Tag Archives: health policy

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

context-matters

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 – Anchored Upstream

river.jpeg

Public Health River Metaphor

A man was fishing in the river when he noticed someone was drowning. He pulled them out and attempted to resuscitate them. Shortly afterwards, he noticed another person in the river and saved them too. He then noticed another, and another and another. Soon he was exhausted and realized he would not be able save all of the drowning people.

He went further upstream to find out why all these people were falling into the river.

On arriving further upstream, he discovered a broken bridge was causing people to fall into the river and end up drowning where he had been fishing.  He decided he would fix the bridge to stop them falling in, instead of fishing them out after they were already drowning.

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There’s a radio ad campaign for the Powerball Lottery in my local area, Raleigh-Durham, North Carolina that has stood out to me more than the hundreds of others I hear on the radio. In the ad,’Wolfman’ (picture Michael J. Fox in the Teen Wolf movie) visits the barber shop for his regular hair cut. ‘Wolfman’ throws out a few ideas – maybe I should shave it all off? “Or maybe a mullet?” His barber asks why the sudden change from his usual cut. ‘Wolfman’ described that his life was so monotonous lately and he wanted to change things up a bit. The barber then responds by recommending that ‘Wolfman’ purchase a Powerball ticket because every jackpot is worth at least $40 million – a life-changing amount; a change that  coincidentally ‘Wolfman’ was looking for. A disclaimer followed in the final seconds stating the odds of winning a Powerball jackpot, which was a measly 1/292 million. Ads, like this one, that tap into our well of emotions leave us particularly susceptible to any product that marketers are hawking, despite the impossible odds or practical necessity in one’s life.

While 1/292 million are nearly impossible odds, 1/4 seems almost certain in comparison. A recent article from the Atlantic highlighted results from Urban Institute’s study on medical debt. 23.8% of adults under 65 in the US has medical debt. Southern states, like Mississippi and Arkansas, have higher rates of medical debt – both over 35%. Furthermore, insurance coverage had a minimal positive effect: 23% of adults with health insurance still had medical debt compared to 31% of uninsured. As mentioned in the article, this has been a common criticism of the Affordable Care Act, aka Obamacare: that expanding health insurance does little to reduce high costs of health care for individuals (out-of-pocket costs) as well as the healthcare system as a whole.

Health policy in most recent years have been focused primarily on health insurance and affordable access to healthcare services. In the river metaphor above, focusing on health insurance would be akin to pulling people out of the river while they were drowning – providing them healthcare when they were sick, rather than figuring out how to prevent, or at least greatly reduce the risk of, illness. In public health and health care lingo this is what’s referred to as “looking upstream.”

In my interview below, Dr. James Leone, professor at Bridgewater State University, describes his career in “looking upstream.” Other upstream heroes of mine include:

Dr. Rishi Manchanda

Dr. Camara Jones

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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 professor at Bridgewater State University.  Describe why you’re passionate about Improving men’s health…why others should care about the health disparities between genders.

James Leone: My journey into public health education and higher education was a bit random/arbitrary. I began in clinical practice serving as a certified athletic trainer (ATC) where I worked in various settings including: professional with the New England Patriots, clinical outreach at high school, collegiate and physical therapy clinics. I also worked with coordinating rehabilitation clinics and strength and conditioning services in a variety of settings. Not too long into my clinical practice, I received an offer to teach sports medicine/athletic training at Southern Illinois University Carbondale, which was a new challenge for me professionally. I continued to teach and clinically practice, but my love of education rose to the top of my priorities, so I pursued a PhD in public health education. I saw value in what I could contribute on an individual level with people, however, my brain has always been geared towards the “bigger picture” – I guess you can say I embrace an upstream mentality/approach. This was my entry into health promotion and public health studies. I made my way up to Bridgewater State University (BSU) after serving on faculty at Southern Illinois University Carbondale, Northeastern University, and The George Washington University (GWU). Additionally, I currently serve as an adjunct professor at Northeastern University where I have taught courses in athletic training, physical therapy, physician assistant studies, and recently in the master of public health program.

