Tag Archives: community

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.

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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 – Champions of Change

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The Looking Glass by Dave Meier

It’s been a full year since I created this blog and after reading each of my posts from the past year, I feel like it’s only the beginning.  Switch/Health has evolved so much more than I could have ever imagined.  Initially envisioned as a “one-stop shop” for all topics that directly or indirectly affect health outcomes, it has become a link to many great stories.  Stories of local leaders affecting real change in their communities.  Stories that describe how health and the healthcare system look from various lenses.  And most importantly, stories that describe their own evolution in finding purpose in their work.  I feel extremely humbled for the opportunity to share their stories with you.

The leaders listed below have been instrumental in empowering people in self-awareness and improvement.  I’m inspired to continue my search in finding the unsung heroes making an impact.  And I hope their stories offer you some insight and inspiration as well.

A Maria Hester – Dr. Hester Empowers Her Patients
Bri Isaacs – YogiBriii in the OC
Betty Jung – Web Master and Lecturer Betty Jung
Elizabeth Greenberg – Non-Scents Makes A Lot Of Sense
Rachel Safeek – Rachel Safeek Fights the Status Quo with “Fight Stigma”
Heather Freeman – Heather Freeman Believes We All Have Capes
Braden Rawls – Health Doesn’t Have to Cost an Arm and a Leg
Jonathan Bonnet – Walking the Walk
Elizabeth Poindexter – Mobilizing for Collective Impact
Ryan Shaw – Leveraging Health IT to Improve Outcomes
Patricia Carcaise-Edinboro – Hearing the Unheard
Michael Allen – Mind the Gap
Prathima Kannan – Communities Creating a Culture of Health

“The best way to find yourself is to lose yourself in the service of others.” — Mahatma Ghandi

Public Health in Action – Communities Creating a Culture of Health

images I first heard about SEEDS through a community email listserv that my roommate sent me.  SEEDS frequently has volunteer opportunities throughout the year and I signed up for their most recent annual fundraiser, Pie Social.  It was such a fun event!  People donated all kinds of pies that day from sweet to savory to pizza – they were all there for everyone to enjoy.  One of the most inspiring aspects of that event was the community’s support.  Well-renowned chefs and residents alike spent hours to create delicious expressions of edible art.  And all the attendees were more than happy to splurge on various delicacies.  Veterans of the event even brought Tupperware to share their pie-riches with family and friends.

After volunteering, I wanted to learn more about SEEDS and was connected with another volunteer Prathima Kannan.  Here’s my interview with her…

Me: How did you end up doing the work that you’re currently doing?

Prathima Kannan: Right now, I work at Alamance County Health Department as a Registered Dietician for the Special Supplemental Program for Women, Infants, and Children (WIC) and also have a small nutrition private practice.  How I got here was a combination of interest and personal experience. During college and in my 20s, I struggled with my weight and nutrition. I chose to eat unhealthy foods; ate to cope with difficult emotions; ate mindlessly; and decided not to exercise most of the time. I dealt with the consequences of these choices: abnormal lab values and weight gain.  It was clear that these symptoms had a negative impact on my health, but less obvious were the negative impact on my self-esteem, social experiences and my work life.  I needed to make changes quickly and I revamped my diet, increased my physical activity levels, and changed my attitude towards living a healthy lifestyle—it doesn’t have to be drudgery.  I discovered that eating healthful foods can be delicious and that exercise can be enjoyable – all of which I had utterly dismissed in the past.   Though it all seemed too simple and straight-forward, it worked: today my lab values normalized and I feel radically different.  My own struggle with weight inspired me to help people change their lives through behavior modification, with particular focus on their diet. I found that health could be reversed through lifestyle changes, and since I wanted to help people on a community level, I chose to work at the Health Department. How did I find SEEDS? I went to graduate school at UNC Chapel Hill School of Public Health for Nutrition. I went into the program with an interest in growing food, gardening, nutrition and cooking and I wanted to find a place where I could combine these interests to help children or adults.   In the break room some students were talking about SEEDS and I also remember my Professors mention the organization in the context of increasing access to healthy food and improving community health through community gardening.  I made a mental note to follow up and started volunteering in 2014.  At SEEDS, I work with kids and I really wanted to show them that healthy living and prevention can be fun.

