Joseph F. West, ScD

OriginalIntroduction

After graduating from the University of Illinois, Dr. Joseph West worked in child welfare for two years, where he grew frustrated and decided to pursue a PhD in Sociology.  He was en route to a Master’s in Sociology when he worked on the Project on Human Development in Chicago Neighborhoods, where he met Dr. Felton Earls, a professor in Public Health and Social Medicine at Harvard.  Dr. Earls convinced him to switch paths to public health, and became a key mentor as Dr. West became the first African American to obtain a doctoral degree from the Harvard School of Public Health.  Since then, Dr. West has conducted research in numerous areas including smoking cessation and diabetes.  He has also written and produced several plays including Suga Foot Blues, and the memoir Trod the Stony Road.

Career in Profile:

  • 1994 – Graduated from the University of Illinois Urbana-Champaign with a Bachelors in Sociology and a minor in Economics
  • 1999 – Completed his M.Sc. in Health and Social Behavior
  • 2004 – Completed his Sc.D in Social Epidemiology and Health Policy from the Harvard School of Public Health
  • 2004-2006 – Worked as a researcher on the California Foster Care and Chicago Housing Project Study at Chapin Hall Center in Chicago
  • 2006-2007 – Worked as Project Director at the Center for Study Cultural Diversity in Healthcare at the University of Wisconsin Medical School. Studies included the Neighborhood Disparities Project and the Milwaukee Infant Mortality Project.
  • 2007 – 2013 – Served as senior epidemiologist and project director at the Sinai Urban Health Institute. Work included the Block-by Block Diabetes Community Action Project and the Breathing Freedom Smoking Cessation Project.
  • NOW –  Senior Partner at Whitaker Kinne Group

So how did you end up in public health?

After undergraduate at University of Illinois, I spent two years doing child welfare work transitioning young people involved in foster care to adulthood. I got frustrated with that and I felt that I needed and wanted to go back to graduate school. I wanted to get a Ph.D in sociology and was actually taking classes at Roosevelt University in the evening, studying sociology towards a master’s degree, and then I started working on the Project for Human Development in Chicago neighborhoods.

I was working there during the day, I was going to school at night and that’s when I met Dan Kindlon (sic), Steve Buka (sic) and Dr. Earls. Tony Earls, after a conversation about what I wanted to do and study, he said, “You are not a sociologist, you are an epidemiologist”. I didn’t know what that was, and he said,  “Public health is going to be the key for you”,  and he introduced me to Dan Kindlon, who was part of the project, and wrote that book Raising Cain, that became really popular after the Columbine shootings. Then to Steve Buka, that whole group! So I applied to all these graduate schools and I didn’t get into any except to Harvard.

When I got there I realized why I got into Harvard. It was an eye opener about the graduate process for a Ph.D. It’s a subjective process. I got in because of Dr. Earls. He not only wrote a letter of support, he and Steve, all of the HSPH guys who were working on the PHDCN project wrote letters. They said that this school had not graduated an African American out of the doctoral program and that they would support me. They said I’ve been a part of this project, I’ll have my own data and that they think I should get in. That’s what happened, at least my understanding of it. They made it clear that they were going to mentor me. That was my first introduction to the idea of a mentor and how important mentoring is. Because even though I thought I had the scores and the experience, it was the idea that I was going to continue to work with these scientists that are respected in the field and that they were also willing to allow me to explore some of my own interests while in Boston that led me to public health.

What was working on that project like?

It was incredible.  Field research and collecting data in the field is tough. Its funny because now I am the director of a project where I have people go out to do just that. So I understand what they do because I did it for a year.  Its interesting because when you are in people’s homes, not only are you collecting data on the questions that are on the protocol, you are also collecting data based on your interaction and experience with them in that moment.  I was one of the few research assistants that actually did that.  There were people who went into the homes and only asked the questions and circled the boxes on the list, even though at the end, at the back of the protocols there were all these pages with space for notes. People didn’t write down information about what they were seeing and what was going on and what was happening in the house etc. They didn’t do any of that, but I did. I would try to fill up mine, because there was a lot that I thought was relevant in that home or in that community that was beyond the questions and the boxes. With my team now that’s the hardest thing to get them to do. I try my best, but my team is guilty of that.  They don’t feel comfortable writing it and they don’t feel comfortable commenting. I say all this to say that I realized then that I wanted to do more. I wanted to do more than just to collect the data, I really wanted to do more.

What is one of your greatest career challenges?

Finding the time to write.  Whereas some people can analyze a large dataset and then write, I have to interact with the community or with my team on a daily basis. It’s challenging to block off time to write. I’ve also had to learn to speak to different audiences and to different issues.  My greatest challenge has been putting together my body of work.  I’ve found my stride.  I know exactly what I want to write about and where to build my research. I’ve started another book and I’ve got my focus. I feel a bit of pressure because of my age.  I may not have reached some of my personal benchmarks, but I have reset them, and I want to really reach those goals. If you don’t outline your career steps right now, you will probably bounce around, and will not build a cohesive body of work. I want to build a coherent body of work and continue to grow.

