Tag Archives: health

Public Health in Action – Health, Wealth, and UBI

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Albert Einstein defined insanity as doing the same thing over and over and expecting different results.

As you may know, our country spends a lot of money on healthcare annually – over $3T, to be exact. You may also know that what we spend our healthcare dollars on isn’t exactly improving health outcomes. So, our hypothesis – spend more = better health – doesn’t hold up. So, what’s wrong?

First thing’s first: health and healthcare are not one in the same and should not be used interchangeably. Healthcare is a social determinant of health, which defined by Kaiser Family Foundation is a “structural determinant and condition in which people are born, grow, live, work and age.” Examples of social determinants of health include education, socioeconomic status, physical environment, employment, social support networks, and healthcare – seen in the first figure below.

SDOH2

Social determinants of health essentially contribute to an individual’s overall health in complex ways. And research provides their respective impact on health outcomes, specifically risk of premature death, in the following figure.

SDOH

But why do we spend so much annually on healthcare if research shows it’s only impacting up to 10% of health outcomes? Why aren’t we reallocating some of that toward addressing social and environmental factors like employment and housing?

Ask Einstein.

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Earlier this year, I came across a concept called Universal Basic Income (UBI) and followed up with more reading and research. I continue to wonder and speculate about its potential impact on individual and population health. Financial matters are an integral part of our daily lives – whether it’s paying bills, purchasing food, or filling a prescription, money is on our mind. It’s no wonder that income and wealth are linked to health and longevity, according to this brief from the Urban Institute

I’m excited to share a recent interview I had with Conrad Shaw, a former engineer, turned actor and co-founder of Bootstraps, a documentary series on a UBI trial they’ve developed.

Check it out!

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

Conrad Shaw: It was a long and winding road. I studied mechanical engineering in college, because I was pretty good at it and it represents a fairly safe career and a good education to head out into the world with. I liked it fine, and some of the work was rewarding, but I knew deep down that I was never passionate about it. The one class I really loved in college was Acting 101 in my senior year. I had always been a movie nerd, but this was my first experience with performing, and it brought me to life. I figured I should finish up my degree and get some experience on the resume in engineering, though, as a smart fallback plan and a way to keep my parents from panicking. A year and a half into working on missile systems and satellites for Lockheed Martin in Silicon Valley, I had had enough. Cubicle life was not for me, at least not yet. I gave my notice and moved to New York City to give acting a real go. I came in knowing nobody and struggled quite a lot to find flexible restaurant work, some engineering work, even a little day trading of stocks, and paid my way through acting school. Then I graduated and did all of the struggling that comes with building an acting career. I also wrote a couple of screenplays I’m still working to get developed, but I haven’t yet done anything you would have heard of, in case you were thinking of asking. Needless to say, starting an acting career is not a journey for the faint of heart.

It was meeting and falling in love with Deia Schlosberg – we’re now engaged – that sucked me into the world of documentary film-making. She had already established herself in the field, a supremely lucky break for me, and we were looking to work on a project together. I had just recently read an article that introduced me to the concept of universal basic income (UBI) and had become utterly fascinated. All my life, especially since being in New York, the issue of homelessness and poverty just didn’t quite make sense to me. There just had to be a smart way to handle it with a large governmental program, I always believed, and I’d be happy to pay extra in taxes for it to be so – assuming some day I was making an income that would even be worth taxing. But I never put too much thought into it, distracted by my own struggles, assuming somebody must be working on it. And if it hadn’t been done already or wasn’t in the works, it must be too large of a problem to solve – or so I assumed. We must not have enough resources for everyone to live well. But then along comes this idea of UBI. Well, holy crap, the issue wasn’t scarcity of resources after all; it was inefficiency, corruption, lazy thinking, and bad policy. Suddenly, I could no longer ignore the needless suffering going on around me; I couldn’t walk past a homeless person without a burning rage welling up inside me. How could I? I am part of this system, and so I am responsible for this human being’s suffering. What’s more, I’m especially culpable, because I now have an understanding of how we could fix it! But how could I help, I wondered, other than by sort of screaming into the wind on social media? It’s so hard to know what to do to actually make a difference, and so apathy threatens to numb out the rage.

