Tag Archives: public health

Reflections of 2017 – We’re Only A Millimeter Away from Success in Public Health

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2017 was an interesting, and remarkable year, to say the least. I have no doubt each of you will read your share of best and worst stories of 2017. Before writing this, I did a quick Google search of top stories in healthcare, health, and public health, and as expected, my recollection of this year’s top news stories were completely different, which I’ve listed below.

One of the best decisions I made this year was to incorporate Medium into my daily routine. Every morning, I read a handful of thought-provoking articles to jump start my brain. If you haven’t read any articles on Medium, please do. It’s a curated source of original content from our country’s thought leaders on various topics such as entrepreneurship, healthcare, technology, culture, media, productivity, and design, among others. Learning from thought leaders in sectors outside of public health and healthcare continually challenges me to view the world from an unfamiliar lens – and it’s made all the difference in my personal and professional growth.

Tim Denning is a regular contributor to Entrepreneur.com and several publications on Medium. A recent article he wrote, “11 Ideas that will Rewire your Brain,” caused me to stop, reflect, and later inspired this year end post. His first idea was quite impactful:

You’re only a millimeter away from success

While attending a seminar, I heard a fascinating idea; according to a well-known cosmetic surgeon, the difference between you being butt ugly and a super model is a millimeter in a few spots of your face. That’s it!

Tiger Woods also explains that the difference between getting the ball close to the hole on the first shot, and hitting the ball in the water, is a millimeter either side of your swing.

There are times when you might think you are a million miles away from your desired goal. Remember next time that this is false, and you are only a millimeter away from success.

While I could spend thousands of words describing how frustrated, angry, and drained I was throughout the year, my optimism remains unshaken for what we can still achieve. And my optimism, inspiration, and motivation comes from thought leaders like Tim, Steve Downs, Naveen Rao, and Jordan Shlain, among so many others. It comes from social entrepreneurs and nonprofit leaders in North Carolina, Washington, D.C. and all the various places I visited this past year. Lastly, my optimism is fueled by the passionate, compassionate, and proud residents of communities across the country who volunteer their time to make their communities a better place. Their empathy and altruism is why I love this country so much – and it’s the very reason I won’t waste my time complaining about our country’s struggles. For those aforementioned reasons,  I’m excited about 2018 and beyond because we have a lot of work to do. But remember, nothing ever worth doing comes easy.

 

My Top 17 of ‘17

 

Innovation

Lyft and Uber step in to assist healthcare

Dear Silicon Valley, It Pays to Care About Public Health

Food as Medicine – 5 Good Ideas

Prescriptions for Fresh Produce

 

Application (Best Practices)

Kansas City Physician Takes on Community Health at the YMCA

Stamford, Connecticut Health and Wellness District

New Type of Food Pantry is Sprouting in Yards Across America

Hope – and Healing – Go into Massive Redevelopment Effort

 

Sustainability (Financial Sustainability)

Military Investing for a Less Costly, Fit & Healthy Force

Dreaming Big on Sustainable Financing

Health Insurers Try Paying More Upfront to Pay Less Later

 

Research

Outcomes of Digital Health Program to Reduce Risk of Diabetes

Leveraging Behavioral Economics to Address Health Behaviors

Amazon’s Latest Grocery Experiment Involves Accepting Food Stamps

 

Policy

Berkeley Approves Tiny Houses for the Homeless

Bike Lanes May Be the Most Cost-Effective Way to Improve Public Health

L.A. County’s Latest Solution is a Test of Compassion

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Public Health in Action – Predictably Irrational

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Public Health’s ‘Moonshot’ – Part 1

Advocates for cancer research and prevention efforts converged in Washington, D.C. last week for One Voice Against Cancer’s (OVAC) annual lobby day on Capitol Hill. OVAC, a collaboration of roughly 50 national non-profit organizations, delivered a unified message to Members of Congress on June 6 on the need for increased cancer-related appropriations. A point of discussion in my meetings with legislative staff was the President’s Budget Proposal for FY 2018, which featured budget cuts at both the National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC) and increases for the Department of Defense. Armed with OVAC “asks”, I decided to focus my meetings with legislative staff from Senators Burr and Tillis and Representative Butterfield on the economic impact in North Carolina if funding levels were reduced. North Carolina is home to three National Cancer Institute (NCI)-designated cancer centers, which are awarded over $2B in annual NIH funding and employs thousands of employees.

