of those grocery/recipe delivery services and thought it would be really cool to apply our artwork to something like that, and gear it towards kids, teens and families. So, we created Black Streak Kitchen as a source to teach kids, teens and families that cooking healthy can be delicious, while also teaching them how the ingredients can benefit their bodies and minds.

I love to cook and create new dishes by fusing unorthodox fresh ingredients and flavors. I love how eating healthy makes me feel and look; it’s very satisfying to me. And I want everyone to experience that satisfaction.

According to a study published in the Journal of the American Medical Association, the amount of children with type-2 diabetes, which is associated with obesity, jumped more than 30% from 2000 to 2009. When we were growing up, diabetes was an ‘old-person’ disease and obesity was a grown-up problem, but today, these conditions are affecting our children. One of the best way to combat America’s failing health grade is through cooking and nutrition education. Black Streak Kitchen provides cooking and nutrition education while making the presented material fun and entertaining.

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Image of recipe from Black Streak Kitchen

 

Me: What inspires you on a daily basis, especially when things get hard?

TLR: Seeing the reactions of the people we introduce to our brand, getting messages and comments from parents on how our app and comics teach them and their kids so much about cooking and nutrition, and even getting props from chefs and nutrition professionals is what motivates us to keep pushing. We pray and work hard, so it’s a true blessing when the Lord answers through the words of people who enjoy our brand.

Me: Can you tell us more about your collaboration with educators and any key outcomes or success stories from your comic books?

TLR: Well, our first comic doesn’t drop until January 15, but as far as collaborators, we’ve been blessed to have some accomplished chefs come on board. Chef Ed Harris will be featured as a Character Chef in our first issue, presenting his recipe “Roasted Cauliflower Stir Fry”. Chef Harris is the winner of Food Network’s ‘Chopped’ season 4 and ‘Iron Chef International’. We are also collaborating with Chef Robert Stewart, winner of ‘Guy’s Grocery Games’, ‘Cutthroat Kitchen’ and star of OWN Network’s ‘Raising Whitley’. Another collaborator of ours is Chef Ethan Taylor. He is the owner of ‘Great EETS’ catering in Los Angeles, CA. He works as a personal chef for numerous A-list celebrities, like Justin Beiber, Jamie Foxx and Mary J. Blige. All of these professionals have great elements to bring to our brand and help us succeed.

Me: What role do you envision comics and visual art having in educating youth?  How much of an impact did comic books play while you two were growing up?  Where do you foresee BSK in the next 5 or 10 years?

TLR: The use for comics and art are limitless. Fusing education with whimsical and visually appealing artwork grabs kids’ attention like nothing else, so it’s the perfect marriage. When were kids, we were big fans of comics. I read every monthly Spider-Man series in publication, and Justin was a big fan of Japanese manga. Comics sparked my imagination and took me on adventures that I could never experience in real life. As a matter of fact, we are still big comic fans!

In 5 to 10 years, we will have a home delivery service where we will deliver our recipe comics and the ingredients for our recipes to families homes. We will also have a cooking and nutrition animated series featuring our characters and signature Black Streak style. Having Black Streak Kitchen product lines through licensing is also a goal of ours.

Me: What are the current needs in the city live in as they relate to social determinants of health (i.e SES, poverty, access to care, transportation, safety, etc.)?

TLR: We live in a suburb outside of Youngstown, Ohio. Youngstown used to run off of the steel industry, but once the steel mills shut down, the city was hit hard. Unemployment is high, schools have been shut down, public transportation is limited, there are no grocery stores to purchase healthy food, and there is little opportunity to succeed – it’s quite depressing.

Giving back is important to Justin and I, so we want to sponsor the establishment of community gardens in urban neighborhoods where fresh produce is hard to come-by. Establishing community gardens provides a sustainable food source for the neighborhood residents to draw from. It also helps bring the community together and helps the youth of the community learn a constructive skill that will benefit them for life.

We want to build our own kitchen entertainment empire, while also helping people in need, in particular, black youth.

Public Health in Action – The Secret Life of Males

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It was in fifth grade when I first read a handful of James Thurber’s “The Secret Life of Walter Mitty.”  My teacher, Mrs. Dalton, used Thurber as an example of descriptive writing, what she referred to as “Show, not tell” or SNT for short.  I vividly remember writing a story similar to Thurber’s Walter Mitty, where I would drift back and forth from real life to daydreaming and back again – racing a car in my daydream, only to be scolded by the grocery store manager for barreling the shopping cart into an innocent pyramid of watermelons.