In terms of the logistics, the simple mathematical elegance of the concept and implications of universality spoke to the engineer in me. I did some research and ran some back-of-the-napkin calculations on the realities of what our economy could handle, and really learned for the first time just how extreme our problem of economic inequality is in this country. Suffice to say we could fund a UBI multiple times over and still have bajillionaires roaming around. And the idea of having basic security while pursuing one’s ambitions spoke volumes to the struggling actor side of me. The kicker came when I was discussing it with a friend from the other side the political aisle, with whom I always disagree on everything, and we quickly were finding a lot of agreement on this radical new policy. I was hooked on the concept after about two weeks, and that’s around when Deia casually mentioned that it could be the subject of our next project together. The lightbulb went off at that moment, and we started working at it with all of our energy and haven’t stopped sprinting since.

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

CS: There are the little things in life, like acts of kindness, good art, cute kids, that are always sure bets for daily inspiration. Then there’s Deia of course. She’s a total badass – she’s all heart and kindness – and we certainly lean on each other and become better than the sum of our parts. I also read a lot about the problems we face and the solutions coming down the pipeline through the eyes of economists, futurists, thinkers, and policy makers who regularly blow my mind. But lately, too, there’s our project, Bootstraps, and what we’ve managed to cobble together so far. We’re running our own basic income trial in order to document and share the stories of regular Americans receiving basic incomes. It was and still is incredibly difficult to raise the funds both for a production and for a separate UBI trial, but we’ve had enough success at it that our trial now has 17 participants (soon to be 20) across 10 states. Letting them know they would be getting $1000/month in unconditional support for the next two years was the most rewarding and joyous thing I’ve ever experienced. And now, every day, we’re getting to see these beautiful people face life’s struggles with a little more confidence in their step and a bit more security in their hearts. We’ve seen a 56-year-old homeless man open his first checking account and save up for his first apartment. We’ve seen a prison inmate make the leap to push for his parole after delaying for 3 years out of fear that he’d fail on the outside. We’ve seen a family able to spend an entire year caring for their newborn in the hospital, able to take time from work to ensure that he continues to develop and have as normal a life as possible despite suffering a genetic condition. The list goes on. These people inspire Deia and I on a daily basis.

Me: Illustrate what problem this film series and UBI is attempting to fix.

CS: I could go deep into the weeds here, but the essence of basic income, as I see it, is shifting power to the people. It is the most efficient and elegant way to guarantee that everyone has a voice and can impact the way the world operates around them. It is a floor not only below which nobody can fall, but also one upon which everybody can stand and build. If everyone can vote with their wallets on what they care about, and if everyone can spare their time and attention on what is important to them without sacrificing their most basic security, then democracy, morality, and community flourish. We take a society preoccupied with accumulating as much as possible to hedge against catastrophe and protect themselves first and  foremost – a society designed to be selfish out of necessity – and evolve it into a society of interdependence and common strength in which every citizen feels part of the whole and cared for. Suddenly people can instead focus on what they can give back to society, how they want to contribute and to matter. Despite all the fearful rhetoric about looming job loss due to automation – which I do believe is a serious concern – UBI at its root is more importantly an issue of human rights, and of humanism itself. It’s a respect for the inherent value in every individual and a societal decision to include and invest in each person’s potential.

The goal of our film series, Bootstraps, is more specific within the UBI movement. We see a gaping hole in the conversation. To date, it is very technocratic and academic. We read daily about the threat of automation and growing support from Silicon Valley billionaires. We learn about ambitious UBI experiments happening in Canada, Oakland, Kenya, Finland, and more. However, political change doesn’t only happen because billionaires and professors, or even politicians, speak out for it, even if they do so beautifully. Things shift when the public rises up and demands that change. Not many people know that we almost had a basic income under Nixon in the 70s. We even had significant experiments of the concept back then, too. The parties in Congress were split on what level we should implement, though, and the people weren’t really kept in the loop so well, and the idea fizzled. We ended up with the crappy welfare system as we know it today. We won’t get the basic income we deserve and need unless it’s fully supported by a people’s movement, and the UBI movement is not yet bringing the people along. Most Americans don’t read thought pieces on economic policy, and certainly won’t read the white papers coming out of these current experiments. Nobody has time to research; we’re all trying to survive.

