Tag Archives: Durham

Public Health in Action – Predictably Irrational

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Richard H. Thaler is a kind of a big deal, and if you don’t know, now you know.

Professor Thaler, who teaches at the University of Chicago Booth School of Business, was awarded the Nobel Memorial Prize in Economic Sciences last month for his contributions to the field, specifically in understanding human behaviors. His life’s work illustrated that humans act irrationally in consistent ways that can be predicted and modeled. The implications of his work transcend all sectors. In 2008, Thaler co-authored “Nudge” and encouraged governments to use their insights for public good. Enrollment in retirement savings accounts significantly increased with a slight change: enrollment was the default option, which forced people to “opt out” if they weren’t interested. Observing and prioritizing human behavior, such as what behavioral economists describe above as “inertia”, over standard economic theories of rational actors, has made all the difference and has created myriad pathways into practical application.

Take the Center for Advanced Hindsight (CAH) at Duke, founded by Ted rockstar Dan Ariely. It houses decades worth of social and behavioral science knowledge, researchers AND entrepreneurs all under the same roof. CAH’s current focus has been working with startups that address financial security or health behaviors.

Public health, like economics, was built on the assumption that people behave rationally at all times. Thaler and Ariely have challenged those assumptions time and time again. We, as public health professionals, need to lean into uncertainty, especially when in matters of health behaviors. The populations that are most at-risk and need public health folks the most don’t live in ideal conditions. They may or may not have stable income, housing, transportation or have access to their next meal. If we can’t assume that people will behave rationally in a “normal” situation, we can’t assume they would behave rationally in a “distressed” situation.

Those are exactly the questions that crossed Allison Sosna’s mind at various points in her life and she shares her experience with us, below.

 

Allison Sosna, aka Chef Alli, is the founder of the MicroGreens Project

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Me: How did you end up doing the work that you’re currently doing?  Describe your journey to your current role as founder of MicroGreens.

Allison Sosna: I was in college and on the rowing team. Food, at that time, was synonymous for fuel that my body needed to perform. Sure, I ate healthily – lots of veggies, carbs, and protein (mostly chicken and eggs) but I did not give it any further thought. In my junior year, I lived in Italy. It was there that I was enlightened by the power of food on a community and would therein change the course of my life. I lived in a small neighborhood outside of Rome where residents all knew one another. They knew the barista and asked him how school was going. They wanted to know if the butcher’s cold had gone away. Everyone cared about one another and food was clearly the denominator of affection. In Rome, I realized that I wanted to do something with food and people. I did not come back wanting to be a chef, but, I saw that as a way for me to create food and community. So, I volunteered as a prep cook down the street when I got back to DC. I loved it. I loved the physical exertion that went into working on the line during dinner service. I loved wearing a uniform and feeling part of a community; a diverse community of women, men, people of different races, and different backgrounds with different stories. The sociologist in me was in love.

Shortly after, I went to culinary school, had a jaunt in fine dining, and then got a full time job at Dean and Deluca. While I learned a lot there, I realized I wanted to do more with my community; I didn’t want to feed rich people anymore. I had veered off course from the initial eureka moment. Leaving that job, I landed a job at a non-profit called DC Central Kitchen overseeing Fresh Start Catering, the social enterprise of the non-profit. When I started, we were providing the food services for a private school for at-risk boys, but it was generic and too similar to the lackluster school food that America is known for. Seeing such, I brought in healthier options, started making food like meatballs in-house, a salad bar, and marketed our vegetables to be more “fun” by using them as anecdotes. For example, I would say that foods like roasted carrots was a veggie that basketball players ate to perform better on the court (It’s true!). We had a lot of success there and that led us to win a food service bid for 8 DC Public Schools. We served thousands of meals a day to low-income kids who didn’t have easy access to fruits and vegetables (in 2010). Kids, of course, were coming to school with chips and soda, but I wanted to do something about it. I thought about the parents or guardians that were at home with the kids. How did they eat? Was it influencing their kids’ eating behaviors? How could I shift behavior? What I drew from all these questions was the question of their budget. How does a low-income family eat healthily? If I was a parent on SNAP, how did I use my money? Did I know how to cook? Did I know what to buy? The majority did not. As a result, I started MicroGreens and the Allison Sosna Group (ASG). ASG is my consulting “firm” for menu development, food service consulting, and private chef services. I had left my job to start MicroGreens, but also needed an income! I continue to consult today.