Now more than two decades later, I still chuckle at Thurber’s humorous tales; humbled by his seamless transitions between fantasy and reality.  But on a deeper level, the life of Walter Mitty illustrates distinct social norms and narratives.  Walter’s fantasies transport him into a life that’s far more exciting, full of adventure and intrigue, and completely different from his normal life.  He’s the stoic commander of a helicopter flying into a snowstorm or the Air Force captain taking a few drinks of brandy before jumping behind the machine gun turret.  He becomes his own hero; a figure of admiration by those around him.  But the story beneath reveals a few underlying messages to males, in particular: take risks, be heroic and be brave.  And those messages are absorbed, accepted and passed from generation to generation.  These “rites of passage” have a profound effect on personality, lifestyle and behavior. Moreover, they may also explain the following:

Males are:
*less likely to have health insurance
*half as likely to visit a healthcare provider
*employed in the most dangerous of professions – fishing, mining, fire fighting, construction
*more likely to take risks at younger ages

As a result, males aren’t as healthy as their female counterparts.  And for a group of this size, roughly 150 million, the impact on society is a staggering thought.

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I had a chance to catch up with Dr. Michael Rovito, assistant professor at UCF about his passion and interest in men’s health.  Let’s check out his story.

 

Me: How did you end up doing the work that you’re currently doing?  Describe your journey to your current role as assistant professor and researcher at UCF.  Describe why you’re passionate about making men healthy…why others should care about the health disparities between genders.

Michael Rovito: I had an unorthodox path to practicing public health, actually. I obtained a BA in Geography and a MA in Urban Studies. I was a bit aimless with life goals and no real idea of what I wanted to do with my career. During my graduate studies, I had a class called ‘Medical Geography’. An epidemiologist taught the course and it opened my eyes to the idea of public health and what I can do, not just with my own career, but for other people. I don’t think we really reflect on how we can assist others with our profession and that was my ‘eureka’ moment with public health.

After I realized I wanted to get into public health, I reflected back on my life and the health behaviors I made when I was younger and I focused in on men’s health. The notion of life course perspective was brand new to me so I dove in head first, borderline psychoanalyzing my past habits and trying to predict my future health outcomes. I chuckle now at my naiveté at the whole process, but it’s what we all do when we discover a new toy or gadget, right? We kind of go overboard a bit. But, I am thankful for my rather intense puzzling of the past with present outcomes as I remembered a time when I was 16 and I discovered a lump on my testicles. I thought it was cancer. Being the mid-90’s, there wasn’t the internet that we know today. No WebMD. No Google. So, I just kept quiet and suffered silently. Eventually I broke down and told my parents. That anxiety is some serious stuff. Worrying about the possibility of having cancer at 16 with no information…it was pretty rough.

Eventually I saw a urologist and fortunately it was not cancer. I went through the cancer scare right around the time of my introduction to public health so I thought to myself that I needed to help other guys who were in the same situation as I was. I wanted to help them feel less confused, more comfortable, and empowered. So, after obtaining my PhD in Public Health from Temple University in Philadelphia, I decided to devote my professional life to, again, helping males get healthier in any way possible – from learning new information to practicing new preventive behaviors. Whatever it took, if I can help even in the slightest sense, I wanted to do that. It seems like a simplistic mantra to explain why I do what I do, but deep down, I think most of us who practice public health have similar ambitions.

Me: What inspires you on a daily basis, especially when things get hard?

MR: I guess I should say “who” inspires me now is my wife and my daughter, and my little Shiba Inu, Lola. What currently inspires me? Making sure they have the best life possible. Having this new family of mine has REALLY changed my perspective on life. I had always heard while growing up how kids and family life changes you, but I shrugged that off and rolled my eyes at it. I mean, how would I know just how much that would alter my view on life if I never had them? It’s understandable, I guess. But, now, I can’t let them down. That’s what drives me everyday.

