Friday, July 22, 2016

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.

Pre-mature aging represents a significant public health issue as the global population grows

Anonymous Interview; Region X (7/11/16)

1.     Identification:
         
          -What is your name? Anonymous
          -Where were you born? West Virginia
          -Where did you grow up? Eastern Tennessee (Rural Tennessee)
          -Profession currently: Gerontology; Run a charitable foundation that works with old folks;                    primarily rural communities
          -Region working in right now: We work near Appalachia Mountains; comprised of 7 states:                  Kentucky and West Virginia, Oregon and Central America (Nicaragua)
          -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?

Chronic disease is a public health issue, and I face this all the time when dealing with older adults. We explore the management of chronic disease. Not only is chronic disease genetic, but it is also related to socio economic factors which are now called social determinants of health. And since we deal with older adults, we would be interested in those factors while speculating on what does that mean going forward?

We have made a lot of strides within public health but not a lot of strides within chronic disease issues. Yes, we have worked a lot on younger health but not chronic disease. So the bigger question now is how we can support them later in life? On a last note, pre-mature aging represents a significant public health issue as the global population grows. Including right now- we are facing it right now in the US but we will face it globally within the next decade.

3.     What is health equity to you?

      Adequate access to health and social services for populations in all areas. For example, in the         rural areas they do not have health equity. Because they do not have access. Particularly those         who are not mobile. Means access and a provider system that understands the health related             issues of the population. So if you have a focus on particular disease, that excludes other                 subgroups then that is not equity. If one cannot get to services, that is not equity. Access and           knowledge system for the specific sub populations (characteristics: age, race, ethnicity) is               important. Equity: ability to address and provide to all populations.

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

          Access in rural areas because either people cannot get to provider or there is no provider.                     Haven’t really developed virtual medicine to the extent that we need to. Have not thought                    through how to increase access in comparison to where they are at. Populations in rural areas              are isolated. Another challenge is health education. Therefore, 2 specific problems that still                  persist in our system today is the lack of health education and rural health access. We simply                have fundamental access issues that we have not really resolved.

5.     Why do you think those challenges still persist?

There are 3 reasons why these challenges still persist:
a)     Money
b)     Based upon your political orientation. What is the role of the government both local, state and federal? A lot of opinions on that.
c)    I don’t think we have fully embraced how to use technology to increase access.

Ex: older people are wary of using nurse practitioners and physician assistants when probably in many cases for the management of chronic disease these people are the best people to do it. Also, licensing laws are not embracing how to increase access (specifically physicians). We are not doing a lot with technology and bringing awareness to the education people can receive virtually through virtual visits with physicians. Another issue is not sharing medical records readily either. All of these issues affect health care. We probably are not doing a lot of preventative care either. The system is still biased. In terms of treatment; active treatment versus active prevention.

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

I am a big believer in community health (ex: Promotora work). I feel that we can re-examine and look at the underlying issues with Promotora model, but I don’t think we have taken fully advantage of this model- particularly in areas where resources are scare.
We simply need to have:
     -Aggressive exploration of using technology for health care
     -Extension of Promotora program within communities
     -Full embrace of professional system that uses all community health workers in the health         system (ex: utilizing NP, PA, nurses, etc.)

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?

           There has been improved access from when I began 40 years ago. Definitely improved access              through Medicare and Medicaid. These programs were just being implemented when I was                  starting in the field. Another change that happened is that there is a grow in realization that                  decreasing length of stay in hospitals is ideal (not good place to stay when sick because                        probability of infection). There has been improved techniques and specialization within health            care and hospitals as well. We are routinely replacing joints, cataracts surgery in the same day              and so on. Technical deliveries are phenomenal. We are starting to understand how to treat                  chronic disease. But some issues that have risen over the years is that we don’t know how to                manage pain anymore. Patients over-utilize pain medication. There is also an over-dependence            on testing. We don’t support primary care physicians anymore. These physicians should be the            case manager for the patients (particularly in chronic disease) but that is not the case. We have            probably over-specialized and or over-glamourized specializations. People simply don’t have              the same doctor for many years anymore. A piece of paper does not understand the depth of                knowledge that a physician can know if they are consistently our doctor for many years                        (versus that one piece of health documentation).