What is something in your career that you feel really proud of?

My diabetes work.  I got the grant funding and started working in the community through the Block by Block project, and there’s been some spin off.  We’ve been able to fund other activities in the neighborhood, to start a dialogue about diabetes and food.  We can engage the community around these issues.  In the Lawndale Diabetes Project – a follow up of the Block by Block project – we train health educators to go door to door within the community.  They talk with residents about diabetes, provide basic guidance around diet, exercise etc.  After we work with people to get them advice and support, they can be turned over to disease management and then follow up with doctor appointments etc.  So now, I’m at that point in my career where I have enough, in terms of ideas and experience, to really produce.

I am fascinated that you’ve written a book that is not entirely public health related, and that you are also producing plays that seem public health oriented. Can you talk about those projects?

By my understanding, I was the first African American male to obtain a doctorate from the Harvard School of Public Health.  I wrote Trod the Stony Road to try to make sense of my journey.  I live in the community where the Lawndale diabetes project takes place.  I also lived in East St. Louis, a pretty challenged community.  I had a brother who used to be in and out of prison.  So how does a kid come from this type of background make it all the way to Harvard?  I talk about all the things that I went through, from an attempted suicide when I was 13 to having a gun to my head, and then I talk about grace and my sense of space.  That I was spared for a reason, or maybe for some kind of purpose, was something I needed to make sense of.  I felt like I was just stumbling forward, trying to make sense of it all. That’s why I wrote that book.

As an undergrad I did a lot of theater, and I’ve realized that my creative side is just as important as my scientific side. I like to write!  I’m doing diabetes scientific work, and that’s what for one audience.  But there’s another audience that needs to understand the human side of diabetes.  Suga Foot Blues is the story of a female dancer who has Type II Diabetes. She hasn’t taken great care of herself, so she is going to lose her foot. We all know all the clinical issues that come with poor management of Type II Diabetes … but what about when she goes home and has to deal with the emotional issues?  What happens in that home?  Because it’s not just her, she has a family and they have to deal with it, too.  It’s how I take my day-to-day profession and turn it into art.   It is about the healing power of art, theater and the spoken word; it’s about how you take relevant, quantitative, quantifiable data and translate it into art.

So when it comes to public health, what matters to you and why?

Public health really is about human development and what people need to learn early in life.  Adult behavior change and learning is difficult, even things like washing your hands are difficult. Our relationship to food, our cultural rights and rituals with food…a lot of people are not connected. There are a lot of social networks but people are not connected. We have a culture that promotes recklessness with each other and with our selves.  We all struggle with learning.

Many of the poverty-related health issues relate to lack of empathy and understanding.  It’s not strictly economic.  Before diabetes, I worked on a smoking cessation project where we tried to reach out to young pregnant girls. Most were exposed to large amounts of second hand smoke.  Their challenge was that they didn’t have a place to stay, so they might be with their parents or grandparents, and say their mother had a boyfriend and they both smoked.  “I can’t tell them not to smoke just because I’m pregnant, because they’ll say, ‘You’re the one that’s pregnant, you move.’  Or maybe her boyfriend is really abusive and she can’t tell him to not smoke.  You realize that there are people that don’t have empathy for her or her child’s health. That’s not racism! That’s not poverty! That’s a lack of human development and empathy.

Our diabetes project has a cooking class, and one participant said that when she tried to cook a really nice meal and serve with right portion sizes, her family looked at her like she was crazy.  “I’m supposed to eat this little bit of food?  You are supposed to fill up my plate.  You’re the one that has diabetes, not us!”  If people aren’t supportive, what can you do?

Policy makers also lack human development and empathy.  They create policies without understanding how those policies impact people’s lives.  We have illiterate policy makers and legislators. They can read what’s written, but they can’t understand the human condition.  There’s a gross degree of lack of understanding on both sides of the aisle.

So what is your ideal solution?

That’s a challenge. We have to start on both ends.  We have to engage people at a grassroots level to talk about their own health, well-being, community, family.  I see so much fragmentation and brokenness in communities now.  We have to think about how we can be connected together.  At the other end, we have to get politicians and policy makers and legislators to have honest discussions about policy.  We have not had a truly honest discourse about policy.  Everything is a sound bite, and you can’t grow on a sound bite.

Angela Reyes, MPH

AngelaReyes Angela Reyes is a dynamic leader in the Latino and Southwest Detroit communities, where she grew up.  She is the founder and Director of the Detroit Hispanic Development Corporation (DHDC), a youth violence prevention and gang retirement organization located in neutral gang territory in Southwest Detroit.  She started DHDC in her living room, when she helped to form a truce between the leadership of several rival gangs and negotiated the release of gang members in exchange for jobs.  Today, DHDC offers a range of programs, including GED basic education, retired gang member re-entry, tattoo removal, English language training, after-school and summer programs for children at risk for gang involvement, and a parent leadership and advocacy training program to address issues such as education, immigration, environmental justice and health.  Angela also collaborates with other leaders in the Latino community to address community- and systems-level change.  Young people are Angela’s and DHDC’s motivation and teachers.  Angela marks success in violence prevention initiatives at the DHDC by the number of graduations she attends each year, which now exceed the number of funerals she attends.  Her leadership and innovation in the areas of violence prevention and issues that face the Latino community make her an obvious public health hero.