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

PK: What drives me is running into kind, friendly, helpful people anywhere in the word who work hard to realize their dreams or make a positive difference in the world.  Sometimes, after meeting a terrible person, I get jaded.  My spirits are immediately lifted after I run into someone great. Animals, especially wildlife, also inspire me. I admire their strength to keep going despite damage to their environment.  They are truly resilient.

Me: What do you think it will take for our healthcare systems to improve?

PK: Our healthcare system can improve in many ways.  One way that comes to mind is putting more holistic, preventive programs, individual care and initiatives in place, especially when dealing with diet-related chronic disease. Healthcare should be more coordinated as well. Physicians and other members of the healthcare team should really work more with registered dietitians, exercise physiologists, personal trainers, health psychologists and others to help a patient change behaviors/lifestyle instead of immediately writing a prescription.  Our healthcare system is too dependent on medicine and physicians for every diet-related health issue, and it’s not effective.  Despite the development of new medications, obesity and diabetes rates, for example, continue rise every year.

Me: Why do you think education is important?  Specifically, tie in your work with SEEDS on teaching kids about nutrition.

PK: Health education and health communication are key.  A quote I found from World Health Organization really resonates with me: “The focus of health education is on people and action.  In general, its aims are to encourage people to adopt and sustain healthful life patterns, to use judiciously and wisely the health services available to them, and to make their own decisions, both individually and collectively, to improve their health status and environment.” Excellent and accessible health education combined with health communication plays a huge role in whether or not someone will adopt positive health behaviors.  Children are faced with many choices that could affect their health on a daily basis.  Without being informed, it’s hard for a child to make smart, healthful decisions.  My goal at SEEDS is to encourage the kids I teach to take action and take control of their health after learning nutrition and healthful cooking skills.  After each lesson, I want them to eat more fruits and vegetables and know why they are beneficial; I want them to know how to eat healthfully when there are financial constraints or transportation and access issues to the best of their ability; I want them to make excellent health promoting decisions when faced with temptation like exposure to unhealthy foods at the supermarket, disease promoting internet and TV advertisements that are actually geared towards them, or possibly exposure to unhealthy eating habits of their peers or adults.

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

PK: Reducing or eliminating health disparities is a current need.  Health disparities definitely exist in Orange County, NC. I see it every day.  Priority health issues in Orange County are access to health care, insurance and information; chronic disease/health promotion, exercise and nutrition; mental health and substance abuse; and injury.  This is based on the most recent Healthy Carolinians of Orange County’s Community Health Assessment.  The social determinants of these issues seem to be poverty, education level and whether or not someone lives in safe housing and in a health promoting environment (ie: Do they have access to a supermarket or farmers’ market? Do they live near a park or trail? Are there sidewalks?).  It is certainly known that people with higher incomes and more years of education who live in a healthy and safe environment tend to have better health outcomes and generally live longer.

Public Health in Action – Hearing the Unheard

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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.

Public Health in Action – Leveraging Health IT to Improve Outcomes

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In the broadest sense, Health Information Technology (HIT) is applying IT to health care in order to improve patient outcomes, quality of life and reduce health care costs.  The field is growing and fast.  By 2017, the field is predicted to yield over $30 billion.  And it’s not hard to find.  A recent visit to Apple’s app store can be overwhelming – even after filtering the apps down to “health.”

Healthcare providers, from hospital systems to individual healthcare professionals, as well as healthcare payers (consumers, government, insurance companies) have bought-in to the promising field.  Startups keep popping up.  Health is a primary focus in various innovation challenges.

In the bigger picture of improving our healthcare system, I think HIT has the potential if leveraged the right way.  I recently interviewed Dr. Ryan Shaw, professor at Duke School of Nursing on his thoughts about the field and its potential in improving our healthcare system.

Here’s Ryan!

Me: Tell us about your past experiences in work, research and academia and how it ties to your current role.  Also highlight your interests in the field of Health IT and what Health IT could lead to in terms of health outcomes.

