Tag Archives: health disparities

Public Health in Action – The Secret Life of Males

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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Public Health in Action – A Silent Health Crisis

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Of all the things in the fields of both public health and healthcare that pique my interest and attention most, it’s health disparities, specifically the numbers 5 and 7.  In a country as productive and innovative as ours, it’s a particularly vexing reality check whenever I’m faced with those two numbers, which I’ve listed below along with their respective contexts.

5  – the difference, in years, of life expectancy between genders

*Life Expectancy at Birth in 2013: Female 81.2 years  Male 76.4 years

**Races considered: Hispanic, White, Black

5 & 7- the difference, in years, of life expectancy between females & males respectively

*Longest life expectancy to shortest in each gender

Health disparities are the end products of a variety of complex factors including, but not limited to the social determinants of health: SES, transportation, access to healthcare, employment, etc.  Additionally, they are also impacted by biological (our genes and family history), social (our culture and networks) and environmental (our physical surroundings) factors.  Lastly, health disparities are impacted by individual health behaviors and lifestyles.

The numbers 5 and 7, to me, represent a collective challenge: how can we bring these numbers down, thereby reducing  health disparities in our country?  What other perspectives do we need outside the fields of public health and healthcare to reduce health disparities?

My conversation with Steve Petty, Corporate Director for Community Health Improvement at INTEGRIS Health could offer some insight to the issues I’ve raised above.

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

Steve Petty: I have been working in health care for 29 years.  I started in a marketing/public relations role and several other areas and have worked in community and employee wellness for the last 20 years.

In community wellness, our mission (the same as INTEGRIS Health) is to improve the health of the people and communities we serve.  Our department works in many at-risk, minority and under-served communities.  The state of Oklahoma has very poor health indicators for about everything you can possibly imagine.  We are working to provide health, wellness and health education services to those most in need, but to also educate people in general about the need to take care of themselves – know their health numbers (blood pressure, cholesterol, etc.), to get routine and regular exams, among others.

One area that continued to grab my attention was comparatively poor health indicators for men.   It was alarming to discover that such few men actually went to a regular doctor or health provider, let alone had access to any type of screenings.  INTEGRIS had been doing a Women’s Health Forum for many years then.  Most of their outreach efforts were for women who had insurance (employer-based or from retirement) but a majority of them were proactive with their health for the most part.

Two of my colleagues and I developed a proposal that would address men’s health in a different way that wasn’t intimidating to men, but still covered all aspects of their health and education.  Our leadership liked the idea, but a few seemed skeptical that we would be able to attract men to a health event.  We were confident that we could succeed if we tied it to something they were interested in, so, naturally, we partnered with the local sports radio station and used humor to make it a different kind of health event.

In our first event in 2004, over 300 men attended our event and we’ve had steady attendance ever since.  We continue to add more events and health screenings which have proven successful and have replicated many of these screenings and events in our rural communities where we have smaller hospitals and populations with limited access to health education programs and services.

We started planning our event back in 2003 and realized there wasn’t a lot of information on men’s health events anywhere.  Through internet searches, I stumbled upon the Men’s Health Network (MHN) webpage.  We finally found a resource to help us secure health education literature for our upcoming men’s health conference and MHN’s Jim Boyd and Scott Williams were crucial partners in planning that event and others since.  MHN has been one of our biggest supporters and partners in our efforts to improve the health of men and boys in Oklahoma.  The partnership has given me the opportunity to present our program and services across the country and at the 2009 International Society on Men’s Health in Vienna, Austria.  I’ve served on several committees through recommendations by MHN, and that’s how I got involved with the American Public Health Association (APHA) Men’s Health Caucus (MHC).  I was fortunate enough to be involved with the caucus early and have served in several positions since its inception in 2008.  I currently serve as the chair for the MHC and represent our group in the APHA’s Caucus Collaborative.

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

SP: I’m inspired by all the work being done which focuses on the health of men and boys.  It’s amazing to see how awareness and interest to keep men healthy has escalated over the years among government officials, businesses, marketing professionals and the public as a whole.   I’m also inspired by all of the great programs and services we’ve implemented here in Oklahoma, not just for men, but to improve health outcomes for the entire population, including children, senior citizens and minority populations.  We have a long way to go to show impact, but we are slowly making progress throughout the state.

Me: Can you share some of the progress you’ve made at INTEGRIS as it relates to men’s health outreach?

SP:  A large percentage of men have only limited contact with physicians and the health care system as a whole. Men not only fail to get routine check-ups or preventive care, but often ignore symptoms or delay seeking medical attention when sick or in pain. These poor health habits take their toll – beginning at early ages and rising significantly as males reach retirement age.

Because INTEGRIS is determined to raise awareness of this “silent crisis” and turn the tide, we’ve implemented an innovative men’s health initiative, Men’s Health University (a.k.a. Men-U). It’s designed to educate men and their families on the importance of men taking charge of their own health. Established in 2004, Men-U consists of free screenings and information, physician seminars, an annual wellness fair, (the 2006 event drew more than 700 people), and this website devoted solely to men’s health.

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By bringing men back into the health care system, INTEGRIS is helping them overcome one of their biggest health risks – that of just being a man. And knowledge is power. Even if males are aware of just two numbers, blood pressure and cholesterol, and take active steps to lower them if either reaches an unhealthy range, it can make a huge difference in their longevity.

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Me: Describe your vision for Integris Health.  Where do you see Integris and/or MHC in 1, 5 or 10 years and what kind of impact do you plan to make?

SP: My vision for INTEGRIS Health is really coming together for our community.  INTEGRIS is one of the few health systems in Oklahoma that gives back to the community in such a substantial manner.  We are finding new partnership and collaborative opportunities with agencies and organizations who have similar missions.  Additionally, we continue to explore innovative ways to make an impact on the health and wellness of our communities by sharing resources and services with partners like the Regional Food Bank, Oklahoma City County Health Department, the local Federally Qualified Health Center, churches and colleges.  All of these groups are coming together to hold events, offer services, programs and share resources, all of which help us improve the lives and health of our targeted communities.  I hope in the next year, our work to develop a comprehensive health, wellness and education resource center will come to fruition.  I hope we can replicate this model across our service areas in the next 5 to 10 years.  This will make a huge impact on patient access, especially if we can get other hospital systems to join with us.

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

SP:  The needs in all of these areas listed above are, unfortunately, not being met in many areas.  We observe access to care being a recurring obstacle for many individuals.  People can’t afford health insurance through the Affordable Care Act and/or their co-payments, so they have to use our emergency departments as a clinic or their healthcare provider.  We have about 19 free clinics in the metro area that are at capacity due to unmet needs of populations with limited resources or circumstances – uninsured, undocumented and underprivileged.

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Oklahoma, as a state, faces many challenges as documented in their annual state report, however, passionate community leaders like Steve Petty and his colleagues are working diligently to improve health outcomes at the local level.

“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

If you’re interested in learning more or working with Steve to improve health and well-being in Oklahoma, contact him at Stephen.Petty@integrisok.com.

 

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 – Rachel Safeek Fights the Status Quo with “Fight Stigma”

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

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

So without further ado…

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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