MicroGreens teaches kids to cook on a budget of $3.50 per meal, per family of four. The program has graduated over 150 kids across the country, with the help of community leaders that want to make their neighborhoods healthier. MicroGreens can be implemented anywhere, for any income level, for any length of time, and with any age group.

I moved to New York City in 2013 and while I was still working on MicroGreens and taking chef jobs, I needed an income and a job I truly cared about. So, I applied to jobs in public health nutrition with a focus on project coordination. After a year and a half of coming close to many jobs (NYC is tough!), I went back to school for a Master in Public Health degree.

Over the last year I’ve been intrigued with hospital food and its obligation (or lack thereof) to ensure that everyone has access to healthy food – from its staff to patients and also to visitors. While I am not trained in therapeutic meal development, I am trained to assist in cafeteria food services. I’ve been fortunate, by way of hustling and networking, to be part of the NYC Department of Health and Mental Hygiene’s Healthy Hospitals and Colleges Initiatives. We are working with food distributors to get chefs and food service directors healthier products for their hospital or college. It’s an incredibly rewarding experience to be on the other side helping the chef. I would have loved this help when I was working.

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

AS: On a daily basis, knowing that I am a part of something larger gets me through tough times. I know inherently that I am making a difference by bringing in healthier options for people. Every time a consumer replaces an unhealthy product for a healthier option, I know that I helped facilitate that. And as we all know too well, establishing healthy behaviors takes time.

As a student with a part-time job, I’m constantly moving around, not being able to cook for myself nearly as much as I want to, paying copious amounts for transportation, and don’t have a social life. But, I know I will, and am looking forward to graduating next year, when I can stay put and focus on doing work for my community full-time.

Moreover, the people I work with are incredibly supportive and that support allows me to focus on doing well in school and do an even better job at work.

Me: Tell us more about MicroGreens. How did you get into the social impact space? Why is it important to reach underprivileged populations?

AS: We must think about sustainability when we design programs. That being said, MicroGreens was originally going to be funded by a fast casual restaurant I was going to open. It would serve as part of the capital going into the non-profit. I’ve always believed that business needs to be part of the equation when designing interventions such as MicroGreens. I got 70% funded for the project but then had to let it go. I came close though and I’m proud of that.

If we do not focus on creating upstream programs first, we are doing a disservice to our communities, whether they are privileged or not. It truly does come down to the old adage “Give a person a fish and feed them for a day. Teach a person to fish and you feed them for a lifetime.”

One of the most impactful experiences I had with MicroGreens was not related to cooking. A student who had taken the class before was walking by our teaching classroom and walked in to say hi. He walked over to one of the kids who was having trouble cutting carrots (cutting carrots is hard!) and said “If you ever need help, let me know. I’m MicroGreens alumni.” Not only had this student learned skills and put them into action, but the program had instilled pride and confidence to teach others. There was a kindred relationship forming, a mentorship. That made me so proud.

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

AS: 1 in 9 residents have diabetes in NYC. Communities have little access to healthy foods blocks from affluent neighborhoods with endless healthy food choices. Soda ads saturate low-income areas and schools are without outside playgrounds. All determinants of health are so greatly intertwined that it can be overwhelming, especially for public health officials trying to make a difference. We talk a lot about that at school. How do we design interventions that encompass all contextual factors? First, by working with community stakeholders.

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Public Health’s ‘Moonshot’ – Part 2: A Local Context

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Courtesy of Inspector Insight

 

In the first post of this series, I briefly described healthcare system expenditures, as a percent of GDP, for the U.S. and a number of OECD member countries. When coupled with population health outcomes data, the amount spent per person on healthcare in the U.S. seems excessive and arguably wasteful. Individual health behaviors, genetics and a broad range of social and environmental factors account for 90% of an individual’s risk for premature death. Addressing the factors outside the healthcare system, through a reallocation of spending into social services such as employment programs and supportive housing, may play a key role in improving population health outcomes.

Social determinants of health are “the structural determinants and conditions in which people are born, grow, live, work and age”. As such, a contextual understanding of communities and their history is critical to tackling deep-seated social issues. Below, I focus on the community of Durham, North Carolina for place-based contextual understanding.

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The Robert Wood Johnson Foundation (RWJF) is the nation’s largest philanthropic organization dedicated to improve health. RWJF’s focus, once solely on innovation in the healthcare system, has evolved to address the social and environmental factors as well in “building a culture of health.” Shifting the way society viewed health – from the absence of illness – was an integral part in this movement. It emphasized health as a resource for living fulfilling lives and collectively contributing to a competitive and thriving nation. It developed and strengthened relationships with key stakeholders and facilitated cross-sector collaboration. And it’s engaging leaders in communities.