But, before my family, my inspiration was to succeed where most of the people I grew up with didn’t. The odds of leaving the little Appalachian town in the hinterlands of Pennsylvania were certainly not in my favor growing up. There’s certainly nothing against not leaving, but I needed to leave. I wanted to leave. So, finding the means possible to leave, to grow, and mature in ways that weren’t readily available to me was my primary motivator. If anyone reading this ever grew up in small town America, they can relate. They can relate to the entirety of John Cougar Mellencamp’s discography serving as the official soundtrack to their lives. My inspiration then was to make a new soundtrack.

Me: Describe your research interests and/or current research projects.

MR: I have two primary research interests: testicular self-examination (TSE) promotion and intervention/instrument design within young adult and adolescent male populations. In terms of the TSE work, I am currently focused in on the health policy side of it all. I am embroiled in a push to directly challenge the USPSTF review of the TSE and its “usefulness”.  In terms of the intervention and instrument design, I developed a series of tools and assessments that can be used in outreach programs that can capture great data on current outcomes and indicators of future outcomes.

Me: What made you decide to be involved in the men’s health movement and the American Public Health Association Men’s Health Caucus (MHC)?

MR: Advocacy is very important to me, as is disseminating my work to a broader body of my peers. MHC does that for me. APHA/MHC provides a pathway, not only to share my work, but also provides a means to collaborate. That’s very important. I can’t stand the thought of being a professor if I can’t profess to people. I can’t stand the thought of having a degree in public health and not actually getting my work into the public. So many of academics don’t actually practice what they preach, which frustrates and angers me. What’s the point? But, MHC is one way that I can get my ideas to others and perhaps implement them in the field.

Me: What are the current needs in central Florida (or focus in on the city you live in) as they relate to social determinants of health (i.e SES, poverty, access to care, transportation, safety, etc.)?

MR: Central Florida has the same needs as pretty much the rest of the country, but it’s just amplified due to the huge population growth and the diversity here, which makes it a bit different than some other areas of the US. But, overall, the needs are the same: we need to inform, we need to empower, we need to advocate.

Public Health in Action – Vital Plan Strives for Impact, One Person at a Time

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There’s one lecture from graduate school that I constantly remember. In that particular Healthcare Delivery in the U.S. course lecture, my professor walked through a clinical visit with a recurring patient. Medical students and residents learn to obtain three important pieces of information from the patient: chief complaint (the reason for their visit), symptoms and a brief medical history. He then opened it up to us – was there anything else we would like to know? Coming from a public health perspective, our questions dove deeper into the social determinants of health -physical environment (housing), SES (access to health insurance, employment), etc. –  to clarify if there were any underlying issues causing the patient to return with similar health issues. That deeper dive, he said, was the distinction between the fields of medicine and public health.

An article published by WBUR last month illustrates a shift in medical school and residency programs to integrate public health principles, most notably the social determinants of health, into their learning objectives.

A holistic understanding of each patient is ideal when tailoring a plan not only to treat illness, but to achieve long-term well-being. The whole-person approach to treating chronic illness is what makes Vital Plan a unique part of the vast healthcare landscape.

My interview with CEO Braden Rawls catching up 2 years after our first interview, below.

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Me: I can’t believe it’s been almost 2 years since I published our first blog interview.  How’s Vital Plan?  What’s new that you can share with us?

Braden Rawls: It’s been a busy two years! Vital Plan has grown its customer base significantly, and this has allowed us to recruit ten new team members to continue improving our programs and expanding our reach. What really clicked for Vital Plan was selling our herbal supplement products in bundles alongside supportive health programs. Our signature program is the Restore Program, which includes four supplements plus health coaching support and a six month online course with education about restoring balance in the body through diet and lifestyle.  We’ve received very positive feedback on this program from customers and have expanded it to an international audience, with customers across Europe, Canada and Australia.

Me:  Why was it important for Vital Plan to become B Corporation Certified?

BR:  B Corp certification is important for Vital Plan to showcase third-party verification of our commitment to doing business with integrity. We are on a mission to restore and rebuild trust in the herbal supplement industry after its reputation was tarnished by deceitful players. Being able to showcase our commitment to doing business with integrity has already proven valuable in gaining new customers and recruiting talent. From the start, our goal has been to empower everyone that our organization teaches individuals to become more proactive about their health and to be mindful of the way they live. B Corp gives us a framework to support this mission and put best practices in place to grow our company in a smart, sustainable way.

Me:  One of the illnesses that Vital Plan focuses on is Lyme Disease.  Could you describe why it’s been a major focus for Vital Plan?  How does Vital Plan’s approach differ from traditional approaches?

