Tag Archives: advocacy

Public Health’s ‘Moonshot’ – Part 1

Advocates for cancer research and prevention efforts converged in Washington, D.C. last week for One Voice Against Cancer’s (OVAC) annual lobby day on Capitol Hill. OVAC, a collaboration of roughly 50 national non-profit organizations, delivered a unified message to Members of Congress on June 6 on the need for increased cancer-related appropriations. A point of discussion in my meetings with legislative staff was the President’s Budget Proposal for FY 2018, which featured budget cuts at both the National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC) and increases for the Department of Defense. Armed with OVAC “asks”, I decided to focus my meetings with legislative staff from Senators Burr and Tillis and Representative Butterfield on the economic impact in North Carolina if funding levels were reduced. North Carolina is home to three National Cancer Institute (NCI)-designated cancer centers, which are awarded over $2B in annual NIH funding and employs thousands of employees.

Our advocacy training included a presentation by Dr. Warren Kibbe from NCI on the state of NIH funding and a quick brief on the Cancer Moonshot Initiative. Led by former Vice President Joe Biden, the initiative focused on concentrated and collective action to accelerate a decade’s worth of progress in preventing, diagnosing and treating cancer into a five-year time frame. The Cancer Moonshot has buy-in from academic, public and private sector partnerships. My immediate thought: why doesn’t public health have this type of dedicated initiative with annual federally-appropriated funds?

The Robert Wood Johnson Foundation’s Culture of Health initiative is public health’s “moonshot”. Its Action Framework parallels the Cancer Moonshot Initiative in identifying focus areas and key performance metrics to measure progress. RWJF’s Culture of Health has achieved significant buy-in from a myriad of cross-sector stakeholders. The only distinction between the two initiatives, from my perspective, is dedicated federal support. Imagine the possibilities if public health’s “moonshot” received the same attention and resources as the Cancer Moonshot Initiative. A decade’s worth of progress in a 5-year timeline for the social determinants of health would really change the trajectory of the field of public health.

In the next few posts, I plan to take a deeper dive on exploring innovative ways to address the social determinants of health, specifically at the local level, in the city where I currently live – Durham, North Carolina.

Below, I offer background on the U.S.’s healthcare system to provide a larger context the many layers and contributors to an individual’s health outcomes.

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Healthcare expenditures in the United States was approximately $3.2T, or $9,900 per capita, in 2015 which accounted for 17.8% of its gross domestic product (GDP). When compared to 12 other high-income member countries of the Organization for Economic Cooperation and Development (OECD), the U.S. spent significantly more annually. According to the Commonwealth Fund, the U.S. spent roughly $3000 more than Switzerland, the runner-up in per capita spending, in 2013. As a result, it outspent the next highest spender, France, by 5.5% of GDP in 2013. But despite its additional spending, the U.S. underperforms on population health outcomes such as life expectancy and chronic disease prevalence when compared with other OECD countries. Additionally in its analysis, the Commonwealth Fund compared healthcare expenditures to those spent on social services – retirement, disability benefits, employment programs and supportive housing, among others – for 11 OECD countries. In this comparison, the U.S. spent the least on social services at 9% of GDP, with Canada and Australia spending 10% and 11% of GDP, respectively. France and Sweden spent the most on social services at 21% of GDP. This imbalance in spending, posit the authors, may contribute to the country’s poor health outcomes.

Policies to improve population health have historically focused on the healthcare system according to Kaiser Family Foundation’s Heiman and Artiga. The Affordable Care Act, signed into law in 2010, expanded access to healthcare services for millions of Americans. However, as the authors explain, research demonstrates that healthcare is a relatively weak health determinant. Individual health behaviors, genetics and a broad range of social and environmental factors account for 90% of an individual’s risk for premature death. Thus, addressing the factors outside of the healthcare system may play a key role in improving population health outcomes, and the value it generates could justify reallocation of current spending levels.