So, our aim with Bootstraps is to mainline the idea of UBI straight into people’s hearts and minds and create a major catalyst for a grassroots movement. We don’t want to do this with an advocacy piece, mind you. We’re not here to push UBI, but to spark awareness about, and discussion of, UBI. I happen to be an advocate on the side, because I’m pretty sold on the idea so far, as you may have noticed, but we’ve designed Bootstraps to be an honest experiment. And while the other experiments occurring are more quantitative, with large sample sizes and measuring for all kinds of statistical results, Bootstraps is meant to be more qualitative. Essentially, our goal is to show every American stories of fellow Americans who they would relate to, as well as some who they might judge negatively or suspiciously, and introduce a lens of UBI into those stories. Each of our 20 or so participants will receive their basic income for two years, and we will show what they do with it – the good and the bad. We don’t wish to teach people what we believe they should think, but rather to kickstart serious and widespread discussion on the potential merits and flaws of guaranteeing everyone a basic income. And we hope to stream these stories to millions of living rooms in every part of the country.

Me: What’s your vision for the film or movement in the next year, 5 years and 10 years? What do you need to get there? How can we help you?

CS: If the movement can keep growing at the pace it has been for the past few years, it would be incredible. The number one thing people can do to help is to get interested and to learn more. And don’t just listen to your news source of choice. Do some digging. The thing that’s special about UBI is it has serious support from all ideologies, and detractors. Find the different points of view and read them carefully. Let them land on you, and then sit with them. Discuss them with your friends and family, those with whom you agree and disagree. Try to imagine what kind of a system you would want to create to address the issues that UBI seeks to. This idea, I believe, might just prove to be a defining moment in history, a major legacy of our generation, so get engaged!

We will release the film in early 2020 in order to have maximum impact on the national discussion leading up to the presidential primaries. There is already one candidate, Andrew Yang, running with UBI explicitly as his main platform, and many other politicians toying with the idea of endorsing, so we need to do all we can in the meantime to apply pressure to them. My hope is that UBI will be a major issue discussed in earnest on stage in the 2020 presidential debates. I’ve talked to many who don’t anticipate it growing that fast, but these people haven’t been following UBI and interviewing people on the streets about it for the last year and a half as I have. This movement has legs, and the public is poised for a major change in the way we operate. Hell, we voted in Trump, didn’t we? If that’s not a giant red flag that revolution is nigh and possible, then I don’t know what is.

I don’t really have much of a 5 or 10 year plan on UBI. My thinking right now is generally grounded in that 2020 timeframe, because that’s when our project will release. We’ll just have to keep adapting to what circumstance brings moving forward. I’m sure there will be no lack of work to do.

In terms of how people can help with the film, they can get engaged with us, too! Go to our website and get on the newsletter; follow us on social media (@bootstrapsfilm); donate to the production or introduce us to major funders if they have that ability or those connections. They can share about us with their friends. We’ll be working between now and 2020 not only to create this film, but to bring the latest and best information on UBI to our followers, primarily through Facebook and the newsletter. We’ll also be sharing other ways people can help the movement as they come up.

Me: What are the current needs in NYC (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.)?

CS: In general, my overarching philosophy revolves around opening up access and security to everyone, efficiently and universally, such that each can most easily contribute to their maximum potential. In New York City, same as everywhere else, there are several basics in life people need to be able to operate effectively. I think this applies to rural America and NYC similarly, the only difference being that NYC just has a bigger logistical scope to contend with. Along these lines, I would promote universal access to: 1) food and shelter, 2) healthcare, 3) transportation, 4) information, and 5) education, in that order of urgency, but there’s no reason I wouldn’t support doing them all at once.

Food and shelter would best be secured with UBI. In terms of providing affordable housing, I would love to see our awful system of shelters and soup kitchens perhaps replaced by something more along the lines of dormitory style living. What people need at minimum is the safety of a locking door, a place to keep their belongings and sleep at night every night. I would design buildings that provide these rooms, plus things like common areas, restrooms, cafeterias, electricity, wi-fi (this takes care of the information issue), and security staff with the goal of keeping costs below the level of UBI. The formerly homeless, the 20-somethings still working on finding their purpose, the bootstrapping artists and entrepreneurs, the natural disaster survivors, etc. could sustain themselves in dignity while pursuing their own roads to recovery, growth, prosperity, whatever, all the while fostering community and resilience among the residents.

Healthcare, I believe, would best be secured with single payer universal.

For public transportation, I imagine we should be able to find a way to subsidize completely through taxes. In NYC, anyone should be able to take a bus or a subway ride without first swiping. I don’t know the numbers behind this, but I imagine it would benefit society in general not to have people choosing between a trip to the doctor or the grocery store, or parents walking for miles to pick their kids up from school.

