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.
