Joe Zanoni, PhD

imageFolio_jz_final - for websiteDr. Joe Zanoni, like many others, considers himself an accidental public health practitioner.  He started his career as an early childhood/special education teacher in the 1980s.  After he was laid off he returned to school, and entered a labor relations program in hopes that it would prepare him to provide training and education for businesses.  This led him to work with labor unions, which in turn prepared him to work with various populations, from teaching health care workers about blood protections at dawn of the HIV/AIDS crisis, to his current focus on the safety and health of immigrant day laborers.  Dr. Zanoni has drawn upon these experiences and the educational philosophy of Paolo Frèire and others, to promote the importance of peer-led education.  He is particularly proud of his research with workers’ centers.  This work has shown how empowering immigrant workers – whose voices are often unheard and whose labor is markedly unregulated – can reduce their rates of death and injury on the job.  We are pleased to profile Dr. Zanoni as one of our public health heroes.

Career in Profile:

  • 1980: Completed his Bachelors of Science in Education, Disabilities at the University of Wisconsin
  • 1980 – 1983: Special Education Teacher at the Madison Metropolitan School District, Madison, WI
  • 1984 – 1986: Infant Care Provider at the Kunkle Center, University of Wisconsin-Milwaukee
  • 1986: Completed his Master of Industrial and Labor Relations at the University of Wisconsin
  • 1987 – 1991: Research and Legislative Coordinator, Service Employees International Union, Local 150, Milwaukee, WI
  • 1991 – 1997: International Senior Representative for Health and Safety, Service Employees International Union (SEIU) in Chicago
  • 1998: Program Manager, Great Lakes Center for Occupational and Environmental Safety and Health, University of Illinois at Chicago, School of Public Health, Chicago, IL
  • 1998 – 2010: Associate Director of Continuing Education and Outreach, Illinois Occupational and Environmental Education and Research Center (IOEERC), University of Illinois at Chicago, School of Public Health, Chicago, IL
  • 2007 – 2010: Instructor at the Division of Environmental and Occupational Health Sciences (EOHS), SPH-UIC
  • 2010 – Completed his PhD in Education: Curriculum Studies at the University of Illinois at Chicago
  • 2010 – NOW: Research Assistant Professor, EOHS, University of Illinois at Chicago, School of Public Health
  • 2011 – NOW: Director of Continuing Education and Outreach at the IOEERC, preparing masters and doctoral graduates to serve as occupational and environmental health professionals in the areas of industrial hygiene, nursing, medicine, safety and epidemiology

Can you tell us about a career highlight?

I’m really proud of the work that I’m doing with workers’ centers because there are so many things that are part of it. I’m most proud of my dissertation, and also the Charla work.  Charla means “to converse, talk or chat” in Spanish.  It’s a social learning process.  I worked on a pilot study through the University of Illinois School of Public Health, where I learned about workers centers.  These centers are community-based groups, and this brought our focus from unions to immigrant groups.  We went to workers’ centers in Chicago and asked, “How do you like to learn?”  Instead of offering them training, we wanted to know, “How can this be part of what you are doing?”

They said, “We don’t really want to come to a training session, we don’t want to be lectured at, we’d like to learn in some kind of informal chat…like a charla!”  “What would that be like?” “Like sitting around doing different things, and then all of sudden we start talking about something.”

I thought “Wow, why don’t we delve into this?”  So I worked with three different workers’ centers to create a team of people that set up Charlas that invite people to talk about health and safety on the job.  The twist is that we’d do it in a communal setting.  I found a Spanish-speaking, culturally relevant colleague and trained him to facilitate three sessions at each workers’ center.

We’ve since continued this work with another research project. We trained peer educators to lead trainings at worker centers.  We had to have authorized trainers in the room, but they co-lead with the peer educators in a small group workshop format.  We have lots of workers employed in these types of jobs, where many immigrant workers die on the job for a variety of different reasons.

We started in Chicago, and when we heard about other Midwest workers centers we created a train-the-trainer program.  In our third year, we expanded to the Southwest.  We’ve also performed assessments to see how we were doing.  We want to know, “What did they learn?  What is the social context of the training? How are the workers’ centers and the peer relationships? How did they develop and how can they extend practices in the job to protect them?”  That work has been very satisfying.

What’s a career challenge that you’ve faced?

The funding aspect is always a challenge.  How do you sustain an effort? We can create a good idea or a great intervention, but especially if you work with community partners how do we keep it going?

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

The glaring inequities in the U.S.!  So often we are told that we are the richest and smartest country in the world.  We are the top!  We’re the model for the rest of the world!  That’s not necessarily true.  Those of us in occupational health go crazy over the debate about jobs … because it’s not just jobs!  What kind of job are we talking about?  What’s the quality of the job?  What’s the health of the people in their job?  All of that links together.  Yes, some people are healthy but other people are not.  How did we get that way, and what do we need to address in society to fix it?

What is a persistent public health problem that concerns you?

Injury, illness and death on the job.  Overall, if you look at the statistics of death on the job, the trend is decreasing.  But that trend is not true for all subgroups.  For example, Latino immigrants have a much higher “death on the job rate” than white males.  Why is that? It’s the kind of work that they are doing.