In 2013, RWJF named six communities with its “Culture of Health Prize.” Distinct from its traditional grantmaking program, this prize awards $25,000 to communities for the work and successes they have already achieved. By shining a spotlight on a selected group of communities each year, RWJF is able to share lessons and first-hand knowledge with community leaders nationwide. Durham, North Carolina, was one of six communities selected for the Culture of Health Prize in 2014 for the work the Partnership for a Healthy Durham has done since 2004. The Partnership is just one example of community-engaged efforts to improve the lives of Durham residents. A few additional innovative models will be introduced in subsequent posts to illustrate social impact at the local level and offer ideas to accelerate their collective impact.

Durham

Approximately 250 miles southwest of our Nation’s capital, Durham is situated at the northernmost point of North Carolina’s Research Triangle, with Raleigh and Chapel Hill to its east and west, respectively. In its former life, the city was well-known for tobacco and textile production, but fast forward to 2017 and the “City of Medicine” is in a constant state of transformation. Durham was recently anointed as a destination for foodies, “The South’s Tastiest Town,” and boasts a vibrant and diverse culinary and social scene. A major factor in its Renaissance was a collective effort to attract entrepreneurs and catalyze innovation. Community and business leaders invested a significant amount of resources to revitalize downtown and its efforts appear to be paying off. Once described a “nascent startup scene” by Madrigal in the Atlantic, now exudes self-confidence with two Durham-based startups collecting back-to-back wins in 2014 and 2015 at Google Demo Day in Silicon Valley. The startup community has also made waves nationwide for its efforts to empower and nurture diversity; its epicenter, American Underground, a Google Tech Hub, houses 48.2% minority- or female-led companies thanks to initiatives like Code 2040 – a nonprofit organization that creates pathways to the technology industry for underrepresented minorities – and strong partnerships within the Research Triangle.

History

In the early 20th century, Durham had the most African American millionaires per capita than any other city in the U.S. Their success in finance and insurance was evident with a section of downtown named “Black Wall Street” (Forbes) and the city was also known as the “Capital of the Black Middle Class”. The Hayti District, an independent black community founded shortly after the Civil War, became a self-sufficient community and housed residents of all social class along with a variety of businesses, schools, library, hotel and a hospital. African Americans owned and operated over 200 businesses within the boundaries of the District. It flourished for decades through the 1940s until an urban renewal project in the 1950s tore through more than 200 acres in the heart of Hayti, displacing residents and businesses alike. The project was intended to ease commuting for suburban residents by realigning streets and construction of “the Durham Freeway”, NC-147.

Historically, urban regeneration or renewal served as a method for social reform in England to address substandard and unsanitary living conditions in rapidly growing industrialized cities. In the U.S., it came in the form of federal policies used to “reshape” American cities. The Housing Acts of 1949 and 1954 disbursed federal funding for cities to “acquire” areas identified as “slums” and were given to private developers to construct new housing. Additionally, the Federal Aid Highway Act of 1956 allocated 90% of federal funding to states to construct new highways that connected to the larger Interstate System. Large urban cities including New York, Chicago, Pittsburgh and Boston undertook urban renewal projects like Durham in the 1950s. While urban renewal projects generated economic development and improved quality of life in those cities, the destruction of neighborhoods left former residents in dire situations.

Poverty

A slow decline in manufacturing of textile and tobacco in Durham in the 1950s resulted in rising unemployment among working-class black residents due to segregation and discrimination. Coupled with urban renewal in the 1950s and 1960s and Civil Rights movements, the divide between whites and blacks grew. Sarah Willets of Indy Week describes an initial divide between affluent landowners and its workers even when the city was incorporated in 1869. An initial divide in opportunity which persists to this day.

“While some parts of Durham have single-digit and even less-than-1-percent poverty rates, in other neighborhoods, half the residents struggle to make ends meet.” — Sarah Willets, Indy Week

“We’ve always been taught the story of America is one of upward mobility. Durham very much embodies that. But some of the darker sides of the American story are here too.” — Justin Cook, Photographer, Slate Magazine

Photographer Justin Cook’s series, “Made in Durham” and various other pieces in the Indy illustrate what Willets captures in her story on Mayor Bell’s lasting dichotomous legacy – a thriving upward mobility amongst young professionals contrasted with historically African American neighborhoods that struggle with staggering rates of poverty and violence.