Career in Profile:

  • 1986 – Wayne State University, BA in Political Science
  • 1986 – 1997 – Director of Youth Services, Latino Family Services
  • 1987 – Present – Trainer and consultant for community collaborations, community-based participatory research partnerships, and issues related to youth violence and gangs
  • 1997 – University of Michigan, Masters of Public Health, Health Management and Policy
  • 1997 – Present – Founder and Executive Director of Detroit Hispanic Development Corporation

How did you come to do this work?

Most of my career I’ve worked with youth.  I’m the second of ten children, so I grew up working with youth in one way or another.  I began my career running summer programs in this community.  When I was a teenager, we only had summer youth programs.  When I was 19, I organized a meeting with community leaders and groups to establish year-round youth programs.  That was the beginning of the year-round youth program at LA SED (Latin Americans for Social and Economic Development, a non-profit organization in Southwest Detroit).  Actually, Southwest Detroit has some of the most – in terms of number and quality – youth programs in the city, due to our long history of working in this community.  I started DHDC after years of youth work at multiple organizations, including 12 years as Youth Director at Latino Family Services.  Youth work was my core.

While I was still at Latino Family Services, I met several people from the University of Michigan School of Public Health.  They told me that the work that I was doing was really public health – I was doing violence prevention, substance prevention, HIV prevention, drop-out prevention.  They said, “That’s public health.”  I’d never heard of public health.  They recruited me into the University of Michigan in the On Jobs-On Campus Program, where I went through a 24-month public health boot camp to get my degree in public health in policy and management.  The program gave me the solid, broad training to do my current work – not just direct service, but also the administrative piece.  I was midway through that 24-month training when I left Latino Family Services and started DHDC.

What are some of your best career successes or career highlights?

I don’t know that I think much about my career highlights.  I guess I’d have to say establishing DHDC, and growing it for 15 years now – we recently celebrated our quinciñera, with dinner and dancing.

Seeing young people be successful is my career success.  None of this would be worthwhile if the young people and the parents weren’t successful.  We’ve had some parents who started out really shy – almost scared in some cases – who now hold leadership positions.  Some who were citizens, some who became citizens, and some who have gotten jobs in leadership positions and have made tremendous strides and are now leaders in their own right – both parents and youth.  I think those are the biggest accomplishments, more than a building or degrees.  It’s those relationships.

I’m also proud to have taken a leadership role in moving the Latino agenda forward.  The Latino community in Detroit has been invisible until this point, but we’re creating a movement in our community which is very unprecedented.  It’s really changing.  We’re being a voice and getting recognized.  I think that is a really significant thing that I have been able to play a piece in.

When it comes to public health, what matters to you and why?

Working on the issues of racial equity and health disparities.  Those are systemic issues that have had long-term impacts on this community, and they are the underlying causes of a lot of public health issues.  Addressing those systemic issues means that we won’t have to do the same work over and over again.

What are some of our most pressing public health challenges?

Education.  The Detroit Urban-Academic Research Center is helping parents and youth become leaders, because education and health are intricately related.  One of the biggest determinants of health status is education and income.  The environmental factors are some other challenges in this community, like when the government builds more bridges to Canada and increases truck traffic.  It can feel overwhelming to try to address these challenges, because there are so many forces pushing for these changes that don’t factor in the health of the community.

Youth violence is another issue.  In particular, having the needs of the Latino community recognized and addressed.  Some people forget that we are 12% of the population in the city now.  In the past, we have been 3% [of the Detroit population], and people are still operating as if we were 3%.

Immigration has tremendous implications for health access to services.  Let me use HIV services as an example, because we do HIV testing and counseling as well.  People are afraid to get tested because they may not be eligible for citizenship if they test positive.  They’re really in the shadows.  We suspect there’s a large HIV-positive population that has not been uncovered yet.

What do you think it will take to address some of these challenges? 

Partnership and collaboration.  For example, with the Latino agenda and the systemic issues that we’ve started to address, we’ve been very intentional about creating stronger relationships with other communities, particularly the African-American community.  In this area we also have a large Arab- and Native-American community, and we’ve also worked with the White community and other allies that have similar interests.  Truly establishing those partnerships is probably the only way we’re going to survive and succeed.