It’s almost like we are coming back around to what Jane Addams and her colleagues at Hull House worked on.  We need to improve workplace conditions for specific groups of people who are on the margins, or those who are trying to integrate into society and don’t get enough support.  Liberty Mutual estimates that we lose $50 billion a year due to injury, illness and death on the job.  It’s important to look at where work happens, who knows about it, and who can create the structure and support.  A lot of effort went into creating OSHA but that’s for traditional work places. What about other work places?  What about day laborers, construction, family businesses?  We should place greater effort into addressing and enforcing non-traditional work.

What’s your ideal solution to this problem?

We should support the education of community health workers and peer educators. What kind of curriculum do they want?  There are some groups doing incredible grass roots work with communities to determine what those communities want and need. They collaborate to develop training and curricula that meets people where they are. How can we support workers to learn and share with each other, and put more energy into their organizations? How can public health teach them how to work in collaborative ways? How can we teach them to teach each other about being healthy and safe, and how can that expand and make their work more secure?  We have very vulnerable workers who are day laborers, or people that have just come in the country trying to find work, they are trying to survive.  We need to explore these issues in public health, and we should do it through workers’ centers, community health workers and peer communities. All these people need to be encouraged and supported.

Len Syme, PhD

Len Syme, PhDDr. S. Leonard Syme has been pioneering research on the social determinants of health since the 1950s.  He is regarded as the “father of social epidemiology” for both his ground-breaking work and his mentorship of numerous leaders in the field, including Sir Michael Marmot, Dr. Lisa Berkman, and Dr. Nancy Krieger.  His body of work has focused on child health, job stress, social support, poverty, and social inequities on health.  He joined the faculty at the UC Berkeley School of Public Health in 1968, where he is now an Emeritus Professor and Co-Director of the Health Research for Action Center.  Dr. Syme was elected into the Institute of Medicine and has won numerous awards, including the Lilienfeld Award for Excellence in Teaching by the American Public Health Association and the JD Bruce Award for Distinguished Contributions in Preventive Medicine from the American College of Physicians.  His pioneering work on the social determinants of health, and his commitment to translating this research into successful interventions, make him a clear choice to profile as a public health hero.

Career in Profile:

  • 1953: Completed BA in Anthropology and Sociology from UCLA
  • 1955: Completed MA in Sociology from UCLA
  • 1957: Completed PhD in Medical Sociology from Yale
  • 1957 – 1960: Sociologist, Heart Disease Control Program, US Public Health Service
  • 1960 – 1962: Executive Secretary, Human Ecology Study Section, NIH
  • 1962 – 1965: Sociologist and Assistant Chief, Field and Training Station, Heart Disease Control Program, US Public Health Service in San Francisco
  • 1966 – 1968: Chief, Field and Training Station, Heart Disease Control Program, US Public Health Service in San Francisco
  • 1968 – 1993: Professor of Epidemiology, UC Berkeley School of Public Health
  • 1975 – 1980: Chairman, Department of Biomedical and Environmental Health Sciences, UC  Berkeley School of Public Health
  • 1993 – Present: Professor of Epidemiology and Community Health (Emeritus) and Professor in the Graduate School of Public Health, UC Berkeley

 

You are often called “the father of social epidemiology.” How did you get into this work?

In graduate school, I came across Emile Durkheim’s work on suicide.  He observed that the causes of suicide are thought to reside within individuals, but certain groups have consistently high or low rates of suicide.  If individuals come and go in a community, then why do group rates stay high or stay low?  He proposed that there must be something in the community that increases the rate of suicide, even though it doesn’t predict which individuals will succumb.  I said, Whoa.  It’s like the symphony orchestra.  You can study the violin or the trumpet or the drums to become an expert on the individual instruments, but that won’t help you understand symphonic music.  That’s when I began to get into community stuff.

My early work focused on social class as a determinant of health.  Michael Marmot’s work with the British Civil Servants was the breakthrough.  The Civil Service is divided into different Steps (with higher pay grades associated with more prestigious steps), which means you’ve got a cross-section of socioeconomic strata right within the Civil Service.  Marmot’s initial research focused on heart disease, and he showed that the Ministers at the very top of the Civil Service hierarchy at Step 1 have half the rate of heart disease as those who in Step 2 – Professionals and Executives – doctors and lawyers – just one level down.  This gradient existed throughout the Civil Service.  The lower the Step, the higher the rate of heart disease!  But the higher rates are not just among people at the bottom.  They exist from top to bottom.

When I was with Marmot in London, we decided to look at all diseases.  It turns out this gradient exists for all diseases in the Civil Service.  When I got back to Berkeley we reviewed the world literature, and we found that the gradient exists for all diseases, in every industrialized country.  We controlled for blood pressure and cholesterol, smoking and physical activity, but there’s still a three-fold difference.  If you don’t control for social class, it overwhelms everything.  So we control for social class so that we can study other things, but that means that the elephant in the room – the most important determinant of health – sits bright and unexamined.