Our advocacy training included a presentation by Dr. Warren Kibbe from NCI on the state of NIH funding and a quick brief on the Cancer Moonshot Initiative. Led by former Vice President Joe Biden, the initiative focused on concentrated and collective action to accelerate a decade’s worth of progress in preventing, diagnosing and treating cancer into a five-year time frame. The Cancer Moonshot has buy-in from academic, public and private sector partnerships. My immediate thought: why doesn’t public health have this type of dedicated initiative with annual federally-appropriated funds?

The Robert Wood Johnson Foundation’s Culture of Health initiative is public health’s “moonshot”. Its Action Framework parallels the Cancer Moonshot Initiative in identifying focus areas and key performance metrics to measure progress. RWJF’s Culture of Health has achieved significant buy-in from a myriad of cross-sector stakeholders. The only distinction between the two initiatives, from my perspective, is dedicated federal support. Imagine the possibilities if public health’s “moonshot” received the same attention and resources as the Cancer Moonshot Initiative. A decade’s worth of progress in a 5-year timeline for the social determinants of health would really change the trajectory of the field of public health.

In the next few posts, I plan to take a deeper dive on exploring innovative ways to address the social determinants of health, specifically at the local level, in the city where I currently live – Durham, North Carolina.

Below, I offer background on the U.S.’s healthcare system to provide a larger context the many layers and contributors to an individual’s health outcomes.

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Healthcare expenditures in the United States was approximately $3.2T, or $9,900 per capita, in 2015 which accounted for 17.8% of its gross domestic product (GDP). When compared to 12 other high-income member countries of the Organization for Economic Cooperation and Development (OECD), the U.S. spent significantly more annually. According to the Commonwealth Fund, the U.S. spent roughly $3000 more than Switzerland, the runner-up in per capita spending, in 2013. As a result, it outspent the next highest spender, France, by 5.5% of GDP in 2013. But despite its additional spending, the U.S. underperforms on population health outcomes such as life expectancy and chronic disease prevalence when compared with other OECD countries. Additionally in its analysis, the Commonwealth Fund compared healthcare expenditures to those spent on social services – retirement, disability benefits, employment programs and supportive housing, among others – for 11 OECD countries. In this comparison, the U.S. spent the least on social services at 9% of GDP, with Canada and Australia spending 10% and 11% of GDP, respectively. France and Sweden spent the most on social services at 21% of GDP. This imbalance in spending, posit the authors, may contribute to the country’s poor health outcomes.

Policies to improve population health have historically focused on the healthcare system according to Kaiser Family Foundation’s Heiman and Artiga. The Affordable Care Act, signed into law in 2010, expanded access to healthcare services for millions of Americans. However, as the authors explain, research demonstrates that healthcare is a relatively weak health determinant. Individual health behaviors, genetics and a broad range of social and environmental factors account for 90% of an individual’s risk for premature death. Thus, addressing the factors outside of the healthcare system may play a key role in improving population health outcomes, and the value it generates could justify reallocation of current spending levels.

Social determinants of health are “the structural determinants and conditions in which people are born, grow, live, work and age”. Examples of social determinants of health include social economic status, educational attainment, the physical environment, employment and social support networks. Social determinants form the basic foundation for each individual and his/her life experience. It also sets a baseline for future health outcomes. For example, an individual who is unemployed for an extended period of time may become homeless, food insecure and have limited access to healthcare services. It’s reasonable to conclude that this individual may be at higher risk of premature death due to his/her life experience. Unfortunately people all over the world have lives filled with adversity and struggle. Social, economic and/or environmental disadvantage creates differences in health outcomes, also known as health disparities, in populations across the world. One goal of Healthy People 2020, a strategic 10-year plan to improve U.S. population health, is to achieve the highest level of health for all people. Health equity includes the elimination of health and healthcare disparities.

One population of interest are known as “high utilizers” or vulnerable patients with complex social, behavioral and health needs. According to Anderson, the top 5% of individual utilizers account for about 50% of overall healthcare expenditures. Programs that pair patient navigators, community health workers and behavioral health resources with identified “high utilizers” have been implemented recently with hopes of improving health outcomes and generating value. A thorough review and analysis of the results for impact and effectiveness in improving health and cutting costs for this subset of patients is a critical next step.