As previously mentioned I have embraced a more “upstreamist” approach in my world and professional view. That said, I realized that male health always seemed to be lacking whether from personal experience or reviewing study after study and large data sets. I always have championed efforts to advocate for groups, be it my athletes or gender (in this case). Also, in 2007 I was approached by my former Chairperson at GWU to offer a class in men’s health, which I quickly embraced since my thought process was already in-tune with this topic. I quickly realized that evidence was lacking in terms of “why” men live sicker and die sooner than women. Also, there were few academic resources (i.e. books) from which to facilitate the topic. I set out consuming as much as I could to develop my course and my knowledge in this area of research. This journey led me to propose a textbook on male health (published in 2012) as well as develop two courses on male health (one at GWU and the other at BSU, presently). I am currently pursuing opportunities to develop male health curricula further so that beyond greater awareness of the topic and issues, we can move dialogue into action and advocacy by training public health professionals and providers on gender-specific needs of men and boys.

So, why do I care about male health topics? I have always been an advocate for people, ethics, and basic human rights. Poor health outcomes in males challenges these aforementioned principles, negatively impacting overall population health. From the public health perspective, we are morally and professionally obligated to help right these wrongs so as to create a more equitable society aimed at a “true public health for all.” I believe Sir Geoffrey Vickers captured it best in his quote, “public health consists of “a successive re-defining of the unacceptable.” I believe gender disparities, particularly those affecting men have been “unacceptable” and warrant our full and undivided attention at present times.

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

JL: My commitment is based on my ethics and morals, which guide my actions. My intolerance for average often guides my “drive” to improve most things in my personal life and professional practice. Knowing that I do work that directly corresponds to people’s health and experiences is more than enriching for me on a daily basis. When times get rough I often remain mindful of the transient nature of life and experiences – the viewpoint “nothing is guaranteed in life” often helps me to keep my life and work perspectives in check most days.

Me: I saw your presentation at this year’s American Public Health Association (APHA) conference on men’s health as a national security concern.  Can you describe your perspective on this issue?

JL: I was in a graduate school lecture discussing public health initiatives and Harry Truman’s 1946 speech was referenced in the talk. As part of that talk, Truman commented on the nature of the military and investing in the health of the youth to strengthen the defense system of the U.S. Of course, at the time, the vast majority of the military were younger men whose overall health and qualifications for military service were being called into question. The latter point got me thinking as to what it would be today; likely, things have gotten worse with rising overweight and obesity issues nationally. This perspective motivated my presentation at APHA in November. Overall, I think this is an incredibly important issue for two main reasons: 1. Of course we want to a strong system of defense if called upon, and 2. And perhaps most importantly, poor men’s health brings to light the overall issues in male health in the U.S. When we are able to gain the attention of the Department of Justice and Department of Defense, we might actually see Congress move on some of the issues in men’s health that we have been advocating for over the past few decades.

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)?

JL: I saw the APHA MHC as a strong platform from which to pool my energies and resources on advancing male health. I value like-minded people, but also, I am challenged by various ways of thinking and working towards solutions in these groups. I have learned that even though there is a shared value and perspective, we all have something unique to contribute to the conversation over men’s health. The men’s health movement attracts me simply because we as a society must look upstream to the issues that we generalize and deal with downstream. We have grown too normalized with poor men’s health and the forces that drive it. I think working with Men’s Health Network, MHC, and APHA can embolden an area that has gone largely unnoticed even at the detriment of society.

Me: What are the current needs in the Boston 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.)?

JL: I consider Boston and the surrounding areas as “lucky” because we have so much access to health, healthcare, education, and most of the social determinants that can positively affect population health. However, when we look below the generalized population data, we still see a consistent and stark contrast in the health of the privileged and the socially marginalized as with most other major cities. Boston struggles to meet the needs of harder to reach populations and men just like most other major cities in the U.S. We do have some excellent and progressive programming such as the Men’s Health Center (Whittier Street) in Roxbury and the men’s health program through Cambridge, however, the salient question is always: are we meeting the needs of the most vulnerable at the right moments so as to promote long-term individual and population health – I guess time and statistics will tell that story.

Behind the Scenes

silos

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

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

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

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

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

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

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

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

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

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

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

3) What do you think it will take for our society to view health more seriously?  As in, why is health lower in priority to careers and education and relationships?

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

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

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

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

5) What are the current needs in your city as they relate to social determinants of health (ie SES, poverty, access to care, transportation, safety, etc.)?  Social determinants of health are any factors that directly or indirectly affect health.  For example, being homeless could cause stress and malnutrition which could drastically affect one’s health.