Social determinants of health are “the structural determinants and conditions in which people are born, grow, live, work and age”. Examples of social determinants of health include social economic status, educational attainment, the physical environment, employment and social support networks. Social determinants form the basic foundation for each individual and his/her life experience. It also sets a baseline for future health outcomes. For example, an individual who is unemployed for an extended period of time may become homeless, food insecure and have limited access to healthcare services. It’s reasonable to conclude that this individual may be at higher risk of premature death due to his/her life experience. Unfortunately people all over the world have lives filled with adversity and struggle. Social, economic and/or environmental disadvantage creates differences in health outcomes, also known as health disparities, in populations across the world. One goal of Healthy People 2020, a strategic 10-year plan to improve U.S. population health, is to achieve the highest level of health for all people. Health equity includes the elimination of health and healthcare disparities.

One population of interest are known as “high utilizers” or vulnerable patients with complex social, behavioral and health needs. According to Anderson, the top 5% of individual utilizers account for about 50% of overall healthcare expenditures. Programs that pair patient navigators, community health workers and behavioral health resources with identified “high utilizers” have been implemented recently with hopes of improving health outcomes and generating value. A thorough review and analysis of the results for impact and effectiveness in improving health and cutting costs for this subset of patients is a critical next step.

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Public Health in Action – Acceptable Risk

CA Healthy Nail.png

 

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.

Behind the Scenes

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It’s been a few months since I’ve posted a blog post and for that I realize that it’s time to reflect back my latest endeavors and my progress since then.  I’d like to take a moment and turn the same questions that I posed to the previous people I’ve interviewed and answer those questions myself.

1) Tell us about Switch/Health and how you envision this blog serving an unmet need.

Switch/Health is the culmination of all my experiences in the field of public health and my observation that the internet acts as a double-edged sword at times.  The vast amounts of information on the internet can result in a daunting task of selection.  In my own experience, I can spend hours doing research for any one specific topic, but still not have the motivation to start writing or making progress towards completing the task at hand.  This paralysis due to too much choice or options is summarized in an easily digestible way by Barry Schwartz in a humorously informative TED talk.  His argument: too much choice is at times overwhelming.  Some of the most successful models and ideas are broken down to its simplest forms.  I enjoy going to places like Roti or Chipotle at times because I don’t have any extra decision-making energy to figure out what to eat and their menu limits the amount of choices I need to process in order to have lunch.  I read an article in which President Obama saves time and energy in the decision-making process by having two different color suits, black  or navy, so his morning routine becomes more efficient when picking out what to wear.  His time and energy is better served leading our country.  So my impetus for developing this blog was along the same lines – as a professional working to improve the health and well-being of individuals, I wondered, “what can I do to make my job more efficient?”  My sincere hope is that people find this blog with all its content, resources and links as a useful and valuable site to help them find what they need in a more efficient manner way.

The second driving motivation for me to start this blog: the way infrastructure is set up on the federal level, which more than likely translates into state and local governments – silos.  My experience working in government made me more aware of how complex it truly was.  A glimpse of any federal agency’s organizational chart will illustrate this further – here’s one that I looked at for 4 years: HHS organizational chart.  Organization and structure is important and I won’t attempt to argue the merits of how any governing body or company is organized.  But what I would like to focus on is the mere fact that the number of units in the chart is overwhelming.  Additionally, I would argue that having so many separate entities makes collaboration between them that much more difficult.

When I think about what a successful program looks like, I take pride in conducting a thorough search of what has and hasn’t been successful.  And when I explore these case studies, I always try to view them from different angles.  In the past year I’ve not so much taken my public health hat off as I’ve also put others on.  I realize that the field of public health has been around way longer than people really know, but only now does it get the acknowledgement that it deserves.  I also realize that other industries have also been around for many years and that there is wisdom that can be leveraged in any field, including public health.

Our healthcare system is one of the costliest in the world, if not the most.  We spend too much per person on healthcare than any other nation, but a higher sticker price doesn’t always lead to better health outcomes.  This fact, among others, is especially troubling when our nation has other issues to address, which don’t always receive the same attention and ultimately, the same amount of funding as our health care industry does.