Alison Templeton, a research assistant at the UNC Center on Poverty, Work and Opportunity, released an update on urban poverty in Durham using current Census data in 2013. Templeton identified census tracts as “distressed” based on its performance compared to the state’s average on the following: per capita income, unemployment and poverty rates. 22% distressed census tracts in Durham County were identified in the report, which rose from 15% back in 2000. Other poverty-related statistics in Durham’s distressed tracts:

Poverty 46.7%
Child poverty 55.2%
Elderly poverty 25.6%
HS graduation 72.6%
Families led by Single Mothers 66.5%
Homeownership 27.6%

Poverty and the consequences of sustained poverty for individuals and communities significantly impact population health outcomes. Understanding historical context is a crucial first step in adequately addressing deep-seated social issues.

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.

How Digital Health will Disrupt the US Healthcare System

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One-sixth of the US economy is spent on the US healthcare system.  About $2.8 trillion is spent annually or an average of $8,500 per person.  When compared to other countries, the size of the healthcare system alone would rank fifth in the world.  An informative article from Vox analyzes this spending through various comparisons and graphs.

US Healthcare: Past & Present

In the past decade, healthcare reform in the US has focused on providing people with more access to healthcare by means of affordable health insurance.  Key facets of the Affordable Care Act include non-discrimination of potential enrollees with chronic conditions and creating health insurance exchanges which helped consumers buy insurance.  Though strongly contested through King vs. Burwell and National Federation of Independent Business vs. Sebelius, the ACA remains as intact as law.

On the other end of the health spectrum is public health and preventive medicine.  The main principle of public health is prevention through health education, epidemiology and health behavior change, among others.  Several industries have grown in the space outside of direct healthcare, including health/wellness/fitness, complementary and alternative medicine and most recently wearable technology through apps and sensors, illustrated in a TED talk by Ted Wolf in “quantified self

Startups & The Future of Health

The market size of offerings outside of the healthcare space is growing and appears to be an ongoing trend.  Key stakeholders in healthcare are jockeying for position.  Hospitals systems like the Mayo Clinic and Cleveland Clinic, insurance companies like Blue Cross and Kaiser Permanente as well as retail giants CVS and Walgreens have all embraced recent trends.  The onus has been on consumer engagement to improve population-level health outcomes.  For example, Kaiser Permanente celebrated a 10-year anniversary of their social marketing campaign KP Thrive last year and continues to promote healthy lifestyles in partnerships with national initiatives. Even CVS rebranded to CVS Health to “help people on their path to better health.”

Two startups based in the Triangle of North Carolina have been growing rapidly and have the potential to impact population health.  First is startup, Validic, based in Durham, NC.  It offers wellness companies and healthcare providers a platform to manage and analyze their patients’ wearable technology-based data.  In its most recent round of funding, Validic secured another $12.5 million, which included Kaiser Permanente’s ventures arm, Kaiser Ventures.  Considering the number of apps to collect health data from various sources, Validic looks to be a key player in data aggregation and management of personal health data.

The second startup that grabbed the attention of “high-profile investors” a few weeks ago is Predictify.me. The Raleigh-based startup takes large data sets and “extrapolates” them into the future data sets.  Future data sets enable analysts to forecast and can plan strategic moves accordingly.  Chief Data Scientist, Dr. Usmani, is renowned for his work in public safety and counter-terrorism in his native country of Pakistan.  Despite starting in the private sector for consumer buying habits, Dr. Usmani and Predictify.me aims to focus on making social impact.  Innovating to improve the healthcare system just may be the social impact that Predictify.me is looking for.  Imagine if predictive analysis took place with an individual health consumer.  How might researchers, public health practitioners and companies utilize this to keep individuals healthy?

The US economy cannot sustain the pace of healthcare spending and the potential applications outside of the healthcare system seem ready to bring more value for each dollar spent.  How wearable technology will affect population-level health outcomes is still unknown.  But with Validic, Predictify.me and others leveraging technology to obtain, manage and analyze data sets, don’t be surprised if health outcomes start to improve.

Originally published on Startup Grind

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 – Leveraging Health IT to Improve Outcomes

healthit

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 – Mobilizing for Collective Impact

durhamcares

At one point or another, you’ve probably heard the phrase, “think global, act local.”  That phrase has always stuck with me, but context is everything.  Living in Durham, the phrase has resonated with me so much more than it has in the past.  I regularly consider how my actions may affect my local community.  And after living and working on the national level, I see more clearly now that the issues are either solved or propagated at the community level.

