Sunday, July 31, 2016

There is more diversity than before in leadership and decision-makers

Lorena Sprager Interview; Region X (7/19/16)

1.     Identification:

           -What is your name? Lorena Sprager
           -Where were you born? LA
           -Where did you grow up? Oversees; Brazil; Japan; Mexico: Moved to Texas when I was 14;                  dad was a film maker in the foreign service
           -Profession currently: Supporting the community health worker model; advocating and                         addressing health literacy and plain language for Spanish and English speakers
          -Region working in right now: Region 10
          -State living in right now: Rural Oregon

2.     Why are you interested in public health and how did you get into the field of public health?

There are a lot of justice issues and concerns that need to get addressed, such as access to health care and appropriate treatment. There are also issues like good housing, education, health opportunities, environmental health and justice, health literacy, or the Social Determinants of Health.

3.     What is health equity to you?

Its hard to pin it down but the best way to put it is “ensuring that the diversity of our communities is supported to be at the decision making table”. It’s important to address through representation racial and ethnic diversity, also economic diversity, gender diversity, educational diversity and others.

4.     What are some challenges (that still persist) within the field of health equity in public health?

There are a lot of grave injustices related to social determinants of health. I think one of those challenges that still persist is, again, the lack the lack of representation and decision making voice of so many in our nation. This is unacceptable.

5.     Why do you think those challenges still persist?

The people who have education, economic, gender, racial and ethnic privileges are pre-dominantly top decision makers in systems. And our systems are inherently oppressive.  There is a lack of recognition as to the inherent oppression in our systems. For example, there is a high level of color-blind racism, blindness to economic bias, educational bias, gender bias, as well as ethnic, racial and cultural bias.

6.     What models within your workforce have worked to encourage health equity?

One of the models that has encouraged health equity is the Community Health Worker (CHW) model. Community Health Workers are leaders and respected members of their community. They work together to support their fellow community members and empower each other.

One concrete example is Providence Hood River OASIS Palliative Care where I work.  We have one of the only programs that has integrated a CHW into the palliative care team of medical providers, social workers and chaplains. Our goal is to promote access to and appropriate care in palliative care to the Latino community in our rural service area.  

Another model that I really like is the Nuestra Comunidad Sana model of The Next Door, Inc. where I also work. We are a nonprofit health promotion program that has a non hierarchical structure. Here, we really work as a team. Each of us holds unique skills and brings something to the table. This structure encourages equity, even among our own staff.

On another note, I work as a health literacy and plain language consultant primarily in Spanish language, and also English language. I’ve recently been promoting a new national standard for health materials translated from English The Culturally and Linguistically Appropriate Services (CLAS) Standards are very important: https://www.thinkculturalhealth.hhs.gov/content/clas.asp  They The model I’ve been encouraging with my co-author, Dr. Octavio Martinez, is about promoting a new national standard and taking us beyond the CLAS Standards once they have been met. Translation almost consistently results in immediate disparity and inequity because the translation tends to be more complex than the original document. So after a high quality translation, it is important to do a plain language adaptation to the translated material.

When translating, it is also important to make sure motivators are culturally appropriate.  Ideally, in the United States, we would want to at minimum meet the CLAS Standards.  To be truly equitable we need to speak to the diversity of our nation and not in the voice of the dominant culture. Most of us cannot see our own biases. This is because each and every one of us sees the world through our own lenses. It’s important to learn how to step back and recognize our biases. The it’s important to address if we are being inclusive. Me included.

7.     At the beginning of your career, what were some root causes for health inequities and health disparities? How has those changed (or not at all) following the end of your career?


Sadly, root causes are still very similar. There hasn’t been a significant amount of change. Even though its sad how similar it is now to how it has been in the past, there have been some improvements. There is more diversity than before in leadership and decision-makers, but we still have a long way to go. The first step is to acknowledge there is a problem. There is a lack of acknowledgement or awareness in our leaders that there is even an issue- and I think the lack of awareness is related to privilege.