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

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

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

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

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

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

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

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

So without further ado…

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Why Artificial Intelligence Excites Me, Then Worries Me

patchAugust 27

Twitter is something else.  I signed up to Twitter a few years back, but never really did anything with it – mainly because I didn’t really understand how to leverage it to the fullest.  Fast forward to roughly a month ago and I’m a tweeting – bordering addicted – fiend.  If (the optimist in me says when) you check out my Twitter page (@randomRPL) you’ll notice that I tweet a lot.  Like all the time.  And it’s not a bot or HootSuite managing my social media.  This is me when I have a few minutes of free time.  I’m fortunate enough to live in a city with a solid public transit system, so that’s where I spend quality time on the Twitterverse.  But don’t worry, this is borderline addiction is moderated by my regular yoga practice at my local yoga studio.  Yes, I practice yoga.  Yes, it gives me some zen.  And yes, my addiction to social media is on the healthy side – there’s a method to my Twitter madness.  So, don’t panic…yet…I’ll let you know when to panic when I literally type “PANIC” below.

Featured in this morning’s Washington Post: Express this morning was a piece titled, “Look, D.C., no hands!”  Yes, the driverless car made it to the streets of DC for a test run.  I can only imagine how entertaining it must have been to witness the experiment in person.  How exciting is it that we are finally at the point where the science-fiction futuristic movies are finally turning into reality?  Remember TimeCop back in the 90s?  I know someone else saw that movie, so save the eye rolling for policy debates and all the inaction happening in Congress.

Here’s where my excitement stalls.  The authors describe that computers can detect certain things that happen – in this case a police officer managing the flow of traffic – but it cannot (at least at this point) detect the context of any situation – at least not as of this round of testing.  If you have ever driven in Washington, you know how completely nuts it is out there.  If you have not driven in Washington, please save yourself the road rage and stress and stay on public transit, taxi, Uber, Capital BikeShare or just walk it out.

I have complete faith and trust that Artificial Intelligence (AI) technology will continue to progress towards the sophistication and understanding that human beings possess.  I am excited to see the next generation of technology.  Heck, I would probably ride in a driverless car in the near future if given the opportunity.  But on two conditions: 1) the AI technology has to be sophisticated enough to understand and react to contextual factors (e.g. road rage) and 2) it would have to be in a less dense setting.  Innovation has come so far and we have that much further to go…

Which brings us into my favorite topic: healthcare.  How can we innovate in this field to deliver our patients – friends, family members and ourselves – quality health care that leverages technology to automate a variety of time-intensive, laborious things?  Twitter is one example of innovative, disruptive technology.  It not only delivers consumable pieces of information in real-time, but its technology also recommends connecting with other individuals based on similar interests.  Maneesh Juneja and I were matched via this Twitter algorithm and I could not be more grateful to the Twitterverse for this.  Maneesh is a digital health guru and is well-versed in future technologies to improve health.  He is constantly tweeting and in a sense, teaching a virtual class on health innovation.  I feel privileged enough to be in the front row and enjoy reading many of the articles he links to from his handle @maneeshjuneja.  Another teacher of mine in the Twitterverse is Dr. Kevin Pho of KevinMD.  Dr. Pho curates the most relevant articles in the field and tweets them to his 100,000+ followers.  The topic of robots in healthcare triggered in my mind when reading the driverless car article.  There are a few articles on the site that are worth reviewing: Robot Caregivers; How Robots Will Teach Us Who We Are As Humans; and Will Robots Reduce the Need for Doctors?  All three feed into a dialogue that we should be having on a larger scale.  Are certain technologies capable of easing the burden on healthcare professionals in a way that it does not jeopardize health outcomes?

Let’s circle back to the points I brought up about AI and context.  Imagine a robot with its sophisticated computer systems having to understand the contextual nuances as it relates to a healthcare setting.  Healthcare providers are already facing overwhelming demands when it comes to delivering quality healthcare to their patients all while balancing the needs of the business side of things – reimbursement claims, proper and secure patient records and malpractice, among other pressing issues.  The million dollar question is how can we integrate appropriate AI technology to ease the burden on health care providers?

As I stated earlier, in order to have me ride in a driverless car, the situation would need to address my aforementioned conditions.  In the healthcare world, I cannot even imagine how many more conditions are necessary before I could trust my own health and well-being in the hands of a robot, regardless of how sophisticated their AI technology might be.

Now is the time to PANIC.  I throw that word out there not to panic for the technology itself, but because the discussions we are having on healthcare at this point are simply useless.  The most talked about topic in healthcare is on reforming, repealing or strengthening the Affordable Care Act.  I completely understand that this is an important piece of legislation that needs to be handled appropriately and I also understand that it is not perfect.  But all the divisive rhetoric being slung from both sides are not productive.  The worries flowing from my mind have to do with the lack of focus, vision and discussion on innovative solutions to move our country, collectively, forward.