Anthony Iton, MD, JD, MPH

Tony Iton croppedDr. Iton’s commitment to improving the fundamental conditions of people’s lives is profoundly shaped by contrasting his experience of growing up in Montreal, Canada to the inequities he witnessed in the United States, when he moved to East Baltimore, Maryland to attend medical school.  He found it problematic that health-promoting resources such as health care, childcare, and higher education were available to everyone in Canada, whereas he attended a world-renowned medical school that was situated in what he calls “one of the worst slums in America”.  Boldly implicating power dynamics in the United States and working in partnership with communities to address structural poverty and institutional racism, fundamental factors that affect health, Dr. Iton is a clear public health hero.   Currently, Dr. Iton is the Senior Vice President of the Healthy Communities initiative at the California Endowment.   In this role, he and the Endowment partner with 14 communities in California to identify key priorities and to develop strategies with communities to design interventions and policy and systems change to make interventions more sustainable.  Working in partnership with residents of low-income communities, Dr. Iton describes his work and partners as humbling, inspiring, exciting and fun.  Summing up key players in efforts to eliminate health inequities, he explains, “it’s really about community and community’s selfless efforts to enhance other people’s lives, not just their own.”

Career in Profile

  • 1981-1985 – Studied neurophysiology at McGill University
  • 1985-1989 – Attended Johns Hopkins Medical School
  • 1989-1990 – Intern at Cornell Medical Center/New York Hospital
  • 1990-1993 –  Attended the University of California, Berkley, Boalt Hall School of Law
  • 1993-1994 – Staff Attorney/Health Policy Analyst, Consumers Union
  • 1991-1996 – Primary care physician and advocate for the homeless, San Francisco Department of Public Health
  • 1996-1998 – Preventive Medicine/Public Health, California Department of Health Services
  • 1998-2000 – Chief Resident, Yale Health System/Greenwich Hospital
  • 2000-2003 – Director of Health & Human Services for the City of Stamford, Connecticut and Internal Medicine Physician, Stamford Hospital HIV Clinic, Stamford, CT
  • 2003-2009 – Director and Health Officer, Alameda County Public Health Department
  • NOW – Senior Vice President for Healthy Communities at The California Endowment

 

You are very open about the role of power dynamics and power differentials in posing a barrier to addressing structural influences on health inequities.  In contrast, others in the area of racial and ethnic health inequities may not implicate power as a key cause of persistent health inequities although they definitely recognize that in their work and in their approach.  Can you speak a little more about how you have come to understand these power dynamics and your approach to addressing this and why speaking so directly about it matters to you?

In my mind, we have everything that we need to know about what improves people’s health.  We know people need to exercise.  We know people need to eat healthy.  We know that they need to have access to health care, particularly preventive health care.  We know they need to have meaningful work and purpose in their lives.  All of these things are known.  It’s not like this is a mystery.  We have so many people that are suffering from preventable illness because we don’t care enough about those people.  We think that those people are less valuable than other people, because we have a national history of systematically devaluing certain populations.  You don’t have to be a rocket scientist to see that we created an apartheid regime in this country that separated people by race and skin color and ethnicity.  It systematically devalued their contributions and their ability to participate in processes.

When you walk into a place like East Baltimore and try to understand how this came to be, it doesn’t take very many steps to get to racial segregation.  It’s stupid to pretend that just because segregation is now illegal, it doesn’t have a legacy.  It lacks any form of critical thinking.  So, if you acknowledge that there is a legacy to these past practices, and these past practices were based on a systematic devaluation of certain people based on their race or their skin color or their disability status, their immigration status, their sexual orientation – you name it – you recognize it plays out in policy to steer opportunity to preferred populations and away from despised populations.

Historically, the only way ever this changes is through a change in power dynamics.  People do not yield privilege voluntarily.  It has to be taken from them, through democratic processes designed to facilitate the sharing of power and the sharing of resources. I often refer to this work as “optimizing democratic processes,” because democratic processes are about balancing power.  They’re just not working very well, in part because people with power are able to manipulate them.  The only way to balance the scale is to organize people and marshal their collective power, within these democratic processes, to advocate for a different set of priorities and a different approach to sharing these resources.

This is about power.  People need to understand what they’re looking at.  People can dance all they want around this, but at the end of the day, if you’re serious about being effective in eliminating health disparities, then you have to understand the root causes of health disparities.  The root causes of health disparities are power differentials that are rooted in present and past practices, as well as the legacy of those past practices.  I don’t know what else to do to try to undo this.  If you are serious about eliminating health disparities, yet you refuse to acknowledge the legacy of discrimination and segregation and the apartheid nature of this society that has differentially denied people access to basic resources like parks, grocery stores, decent schools and jobs, then honestly, I don’t know what you’re doing.  It’s not eliminating health disparities.  That much I can tell you.  It may be something, but it’s not eliminating health disparities.

People sometimes pose this as white against black, white against brown, or gay against straight, or whatever.   That’s not the right frame.  I think the majority of Americans are essentially dispossessed of political power.  As a result, white middle class Americans are unhealthy.  It boils down to the stresses that people have to experience, on a day-to-day basis, to get from A to B.  The commutes that people have to get through to their work, the fact that people have to worry about losing their health insurance if they lose their job or if they quit, the fact that it’s very difficult to afford to send your kid to college, the fact that finding decent child care is ridiculously expensive and inaccessible – all of these things are stressors in the lives of lower, middle, and upper middle class populations.