Public Health in Action – Anchored Upstream

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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.

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 – Vital Plan Strives for Impact, One Person at a Time

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There’s one lecture from graduate school that I constantly remember. In that particular Healthcare Delivery in the U.S. course lecture, my professor walked through a clinical visit with a recurring patient. Medical students and residents learn to obtain three important pieces of information from the patient: chief complaint (the reason for their visit), symptoms and a brief medical history. He then opened it up to us – was there anything else we would like to know? Coming from a public health perspective, our questions dove deeper into the social determinants of health -physical environment (housing), SES (access to health insurance, employment), etc. –  to clarify if there were any underlying issues causing the patient to return with similar health issues. That deeper dive, he said, was the distinction between the fields of medicine and public health.

An article published by WBUR last month illustrates a shift in medical school and residency programs to integrate public health principles, most notably the social determinants of health, into their learning objectives.

A holistic understanding of each patient is ideal when tailoring a plan not only to treat illness, but to achieve long-term well-being. The whole-person approach to treating chronic illness is what makes Vital Plan a unique part of the vast healthcare landscape.

My interview with CEO Braden Rawls catching up 2 years after our first interview, below.

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Me: I can’t believe it’s been almost 2 years since I published our first blog interview.  How’s Vital Plan?  What’s new that you can share with us?

Braden Rawls: It’s been a busy two years! Vital Plan has grown its customer base significantly, and this has allowed us to recruit ten new team members to continue improving our programs and expanding our reach. What really clicked for Vital Plan was selling our herbal supplement products in bundles alongside supportive health programs. Our signature program is the Restore Program, which includes four supplements plus health coaching support and a six month online course with education about restoring balance in the body through diet and lifestyle.  We’ve received very positive feedback on this program from customers and have expanded it to an international audience, with customers across Europe, Canada and Australia.

Me:  Why was it important for Vital Plan to become B Corporation Certified?

BR:  B Corp certification is important for Vital Plan to showcase third-party verification of our commitment to doing business with integrity. We are on a mission to restore and rebuild trust in the herbal supplement industry after its reputation was tarnished by deceitful players. Being able to showcase our commitment to doing business with integrity has already proven valuable in gaining new customers and recruiting talent. From the start, our goal has been to empower everyone that our organization teaches individuals to become more proactive about their health and to be mindful of the way they live. B Corp gives us a framework to support this mission and put best practices in place to grow our company in a smart, sustainable way.

Me:  One of the illnesses that Vital Plan focuses on is Lyme Disease.  Could you describe why it’s been a major focus for Vital Plan?  How does Vital Plan’s approach differ from traditional approaches?

BR:  Lyme disease is an illness that is personal for Vital Plan, as our founder, Dr. Bill Rawls, suffered with pain and insomnia for many years before ultimately testing positive for Lyme disease. However, Dr. Rawls’ personal struggle motivated him to research microbial illness from all angles, and he feels that Lyme disease is only one microbe of thousands behind chronic illnesses such as fibromyalgia, chronic fatigue syndrome and rheumatoid arthritis. Dr. Rawls believes that the true problem is not the stealthy microbes, but rather suppression of our immune systems that is allowing these stealthy microbes to flourish. He feels that chronic immune dysfunction is the real driver of the increase in chronic disease in developed countries, as exposure to toxins, radiation, stress and processed foods has depressed our immune system and is allowing microbial disease to flourish.

Me:  Vital Plan’s belief in addressing the underlying causes of disease is non-traditional.  Could you speak why your team is so passionate about taking this route?

BR:  The approach of treating symptoms is valuable for helping an individual to live more comfortably short term, but it is generally not a long term solution for fostering wellness.  Our team believes that disease in the body is often the result of environmental and dietary factors that are under our control, such as inflammatory food, chronic stress, and exposure to toxins and microbes. Through awareness of these disease factors, we believe that better health is in reach for many individuals. We feel that herbal medicine and natural healing modalities are also effective tools for individuals to take advantage of to promote healing and restore balance in the body.

Me:  Based on the patients that Vital Plan serves, what would you say are the biggest challenges for them to get back to normal? “Normal” being before their respective diseases produced symptoms so severe that it affected their quality of life.