So then let’s just get rid of social class and everything will be fine!  That’s not going to happen tomorrow.  In fact, there’s evidence that it’s impossible to get rid of social class.  In the 1930s the Israeli kibbutz tried to eliminate social class, but that failed.  We have evidence that social class divisions begin in nursery school.  But what is it about social class that really matters?  Is it low income or low education?  Is it poor medical care, poor housing, poor jobs?  It’s a whole list of things associated with low social class, and they’re so hopelessly intertwined that you can’t tease them apart.  Many of us – Marmot and others – hypothesize that the most important factor is whether or not you have control over your destiny.  We now know there are biological changes in immune function when people have less control.

Health Research for Action is devoted to helping people have more control over their lives.  We have guides for new mothers, we have guides to help older people avoid falls, we have a guide for disability.  None of these guides deal directly with diseases or risk factors, but they do help people deal with the problems that they face in their daily life.  Our theory is that when people have more ability to influence the events in their life, better health will follow.  So that’s what the center is about.  Our evaluations show that people keep the guides and refer to them, they share them with their friends, and they’ve changed the way they think about life.  But you can’t show a change in health because we’re talking about a change in immune functioning, so we’re talking long-term.  This is not the type of work we do in public health.  It’s very hard to get outcomes information, and it’s very hard to get a grant that is not focused on one disease or another.

Translating research to practice is really, really hard.  First of all, we “authorities” always pick the wrong topic to focus on, because we never pick the topics that people care about.  We rarely think about health literacy.  Almost all of our interventions have failed.  We’ve done two things well.  Smoking rates have declined, and seat belts have saved lives.  Most of those successes are due to changes in laws and policies, tobacco price increases, and limitations on where you can smoke and how you can drive.  Rarely has our brilliant statistical work on risk factors translated into successful interventions by itself.

What’s been a challenge in your career?

A major flaw in our field is our focus on diseases.  We’re really talking about psychosocial risk factors and compromised immune functioning, and while these don’t cause one disease, they increase the risk of all diseases.  Once you pick a disease, you’ve lost the power of the approach.  But where would you send a grant to study discrimination diseases?  Or hopelessness diseases?  We don’t have a way to do that, because all the money is focused on clinical outcomes and risk factors.

Awhile ago, the CDC offered a grant to study kids in fifth grade.  The CDC was interested in violence, smoking or drugs, inappropriate sexual behavior, school performance, things like that.  We submitted a proposal to study “hope.”  Our prior work with fifth graders in Richmond, CA – a very poor community – showed that many of them didn’t think they would live beyond the age of 20.  If you don’t think you have a future, smoking and drugs and school performance don’t matter that much.  So we wanted to see if we could help these fifth graders achieve a goal they’d set for themselves.  We thought improvements in smoking and violence would follow from that.   I’m really amazed, but the CDC made ours the #1 rated grant in their program.  So that was very nice.  We did that for 3 years, and we really did a good job.

We used Photo Voice, where we gave out cameras and asked the students to take pictures of the things they cared about, and that started the conversation.  For example, one group was embarrassed by graffiti in their school.  We worked with them on removing the graffiti, because you don’t just go out and buy paint brushes and cover the graffiti, you have to get permission from the principal and the school board, you have to get money for paint brushes, it’s a whole thing.  That was just one group.  We had a lot of groups, and they all had their own thing.  At the end of 3 years, we talked to the students and it was clear their lives had changed.  I’d like to follow them and find out what difference it made, but where do I get money?  The CDC did “hope” once, but what foundation is interested in hope?  It’s one of the most fundamental risk factors, but it isn’t diabetes or obesity, so it’s very hard to get money.  I’m sitting out here in the wilderness concerned about things like hope, and my field is not with me.

What has been a career success for you?

The students that I’ve worked with.  I do medium research.  I do medium teaching.  But I’m really fortunate to mentor a group of the world’s best people, like Michael Marmot, Lisa Berkman, Nancy Krieger, George Kaplan.  They’re just a group of outstanding students who are now leaders in the field.  Everybody attributes their success to me and that’s just not true.  They’re all fabulous people, and I was just fortunate enough to be involved in their work.

The fact that Michael Marmot is knighted is a reflection of the fact that his work with the British Civil Servants has changed everything!  He’s now the most famous public health person in the world, and he’s changing the agenda everywhere.  Or the work of Lisa Berkman – these people are changing everything.  And I just get to sit back and watch.

What’s a persistent public health problem that you see?

Inequalities in health.  Inequalities are not just devastating to the people involved, they’re devastating to the entire country and society.  It’s also a toxic issue for all of us.  When some of us don’t thrive, none of us thrive.  That keeps me up at night.  When 1% of society has 50% or 60% of resources, this is not a good society.  We really need to pay attention to income inequality.  If you think you can get away with being the winner and not caring about other people … you’ve seen our statistics! The U.S. has a fancy, expensive medical care system but we still rank 37th or 38th in the world.  We’re behind Slovenia!  We need to study all levels of social class, because all of us still have higher rates of obesity and diabetes than other countries.  We need to refocus to wellness.  We’ve got to get our country back.  It’s not a question of being nice to poor people.  It’s good for all of us.  Being on a losing team is not good for any of us.