Ryan Shaw: My undergraduate studies began in computer science and mathematics. After 2 years I switched into nursing. It’s a strange transition but I wanted to go into a career path where I felt I was making a difference in people’s lives. After becoming a nurse, I went back to school to get a masters in informatics at NYU while working as a nurse in NYC. This allowed to merge healthcare and the IT side.

At the end of my master’s program, Duke University just so happened to offer an Information Technology fellowship as part of a PhD program for nurses. I applied for the competitive program and received the fellowship. I ended up working for Duke’s Health Company “Duke Health Technology Solutions” while studying for a PhD at Duke.

Following that, I eventually landed a job as a Professor at Duke’s Nursing School. I love this job and it allows me to do both science and education. On the teaching side, I teach in our masters informatics program. On the research side I discover how to use novel technologies and their data to help patients’ self-manage chronic illness. This is exciting work and allow me to work with an interdisciplinary team of physicians, pharmacists, psychologists, nurses, and IT gurus.

Discovering knew knowledge that will be applied in healthcare is extremely rewarding. While working as a clinician I was able to impact each of my patients lives, research allows me to have a much broader reach of impacting many more lives and creates knowledge that other people will build upon. Our world is changing, and information technology is becoming an integral part of peoples’ everyday lives and thus their health as well. My team and I capitalize on this social change and leverage technology as a conduit to improve health. It’s really cool.

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

RS: Academia is tough. There are real no work hours and no day is ever complete. I could work 24/7 every day for a year and still have more to do. A lot of what you propose is rejected and people don’t value it. Grants that you work months on don’t get funded, manuscripts are rejected, and sometimes you sit in the office asking yourself if you really do make a difference. In discovering knowledge, there is often nowhere to go to look for an answer. Scientists create answers, we seek to answer the unknown and discover more. You need a thick skin and perseverance is of the most important traits needed.

I drive inspiration from my family, I work through stress by exercising (I run a lot and use to be big into triathlon), and view this video from Apple to get me going.

The video reminds me that innovators are the ones who change world and those who succeed are the ones who keep trying even when they fail.

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?

RS: Honestly, health doesn’t come first for many people – and likely won’t ever. Families, safety and financial security usually come first. And in my opinion, that’s probably OK. We need to eat, pay our bills, and survive. These all impact our health. That’s not to say health isn’t important, it’s critical.

For people to take health more seriously, is really going to have to come from the top. In my opinion, there is too much focus on the individual and treatment of health. It’s really societal and public value. We need a greater investment in communities and public health. We’ve created infrastructure that supports poor habits. I think many people forget that physical infrastructure and urban planning are so important. If we make it easy to drive your car to the drive thru down the street, then that’s what people will do. We need sidewalks, urban planning that encourages walking, and a cultural shift that values these things. This is happening, but for so long we’ve focus on suburbs, building a society that is car centric, and making delicious food easy to get. It’s just so hard to change individual healthy habits when the structure around you suggests the opposite.

Me: What are some things/concepts/ideas/insights you’ve learned from your research that can help improve health outcomes in individuals and on a population-level?

RS: Some of the concepts we’ve learned is that technology needs to be designed with the end user in mind. A lot of technology and how it functions is useful for young people and techies. But those aren’t the people who are most in need. The people in need, and the most expensive people in healthcare, are those with chronic illnesses (obesity, diabetes, hypertension, etc.). These are the people that could benefit the most from novel technologies and their data – and they are of all ages, young and old.

We need technologies that truly fit into their daily lives and we need to create infrastructure in the care delivery system that is able to use newer technologies such as wearable devices. As of now, we don’t have this structure. But its possible. If all of our patients monitored their daily data, software could manage most people and guide them in self-management of health behaviors. If people don’t correct those behaviors, it could be bumped up to a nurse or pharmacist to help them. And then after that, it could be bumped up to a physician. This would allow for true population management and would be cost-effective. It would also allow physicians to have a better understanding of their patients’ day-to-day lives when they actually see them in the clinic. This may enhance medical decision making. Check out the article, Mobile Health Technology for Personalized Primary Care Medicine, that we wrote on this.