The costs of education would be mitigated to some degree by UBI already, but I’m certainly open to learning more about subsidized or free tuition for public school. I’m a strong proponent of fostering as educated and skilled a populace as possible.

Some people and pundits would put work opportunities at the top of that list. Many have started promoting things like a “Job Guarantee” program as an alternative to UBI and other tactics. I’m in support for work opportunity programs, sort of like a new ‘New Deal’ approach, as a method of helping people find purpose and ways to contribute in society. However, without a UBI floor first in place to guarantee basic security, a jobs program is not truly optional to the participants and therefore amounts to forced labor. Also, a UBI will allow many to find their own solutions to prosperity, by starting businesses, going back to school, etc. Without it, an attempt at a catch-all jobs program will end up another hopelessly overwhelmed bureaucratic quagmire. With a UBI in place, then sure, let’s invest in giving people more job opportunities doing important society-building work like infrastructure, home care, and more.

Lastly, in NYC politics as well as in all other localities and nationally, I think it’s essential that the voice of the people be empowered above that of any special interest. I would support not only overturning Citizen’s United, but restricting all campaigns to equal public funding only. Plus, I would support automatically registering every adult citizen to vote, making voting day a national holiday, and putting a serious effort into figuring out how to allow people to vote online. The debacle of 2016’s primaries left me among the millions who were thoroughly disillusioned with the idea that this country is actually a democracy we can still shape with our voices and votes. That needs to change once and for all.

If we invest in providing these sorts of universal access, the people of New York City will no longer sleep in shelters and on streets, will not wait endlessly for government to help them in their personal situations, will be empowered to take action in their communities, will be freed up to pay attention to and participate in politics, will be more resilient in the face of misfortune, and will no longer need to wonder how they’ll pay for their next meals. These are simple abilities that are currently not accessible to a large number of New Yorkers, and Americans in general, as I’ve witnessed over recent years.

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Public Health in Action – Seas of Change

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We’re nine days into the new year. Nine days into a fresh start, a clean slate. Many shared in eager anticipation and relief for 2016 to be over and done with in both mainstream and social media. But even though we’ve entered 2017, a magic reset button wasn’t pressed. The same issues we faced 10 days ago will still be the same issues we face this year and for many years after.

I imagine that Jason Roberts faced the same realization over a decade ago. Issues do carry over, year after year, unless something or someone shook things up. Earlier today, I watched Jason’s story as a regular citizen in a neighborhood of Dallas, Texas. His curiosity led to endless questions. The single most important question that kept popping up was “why not?” Why can’t things be different? With a mix of curiosity, resourcefulness, creativity, determination and passion, he made significant, long-lasting impacts that improved the quality of life in those Dallas neighborhoods, block by block.

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I was born in 1983 and I spent most of my childhood before the internet ever existed. I grew up playing sports outside, trading sports cards, playing video games and reading comic books. I was even caught up in that Pog epidemic of the 90s – try explaining Pogs to a teenager nowadays and they’d probably tell you “there’s an app for that”.

Terry and Justin Raimey grew up on comics too, and they were also passionate about food. Their passions fused when they co-founded Black Streak Kitchen.

Terry shares a snapshot of their story below.

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Me: How did you end up doing the work that you’re currently doing?  Describe your journey to your current roles as co-founders of Black Streak Kitchen (BSK).  Describe why you’re passionate about improving health behaviors in youth through nutrition education…why others should care about the work you’re doing.

Terry L. Raimey: Justin and I have always had an interest in health, wellness and cooking. Our mom and dad cooked everyday when we were kids, so we never really ate out. When we moved out of our parents’ home, we carried on the tradition of cooking for ourselves – creating new dishes by combining fresh meats, vegetables, fruits, grains and spices.

I am a writer and Justin is the artist and graphic designer of everything Black Streak Entertainment (Black Streak Kitchen’s parent company). We wanted to do something new and unique with our stories and artwork, something no one else in the comics and animation industry had ever done.

One day, I saw an ad for one of those grocery/recipe delivery services and thought it would be really cool to apply our artwork to something like that, and gear it towards kids, teens and families. So, we created Black Streak Kitchen as a source to teach kids, teens and families that cooking healthy can be delicious, while also teaching them how the ingredients can benefit their bodies and minds.