"A healthy life" are Commodities in a Capitalist Socio-economic System

Lawrence Weiss Interview; Region X (7/18/16)

1. Identification:

-What is your name? Lawrence D. Weiss PhD
-Where were you born? USA
-Where did you grow up? USA
-Profession currently: Retired
-Region working in right now: Anchorage 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?

Public health interests me because it is often intensely political, deals with very real issues of interest to everyone, has a huge policy component, and the subject matter is very broad, and it often deals with the public sector on many levels as well as private sector.

3.What is health equity to you?

From the Health Equity Institute: 
Healthy People 2020 defines health equity as the "attainment of the highest level of health for all people." Everyone deserves a fair chance to lead a healthy life. No one should be denied this chance because of who they are or their socio-economic opportunities. 
This definition is a good place to start, in my view.

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

Many of the factors contributing to "a healthy life" are commodities in a capitalist socio-economic system, or are influenced by dominant socio-economic values conditioned by a capitalist system. All of this systematically works against "a fair chance to lead a healthy life" for all, regardless of socioeconomic status.

5.Why do you think those challenges still persist?

The dominant institutions in our society value money and profits over the actual, practical attainment of health equity. International comparisons with, for example, much of Europe, Canada, and Cuba give some insight to what this really means.

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

Not really sure what "your workforce" means in this context. Public k-12 schools have programs that tend to promote health equity. Community health centers (FQHCs) tend to promote health equity. Some public infrastructure and policies tend to promote a healthy life for all, but even here it is mitigated by the wealth of the community, public and to a lesser extent private programs to feed and house low-income persons promote health equity... A unionized workforce tends to approach health equity more effectively than a non-unionized workforce. 

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?

The socio-economic system is largely the same, but there have been some mitigating factors on both sides, however those factors weakening the attainment of health equity have been predominant. In the last 30 years the percentage of the organized workforce has plummeted, resulting is stagnant wages and declining benefits for health and pensions. Overall health of the nation has plummeted by international comparisons on most standard measures. The cost of health care, and health insurance, and pharmaceuticals in the USA is the highest in the world, while the health of the people has been declining in international comparisons. The trends are not good at all, because the key issues have not been addressed. Lots of PR and tinkering around the margins, but the dominant socio-economic forces run counter to the requirements of real health equity for citizens and residents in the USA.

Decades of purposeful discrimination...



Anonymous Interview; Region V (7/12/16)

           1. Identification:

              -What is your name? Anonymous
              -Where were you born?  Cleveland, Ohio
              -Where did you grow up? Cleveland, Ohio
              -Profession currently: Public Policy Consultant (Health)
              -Region working in right now: Midwest
              -State living in right now: Ohio

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

  My undergraduate degree is a BS Biology. My original ambition was to become a physician. After years of working on the clinical side of medicine, I almost naturally migrated into health promotion and disease prevention as a way of warning communities about the impact of lifestyle and the environment on health.

3. What is health equity to you?

Access to the resources and opportunities that allow for optimal health.

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

Many barriers are social economic and racially based. Many people hold the belief that certain groups of people are less worthy of the right to be healthy and have access to resources to do so.

5. Why do you think those challenges still persist? 

Social structure and attitudes that undervalue the lives of minorities, women and children.

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

None. Few organizations have the passion for the long-term efforts needed to address decades of purposeful discrimination. Some community based social movement are helping but have limited resources to have a full population impact.

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?


Root causes were mainly related to lack of access to prevention resources, and the lack of education concerning wellness and prevention. Those still exist. Schools focus less on teaching about and modeling healthy eating and activity living. Children have less active leisure time and thus are less fit.