BR:  Lyme disease is an illness that is personal for Vital Plan, as our founder, Dr. Bill Rawls, suffered with pain and insomnia for many years before ultimately testing positive for Lyme disease. However, Dr. Rawls’ personal struggle motivated him to research microbial illness from all angles, and he feels that Lyme disease is only one microbe of thousands behind chronic illnesses such as fibromyalgia, chronic fatigue syndrome and rheumatoid arthritis. Dr. Rawls believes that the true problem is not the stealthy microbes, but rather suppression of our immune systems that is allowing these stealthy microbes to flourish. He feels that chronic immune dysfunction is the real driver of the increase in chronic disease in developed countries, as exposure to toxins, radiation, stress and processed foods has depressed our immune system and is allowing microbial disease to flourish.

Me:  Vital Plan’s belief in addressing the underlying causes of disease is non-traditional.  Could you speak why your team is so passionate about taking this route?

BR:  The approach of treating symptoms is valuable for helping an individual to live more comfortably short term, but it is generally not a long term solution for fostering wellness.  Our team believes that disease in the body is often the result of environmental and dietary factors that are under our control, such as inflammatory food, chronic stress, and exposure to toxins and microbes. Through awareness of these disease factors, we believe that better health is in reach for many individuals. We feel that herbal medicine and natural healing modalities are also effective tools for individuals to take advantage of to promote healing and restore balance in the body.

Me:  Based on the patients that Vital Plan serves, what would you say are the biggest challenges for them to get back to normal? “Normal” being before their respective diseases produced symptoms so severe that it affected their quality of life.

BR:  For many people, diet and lifestyle changes are very difficult. However, once a person realizes that the food they are eating (or busy schedules they are slaves to) is making them sick, the changes become much easier to adopt. When you begin to associate foods or lifestyle practices with feeling good, your body will begin to crave those foods and practices instead of the ones that make you feel bad. It is all about training your brain to make those connections. Accelerating those connections for people is a big part of the mission behind our programs at Vital Plan.

Public Health in Action – Acceptable Risk

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Have you ever gone to work knowing you weren’t feeling too great or knew you were sick?  I definitely remember at least a handful of times when I’ve gone to work and potentially exposed co-workers to my cold or flu.  And I have no doubts that a majority of us have done the same.

But let’s say you worked in a more public setting, like a hospital or restaurant, where illness could spread to a larger population.  Would that influence the decision to stay home?  At least half of workers in more public settings show up to work sick, according to a recent NPR article.  Participants of the poll listed a variety of reasons for showing up to work sick, including a lack of paid time off or concerns over job security.  But another reason was inadequate back-up staff.  Sick employees didn’t want to overburden their co-workers in their absence.

Now imagine an opposite scenario where employees are at higher risk for illness or injury while at work; where exposure to toxic chemicals is part of the job.  Nail salon workers fall into this group and are routinely exposed to such chemicals, resulting in reproductive and developmental issues or cancer.  Does an increased risk to health issues have to be a necessity for nail salon workers?  Fortunately, not.  The California Healthy Nail Salon Collaborative (CaHNSC) was established in 2005 to improve the health, safety and rights of this workforce.  My interview with Catherine Porter, policy director of the Collaborative, below describes their impact on the industry in California.

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Me: How did you end up doing the work that you’re currently doing?  Describe your journey to your current role with the CA Healthy Nail Salon Collaborative – why is CaHNSC important to you? Why is it important to customers?

Catherine Porter: I have a great passion for workers’, particularly women workers’, rights and health.  As an employment rights attorney, I represented clients in gender and race discrimination claims and also represented teachers in arbitration and layoff hearings. After a breast cancer diagnosis at the age of 40, I decided to work on a policy level to have a greater impact on larger social, legal, and environmental issues such as eliminating the epidemic of cancer and other chronic diseases linked to toxic chemical exposures. I worked in an organization that focused on women with cancer and the environmental links to the disease; at another organization I focused on occupational safety and health, including workplace chemical exposures. I started with the California Healthy Nail Salon Collaborative (Collaborative or CaHNSC) in 2008 and now serve as its policy director.  Working with the Collaborative represents a natural progression of policy issues for me because we focus on environmental health and safety rights for both workers and women.