Switch/Health is an idea that breaking silos could improve our country as a whole, specifically to reduce costs related to health care while improving the quality of care we receive.  Creating value with less by leveraging the best ideas and wisdom from the following: research, policy, innovation, public health in action and sustainable funding models.

So that’s where I am now.  I’ve come a long way from the pre-med student who then bought into the principles of public health who then discovered advocacy and policy in DC then managed and developed health and wellness programs for the government.  Now my focus is on creating solutions from the local level.  And I’m excited about the journey ahead.

2) What inspires you on a daily basis, especially when things get hard?

I try to focus on gratitude and service.  With gratitude, I focus on the things I have, rather than the things I don’t.  As for service, I try to volunteer whenever I have free time.  Since moving to Durham, NC, I have made more of an effort to be involved in a few different community-based organizations to serve residents that may need a helping hand.  When I see people slipping through the cracks – either in health care or employment or housing or education – I can’t resist the urge to offer whatever help that I can provide.

Also, TED talks and music helps me get started on a daily basis – there’s nothing like some inspirational talks and ideas and a solid playlist to keep me moving forward.

3) 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?

I really think it comes down to a higher level of personal awareness and how we can each contribute to the larger society as a whole.  I’m a firm believer that we each have something to offer the world, it just takes some time to understand what that is and accepting it fully then using those skills to make positive changes in our lives and to those around us.  Health is such a complex and daunting concept confounded by so many variables.  If we can tackle it first on an individual level – former acting Surgeon General Boris Lushniak considers it an act of patriotism to get ourselves healthy – then our society can progress slowly.  The next wave would be to work on a more collective basis to address the factors that indirectly affect health in certain populations, such as un/underemployment, homelessness, transportation, built and social environments and education, among others.  It is our natural tendency to focus on careers, education and relationships, but I would argue that valuing our health is as important.  Viewing health as a resource to do all the things we want to do in our lives is a concept that we should each embrace.  I’ve read and heard many stories where individuals describe periods of their lives in which they focused only on their career or relationships at the expense of their own health and well-being and have paid the price for it – from stress-related disease or other physical manifestations of burnout and exhaustion.  When we start to value our health in the overall picture of work and life, I strongly believe that we won’t regret the shift.

And it can be something as simple as taking a walk during a break during the day or breathing exercises after a long day.

4) What are some things/concepts/ideas you’ve seen either here in the U.S. or abroad that, if disseminated in an effective way, would change how people think about their own health?

Social entrepreneur Navi Radjou had a powerful TED talk that I watched a couple weeks ago. He highlights the innovative techniques that people in India and other developing countries, where resources are severely limited, that are solving common issues.  The mentality of doing more with less or leveraging what is available is a concept that I embrace and remains ingrained in my mind when thinking about current and future projects.  If we could each harness the same attitude when it comes to health and wellness on the individual and population levels, I know we could turn the corner on reducing costs of health care while improving overall quality of life.  It just requires a more conscious and creative thought process than the status quo.

5) 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.

I moved to Durham, NC from Washington, DC in November and I’d like to address both cities in my response.

First, since I lived in Washington, DC for almost six years, I think there are a lot of resources to serve the needs for a majority of the residents.  There are, however, many opportunities.  Living in a city the size of DC, provides the opportunity to see and interact with many different populations – from the elected officials all the way down to underprivileged homeless residents.  While there are significant resources available for the underprivileged, it is not difficult to notice the struggles of homeless residents.  I found myself, on many occasions, thinking about the reasons they were (or remained) homeless and wondered if they knew about the resources available.  In some conversations, some were living at shelters, but those were often full and had waiting lists.  My former neighbor often provided temporary housing and access to a shower, clean clothes and food to those she interacted just blocks away.  I think about how many more individuals could be helped, at least temporarily, by the kindness of a friendly and concerned neighbor; one who spoke with empathy and kindness and the desire to help.  I realize that mental health has been inextricably tied to homelessness.  So, more than anything, I hope mental health, homelessness, unemployment and other social issues could be viewed as interconnected and addressed in that same manner.