Let’s not forget that health knows no party line.  And neither does compassion.

“Lead me, follow me, or get out of my way.” — General George Patton

Tomorrow’s Hope

hope

June 30, 2014

May 24, the Saturday of Memorial Day weekend was a memorable day.  it’s the day that my friend, and health policy wonk, Adam Dougherty’s life changed forever.

Arguably one of the most important days of his life, my good friend was crossing a major threshold, another chapter of adulthood; Saturday, May 24 was his wedding day.  A weekend capped with family and friends; emotional highs soaring and a union of two souls who truly completed each other.  I couldn’t be happier for him and his lovely bride, a sentiment shared by everyone in attendance.

Little did we know what took place the night before.  We can only imagine the lowest of lows that many families and friends experienced on May 23.

The shootings in UCSB’s neighborhood of Isla Vista on May 23 caused many ripples.  Ripples which continue to affect the lives of the victims, survivors along with their family and friends.  6 victims killed, 13 injured and the death of the shooter.

I write this piece now only a few days after the one-month anniversary of the tragedy and days since the shooter’s father, Peter Rodger was interviewed by Barbara Walters.  A truly heart-breaking story on both sides.  The emotional damage produced on the victims’ families and friends is nothing I will ever be able to comprehend.  But little did I know, the torment of Mr. Rodger is as remarkable.  He only agreed to an interview to shed light on their situation, hoping to prevent any more unnecessary violence and bloodshed.  Can any lessons be learned?  Can action be taken?  Mr. Rodger hopes so.  

Calls for new legislation on gun control and mental health were once again on news headlines after the shooting.  As they were after the Sandy Hook shooting and the other shootings before it.  Progress on either issue, unfortunately, is minimal, if at all, and anger at Congress’ inaction continues.

Mr. Rodger acknowledges that his son Elliot had serious problems.  After his divorce with Elliot’s mother, Elliot started therapy at age 8.  As the years passed, he noticed that Elliot grew more isolated.  And at 18, legally an adult and independent, he made his own decisions regarding his health and well-being, deeming mental health care unnecessary.  Mental illness, left untreated, has dire consequences.  Elliot was another individual who slipped through the cracks.  An individual who wrote a 107-thousand word, 137-page manifesto that chronicled his suffering.  And later posting a video describing his planned attack in detail.

Were there warning signs earlier?  Mr. Rodger says yes.  He concedes that he thought his son could be suicidal, but did not imagine he would be homicidal.  But even if the warning signs were acted upon, what can health professionals really do if an individual refuses care?

As a public health professional, I whole-heartedly believe in prevention efforts.  But could this have been prevented?  Could any of the other mass slayings have been prevented?  Stronger gun control or mental health policies may be part of the solution.  Mental Health America currently has 11 legislative priorities for this year.  While I see the merits of both types of policy recourse, realistically, there are never guarantees.  Stronger policies have the potential to help reduce this happening in the future, but at the end of the day, though, it is the individual that ultimately decides his own fate.

In his book, A Million Miles in a Thousand Years, best selling author Donald Miller hit a wall personally.  Without purpose, but full of internal questions and self-reflection, he realizes that everyone needs a role to play and “…we have to force ourselves to create these scenes. We have to get up off the couch and turn the television off, we have to blow up the inner-tubes and head to the river.”  As masters of our own fate, it is our responsibility to contribute to the community around us – to be productive citizens.  A supportive environment with positive role models may have nurtured and encouraged Elliot to another path.  National programs such as Miller’s The Mentoring Project and President Obama’s My Brother’s Keeper Initiative are great examples of interventions that can complement policies on gun control and mental health – programs that focus on developing caring and responsible individuals.  I would be remiss if I did not recognize the important work done in local communities through outreach and service.  One such program, led by Darrell Sabbs at Phoebe Putney Health System, a local champion of Men’s Health Network in Albany, Georgia, trains and guides teen boys and men on a variety of fatherhood issues.

With the July 4th holiday behind us, I encourage you to take a moment to reflect what patriotism means to you.  I look forward to the day when tragedies such as the UCSB shooting and dozens of others are a thing of the past.  I look forward to the day when mental health care becomes as common as treating other debilitating diseases such as cancer and diabetes.  I look forward to the day when patriotism is the act of being a productive citizen AND maintaining one’s own health and well-being.  Until then, we work for progress.  

“Tomorrow hopes we have learned something from today” – John Wayne.