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.   

We need to become more aware of unconscious bias

Anonymous Interview; Region X (7/15/16)

                1.     Identification:

                -What is your name? Anonymous 

                -Where were you born? LA Boy

                -Where did you grow up? LA; Santa Monica Area

                -Profession currently: Health Profession

                -Region working in right now: 10

                -State living in right now: Oregon

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

      Both parents were health professionals. Just figured it was a natural place for me to go. It seemed to be a natural way for me to give back.

3.     What is health equity to you?

      Doing the things that individualize care to help optimize health status. Doing the individual things specific to a consumer, family or community that helps level their playing field that helps them achieve optimal health and their health goals.

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

      People not knowing what it means, i.e., cultural competence -cultural awareness and cultural sensitivity. Just knowing what it is important. What s even more so is when people know why it is in their best interest as well as their client’s. Far too often, however, people see it as a zero sum game, that is helping one community at the expense of another.  But often we fail to see how effectively helping our clients is actually in the best interest of society and the professionals and organizations working on their behalf.

5.     Why do you think those challenges still persist?

      Miscommunication about the viability of human services. One side of the political aisle that would like to diminish public health and another aisle does not understand the full extent of health and related determinants. If you don’t have a life worth living, then personal health may not a priority. We have to get on the same page to promote health equity in ways that decrease health expenditures and increase satisfaction in life.

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

      Hiring, on boarding and orienting the correct people. Ensuring that everyone is ready for this. And while we desire and understand the value of a diverse work force, not just hire based on race, ethnicity or what they look like but their willingness to become  a health equity asset. Furthermore, we need to become more aware of unconscious bias. We need to be able to have the ability to work cross-culturally. This means doing your HW around different cultures and advocating for different groups. Getting people to understand the platinum rule is a lot of work. You have to ask, do your HW, and it varies from client to client.

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?

      Some root causes are people being uninsured or underinsured for generations and or unemployed or underemployed for generations. The concern for pursuing one’s health often competes with paying rent and putting food on the table. There is also the issue of the lack of access to providers.  Then they potentially face another issue of the providers not speaking their language and are not comfortable with them as a whole. On a different note, among the other issues include micro aggressions, biases, food deserts are impacting certain group of people.