The past year has been quite a learning experience for me. Since leaving my previous position working in the federal government, I’ve shifted my focus and attention to understanding how things work at the community level. This new perspective has piqued my interest and generated many more questions as they relate to public health interventions, specifically what characteristics, if any, need to be in place to achieve broad-based support for public health programs to succeed. I also wonder if we, as public health professionals, take the reins more than we need to.
My first exposure to Photovoice was in graduate school. Similar to any accredited Master of Public Health (MPH) program, each MPH student learns about various interventions to improve health outcomes of a target population. Photovoice is a method that has been used successfully in the fields of community development, education and public health, among others. Essentially, photovoice is a way to understand more about a specific topic from the perspective community members through a collection of pictures and their corresponding stories or essays.
On a trip to Washington, DC, I visited Virginia Commonwealth University (VCU) and their Department of Social and Behavioral Health. I had the privilege of speaking with two faculty members about their research and was referred to Dr. Patricia Carcaise-Edinboro, who led VCU’s research team for “PhotovoiceRVA: The Community Voice Project,” based in Richmond, VA.
I contacted Dr. Patricia Carcaise-Edinboro for an interview and I appreciated the opportunity to understand public health from her perspective.
I hope these insights are as informative for you as they were for me.
Now for Dr. PCE!
Me: Tell us about your past experiences in research and academia and how it ties to the photovoice project in Richmond.
Patricia Carcaise-Edinboro: My previous research experience at VCU has centered on health disparities in health care access and utilized primarily large national databases. These databases provide the opportunity to evaluate large numbers of patients within the healthcare system and make associations between their sociodemographic characteristics – where they live, a little about how they live and what kind of health care services they use. It also allows us to look at the healthcare delivery side and observe where disparities in service and care exist. What the large databases don’t allow is the patient/consumer perspective or lens of the subtle and not so subtle barriers to care and good health for certain segments of society. I wanted to answer some of the larger questions that arose from my previous research by hearing from those on the front line. Photovoice was a technique that allowed me to do this in an authentic and truly engaged way; moreover it allowed a group of community residents to have their voices heard, some for the first time.
Me: What inspires you on a daily basis, especially when things get hard?
PCE: I am inspired by the simple, consistent beauty that exists in nature and in the people I encounter. By this I don’t mean my frustrations and disappointments aren’t real and challenging, but that being aware of my surroundings often brings me back to my own center and place within the world.
Me: What do you think it will take for our society to view health more seriously? As in, why is health lower in priority to careers and education and relationships?
PCE: I am pretty sure I do not have the ultimate answer for this, but I do know our healthcare history of providing acute care versus preventive care has “educated” many generations of Americans to attend to our health only when we become sick. There has been so much in the last 2 decades to address preventive healthcare and more recently mental health, but we as a culture are impatient and like to see results of our efforts now, while preventive health care is a long-term proposition. I believe the mindset that receiving healthcare is something earned and not entitled to also contributes to the skewed prioritization of health, career and relationships . Over consumption of convenience and processed food sets us up for the diet industry assault and direct pharmaceutical marketing to consumers tells us we can solve a lifetime of bad habits with a pill. We all want to believe in the allure of a “magic bullet.” I would like that too.
Me: What are some things/concepts/ideas/insights you’ve learned from the photovoice project that you utilize as a professor and researcher?
PCE: At the risk of being simplistic, I think I learned definitely that health is clearly holistic in nature. The message I received from those who shared their stories was this: health involves the Mind, body, and soul. Additionally, place matters – where and how you live informs your state of health. But most importantly, being seen and heard is critical to human dignity and at the core of being ‘well’.
Me: What are the current needs in your city as they relate to social determinants of health (ie SES, poverty, access to care, transportation, safety, etc.)? Social determinants of health are any factors that directly or indirectly affect health. For example, being homeless could cause stress and malnutrition which could drastically affect one’s health.
PCE: Housing, jobs, transportation, availability of whole and fresh food in the city…. in that order.