I love to cook and create new dishes by fusing unorthodox fresh ingredients and flavors. I love how eating healthy makes me feel and look; it’s very satisfying to me. And I want everyone to experience that satisfaction.

According to a study published in the Journal of the American Medical Association, the amount of children with type-2 diabetes, which is associated with obesity, jumped more than 30% from 2000 to 2009. When we were growing up, diabetes was an ‘old-person’ disease and obesity was a grown-up problem, but today, these conditions are affecting our children. One of the best way to combat America’s failing health grade is through cooking and nutrition education. Black Streak Kitchen provides cooking and nutrition education while making the presented material fun and entertaining.

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Image of recipe from Black Streak Kitchen

 

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

TLR: Seeing the reactions of the people we introduce to our brand, getting messages and comments from parents on how our app and comics teach them and their kids so much about cooking and nutrition, and even getting props from chefs and nutrition professionals is what motivates us to keep pushing. We pray and work hard, so it’s a true blessing when the Lord answers through the words of people who enjoy our brand.

Me: Can you tell us more about your collaboration with educators and any key outcomes or success stories from your comic books?

TLR: Well, our first comic doesn’t drop until January 15, but as far as collaborators, we’ve been blessed to have some accomplished chefs come on board. Chef Ed Harris will be featured as a Character Chef in our first issue, presenting his recipe “Roasted Cauliflower Stir Fry”. Chef Harris is the winner of Food Network’s ‘Chopped’ season 4 and ‘Iron Chef International’. We are also collaborating with Chef Robert Stewart, winner of ‘Guy’s Grocery Games’, ‘Cutthroat Kitchen’ and star of OWN Network’s ‘Raising Whitley’. Another collaborator of ours is Chef Ethan Taylor. He is the owner of ‘Great EETS’ catering in Los Angeles, CA. He works as a personal chef for numerous A-list celebrities, like Justin Beiber, Jamie Foxx and Mary J. Blige. All of these professionals have great elements to bring to our brand and help us succeed.

Me: What role do you envision comics and visual art having in educating youth?  How much of an impact did comic books play while you two were growing up?  Where do you foresee BSK in the next 5 or 10 years?

TLR: The use for comics and art are limitless. Fusing education with whimsical and visually appealing artwork grabs kids’ attention like nothing else, so it’s the perfect marriage. When were kids, we were big fans of comics. I read every monthly Spider-Man series in publication, and Justin was a big fan of Japanese manga. Comics sparked my imagination and took me on adventures that I could never experience in real life. As a matter of fact, we are still big comic fans!

In 5 to 10 years, we will have a home delivery service where we will deliver our recipe comics and the ingredients for our recipes to families homes. We will also have a cooking and nutrition animated series featuring our characters and signature Black Streak style. Having Black Streak Kitchen product lines through licensing is also a goal of ours.

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

TLR: We live in a suburb outside of Youngstown, Ohio. Youngstown used to run off of the steel industry, but once the steel mills shut down, the city was hit hard. Unemployment is high, schools have been shut down, public transportation is limited, there are no grocery stores to purchase healthy food, and there is little opportunity to succeed – it’s quite depressing.

Giving back is important to Justin and I, so we want to sponsor the establishment of community gardens in urban neighborhoods where fresh produce is hard to come-by. Establishing community gardens provides a sustainable food source for the neighborhood residents to draw from. It also helps bring the community together and helps the youth of the community learn a constructive skill that will benefit them for life.

We want to build our own kitchen entertainment empire, while also helping people in need, in particular, black youth.

Public Health in Action – 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 – Actions Speak Louder Than Words

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Source: article.wn.com

Muriel Bowser was sworn into office this past January and remains focused on delivering a fresh start for the District of Columbia (DC).  Mayor Bowser, a native of Washington, pledges to tackle problems past mayors haven’t: chronic homelessness, economic divide and disappearing affordable housing.  Engaging residents through community forums for their input and new ideas appear to be a long-term strategy for progress.  One such initiative that caught my attention was the 1 Billion Steps Challenge (currently at 3 million), under the larger FitDC umbrella.  The FitDC website serves as a resource and platform to engage residents on nutrition and fitness.  Currently, ten coaches are in place to motivate residents to improve their health and well-being.  I connected with Darryl Garrett, appointed the “Senior Coach” for older city residents (In 2013, individuals 65 and over comprised 11.3% of the population), and asked him a couple questions.

Let’s see the world of health and well-being from Darryl’s perspective.