We have created this hyper-individualistic society which is fueled by this notion that government doesn’t matter and that the private sector will solve all problems.  As I see it, the evidence speaks very much to the contrary.  If you look at the health of middle class Americans compared to the health of wealthy Americans, you see life expectancy gaps on the order of 3 to 5 years.  In terms of life expectancy, our wealthiest do about as well as Britain’s poorest.  And I’m talking about whites.  It’s absurd to argue that somehow our system is working for people’s health.  The data say the exact opposite.  It’s not just about race.  It’s also about the stressors that we expose people to, ones involved in pursuing basic life resources that we all need to be healthy.

On that notion of there being so much more to do, can you talk about some of the pressing public health challenges related to the work that you do and what you see as the work that remains to be done?

The challenge that remains is the elephant in the room: the health care delivery system, and everyone’s fascination with trying to modify because they believe it is the vehicle for improving the health of this country.   Reality suggests that even the highest performing health care delivery system is not going to make much of a dent in persistent health disparities and health inequities.  I got into this work around health insurance and universal health care.  That was once my passion.  I still think it is important, but for other reasons.  As I mentioned before, the stresses that people have to live with are the root causes of health disparities.  The further down you are on the economic totem pole, the greater the amount of chronic stress you have to deal with.  Access to health care is a contributing stressor in this society.  So, if we can largely eliminate that stressor by facilitating people’s access to health care in a more reliable fashion, we will have done a good thing for people’s health independent of access to the doctor.  I think it’s just going to relieve people’s stress.

I think it will also allow people to refocus their energies on these larger questions about inequity.  I think that the election of Obama has done that.  It’s been a resounding, declarative statement that progress is about creating a more inclusive society, not a less inclusive society.  The notion of extreme individualism, us-versus-them thinking, has been rejected.  There’s no way forward with a dynamic of “the privileged” and “the not privileged.”  Those are the big challenges.

If I had to sum it up, the big challenges that remain are the core systems that determine people’s life chances.  Which include the education system, and what communities physically look and feel like – undoing segregation, redlining, and the concentration of poverty.  Those are the things that hold people back – being concentrated in adverse communities that are depleted of resources and educational systems that don’t facilitate a path out.  Those are the big challenges for the 21st Century.  They’re also competitive challenges for this country.  Other countries recognized this long ago, and they made investments in their educational systems.  They invested in systems that facilitate more equity at the community and place level.

All of those things (segregation, poverty) are not within the control of individuals.  They’re within the control of society.  Societal decision-making processes that are essentially askew in this country.  That’s the question for public health: to understand why they’re so askew and what do we do about realigning them?  How can we redirect our focus towards policies and practices that make it difficult for whole communities to participate in society?  That’s the challenge of public health: to ask the right questions and to stop chasing everyone down with brochures to try to change their behaviors.

Renee Canady, MPA, PhD

RBC Interview photoDr. Canady’s public health career reflects her longstanding commitment to address racism and promote health equity through research, health promotion interventions, and in her current role as Health Officer for the Ingham County Health Department in Michigan.  Her commitment and courage in addressing racism as a root cause of health inequities, combined with her long history of collaborating with community partners and other public health organizations, make her an obvious public health hero to highlight.  She has led initiatives to identify, acknowledge, and address the influence of racism on health department policies and procedures, which may contribute to racial and ethnic health disparities.  Dr. Canady also serves as chair of the Health Equity and Social Justice board for the National Association of City and County Health Officers (NACCHO).

Career in Profile

  • 1983 – Majored in zoology (B.S.) at University of North Carolina
  • 1984 – Majored in public health (B.S.P.H.) at University of North Carolina
  • 1984 – 1986 – Assistant Area Director, University of North Carolina, Department of Residential Life
  • 1987 – AIDS Education Coordinator, Ingham County Health Department, Communicable Disease Control Unit
  • 1987 – 1989 – Adolescent Health Coordinator, Ingham County Health Department, Adolescent Health Services
  • 1989 – 1992 – Health Education Coordinator, Michigan Department of Corrections
  • 1992 – 1994 – Supportive Services Specialist, Michigan State University College of Nursing, Office of Student Affairs
  • 1993 – Master of Public Administration (M.P.A.), Western Michigan University
  • 1994 – 1996 – Assistant Director, Michigan State University College of Nursing, Office of Student Affairs
  • 1996 – 2005 – Director, Michigan State University College of Nursing, Office of Student Affairs
  • 2001 – Ph.D. in Medical Sociology, Michigan State University
  • 2005 – 2007 – Assistant Professor, Michigan State University
  • 2007 – Present – Associate Professor, Adjunct Appointment, Michigan State University, College of Human Medicine
  • 2007 – 2011 – Deputy Health Officer, Public Health Services, Ingham County Health Department
  • 2011 – NOW – Health Officer (Director), Ingham County Health Department, Lansing, MI

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There seems to be a social justice element in your work that doesn’t always come through in the work that others do in public health.  Can you talk about your inspiration for social justice?