Me: What are the current needs in your city as they relate to social determinants of health (i.e. 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.

RS: The Raleigh-Durham is certainly trying to address some of these social determinants of health. For example, transportation wise we are trying to get in light rail that will have stops next to low-income housing. The bus system is being revamped to meet more people’s needs.

In terms of access to care, the affordable care act has and is helping with a lot of this. But North Carolina chose not to expand Medicaid as much as many other states, to access to care is still an issue for many people.

The city of Durham is quite focused on measures to alleviate poverty and help with homelessness. There is more focus on adding in sidewalks so people don’t walk in the street for safety reasons, they’ve been building affordable housing, and are pushing measures that new development including a % of low-income housing.

Public Health in Action – Walking the Walk

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Jonathan Bonnet, MD
Duke Family Medicine, PGY-3

I was fortunate enough to attend the National Physical Activity Plan Congress last week in Washington, DC and was inspired by many of the leaders working in the field of physical fitness and activity.

One program, in particular, really caught my attention.  Walk with a Doc (WWaD) has a simple idea: encourage physical activity in the community by walking alongside physicians.  I think it’s safe to say that the last time each of us had a visit with our doctor, he/she discussed our health behaviors and/or lifestyle, which more than likely included a question or two about how active we have been.  Physicians also typically encourage their patients to get active, eat healthier, cut back on alcohol intake and to stop smoking.  What impressed me the most is the extra step WWaD takes to engage with their patients and local communities.  They encourage their patients to walk alongside them.  By being outside and actually leading by example, I strongly believe that physicians not only connect with their patients on a higher level by building rapport, but it also makes the visit less formal and transactional.  If I were a patient and walked alongside my doctor and we chatted about things other than health and medicine, I would feel that much more comfortable and more willing to share any issues that I was having.  By re-shifting the context in which providers interact with their patients, using this less formal, social setting can have profound results.

I had the pleasure of meeting and interviewing Dr. Jonathan Bonnet for this blog post and I feel privileged to share his story with you all.

Me: Tell us about the path you’ve gone through – college/medicine/residency – and what captured your interest with Walk with a Doc.

Jonathan Bonnet: Sports had always been a large part of my life growing up. It wasn’t until undergrad at Ohio State University (OSU), when I fell in love with exercise and physical activity. I ended up majoring in exercise physiology, working in the exercise labs at OSU, and ultimately becoming a personal trainer and interning at Anytime Fitness. The ability to change lives with physical activity inspired me to do more for health and pursue a career in medicine.  As fate would have it, in my first year of medical school at OSU I discovered the national nonprofit  organization, Walk With a Doc (WWaD). Ironically their national headquarters was located in Columbus, OH.  Although the name had initially caught my attention, the people and program inspired me to get more involved and stay involved indefinitely.  I was struck most by the simplicity of the program, as well as the open invitation to the entire community.  The premise was simple: bring doctors and healthcare professionals together and practice what medicine preaches.  I loved the idea of literally ‘walking the walk’ with patients and the community.  The walks are a fun, social event, with the added benefit of everyone getting their daily exercise, too.  After getting involved with the local walks as a medical student, I initiated an Ohio State Walk With a Future Doc program with my peers. My passion for the program as well as my interest in promoting physical activity has continued through residency. With the support of the Duke Community and Family Medicine department, we launched the Duke Family Medicine (WWaD).  Although the walk targets the patients with obesity, it is open to everyone, including the Durham community at large.

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

JB: I am continuously inspired by the patients I see, my community, the WWaD leadership, and above all else my family and friends. When I see the people around me, with life situations much more challenging than mine, rise up and make the best of their circumstances, I feel truly inspired to help others do the same. I have been incredibly blessed in my life and have a passion to help spread and promote health and happiness to everyone around me.  Seeing family, friends, and loved ones suffer the consequences of largely preventable chronic diseases is devastating.  Research has already shown that lifestyle behaviors – being physically active, eating a healthy diet, not smoking, and maintaining a healthy weight – can prevent 80% of the chronic diseases we face.  This failure to translate what we know into what we do drives me to help make a difference. I firmly believe we can make a difference.  It won’t be easy, but it will absolutely be worth it. Dennis Waitly said “there are two primary choices in life: to accept conditions as they exist or accept the responsibility for changing them.”  I have chosen the latter.