Me: How did you end up doing the work that you’re currently doing?  Describe your journey from your work in the federal government to your leadership in health coaching in the DC community.

Darryl Garrett: I spent 25 years at CIA and then took an early retirement at 48. I then worked for a couple of defense companies before becoming an independent consultant working inside the intelligence community (IC). I’ve been doing that for about 12 years and was wondering what to do with the last third of my life. I continue to enjoy the mission and people in the IC—it is more like a calling than a job—but thought it would be fun to do something different.

About four years ago I and my wife started working with a terrific trainer—Deshaye Tillman—and I became inspired by the transition that occurred as he helped people become healthier. So I started studying to be a personal trainer and applied and got into the third running of Georgetown University’s Health Coaching Certificate program. That program will end in September. Then I will see if I can start a business of health coaching, while continuing to work part time in the IC.

At about the time I was starting the health coaching program at Georgetown I saw a news story about DC Mayor Bowser’s FitDC initiative. I applied to be one of the community health coaches and was blessed to be picked as the FitDC coach representing seniors. It has been an absolute blast working with the FitDC team: it is a diverse and interesting group that mirrors the city, I think. And as an old CIA hand who avoided the public light, it has been an amazing experience going to photo shoots and getting my first Twitter account!

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

DG: I try to remember that it is not my life, but life and I am a part of it. I try to make the best of it but at the end of the day billions of people go to sleep without thinking about me and my problem at all. I am not the center of the universe. I also have several networks of friends and colleagues that I rely on for support.

And sometimes I drink a little bourbon and have some popcorn!

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

DG: I remember being on a consulting team for a large IT company that had several retired military flag officers. One of them was also a doctor and had been the Surgeon General for his branch of service. He once said something that stuck with me: “Everyone knows that the US medical system is broken. And no one wants to fix it because everyone knows how to make money from it.” I took that to mean that the system is so complicated that any reforms upsets the revenue flow, so there is some group or groups who will oppose almost any change.

So I don’t see that changing radically in the near future. However, estimates are that 60-70% of chronic diseases could be eliminated or at least controlled by lifestyle choices. Many of our most severe challenges—diabetes, obesity, cancer, smoking, high blood pressure—can be effectively combated with exercise, healthy eating and adhering to medication plans.

When I started training at 60 years old, my bio markers after a few months dropped into a normal range where they had not been since my late 30s. That is the power of exercising and eating healthy food.

Me: Why is holistic and community health so important?

DG: People often have the information on how to stay healthy or prevent a disease, and yet many people cannot do it. I think there are several reasons for this:

  1. People don’t like to feel they are being told to do something. They often get resistant.
  2. People know the large goal “exercise more” but struggle with breaking it into small, actionable steps.
  3. People start and encounter relapses, obstacles and challenges and give up.
  4. Once starting it is hard to continue something long term on your own.

So community health can help to break down these challenges. Health coaching can help a person visualize something that is powerful for him or her: so instead of “I need to exercise.” The vision is “I want to be able to play with my kids at the park like the other moms.” Setting a powerful vision of health helps a person relate why they are doing something new and perhaps difficult to something that is important to them.

Working with initiatives such as FitDC and other DC and community programs also make it easier to stick to a program. Hard programs can be made fun and having buddies give you a team to help you overcome obstacles, break down goals into small steps, and stick to a plan over the long term.

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

DG: DC, like many cities, has areas of great access to healthcare and healthy food, and other areas where that access is a struggle. As a representative for the senior residents I know that some of them cannot drive and must rely on public transportation. While the city has a robust transportation system, it can be hard to carry many bags of groceries on a bus or metro…and relying on cabs can be expensive for some. Seniors sometimes can be challenged by navigating the healthcare system and understanding complex medication regimes, which can lead to poor adherence to treatment plans.

That is why I am proud to be part of an initiative that will help focus attention on the importance of moving and eating healthy. We currently have a Billion Step Challenge in which each ward has a community “Ward Walk”, and citizens are encouraged to log their steps each day. We hope to get to a billion steps in the next year.

Public Health in Action – Leveraging Health IT to Improve Outcomes

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

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

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

Here’s Ryan!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Public Health in Action – 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.

Public Health in Action – Walking the Walk

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Jonathan Bonnet, MD
Duke Family Medicine, PGY-3

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

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

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

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

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

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

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

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

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

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

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

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

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

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