The Collaborative is having a positive impact on a vulnerable population of low-wage women workers. On the policy front, we are working to reduce exposures to toxic chemicals that are pervasive in nail salons. We also provide information regarding labor law rights and obligations, and work to ensure this important information is available and accessible to the nail salon community.  In California, manicurists are predominately Vietnamese immigrant women of reproductive age. Language can be a barrier to understanding occupational safety and health and labor rights.  The Collaborative has sponsored successful legislation that requires California state agencies to provide improved language access for the nail salon and other immigrant communities in California.

The Collaborative has built relationships in the nail salon community by providing trainings on healthier and more fair ways to do business.   Our successful advocacy for Healthy Nail Salon Recognition Programs (HNSRPs are now operational in four counties and one city) contribute to a safer and more enjoyable experience for nail salon customers.  These local programs acknowledge and support nail salons that use less toxic products and practices in their shops.

For example, nail salons must use products that do not contain the “Toxic Trio” of dibutyl phthalate, toluene, and formaldehyde, all known to cause reproductive and developmental harm or cancer.  Salons also must improve their ventilation and participate in trainings about how to avoid the most toxic exposures. According to our survey data, most salon owners that participate in the program say that they and their workers feel healthier and that they have experienced an increase in customers.

Me: The CA HNSC is involved with advocacy efforts – what legislation is realistic in the next few years and what would your ideal legislation look like?

CP: To promote the spread of Healthy Nail Salon Recognition Programs (HNSRPs) across California and beyond the current five jurisdictions, the CaHNSC and Asian Health Services of Oakland (AHS) are currently sponsoring AB 2125 (David Chiu) which requires a state agency to inform local county and city governments across California about HNSRP guidelines, and to conduct activities to improve consumer awareness of these local programs.  AB 2125 passed the state Assembly and two Senate policy committees with overwhelming support. It currently awaits consideration in the Senate appropriations committee. One reason AB 2125 has received such large bipartisan support is that it involves an incentive approach to policy change; it calls for rewarding good behavior as opposed to penalizing bad behavior.

However, frequently, a legal prohibition or requirement is necessary and most effective to change behavior, but it is much more difficult to get the necessary support from both sides of the aisle in Sacramento for this kind of policy.

For example, cosmetics are woefully under-regulated as there is no requirement for cosmetic products to undergo pre-market safety testing.  Furthermore, manufacturers are not required to list ingredients on the labels of professional cosmetics. And the chemical components of the ingredient known as “fragrance” do not have to be disclosed to consumers.

Ideally, filling these three gaps in cosmetics policy would be a good starting point for some meaningful legislation.  In fact, such a measure was introduced in Washington, D.C. by U.S. House Representative Jan Schakowsky (D – 9th).  But proposals like this are unlikely to receive enough support given the current political makeup of the Congress and the ongoing influence of the chemical and personal care products industries.

From a wider lens view, other legislation that would positively impact nail salon and other low income women workers include establishing a single payer health system; overturning Citizens United; and a state measure reining in the cost of housing including rental rates.

Me: What inspires you on a daily basis, especially when things get hard?

CP: We have strived to bring the voices of local Vietnamese nail salon workers to policy debates.  When I hear their powerful messages as they enthusiastically advocate for safety and health in the workplace, I am reminded of why my Collaborative colleagues and I do this work. This year, during the course of our campaign for AB 2125, many nail salon colleagues and Collaborative member organizations representing the local Vietnamese community participated in lobby days and hearings in Sacramento.   It is deeply satisfying to see a largely immigrant community become engaged in the political life of America as a result of the Collaborative’s Leadership Trainings and other education and outreach efforts.

Me: In your opinion, how effective are community outreach efforts like the Healthy Nail, Beauty Salon and Barbershop programs compared to other forms of health education (e.g. presentations, one-on-one, small group, etc.)?  Specifically – reaching target audiences where they spend recreational time (in a nail salon or barbershop).

CP: The most effective outreach efforts rest on relationship-building to develop trust and common ground among parties.  Our work with the nail salon community and successful implementation of Healthy Nail Salon Recognition Programs (HNSRPs) involve ever stronger ties with nail salon workers and owners.  Outreach workers are generally native Vietnamese speakers and understand how to bridge cultural differences.  They make in-person visits to salons to get to know the individual workers and owners. Over time, they begin to tell salon owners and technicians about the Collaborative’s work and how to make nail salons healthier for themselves and their customers.  Salon workers and owners will be invited to trainings on safety, health, and labor law as well as community gatherings sponsored by the Collaborative. County or city staff responsible for HNSRP implementation also conduct on-site trainings at the salons and convene small group informational meetings at the Collaborative offices. All written materials and spoken word are offered in Vietnamese and English.  We also make sure we have fun – community members and Collaborative staff come together regularly to share food and stories about work life in nail salons.