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?

JB: In general, health is something that everyone, who has it, takes for granted. It is not until we lose our health, that we realize how precious and valuable it is. I think it is also important to realize that health encompasses more than merely being “not sick” or working out everyday. Health encompasses the physical, mental, social, emotional, and spiritual aspects of life. Health is much more difficult to measure than education, career accomplishments, or relationships.  One of my favorite quotes is that not everything that can be measured, counts, and not everything that counts, can be measured.  Health is a somewhat ambiguous part of life that is difficult to assign value, and it is not something that generally changes overnight.  The gradual loss of health, or what I would prefer to say, lack of vitality, makes it difficult to have a sense of urgency and need to prioritize health when it comes to day-to-day decisions. Eating unhealthy food or not being physically active any single day has minimal effect on long term health. It is the cumulative effect of the day-to-day decisions that promote or impair “health.” Humans are much better at understanding and appreciating short term consequences and that is why health tends to fall lower on the list of priorities for many people.

Changing this societal view on health is tough.  Culture and social norms dictate much of this. People who sacrifice sleep for their jobs are idolized. We tend to measure success by material goods, achievements, awards, and honors, rather than the parts of life that matter most: family, friends, health, etc. It is not something that will change overnight, but it has to start somewhere with someone.  That someone is you, me, and people like David Sabgir, who started WWaD. It doesn’t have to be profound. Simply deciding to embrace the challenge of being the healthiest version of you possible, is an incredible start. If there is demand, government, businesses, and societies will change. It will take an honest conversation with ourselves about what truly is important in life, followed closely by an enthusiasm, passion, and dedication to practicing those values everyday.

Me: What are some things/concepts/ideas/insights you’ve noticed that have helped/hindered health-related outreach and education in communities?  Specifically from a provider perspective.

JB: As a provider, one of the most challenging aspects of care is to really understand the situation and environment a patient is coming from.  It is difficult to do more than graze the surface of what a patient’s living situation and day-to-day life actually looks like in a 15-minute visit. Although it is easy to be idealistic and think everyone can adopt healthy lifestyles, the truth is that the choices we make are subsequent to the choices we have. Frankly, I have patients who do not have healthy options. It is choosing between two bad choices, and that makes it tough.  Oftentimes, it takes multiple office visits and getting to know patients very well before they feel comfortable discussing many of the underpinnings that contribute to their health, or lack of it. Patients are prideful and often times want to “please” their doctor by saying they take their medicine as prescribed and eat healthy, when in reality, the situation may be entirely different.  We know that social determinants of health play a far bigger role than the one-on-one medical care a physician provides, but these are “messy” issues, that do not have quick fixes. Aside from solving world poverty, I think the single best thing we can actually do in health care is to take the time to not talk, but actually listen to our patients and their stories. It is not until we understand our patients values and what drives them, that we are able to facilitate them in making the best decisions for their health.

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.

JB: As with any community, the social determinants of health play a much larger role in the well being of its members than anything that can be done by a doctor in a single office visit. Access to healthy nutritious food and water, medical care, areas to be physically active, education, shelter, and resources are all critical pieces of health. The Durham community is no different. There are individuals suffering from any and all of the aforementioned components. Obesity is arguably the most pressing health issue this country has ever faced, and social determinants contribute significantly to this. Although it is multifaceted, it has been exciting to be part of a residency program that understands these issues.  At Duke, we started a Walk With a Doc to facilitate physical activity among our patients, staff, and community. Additionally, we brought the Veggie Van program to the Duke Family Medicine Clinic every Thursday afternoon. The Veggie Van offers subsidized fruits and vegetables to the community in an effort to make healthy food affordable and accessible to everyone. We are also collaborating with the Durham Public Health Department to identify and offer other services that are beneficial to the community. None of these interventions alone will solve the problem, but it is our hope that the collective effort will yield meaningful changes in the health of our community.