What is your ideal solution to this problem?

I would study kids, from birth to age five.  What happens in the early years doesn’t necessarily track into adulthood – you’re not necessarily doomed – but birth to five is tremendously influential.  By studying kids, you would discover the important early life risk factors.  You’d also have a fighting chance with your interventions, because parents care about kids!  The problem with studying children is that they don’t have enough disease.  But we now have a whole slew of biological markers that measure adult immune function – like interleukin – and I’d try to understand if those are appropriate markers in young people.  Or I’d look for a series of new biological markers that show up in early childhood.  They wouldn’t be diseases, but they would be things that lead to diseases.  I’d investigate what really matters to children, so that we can intervene early in life.

Causandra Gaines, BSW

causandra gainesCausandra Gaines, BSW has worked in Westside Detroit for 27 years.  A social worker by training, Ms. Gaines’ passion for working with young people – spanning from infants to elementary and middle school students to young mothers – clearly comes through when she reflects on her work in the Brightmoor community in Detroit, MI.  Her commitment to community-based participatory research partnerships, and to improving the ability for all community members to live up to their full potential, are evident in her reflections on her thirty-year career.  Ms. Gaines recently retired from a leadership role at the Brightmoor Community Center in Detroit.

Career in Profile:

  • 1974 – 1978: Completed her Associates in Applied Art Social Service Technician Corrections and Bachelor of Science in Human Services at Ferris State University
  • 1982 – 1986 – Counselor, Vista Maria
  • 1986 – 2003 – Group Social Worker, Brightmoor Community Center
  • 2003 – 2005 – Vice President/COO, Brightmoor Community Center
  • 2005 – 2012 – President/CEO, Brightmoor Community Center
  • 2012 – 2013  – Director of Operations, Brighmoor Community Center
  • NOW: Retired

 

What are some of your best career successes or career highlights that you’re really proud of?

I really liked our Zero to Three program, where we worked with mothers and their children aged zero to three.  That’s the point where you can help a young mother who has nothing and give her some of the things that she needs.  It could be a car seat, diapers, or formula.  Or, show her that there is potential out there for her.  That she can get a job, be successful.  Help her to navigate the system so she can get the things that she needs.  Through that program, we have helped people get housing, jobs, and make sure that kids have formula, diapers, and clothes.  It is just a joy to see a person’s face when you are able to give them those things.  That’s what’s important.

One career success was through all of the economic downfalls, and all of the money that the Community Center lost, I was able to keep these doors open.  We survived it.  It was a rough five years, just figuring out how you’re going to keep the place open.  Sometimes I was the only person who was working and I did most of it by myself.

When it comes to public health, what matters to you?  Why?

I think our biggest health challenge in Detroit is exercise.  I think that the best thing that we (the Healthy Environments Partnership Steering Committee, a community-based participatory research project) did is that our walking groups allowed folks to make a change.  We used a participatory process from the planning stage to the implementation stage, and participants really enjoyed the walking groups.  They understood how important it is for people to be healthy.  Exercising and eating the right food does prolong your life.  When you get to be 60, 70 and 80, you want to be an independent person able to take care of yourself.  The way to get there is to take care of your body, especially as we get seasoned.  There are a lot of groups, like health plans and health centers, who are willing to help.   I still believe that we have a long way to go.

What do you think it will take to address these public health challenges?

It’s good to talk about good nutrition and healthy things, but we have to have to access things.  In the summer, we have the farmer’s market.  Now, it’s getting cold.  Fresh vegetables are gone.  How can we continue to bring fresh fruits and vegetables into the community?  How can we leverage the big retailers to want to come and do that?  Also, we need to educate the people in the community.  When you get these wonderful things, you have to educate the community.  Sometimes it’s about educating one person at a time or working with one group at a time.  Once you teach that group, they can spread it on to the next folks.

My main focus over the last 8 years has been to make sure that the Brightmoor Community Center succeeds.  Right now, we’re on our 88th year.  My goal is that it succeeds to be 100, plus.  The community built the Brightmoor Community Center.  This is a focal point for the community.  We want to be a place where we are a one-stop shop, where you can access everything.  We want to take care of your health needs, nutrition needs, and offer a space where you can exercise.  We have a daycare.  We want to make sure that you have a place where your kids can go while you’re at work.  If you have an addiction, you can come get help with that.  If you have spiritual needs, you can come here to church.  We just want to make sure that we can help you to access anything you need.  We may not have a program, but we want you to know where you can go to address your health and other needs.  We’re like a community center that has all of these legs that go in one direction.  The legacy that I want to leave is to make sure that the community center is here, serving the community, and doing what it needs to do for 100, plus years.

Georges Benjamin, MD

benjaminrgbDr. Georges Benjamin has served as Executive Director of the American Public Health Association (APHA) since 2002.  Although he initially pursued a career in medicine in order to learn enough biology to become a gene splicer, he quickly fell in love with the field of medicine.  He attended the University of Illinois College of Medicine on a military scholarship and specialized in Adult Medicine.  Dr. Benjamin joined the army upon graduation, fully planning a career as a practicing physician.   However, an unexpected opportunity to run an army medical center launched his lengthy career in health management.  Dr. Benjamin worked in city and state government, and led organizations through a number of health crises, before assuming the top position at the APHA.  Dr. Benjamin believes he has been able to enjoy such a varied career because he chose an education that prepared him to do a variety of things.  Truly, his career trajectory is a testament to the power of seizing unexpected opportunities!