Interestingly, the history of public health – as a discipline and a field – was birthed out of social justice.  We have many past accomplishments where public health played an integral role in policymaking, such as child labor laws, and other labor and workforce requirements like OSHA (Occupational Safety and Health Administration), health and safety for employees, the average work day.  Since that time, we have gotten caught up in the categorical funding established by our federal government.  Those are important, but in many ways, we have almost lost the creativity in how we do things that are vitally important to the health of our community, but don’t happen to have a categorical funding stream.  That’s where I often say that health equity/social justice is not so much the what we do, but it’s the how and the why we do it.

So, we happen to be a local health department, which because of prior grants, relationships, and community engagements, is positioned to carry this banner to transform public health back to its social justice health equity roots.  How do we stop dealing simplistically with the fact that infants are dying?  From the perspective of this mom who’s pregnant today, how do we ensure that she is going to have a healthy outcome? By starting to deal with the context of that mom’s life before she even conceives!  What’s happening in our community? What true accessibility do people have? What are we doing to make sure that there is an equitable distribution of the resources that people need to maintain their health and wellness?  We know that right now we don’t have that.  We know that there are communities, regions, sectors, hot spots – based upon the numerous ways that we geocode and map – that have higher rates of obesity and morbidity.  We know that life expectancy varies based upon where you live.  When we map life expectancy by zip code, we see differences between communities.

We have to be less short-sighted as public health professionals.  We have to begin to look at the “causes of the causes.”  That requires a social justice lens – a health equity lens.  Margaret Whitehead has an important definition of health inequities.  She describes them as being unfair, unjust, and actionable.  Sometimes people say, ‘that’s just so big – I can’t do anything about poverty.’ No, we can do something about poverty!  And we can certainly pool our social capital and access to policy makers.  We have to tell our public health story differently.  Otherwise, we’ll continue to get grants to educate pregnant moms about how to have a healthy pregnancy.  That can continue on ad nauseum if we don’t also, while we’re working with those pregnant moms, deal with the structure of their lives, and talk to policymakers.

In our efforts at Ingham County Health Department, as related to health equity and social justice, we have the position ‘Coordinator of Health Equity and Social Justice’.  We have the position ‘Environmental Justice Coordinator.’  Those titles are all very intentional.  When I came on board six years ago, the Health Equity and Social Justice Coordinator had the title of ‘Access to Care Coordinator’, but I wanted to bring a broader, more comprehensive acknowledgement of his work (in this case, it was a ‘he’).  We began to be very intentional about the words that we use.  We wanted to shift the thinking within our local health department.  At the same time, our regional and a national leader began to get public health re-engaged and re-empowered to address not just the social determinants of health, but the injustices that are found within the social determinants of health.

Which career highlights are you most proud of?

One accomplishment is my department’s implementation of a comprehensive workshop that addresses public health and health equity.   We have done a lot of education and workshops, we use facilitated dialogue to learn about and then disseminate information regarding health equity and social justice.  At this point, the majority of our staff have been through the workshop.  Now, we are often asked, “What is the next step we should take?”

We believe that dialogue is action.  It is a verb.  People often ask, “Why are we just talking about this? Why don’t we do something?”  Well, if you talk strategically and in a way that is designed to produce outcomes – which is the heart of dialogue – that is doing something.  We’re looking at our next level of implementation.  It’s a partnership between the community organizing field and the public health field.  It thinks about how both sectors can wield power in a way that benefits both the constituents that public health serves, and the residents for whom community organizers advocate.  We’re part of this national innovation because of our experience and reputation, and because I have been privileged to serve as the chair of the National Association of County and City Health Officials Health Equity and Social Justice Committee.  And so the work continues!

I am especially proud of our successful grant writing.  I remember, as a graduate student, learning about the Nurse-Family Partnership, which is an evidence-based model for reducing infant mortality and preterm deliveries among the most at-risk, vulnerable moms.  We were successful in positioning our department to gain funding for this program this year.  We are now in the process of implementing a Nurse-Family Partnership initiative.  In addition, after three years, one resubmission, then twiddling our thumbs when the federal government did not offer any funding, and then a final successful re-submission, we were able to bring another federal initiative into this community, the Healthy Start Program, which also addresses infant mortality.  I am grateful that we have brought a number of resources to the community.  Our selection as a one of the few recipients of the Pew Charitable Foundation/Robert Wood Johnson grant to expand Health Impact Assessment is extremely gratifying.  We do our work in community and with community, through a health equity lens.  We look forward to seeing some changes in the trends and statistics for our community.

When it comes to public health, what matters to you and why?