BR:  For many people, diet and lifestyle changes are very difficult. However, once a person realizes that the food they are eating (or busy schedules they are slaves to) is making them sick, the changes become much easier to adopt. When you begin to associate foods or lifestyle practices with feeling good, your body will begin to crave those foods and practices instead of the ones that make you feel bad. It is all about training your brain to make those connections. Accelerating those connections for people is a big part of the mission behind our programs at Vital Plan.

Public Health in Action – Acceptable Risk

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Have you ever gone to work knowing you weren’t feeling too great or knew you were sick?  I definitely remember at least a handful of times when I’ve gone to work and potentially exposed co-workers to my cold or flu.  And I have no doubts that a majority of us have done the same.

But let’s say you worked in a more public setting, like a hospital or restaurant, where illness could spread to a larger population.  Would that influence the decision to stay home?  At least half of workers in more public settings show up to work sick, according to a recent NPR article.  Participants of the poll listed a variety of reasons for showing up to work sick, including a lack of paid time off or concerns over job security.  But another reason was inadequate back-up staff.  Sick employees didn’t want to overburden their co-workers in their absence.

Now imagine an opposite scenario where employees are at higher risk for illness or injury while at work; where exposure to toxic chemicals is part of the job.  Nail salon workers fall into this group and are routinely exposed to such chemicals, resulting in reproductive and developmental issues or cancer.  Does an increased risk to health issues have to be a necessity for nail salon workers?  Fortunately, not.  The California Healthy Nail Salon Collaborative (CaHNSC) was established in 2005 to improve the health, safety and rights of this workforce.  My interview with Catherine Porter, policy director of the Collaborative, below describes their impact on the industry in California.

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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 with the CA Healthy Nail Salon Collaborative – why is CaHNSC important to you? Why is it important to customers?

Catherine Porter: I have a great passion for workers’, particularly women workers’, rights and health.  As an employment rights attorney, I represented clients in gender and race discrimination claims and also represented teachers in arbitration and layoff hearings. After a breast cancer diagnosis at the age of 40, I decided to work on a policy level to have a greater impact on larger social, legal, and environmental issues such as eliminating the epidemic of cancer and other chronic diseases linked to toxic chemical exposures. I worked in an organization that focused on women with cancer and the environmental links to the disease; at another organization I focused on occupational safety and health, including workplace chemical exposures. I started with the California Healthy Nail Salon Collaborative (Collaborative or CaHNSC) in 2008 and now serve as its policy director.  Working with the Collaborative represents a natural progression of policy issues for me because we focus on environmental health and safety rights for both workers and women.

The Collaborative is having a positive impact on a vulnerable population of low-wage women workers. On the policy front, we are working to reduce exposures to toxic chemicals that are pervasive in nail salons. We also provide information regarding labor law rights and obligations, and work to ensure this important information is available and accessible to the nail salon community.  In California, manicurists are predominately Vietnamese immigrant women of reproductive age. Language can be a barrier to understanding occupational safety and health and labor rights.  The Collaborative has sponsored successful legislation that requires California state agencies to provide improved language access for the nail salon and other immigrant communities in California.

The Collaborative has built relationships in the nail salon community by providing trainings on healthier and more fair ways to do business.   Our successful advocacy for Healthy Nail Salon Recognition Programs (HNSRPs are now operational in four counties and one city) contribute to a safer and more enjoyable experience for nail salon customers.  These local programs acknowledge and support nail salons that use less toxic products and practices in their shops.

For example, nail salons must use products that do not contain the “Toxic Trio” of dibutyl phthalate, toluene, and formaldehyde, all known to cause reproductive and developmental harm or cancer.  Salons also must improve their ventilation and participate in trainings about how to avoid the most toxic exposures. According to our survey data, most salon owners that participate in the program say that they and their workers feel healthier and that they have experienced an increase in customers.

Me: The CA HNSC is involved with advocacy efforts – what legislation is realistic in the next few years and what would your ideal legislation look like?