What initially attracted me to move to Durham was the openness and collaborative spirit of its residents.  I attended an entrepreneurial “startup” weekend in August in which teams were given 54 hours to develop an idea into a viable product to pitch to investors.  The locals on my team were extremely helpful and positive and made me feel at home as a visitor.  After subsequent visits and meeting more like-minded individuals, I knew it was the right place to be for both professional and personal growth.  In one visit, I met Dr. Sharon Elliott-Bynum, executive director of a holistic clinic, CAARE, Inc., based in downtown Durham.  When I toured CAARE, Inc, I understood that this was the model for healthcare in the future.  It addressed the social determinants that can indirectly affect health outcomes and also provided ambulatory care to those needing it.  Although I’m still new to the area, I have seen the impact that Dr. Bynum and CAARE, Inc. has on local residents.  I see the opportunity to use this as a model to branch out in other cities and continue to work with Dr. Bynum to expand its reach on the local level.  This innovative approach breaks silos and epitomizes the do more with less attitude.  And it’s working.  CAARE, Inc is celebrating its 20th year anniversary this year.  Dr. B describes how she’s seen nonprofits and companies alike come and go, but CAARE, Inc has remained.  The model we’ve been looking for to improve quality of life on the local level without the exorbitant price tag exists.  It’s just been under-the-radar and the people making it work have been, for the most part, doing it behind the scenes.

“We are quite rich enough to defend ourselves, whatever the cost. We must learn now that we are quite rich enough to educate ourselves as we need to be educated.” –Walter Lippman

I know that we have the resources to do many great things.  I think it’s time that we made a priority to use those resources in a meaningful way.

Public Health in Action – Rachel Safeek Fights the Status Quo with “Fight Stigma”

fightstigmaIn an earlier post, I marveled about Twitter and all the great things that have happened to me post-Twitter.  It blows my mind how much information there is out there on the internet…which is how I found Rachel Safeek.  Being the public health, upstreamist, social determinants of health geek that I am, I ran a Google search on “health disparities Duke” preparing for a trip down to Durham for one of my consulting projects.  Lo and behold, there were pages and pages of interesting websites, one of which was Rachel’s blog, blue devil banter.  Her perspective and activism was something that I wanted to bring into this blog.  What I value so much in activism and community mobilizing is that anyone and everyone has a voice – whether it’s a solo one or an army of voices – each and every one of us has a voice.

“Never be afraid to raise your voice for honesty and truth and compassion against injustice and lying and greed. If people all over the world…would do this, it would change the earth.” — William Faulkner

So without further ado…

Rachel Safeek
Founder, Fight Stigma Campaign
Duke University 2013
Program II: Health Policy, Human Rights, and Health Disparities

Me: How did you end up doing the work that you’re currently doing?  Student to activist to working at Duke.

RS: I first began working with HIV prevention and advocacy while studying global health as an undergraduate at Duke. I became interested in the various socio-economic factors that predispose women to HIV. My interests led me to spearhead a seven-month research project in Salvador, Brazil, investigating how violence (domestic, sexual, etc.) and economic vulnerability predispose women to HIV and other sexually transmitted infections.

Following my work with HIV, I joined and later became Director of an HIV testing program that offered free, rapid HIV testing at various locations in Durham, North Carolina, including Duke University Campus, Durham Technical and Community College, and El Centro Hispano, a resource center catering to predominantly Spanish speaking populations.

While engaging in HIV prevention work, I observed the manner and degree to which stigma was associated with HIV.  Moreover, overall sexual health served as a deterrent for many seeking HIV testing and/or medical treatment after sexual assaults, and openly discussing safer sex behaviors. This led me to found my organization, the “Fight Stigma Campaign” (FSC). The initiative was launched as a social media-based photo-campaign dedicated to educating the campus community about HIV/AIDS and encouraging HIV testing and open discourse surrounding safer sex, particularly among young adults.