I think partnership matters.  I describe myself as a relationship-driven person.  I believe that everything that we accomplish comes through  and out of relationships.  For example, I remember when we received word of two parallel opportunities: the IRS required local health systems to complete a community health assessment (to show community need for their services), and our department was notified about a national accreditation process through the Public Health Accrediting Board.  Each called for community health assessments.  As the local Health Officer, I could have easily done a local community health assessment.  Similarly, our hospital partners are high capacity health systems – they could have done a community health assessment.  But instead, we came together and cultivated a regional approach, seeking collective impact.  It was not just my local health department, it was also two other local health departments in the tri-county region of Sparrow, Ingham, and Clinton.  In that same spirit, we also included hospitals in that tri-county area – three primary hospitals, with additional contact with some other smaller community-based hospitals.  We all came to the table to talk about how we might leverage this opportunity for greater synergy and a stronger product, based upon what each of us knew about our own regions, areas, and communities.  Collaboration is not always easy, but it has absolutely been worth the extra effort.  It led us to not just coming to a compromise, but coming to a place of agreement.  That could not have been done without previously established relationships of trust, confidence and respect.  Quite simply, I value the blessing and the benefit of relationships that support and facilitate the public health work that I am responsible for.

There is a quote by Richard David that says, “Relationships are primary.  All else is derivative.”  I have found that to be true.  Everything that we do is a derivative of relationship.  Our health department, and community at large, have a strong history of fruitful relationships.  We enjoy partnering on numerous initiatives.  I came from a university setting where you are socialized to accomplish a lot and get credit for a lot – write a lot, put your name on things.  So it was an interesting adjustment to come to the health department, where our philosophy was to position our partners to get credit, instead of taking credit ourselves.  When funding opportunities came up, we would write the grant, and we pushed the money out to the community.  I was struck by that practice.  “Wait a minute, aren’t we going to save some of this money to hire our own people to do this work?”  The response from department leadership was, “The community knows better.  They have a better pulse of what’s happening, so we’ll push it out to them.”  It’s been a counter-intuitive but successful model for our public health interventions.  It’s really exciting for me to think about continuing in that same vein.

What would you say are some of the most pressing public health challenges related to the work that you do?

Well, there are the epidemiological disease models that we continue to study, like infant mortality prevention, childhood obesity, diabetes – all of those chronic diseases, which are influenced both by personal responsibility, but also social responsibility and how we structure the lives of people.  We know that our state and our nation underperforms in these areas.  I think the biggest challenge for us in public health is to begin to think differently about our work, and to learn from the history of very insightful, intuitive, intelligent founders to resurrect some of those norms.  How we value and measure prevention is a huge methodological question.  How do we value prevention in public health, so that we can more equitably and effectively fund prevention in public health?  It’s really easy to see the burning house and jump into action and say, “Oh, we’ve got to put that out right now!” But how do we value doing things to make sure that houses don’t catch fire at all?  If you think about our bodies and our communities as houses, that’s a really big challenge.  I think we’re at a real cusp in public health where we’ve got to figure that out.  How do we elevate the science of public health?  How do we design partnerships and systems that integrate public health and primary care?  I continue to think about the future public health workforce, and how we really recruit and prepare people to advance this agenda aggressively, but perhaps differently than we have advanced it in the past.

The context with which we do our public health work will always vary.  Our goal could be to fix the problem of obesity.  In 10 years or a generation, we should not still be battling obesity at a secondary prevention level, but rather at a primary prevention level.  We will likely be battling some other disease or problem that we may not even be able to name right now.  How do we build the capacity to be diverse and to be responsive and adaptive to the current needs of our community?  That is the strength of public health: it wields a skill set across differing contexts and circumstances.

How do we keep energy and passion at the table?  It’s a wonderful field.  I am also an adjunct professor at Michigan State University, and I spend a lot of time with students, trying to share the key to energy and purpose.  This is very mission-driven work; believing in the mission brings passion and passion brings energy.  Public Health is not a job where you clock in at 8am and clock out at 5pm.  It stays with you.  It confronts you as you drive home, it frames the way you watch television programs, and how you look at things when you’re in a restaurant or walking through a grocery store.  That type of passion and energy will advance us towards becoming one of the healthiest nations in the world.  Public health will always be needed because we’ve got a lot of work to do to get there.

Quentin Young, MD

QuentinDr. Young is a well known physician and health activist who continues to rally for social justice in the field of health. He is committed to ensuring that health care is recognized as a human right in this country. During the civil rights movement he founded the Medical Committee for Human Rights, which provided care to demonstrators in the South during the Freedom Summer, and helped the infamous Black Panthers and Young Lords set up free health clinics, among other deeds. These pioneering actions make him an obvious choice for this series. Nearing his 90s, Dr. Young is still rocking as the national coordinator for Physicians for a National Health Program (PNHP), an advocacy organization which he founded, that supports a single-payer system of national health insurance.