Career in Profile:

  • 1973: Completed Bachelor of Science at the Illinois Institute of Technology – Chicago, Illinois
  • 1978: Completed M.D. at the University of Illinois College of Medicine – Chicago, Illinois
  • 1981: Internal Medicine internship & Residency – Brooke Army Medical Center – San Antonio, Texas
  • 1981 – 1983: Chief, Acute Illness Clinic – U.S. Army Department of Emergency Medicine at Madigan Army Medical Center – Tacoma, Washington
  • 1983 – 1987: Chief, Emergency Medicine – Walter Reed Army Medical Center, Washington, D.C.
  • 1987 – 1990: Chairman, Department of Community Health & Ambulatory Care, D.C. General Hospital
  • 1990 – 1991: Acting Commissioner for Public Health, Department of Human Services Washington, D.C.
  • 1990 – 1991 & 1994 – 1995: Director, Emergency Ambulance Bureau, D.C. Fire Department
  • 1991 – 1995: Health Policy Consultant
  • 1995 – 1999: Deputy Secretary for Public Health Services, Maryland Department of Health and Mental Hygiene
  • 1999 – 2002: Secretary of the Maryland Department of Health and Mental Hygiene
  • 2002 – Present:  Executive Director of the American Public Health Association

 

Are there some points in your career that you are particularly proud of?

In every job you find something you think is really neat.  When I was in D.C., the HIV/AIDS epidemic was a major problem. We spent a significant amount of time and effort addressing AIDS in D.C.  We really focused a laser on HIV/AIDS, in particular among substance abusers and pregnant women, because we were beginning to see the impact of AIDS on women, especially in the black community.  In the early 1990s we responded to the shifting epidemiology and built on our Maternal and Child Health work to address HIV/AIDS.

My years as Maryland Health Secretary were likewise transformative.  We had outbreaks in new diseases like West Nile virus and the Anthrax letters. Tragically, we had a severe drought and we had a tornado! When I was there, in terms of the health statistics, everything that was up, was up, and everything that was down, was down.  I had an amazing staff.  Maryland has a combined health department, which means that everything was in the health department, except Occupational Health and Safety and the Insurance Commissioner.  This meant I could push a lot of people into the same room, I had all the levers.  Very few Health Officers have that capacity!  The 9/11 tragedy brought different types of partnerships together that were new and interesting.  Even though it was a tragedy it created a lot of partnerships and friendships.

What about any challenges?

D.C. was tough!  The economy was in a recession, and we had a tough time balancing the budget.  Many say that D.C. is recession proof, but it’s not.  As Maryland Health Secretary, our Medicaid program grew while we simultaneously moved the financing mechanism from volume-based (e.g., fee-for-service) to value based (e.g., capitation, paying for quality, etc.).  We were successful but it was tough to change the mindset of the people outside government.  We had to push people to accept that we are in the business for health, not managing resources.

When it comes to public health, being where you are now, what matters to you and why?

At APHA, we believe it’s important to be effective. There are a lot of issues on the table so trying to pick the ones that are most important and that you can have the most impact on is most important to us. It is important to be heard on the right issue where we can uniquely make a difference, versus shouting at the rain, and being against or for a lot of important things. If you are not for and against the right things then you are not going to be effective.

I hate to make you pick a problem, but in the landscape, what do you think is still a persistent public health problem that concerns you?

Right now, the issue is maintaining funding for public health. Public health is getting whacked!  All over the place, funds are getting dramatically cut. There is a general view that our government spends more than we can afford. I understand that concern, and we want to be fiscally conservative as well. On the other hand, there are some things you have to spend money for and other things you don’t need to spend money for. Public health is one of the things where we ought to be spending more and more.  It’s a major challenge to push for enhanced resources to move our nation towards prevention and wellness, at a time when you have to balance spending for emergencies and other things.  It’s hard to try and make that argument amongst people who cringe when you ask for another dollar.

So in your ideal world, what is the solution to this problem?

We have to do a better job of defining public health’s “value add” to the public.  Public health always talks about how our best work is done when nothing happens, and that’s true. But when nothing happens you don’t get funded! There are no incentives to put resources behind something that didn’t occur.  If you forget the fact that it didn’t occur because there were resources there in the first place, then you get in a circular argument. What we need to do is put a face to it. I think we need to find the resources to measure public opinion on a regular basis, so that we can craft public opinion.  We do this by getting our message out to people so that they can understand the trade offs and the value of public health.

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.