CP: To promote the spread of Healthy Nail Salon Recognition Programs (HNSRPs) across California and beyond the current five jurisdictions, the CaHNSC and Asian Health Services of Oakland (AHS) are currently sponsoring AB 2125 (David Chiu) which requires a state agency to inform local county and city governments across California about HNSRP guidelines, and to conduct activities to improve consumer awareness of these local programs.  AB 2125 passed the state Assembly and two Senate policy committees with overwhelming support. It currently awaits consideration in the Senate appropriations committee. One reason AB 2125 has received such large bipartisan support is that it involves an incentive approach to policy change; it calls for rewarding good behavior as opposed to penalizing bad behavior.

However, frequently, a legal prohibition or requirement is necessary and most effective to change behavior, but it is much more difficult to get the necessary support from both sides of the aisle in Sacramento for this kind of policy.

For example, cosmetics are woefully under-regulated as there is no requirement for cosmetic products to undergo pre-market safety testing.  Furthermore, manufacturers are not required to list ingredients on the labels of professional cosmetics. And the chemical components of the ingredient known as “fragrance” do not have to be disclosed to consumers.

Ideally, filling these three gaps in cosmetics policy would be a good starting point for some meaningful legislation.  In fact, such a measure was introduced in Washington, D.C. by U.S. House Representative Jan Schakowsky (D – 9th).  But proposals like this are unlikely to receive enough support given the current political makeup of the Congress and the ongoing influence of the chemical and personal care products industries.

From a wider lens view, other legislation that would positively impact nail salon and other low income women workers include establishing a single payer health system; overturning Citizens United; and a state measure reining in the cost of housing including rental rates.

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

CP: We have strived to bring the voices of local Vietnamese nail salon workers to policy debates.  When I hear their powerful messages as they enthusiastically advocate for safety and health in the workplace, I am reminded of why my Collaborative colleagues and I do this work. This year, during the course of our campaign for AB 2125, many nail salon colleagues and Collaborative member organizations representing the local Vietnamese community participated in lobby days and hearings in Sacramento.   It is deeply satisfying to see a largely immigrant community become engaged in the political life of America as a result of the Collaborative’s Leadership Trainings and other education and outreach efforts.

Me: In your opinion, how effective are community outreach efforts like the Healthy Nail, Beauty Salon and Barbershop programs compared to other forms of health education (e.g. presentations, one-on-one, small group, etc.)?  Specifically – reaching target audiences where they spend recreational time (in a nail salon or barbershop).

CP: The most effective outreach efforts rest on relationship-building to develop trust and common ground among parties.  Our work with the nail salon community and successful implementation of Healthy Nail Salon Recognition Programs (HNSRPs) involve ever stronger ties with nail salon workers and owners.  Outreach workers are generally native Vietnamese speakers and understand how to bridge cultural differences.  They make in-person visits to salons to get to know the individual workers and owners. Over time, they begin to tell salon owners and technicians about the Collaborative’s work and how to make nail salons healthier for themselves and their customers.  Salon workers and owners will be invited to trainings on safety, health, and labor law as well as community gatherings sponsored by the Collaborative. County or city staff responsible for HNSRP implementation also conduct on-site trainings at the salons and convene small group informational meetings at the Collaborative offices. All written materials and spoken word are offered in Vietnamese and English.  We also make sure we have fun – community members and Collaborative staff come together regularly to share food and stories about work life in nail salons.

Me:  What are the current needs in the Bay Area relate to social determinants of health (i.e. SES, poverty, access to care, transportation, safety, etc.)?  Ties to nail salon workers and their need to work at potentially unhealthy workplaces.

CP:  The cost of housing and the need for more affordable housing are critical social or physical determinants of health in the San Francisco Bay Area. Two of the ten most expensive residential rental markets are cities in the San Francisco Bay Area—San Francisco and San Jose.  The City and County of San Francisco (64%) and Alameda County (60.9%) rank the highest and 5th highest respectively when it comes to fair market rent as a percentage of single mothers’ median income.

Some of the highest rates of women working in low-wage jobs are in San Francisco Bay Area counties.  Almost 34% of women in Santa Clara County, almost 27% in Contra Costa County, and approximately 25% in Alameda County, work in low-wage jobs.

This underscores the importance of increased consumer awareness of working conditions in this beauty services industry and the need for nail salon workers and owners to receive fair payment from their customers for services like manicures and pedicures.  AB 2125, which would mandate a statewide consumer awareness program, would be an important contribution toward a generally more sustainable nail salon industry.