Me:  What are the current needs in the Bay Area relate to social determinants of health (i.e. SES, poverty, access to care, transportation, safety, etc.)?  Ties to nail salon workers and their need to work at potentially unhealthy workplaces.

CP:  The cost of housing and the need for more affordable housing are critical social or physical determinants of health in the San Francisco Bay Area. Two of the ten most expensive residential rental markets are cities in the San Francisco Bay Area—San Francisco and San Jose.  The City and County of San Francisco (64%) and Alameda County (60.9%) rank the highest and 5th highest respectively when it comes to fair market rent as a percentage of single mothers’ median income.

Some of the highest rates of women working in low-wage jobs are in San Francisco Bay Area counties.  Almost 34% of women in Santa Clara County, almost 27% in Contra Costa County, and approximately 25% in Alameda County, work in low-wage jobs.

This underscores the importance of increased consumer awareness of working conditions in this beauty services industry and the need for nail salon workers and owners to receive fair payment from their customers for services like manicures and pedicures.  AB 2125, which would mandate a statewide consumer awareness program, would be an important contribution toward a generally more sustainable nail salon industry.

Public Health in Action – Not a Zero Sum Game

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With the solstice behind us and the last few days of June ahead, summer is here.  And the reminders are constant: warmer weather, relaxed dress codes and recurring vacation ads on television.  Along with the official start of summer, the month marks an important awareness period for men’s health.  Events and activities centered to encourage and engage men all over the world to be more proactively engaged in their own health and well-being, Men’s Health Month has served as an annual reminder to everyone that men aren’t invincible.  Men, in fact, succumb to disease and premature death at greater rates and earlier ages than their female counterparts.

Peter Baker, director of the Global Action on Men’s Health, wasn’t aware enough to engage in such reminders.  In my interview with him below, Peter shares his personal wake-up call to health and how that catalyzed his passion into the international men’s health movement.

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Me: How did you end up doing the work that you’re currently doing?  Describe your journey to your current role as the Director of Global Action on Men’s Health.  Describe why you’re passionate about making men healthy and why others should care about the health disparities between genders.

Peter Baker: I’ve been active in men’s health for about 20 years and involved in broader men’s issues for over 30. I came to this field through my interest in feminism and an exploration of my own masculinity through men’s groups and writing, including for a small but influential anti-sexist UK men’s magazine called Achilles Heel. I was for a time also actively involved as a volunteer in projects which aimed to end men’s violence against women.

I became a freelance journalist and writer in 1990 and contributed articles about men’s issues to a wide range of well-known UK newspapers and magazines including Cosmopolitan, GQ, The Guardian and The Independent. My involvement in men’s health specifically became much more significant when I was invited to become the health editor for a men’s magazine, Maxim, in 1995. In 1996, my book (co-written with Mick Cooper) The MANual: The complete man’s guide to life was published. This was a self-help guide for men interested in reflecting on and changing their experience of work, sex, relationships and parenting as well as health. My second book, Real Health for Men (published in 1992), focused specifically on health and well-being and the practical steps men can take to add years to their life as well as life to their years.

My interest in men’s health also stemmed from personal experience of some chronic health problems when I was in my 30s. I developed often debilitating back pain and, probably as a result of drugs taken for that, a duodenal ulcer. I’d never taken much care of my health before and, in my late teens and 20s, drank too much alcohol, eaten poorly, done little exercise and steadily put on weight. Alongside the drugs and the physiotherapy for my ulcer and back, I decided to improve my diet, cut out alcohol and start exercising. When my marriage broke down in the early 1990s, I also started psychotherapy which helped me to think about my mental health and wellbeing in a new way.

My men’s health journalism brought me into contact with men’s health advocates and specifically the Men’s Health Forum, an organization that works to improve men’s health in England and Wales. When the coordinator left in 1999, I was invited to take over on a part –time, temporary basis. In 2000, I became the Forum’s first full-time Chief Executive and I stayed for another 12 years. During that time, I helped to develop the Forum into a national charity, launched Men’s Health Week in the UK in 2002, and push men’s health issues onto the agendas of national government and the health services.