Linda Murray, MD, MPH

Linda Murray, MD, MPHWhen Dr. Murray was in college, a friend’s mother, a black doctor, challenged her to consider becoming a physician.  Until that moment, her aim was to be a community organizer, a plan that was motivated by her past involvement in civil rights organizing during the sixties. After that conversation she decided to go to medical school.  She also learned that at the time the majority of African-American doctors were 50 years of age and older and steadily decreasing in numbers. She admits that in hindsight, she had no idea what it really meant to be a physician, but knew that she would need reliable skills in order to make a living and make a difference. If you know Dr. Murray, particularly her impressive career in public health leadership and activism, then you know that she strongly believes that everything is public health. It is with this spirit that she has managed to impact the way many public health institutions, leaders, practitioners and students think about the issues, the work, and their own careers.

Career in Profile:

  • 1973: Completed her Bachelor of Science in Mathematics
  • 1977: Completed Doctor of Medicine degree
  • 1980:  Completed her Masters of Public Health
  • 1977 – 1980: Was the Resident Physician of Internal Medicine and Occupational Medicine at Cook County Hospital in Chicago
  • 1981: Completed residency in Occupational Medicine
  • 1981 – 1982: Worked as an Emergency Room Physician in Chicago
  • 1983 – 1985: Led one of the first Occupational Medical clinics in Canada as Medical Director for the Manitoba Federation in Winnipeg Manitoba.
  • 1985 – Now: Consultant to the International Chemical Worker’s Union and its health and safety staff
  • 1985- 1987: Worked as Assistant Professor in the Department of Community and Occupational health, Director of Environmental and Occupational Medicine and Residency Director of Occupational Medicine at Meharry Medical College
  • 1987 – 1988:  Served as Medical Director of  Environment and Occupational Health and later as Acting Bureau Chief of the Bureau of Comprehensive Environment/Public Health
  • 1988-1992: Internist
  • 1990: Interim Clinical Director of Internal Medicine at a hospital in Chicago
  • 1992- 1997: Medical Director of and Internist at a two-site Federally Qualified Health Center in Chicago
  • 1997 – 1998:  Was Medical Director of two community health centers within the Ambulatory and Community Health Network of Cook County
  • 1998 – 2003: Served as Co-Chief Medical Director of the Ambulatory and Community Health Network of Cook County
  • 2003 – 2007:  Served as Chief Medical Officer of the Ambulatory and Community Health Network of Cook County
  • 2006 – Now: Serves as Chief Medical Officer of the Cook County Department of Public Health
  • 2009 – 2011: Elected and served as President of American Public Health Association
  • 2012: Elected as Fellow of the American College of Physicians

 

What’s a highlight in your career or work that you’ve done that you are particularly proud of?

I don’t think we’ve done anything to be particularly proud of! I think there are lots of activities that I’ve done that I think had impact on other people. At each stage of my career, starting in medical school, there were different things that I thought were more important. For example, when I was in medical school I spent a lot of time trying to make sure that minorities got into medical school, and as a medical student I spent a lot of time trying to collectively organize the minority medical students to make sure that we stayed in medical school.  And that meant study groups, a mock anatomy exam, or politically testifying about the lack of admission, all of those things. So I think at each point of my life, because of the nature of what I was doing in my life outside of my profession, certain things become a highlight. You raise a child, then you are really about the conditions in society that impact the health of children.  Not that you are not concerned about this at other times. When I was in residency and working at Cook County Hospital, a public hospital, I was concerned about the quality of care available at that hospital, and I’m still concerned about that.

So when you say what are you proud of, well, what I can tell you is that when I was an undergraduate student at Circle, there were more black students in the undergrad program, by percent, than there are today. Do we have something to be proud of? When I was in medical school there were more men and more black men in medical school than black women…today we are the only group where African-American men are there in much smaller percentages than our women and it keeps going down.   I think all other things being equal, men and women should be physicians and nurses at equal rates, so why is it that the percent of our men in medical school continues to go down?  Is that progress? The same hospital that I spent time with and risked my career and had repercussions, where I was blacklisted in the city (because of my efforts) to try and keep it open, that hospital is in still danger of closing, but for different reasons and at a different time period. So here we are on the eve of a major reform in medical care, the Affordable Care Act, and this public hospital which shaped my career as a physician, is closer to closing now than it has been in the past 20 years. So I don’t think it makes sense to think about tasks that you’ve accomplished.  I guess if I had to say, if there’s one thing I was the proudest of, it’s my role as a parent in the broader sense. My nickname in medical school was M&M…Mama Murray. To the extent that I’ve accomplished anything is to the extent that younger people have been influenced or guided by my work.

What’s a challenge that you’ve faced in your career so far?

I think the problem that professionals face, and that I’ve faced, has been the same problem over and over. If you stand up you are in danger of being personally hurt, or hurt career-wise or financially. That never changes. That has certainly happened to me. When people are young, your parents lie to you.  They say, “Be good and graduate from high school and college.” But the problem is being a good Negro never stops, because they can always pick away something from you. So understand that if you stand up against a public hospital closing, you might be blacklisted and not be able to get a job. So I spent a couple of years in Canada because I couldn’t get a job in Chicago. That problem and that reputation are always there.  I remember I was looking for a job outside of the city and I had two offers. One was in San Francisco at the General Hospital running their Occupational Medical program. The other was working for a Union in Manitoba. So I was discussing the differences between the two options with my mother and I said, “Well this one in California is a prestigious job in my field it would put me on a good academic trajectory, it’s a solid program. The job in Canada is a more political job.”  Her position was that it doesn’t really matter what you do. As long as you do something that you know is right, they are not going to respect you anyway so take the job you want. She said, “You are a black woman, there’s nothing you can do to make yourself more acceptable. There’s no way you could twist yourself to be acceptable to white folks, no matter how many degrees you have or brilliant research you do. Nothing you do will make you acceptable so you should do the right thing and do want you want to do.”