Career in Profile

  • 1944-1947 – Attended Northwestern University Medical School
  • 1947 – Interned and served as a resident at Cook County Hospital
  • 1964 – Founded and served as National Chairman of the Medical Committee for Human Rights
  • 1972-1981 – Served as Chairman of Medicine at Cook County Hospital in Chicago
  • 1980 – Young founded Health and Medicine Policy Research Group and is currently Chairman of the Board of that organization
  • 1998 – Voted President of American Public Health Association
  • 2008 – Retired
  • NOW – National coordinator for Physicians for a National Health Program (PNHP)

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What inspires you?

In high school and certainly in college, I had to make career choices.  I was leaning towards medicine, and it became clear to me that you could be a physician and be pretty evil.  There’s plenty of opportunity for abuse…but you don’t have to be evil.  So, I made a decision to pursue medicine.  There was so much to be fixed in the health system.  In recent years it’s only gotten worse.  Big corporate interest has invaded the health system, there’s so much money to be made. In 1950, right after World War II, health care expenditures totaled $22 billion.  Last year it was $2.7 trillion.  That’s 18% of the GDP, and arguably the biggest sector in the nation!  I think that our current economic troubles are due to the amounts of resources we have to dedicate to health care.  Mind you, this $2.7 trillion is the result of testing, hospital care, and the high cost of health care.  Yet, despite this expenditure, 50 million Americans have no [health] insurance and are therefore in great risk of bankruptcy.  In this country, about 2 million people file for personal bankruptcy each year, and half are due to unpaid hospital bills. I decided that health is my calling, because there was plenty of opportunity to help people, and it was in huge need of reform.

One of my favorite parts of your career and story is your involvement with helping the Black Panthers and Young Lords with their health clinics. What are some of your best career successes?

The civil rights movement in the field of health, which was led by a lot of people, but mostly by Martin Luther King. I became active in the Medical Committee for Human Rights.  As the name implies, we were eager to see that health care gets to our people, not just those with a lot of money. We were very successful in the early 1960s, when the civil rights movement was developing in the South. The different non-violent demonstrators were gaining public attention and support, and the most important leader – the strategist – was Martin Luther King.  Our committee sent health workers like nurses and doctors.  We were sympathetic to the demonstrators and gave them medical care when needed, and it was needed quite a bit.  The police were very violent but King was steadfast.  He knew being violent would be a losing proposition.

There were certain points, like the bridge in Selma, where the people were beaten one week and next week they were allowed to go through.  As that event ended with victory, King decided that there were other places with segregation that was not enacted by law – in other words it wasn’t legally sanctioned – but it was just as real and just as important.  He wanted to go to a northern city to do what he did in the South.  He did a serious survey of the national strength of the movement and decided on Chicago.  He moved here and participated mainly in school segregation.  I had the good fortune of being designated as his physician. It was obviously a great honor. The problem was he didn’t get sick very much, but he got sick a little bit and I exploited the medical care to just sit there and speak to the great man. We had some very exciting moments.

When it comes to public health, what matters to you and why?

Public health is the heart of the matter.  There’s a health system, a private sector, which takes care of people when they are sick. Even as we speak, we know there’s a huge shortfall.  People don’t have access to physicians, either because of race or discrimination, or just plain not having money. The American health system is not doing the job.  We have public clinics, which take care of part of the problem.  The public sector is a big part of the answer.  All the important public health jobs are there.   Before I end my stay in this world, I hope that I will see that health care is a universal human right.   This country has the money, the trainees, the facilities.  We can make it happen.  There’s a system in place but it’s not functioning, and that is reflected in the statistics: infant mortality, life expectancy, death from preventable diseases, all of these issues of a failing health system is a burden on our society. The bad news is that it’s been bad for this long into the 21st century. The good news is that we have the wherewithal to stand — all that’s necessary to make this a decent health system, we just have to enact it.

What is getting in the way of improving our health system?

Many things, none of them good or justified. There’s money to be made in medicine. It pushes people away from a decent solution. We have to, of course, confront racism.   There’s way too many obstacles based on race and income that we still need to fight. I think it can be done! You can point to other huge problems in our society and we have to find money to solve them, but that’s not the problem in medicine.  The money is there, the hospitals are there, the facilities are there.  We need to address the racial stigma for people going into the health professions. That can be done in seven or ten years. I think the challenge is to make health care a human right in our society.

What would you say is an ideal solution to these public health challenges?

Single-payer national health insurance. Medicare is the best example of that.  Everybody knows Medicare takes care of people over age 65. It is a benefit you get when you reach that age, and it doesn’t matter if you are rich or poor. It passed in 1965 and there were a lot of people who didn’t want it to succeed. Medicare is possibly the most thought out health care system in America. People used to dread getting old and being uninsured, but now they can put that behind them. There’s a statistic: if there was no Medicare, 22% of seniors would be in poverty.  Now that number is 11%. Though it can be improved on, we are fortunate to have that experience, because it makes it easy to explain to the average guy in the street what we need.