After working with HIV prevention and advocacy for a year, I then turned my focus to HIV treatment. Currently, I am working as a Clinical Research Coordinator for the HIV drug trials at Duke Medicine, in which I oversee the enrollment and progress of patients in HIV drug studies at Duke. While I am now focused on the treatment end of HIV, I still dedicate significant time and effort to advocacy efforts for the FSC, all while I applying to medical school.  I hope to one day continue to work with issues related to women’s health and infectious disease as a medical doctor.

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

RS: As a Latina woman who represents diversity in healthcare, I am deeply motivated by a desire to give back to my community. Everyday, I have the privilege of engaging patients from a wide array of socio-economic and racial/ethnic backgrounds. These clinical experiences have afforded me the opportunity to observe first-hand the manner and degree to which racial/ethnic minorities are disproportionately affected by negative health status. Each individual interaction motivates me to continue along my trajectory of working with underserved communities—many of whom represent members of my own community—currently as a clinical research coordinator and HIV prevention worker, and later on, as a medical doctor.

Me: What do you think it will take for our healthcare system improve?  What do you think it will take our society’s health outcomes to improve?

RS: From a human rights standpoint, I believe that before health disparities can be adequately addressed, we must first acknowledge health as a human right. By ensuring individuals that they have a right to health, communities can mobilize to demand this right, raising awareness to the various socio-economic factors that prevent communities from attaining optimal health status. These socio-economic factors, including education level, access to healthcare facilities, transportation barriers, and poverty must be addressed in order to improve health care in our nation. I believe that these conditions stand a higher chance of being addressed if we can empower communities to vocalize their concerns by affording them the right to optimal health.

Me: In the health policy world, what do you think is the next big opportunity and how does this compare to the actual need of the population?  What I mean is that sometimes Congress and the needs of the public aren’t always on the same page…

RS: I think we can all agree that the Affordable Care Act represents a tremendous forward stride, in terms of affording individuals access to care. However, beyond health care coverage, there are still a multitude of factors that predispose populations to poor health, including lack of transportation to health care facilities, lack of access to sustainable nutrition, poverty, low socio-economic status, etc.

One prominent issue in healthcare that I believe is often overlooked is the lack of representation of minorities in healthcare settings. Having physicians and other healthcare workers of diverse backgrounds is necessary for appealing to the culturally-specific needs of patients.

According to the AAMC (Association of American Medical Colleges), African Americans, Hispanics, and Native Americans make up 25% of the U.S. population, but only account for 6% of doctors. Increasing the number of physicians from racial/ethnic minority backgrounds ensures the delivery of culturally competent and sensitive care, thereby fostering a sense of trust between patients and their providers and increasing patient safety and satisfaction. Minority physicians have also historically been linked to working with patients from underrepresented and marginalized groups, who often represent a large fraction of the sick population, further highlighting the importance of adopting progressive policies that encourage and aid minorities in their pursuit of careers in healthcare.

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

RS: Durham, North Carolina, home to Duke University, is uniquely nestled in the Research Triangle Park (RTP), which is renowned for having the highest concentration of MD’s and Ph.D.’s in the world. While boasting this impressive statistic, the city’s high yield of educated individuals also creates a gradient of educational disparities within the area. As a result, there are tremendous racial and socio-economic disparities between the faculty and students of Duke University and the rest of the city.

Duke University Medical Center, nationally ranked as one of the top 10 hospitals in America, plays an instrumental role in affording individuals in Durham County and surrounding counties and states top-notch care. Also, Duke University, as a whole, is the largest employer in the county. However, while the University affords Durham locals various job opportunities, I believe a disparity still exists. Like most of America, the large racial minority population does not comprise the majority of the decision makers who determine how resources are allocated. While there is some representation on boards, this is not enough. In the end, the decision-makers are the ones who control resource allocation, who drive change and make improvements to benefit the community, especially in healthcare.

I believe there should be more progressive policies that aid those of disadvantaged socio-economic backgrounds and under-represented minorities in their pursuit of higher degrees to help diminish the gap in racial/ethnic disparities in education and health.