I started following the non-profit, DurhamCares, a few weeks ago after they were mentioned in the same tweet from another mutual Twitter-er (who also happens to be quite active in the community).  Long story short, I had a great conversation with one of the staff members at DurhamCares and feel strongly that their mission closely aligns this blog – disrupting the status quo by reducing silos.  DurhamCares understands that issues are interconnected and leverages skills that have produced results in other industries, specifically business and journalism, and applies them seamlessly in a non-profit environment.

On to the interview with Elizabeth Poindexter, Marketing Coordinator of DurhamCares!

Me: Tell us about your past experiences in journalism and the path you’ve gone through to get to DurhamCares.  Also, mention the skills you’re leveraging at your previous roles in your current one.  I plan to introduce DurhamCares, but feel free to describe the future vision of it in terms of communication and marketing strategy.

Elizabeth Poindexter: I am a 2010 graduate of the School of Journalism and Mass Communication at University of North Carolina at Chapel Hill. After graduation, I worked for three years as a digital journalist and bureau chief for two television news stations and one newspaper. I learned a skill set in the journalism school that I’ve found to be applicable in other settings. Learning how to shoot and edit video, take photographs, and write well are valuable skills I still use at DurhamCares. At DurhamCares, we focus on content creation and content marketing strategies. Working as a one-man-band reporter taught me why people care about issues, how to mobilize communities, and how good content is part of that effort. While reporting, I saw stories making a difference, and I am thrilled to continue that work at DurhamCares.

I use very similar skills even though I’ve switched career paths. DurhamCares works to fully understand the scope of issues our community faces. Each DurhamCares issue-based marketing campaign has months worth of research behind it, so we can best understand the most compelling facts about each issue. In addition to research, we work to show people why they should care, which is why storytelling is important. DurhamCares also creates issue-based content, including infographics and videos, and I’ve led production for those projects. Overall, working as a journalist taught me the value of content creation. In my current role at DurhamCares, I focus on marketing that content to our target audiences to mobilize volunteers and donations toward Durham’s nonprofits.

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

EP: We’ve worked since summer 2013 to fully develop our issue-based collaborative marketing campaigns, which we solidified in early 2015. Our marketing campaigns leverage the concept of collective impact. We know of a few other organizations around the country leveraging collective impact to impact community development, and we’re testing that model here in the Triangle. Our marketing campaigns went through several iterations, and we are constantly learning how to best bring nonprofits together and focus on a single issue while applying this concept of collective impact to our work. As we’ve developed our campaigns, it is gratifying to hear when nonprofits have used a campaign tactic to bring in donations or to recruit more volunteers. I come to work every day knowing I’m making a difference, whether I realize it or not.

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?

EP: DurhamCares plans to launch a marketing campaign around the issue of health care access in May 2015. We’re counting on experts to help us author what that campaign should look like, but I’ve learned a lot already. In my opinion, health is a necessary building block for other aspects of our lives. Health care and health access have many implications in our lives and can impact our careers, education and relationships in the long-term. Both mental and physical health play a huge role in our community’s success. I believe prioritizing health issues our neighbors face could lead to building a healthier community in the long term.

Me: What are some things/concepts/ideas/insights you’ve learned in journalism that have helped you at DurhamCares?

EP: Storytelling is at the core of journalism. People are a lot more likely to connect with issues if they feel an emotional connection, and people are less likely to remember statistics and facts. I focus on storytelling at DurhamCares, and we try to show people how issues are relevant in their lives, even if it’s not immediately obvious. From a more practical standpoint, learning about content production and content management are also valuable skills to have. DurhamCares also has a strong social media presence, which we use to raise issue awareness. Lastly, networking with Triangle media outlets and knowing how reporters work is valuable in raising awareness through more traditional news outlets.

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.

EP: DurhamCares focuses on nine different issue areas, including senior care, health care access, and youth. We’ve learned over the past couple years that each issue is connected to another in some way. I attended a conference a couple of years ago, and one woman’s story stuck with me. She lived in unaffordable housing, which is a growing issue in Durham as plans for light rail transit are made. This woman had battled mental health issues because of her living situation. I’ve realized a lot of these issues operate on a continuum. Perhaps the woman was previously homeless, unable to find a safe, affordable place to live. Maybe she had no choice but to live in unaffordable, substandard housing, which developed over time into a mental health issue. Unaffordable housing can result in frequent moving, which can result in an unstable home life, unstable schooling, etc., for families. It’s up to the community to care about issues that impact everyone so we can plan for a great future in Durham.