Friday, July 22, 2016

Education and Poverty


Andrea Fenaughty Interview; Region X (7/22/16)

1.     Identification:

           -What is your name? Andrea Fenaughty
           -Where were you born? Bridgeport, CT
           -Where did you grow up? CT & FL
           -Profession currently: Chronic Disease Epidemiologist
           -Region working in right now: Alaska
           -State living in right now: Alaska

2.     Why are you interested in public health and how did you get into the field of public health?

 My background is applied social psychology. My training and research focus was always on issues that related to the public’s health, such as HIV infection. After working as part of a research team on HIV risk behavior at the University of Alaska Anchorage for a number of years, I came over to the state to use my analytical skills to work on injury prevention, and chronic disease prevention. My very first project was to do a large analysis of injury disparities in mortality and hospital discharge.

3.     What is health equity to you?

That everyone has an equal opportunity to obtain and maintain optimal health.

4.     What are some challenges (that still persist) within the field of health equity in public health?

People really struggle with figuring out how to incorporate the concepts of health equity into programming decisions. I think the measurement piece is solid—the people I work with certainly understand the value of identifying disparities and health inequities. But if the root cause of those is poverty or another social determinant of health, that feel outside the scope of what people’s skills and expertise is.

5.     Why do you think those challenges still persist?

I think the issue I described above is a large, complex one. Until there is a solid set of best practices that people can see their role in, progress will be slow.

6.     What models within your workforce have worked to encourage health equity?

I started a small cross-program working group in our Section, with the modest goals of increasing awareness of the issues related to health equity and increasing our sharing of information related to how we see health equity in our work. We incorporated the CO framework into a health equity training we developed, tailoring examples to work our Section was actually doing. This training was modified for the Alaska Division of Public Health.

7.     At the beginning of your career, what were some root causes for health inequities and health disparities? How has those changed (or not at all) following the end of your career?


Well my career hasn’t ended yet, so I can’t say. I think because I was focused on different health issues earlier in my career, some of the root causes were a bit different. Root causes for health inequities in HIV risk in drug using women were associated with race and power. Root causes of inequities in many of the chronic disease risk factors we monitor appear to be related to education and poverty. Race also, but that is probably more a marker of other determinants.

Health is a Symptom

Anonymous Interview; Region X (7/22/16)

1.     Identification:

           -What is your name? Anonymous
           -Where were you born? Glen Cove, NY
           -Where did you grow up? Glen Cove, NY
           -Profession currently: Assistant Professor of Health Sciences
           -Region working in right now: Alaska
           -State living in right now: Alaska

2.     Why are you interested in public health and how did you get into the field of public health?

I like working with communities to develop capacity to solve problems on their own.  There are many proclamations of expertise and self-importance, but communities have all the tools they need to address most if not all public health problems (or at least the ones I’m interested in). I am a medical anthropologist by training and landed in public health almost by accident. Did a post-doc at the Institute for Circumpolar Health Studies and it directly led to my current position. Never would have imagined I would land in a Health Sciences department. I have a background working with people who experience disabilities, both as a direct service professional, care coordinator, director, and (more recently) researcher. Also work with people experiencing homelessness, mental health and substance use disorders, and youth.     

3.     What is health equity to you?

Still trying to figure that out. Unencumbered access to healthcare. Health inequities are social inequities at the core. Health is a symptom.

4.     What are some challenges (that still persist) within the field of health equity in public health?

The industry of public health relies on disparities to keep itself relevant. There is a lot of lip service about serving people and communities but oftentimes researchers in particular are only serving themselves.

5.     Why do you think those challenges still persist?

Because health inequalities ultimately have nothing to do with health.

6.     What models within your workforce have worked to encourage health equity?

 Not sure what this question means.

7.     At the beginning of your career, what were some root causes for health inequities and health disparities? How has those changed (or not at all) following the end of your career?

Much of the world’s problems are linked to economic inequality and structured differences in life opportunity. This has not changed as long as I’ve been in the field.