I left the Men’s Health Forum in 2012 in large part so I could focus more on the men’s health issues that most interested me without the burden of organizational management, a major aspect of my job that I’d always seen as a necessary evil. As a self-employed consultant in men’s health, I’m now able to focus much more on the issues that really interest me. I’ve mainly been working with the European Men’s Health Forum on improving men’s use of primary care services, developing a UK campaign (HPV Action) that makes the case for boys to be included alongside girls in the national HPV vaccination programme, and establishing Global Action on Men’s Health (GAMH).

GAMH came about because I’d become very aware that in most countries men’s health was not being addressed, or even talked about, and agencies with a global role, such as the World Health Organisation seemed to believe that gender was about women alone. My view is that there need not be a conflict between men’s health and women’s health; they are not binary opposites or a zero sum game. In fact, they are closely intertwined: improving men’s health would be good for women’s health and vice versa.

What makes me passionate about improving men’s health is a firm belief that, when it comes to health, men are not being treated sympathetically or fairly. Too many men are dying too young or living too many years with debilitating health problems, both physical and mental. It could be so much better.

Tackling men’s health problems is not only ethically the right thing to do – because enjoying optimal health is a basic human right – it also makes good economic sense too. We know from studies in the United States and Canada that men’s health problems are very expensive for health services and for society as a whole.

Me: What inspires you on a daily basis, especially when things get hard?

PB: I relish the intellectual and creative challenge of finding new and different ways of making change happen even in the least propitious circumstances. I’m also inspired by breakthroughs in men’s health in the least likely places; for example, I learned very recently that a National Men’s Health Policy has been developed in Iran. (Such policies had previously existed only in Australia, Brazil and Ireland.) I’ve also been impressed and actually staggered by the exponential growth in the number of men’s sheds in many countries; these are helping to reduce older men’s social isolation, improve mental wellbeing and increase participation in community projects.

Me: In what ways can healthcare and public health professionals engage men to be more proactive in their health?

PB: The Men’s Health Forum in the UK recently published an evidence-based guide to engaging men in mental health services. This contains ‘Top Tips’ that very neatly encapsulate the actions that are most likely to engage men to be more proactive in almost any aspect of their health. Here are some of them:

  • Start by understanding what the barriers are currently.
  • Communicate with men in a way that respects their maleness.
  • Be positive about men.
  • Ensure that interventions have clear objectives that its users understand.
  • Consider basing interventions on shared activities.
  • Make sure the setting is a ‘safe male space’.
  • Incorporate peer support.
  • Publicize positive examples.

Me: Describe your vision for GAMH in the future.  Where do you see it in the next year, 5 and 10?

PB: GAMH is still in its early stages and is slowly building up its infrastructure and developing its ideas and strategy. In the next 5-10 years, I expect it to be established as a small but influential international advocacy organisation with members in many more countries at all levels of income and development. It will be recognised by other global health agencies, not least WHO, as a reputable source of information, advice and guidance. It will have succeeded in putting men’s health firmly on the global gender agenda.

Me: What are the current needs in (city or country you live in) as they relate to social determinants of health (i.e SES, poverty, access to care, transportation, safety, etc.)?

PB: I live in the UK where male life expectancy still lags behind female (by four years) and where men are much more likely to die before the age of 75 (60% of all premature deaths are male). The group which has experienced the smallest decline in age-specific mortality over the past 20 years is men aged 25-45. There is a marked social gradient in life expectancy and it is steeper in men than women; in other words, deprivation has a bigger impact on men’s health than women’s.

Men are poor users of a wide range of primary care services (general practice, pharmacy, optometry and dentistry) and some screening services, especially bowel cancer screening. They are particularly reluctant to access services for common mental health problems like anxiety and depression. Part of the explanation for this is that services have not been designed with men in mind and they are not actively encouraged to use them. Workplaces also account for a wide range of health problems in men in the UK, particularly deaths and serious injuries.

Although more account has been taken of men’s health in recent years in the UK, there is still no national men’s health policy and practical action tends to be localized, patchy, short-term and small in scale. A strategic approach, both nationally and locally, is needed if men’s health inequalities are to be tackled effectively.