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.