Going to the other job wasn’t wrong.  That’s the clear message here – you have to do what you think is right because if you do anything else then you are wasting your time. And nothing you do is going to make you acceptable. So that makes it a little easier. There are some people that can be more acceptable, I’m just not one of them. If you are black in America, you are not one of them. There’s nothing you can do to be acceptable. I have great respect for white Americans, upper-class, privileged people that actually are acceptable or can modify their behavior to be acceptable. When they make a decision not to be acceptable that’s a true sacrifice, that’s something to be truly admired. Those of us that are women or colored, there’s nothing we can do anyway.  People fool themselves, but there’s nothing that we can really do…so when we do stuff like that it’s really not that heroic or courageous it’s just the way it is.

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

Well I think the basic issue in public health hasn’t changed.  That is, why some people are healthy and others not. Why are some countries rich and others not?  Why are some populations in good shape and others are in bad shape and what can we do to change it? Those questions never change. The only thing that changes is the policy issues of today that can make things better or worse.  Today we are still saddled with racism in this country. We have not addressed that, and until we do we have no hope of functioning as a country. The inequalities on all levels, the injustices on all levels, are still there and they ebb and flow, they are not always the same, but right now we are at a period where they are widening since the 1980s. So things are going to get worse for our people, and everyone in the country. Those are the issues of today. Climate change is the issue of today. The north/south divide. If we don’t address them in a rational way, things will get worse. So something like climate change may be out of control, we may get to a point where there’s nothing we can do about it. I don’t think we even understand whether we are close to that point at all. The critical thing is to link it to all of these issues. There’s a connection between the climate change disaster, and the fact that we haven’t addressed racism, and that fact that we have the north/south divide. The notion that today we have the technology to feed and clothe and amuse everyone in any way we could possibly want, the notion that malnutrition is still the leading cause of death in the world, this is a criminal notion. We should be ashamed. So when we talk about public health issues of today…starvation and malnutrition are still the leading cause of death across the globe. When I ask this in my classes at the school of public health, no one ever gets it. No one ever knows that’s the answer. They talk about HIV or Malaria. It’s starvation and malnutrition, as it has been throughout most of human history.

What’s a persistent public health problem that still concerns you today?

Other than starvation or malnutrition? I think the notion that we have the low hanging fruits is a profound conceptual mistake.  When I get up in the morning I have to work on something, I can’t work on everything.  There’s no question about that. But to think that you can solve one problem and call that a victory is absurd! These problems are all linked together. I can use a jargon word if you would like. We need to fight for social justice! What does that mean? That means you have to fight on all fronts. The minute you ignore a front in a deliberate way, you’ve sown the seed for failure. You can always make the decision that “here are the three most important things that I’m going to work on for the next ten years.” That’s fine, that’s a little different than saying here’s something like racism, or gender issues that I’m going to ignore, and I’m going to worry about small pox. So how we frame problems, these are symptoms. “I’m going to work on youth violence or motor vehicle crashes, immunization, death from malaria”. That is a tool through which you are trying to solve the real underlying forces in society. What are the forces that stratify us? Power and resources, and therefore happiness and outcomes. That’s really what we are talking about. And those things will change according to time and place.

If you could do something about this problem, what would be the ideal solution?

It’s easy to have an ideal solution. The ideal solution would be a society that is socially just. Where you have resources and power equitably distributed. For each according to his means, for each according to his need. You can think of a number of slogans from a number of different fields – political science, history, religion – that express that same notion. I think that those expressions are the heart and soul of public health. Public health concerns itself with health of the whole and that’s the first thing you want. You want the whole and every component of the whole to be as healthy as possible.  So those philosophical notions define public health. I don’t think you can define it by saying, “Here is Healthy People 2020; if you solve these objectives you’ll be fine.” I’m not saying we shouldn’t have objectives and try to solve them, or interventions, but I think it’s a mistake to think that we have separate problems siloed in separate areas that you can do actually something about. This is population level stuff, so it doesn’t mean that I have to work on everything. That’s literally impossible. If I never slept I couldn’t do that. But what it does mean is that collectively, as a society, we have to address all of these issues. That’s the problem, it’s hard for people to think not only individual level.  That’s why we do stupid stuff, like “I can’t worry about that, it’s too complicated…I can’t worry about the impact of racism on black mortality, so let me just try to make sure teenagers don’t get pregnant.” I’m not for teens getting pregnant, but nobody said that one person has to worry about everything. Collectively, we have to work to address all of these issues at all different levels that they interact.

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.

