Tag Archives: Washington DC

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.

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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.

Behind the Scenes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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