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.