Susan Avila, RN, MPH

susanSusan originally planned to be a nun.  Instead, she took advantage of a government-sponsored financial assistance program that would support her through nursing school, a decision that took her to the infamous Henry Horner housing projects in Chicago, where she and a team of community health aides were responsible for the well-being of community residents. Several years later, as a result of a shift in the political climate and subsequent funding cuts, the program was eliminated.  Susan emerged politicized and became involved in union work.  This began a career dedicated to advocating for the health and livelihood of disadvantaged communities in Chicago.  The Affordable Care Act has returned the spotlight to the necessary role that community health workers play in our healthcare system.  Listening to Susan speak about her beginnings as a field nurse reminds us of how vital these workers are to the well-being of all, but especially to those in our communities that are marginalized, under-represented and often unheard.

Career in Profile

  • 1970 – 1973: Completed her bachelor of science in nursing
  • 1973-1987: Worked as a staff nurse at several hospitals and community health centers in Chicago
  • 1987: Created and coordinated Chicago’s Food Protection Program as Director
  • 1988:  Worked as a nurse and certified diabetes educator at the historic Cook County hospital
  • 1991:  Completed her Masters in Public Health in Epidemiology
  • 1995 – Now: Became Nurse Epidemiologist at John H. Stroger Hospital’s Department of Trauma. Established the Injury Surveillance Unit and leads the injury violence prevention programming.
  • 2003 – Now: Serves as Trauma Nurse Coordinator assisting with nurse leadership in violence prevention and overall management of the trauma service with special emphasis on the clinical quality data process

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What’s something in your career that you are particularly proud of?

I feel proud of the times that were most formative. For me this was when I worked at Miles Square Health Center and Rush as the field nurse, the one that went out and visited people. It really impressed on me the issues that everyday people face. As the home health nurse, I loved the ability to establish a relationship with someone outside of the hospitals in their own environment. Understanding how people talk about and love their community. We were in the Westside of Chicago and I still go by there. I remember walking down Madison Street on a spring evening, I was on my way back from a particularly sad home visit.  I had seen maggots and all kinds of horrible things, and yet we were within a five minute drive to the loop (down town Chicago). It was 3PM on a Friday, and people were starting to come out for Friday. People were putting their chairs out in front of the barber shop and liquor store.  There was a shop that did car repairs, and there was a tall guy who wore overalls and played Taj Mahal and danced. So you had this feeling: you’d just left that terrible home, but there was also this strength in the community.  As a community health nurse, you were taught that you were part of that community.  Even though the projects were horrible – clearly dangerous – you were there as the advocate for the community.  Even when you were in the people’s homes you were their advocate and you helped figure out what needed to be done. When you are in the hospital, you are only seeing a part of this person, because you can only try to imagine what their house is like.

Have you faced any challenges in your career, so far?

One of the biggest challenges I’ve faced is finding the ability to do what I really like to do. Finding the ability to create that space where you care for people clinically, but you are also actively involved in some of the real issues that affect them.  The health care system has also been a challenge.  We used to steal medicine for our patients at Rush! You would have a patient that was sent home from Rush and needed medication and had no money, and they were going to die. Or a TB patient they sent home to die. We found a way to fake prescriptions to get them for free, and they caught us. I almost lost my job.   Another challenge is to not feel ground down by the system.  I work at a diabetes clinic now, we have some really good nurses but the system is so messed up they get to the point where their attitude is, “Let me just do my job”.  They are burned out.

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

I guess everything matters to me and I go crazy! But what really matters to me is what I think I can focus on or what I can do. To make a difference is what matters, however you want to define it. Making the connections with people. To me, that’s the most important thing in public health, making those connections with people, so you can constantly keep on thinking of  or understanding the problem and different people’s point of view.

What is a persistent public health problem that still concerns you today?

For me, it’s inequity. In the 70s, I felt like I had more opportunity. The philosophy was there, you saw everyone, your responsibility was clear. For example, you were responsible for making sure the family had milk, that they got their baby in for follow up services. Today, I feel like it’s worse and there are less services. That experience seems like a golden age – and it really wasn’t – compared to what people have to face now. So the persistent problem has been the step backwards.  The step backwards has been so severe that people die because the infrastructure failed them, and there’s no recognition of that. Whereas when I was working in the projects, you knew that the patient was going to die, you knew it was going on, even if nobody else had that understanding. We used to stand on the landing on the 13th floor in the projects and look at the big buildings downtown, and we knew that nobody understood what was going on in that building. 90% of the girls there had been raped and there was no recognition of that, but at least you knew that and they knew that you knew. Now its just there, and nobody knows.

What’s an ideal solution to this problem?

I think people solve it by testimony. What the Chicago Teachers’ Union has done is really a public health initiative.  At school board hearings, people testify about how horrible things are. It has opened up the walls.  People are forced to recognize the horrible conditions and the strength of the people that are in those schools. Before, you would have the Mayor’s presentation and everything was fine.  It’s like when you hear the statistic that 1 out of 4 people go hungry, because it has no meaning to most people, they just say, “Oh, ok!” But when you present it in a public way, and talk about it, and it’s there, you force the policy makers to make a decision about it. So Chicago Teachers’ Union has opened up those doors and started the discussion. I think this should be part of most major public health initiatives.