Sandra Witt, DrPH

Sandra Witt - for collageIntroduction

Dr. Sandra Witt spent 14 years at the Alameda County Public Health Department, where she played an integral role in pioneering health equity practice. She worked on programs and policies responsive to public health issues affecting County residents with the goal of eliminating health disparities.  This work, along with her leadership in health surveillance, monitoring, and technical assistance, won her an Outstanding Manager of the Year award.  Sandra is currently the Program Director of Healthy Communities (Northern Region) at the California Endowment, where she, along with the Senior VP of Healthy Communities and her counterpart in the Southern Region, oversees the implementation of a place-based initiative to strengthen some of California’s most vulnerable communities.  Her commitment to achieving social justice in public health, plus her insights and experiences in transforming public health practice to achieve health equity, make her an obvious public health hero.

Career in Profile

  • 1977 – Obtained BA in Sociology and Health from McGill University
  • 1983 –  Obtained MA in Latin American Studies/Anthropology from University of Florida, Gainesville
  • 1985 – 1990 –  Health and Development Officer, International Development Research Centre, Ottawa.
  • 1991 – Obtained MPH from UC Berkeley
  • 1997 – Public Health Consultant, International Health Programs of the Western Consortium for Public Health
  • 1998 – Completed Dr.PH in Maternal and Child Health, UC Berkeley School of Public Health
  • 1998 – 1999 – Epidemiologist, Alameda County Public Health Department
  • 2000 – 2010 – Director of Community Assessment, Planning, Education and Evaluation, Alameda County Public Health Department
  • 2007 – 2010 – Deputy Director of Planning, Policy and Health Equity, Alameda County Public Health Department
  • 2011 – present – Director, Healthy Communities (North Region), The California Endowment

You’ve worked on health equity practice from two different perspectives, a local health department and a foundation.  Can you tell us a little about your work in each?

During my time at the Alameda County Health Department, we recognized that we could continue to provide needed services – and the community certainly needed services – but it was also important to figure out how we could change the social conditions that created the need for services and entrenched health inequities to begin with.  We felt that the real focus of health equity is not just health disparities – the outcomes in health status – but rather the root causes that create those disparities.  Today it is widely recognized that there are huge differences in life expectancy based on where you live.  Your zip code matters.  When we were starting this work we invested resources to get people to understand that the opportunities in place have a lot to do with how long and how well you live.

Currently I work at the California Endowment, where I’m the Director of Healthy Communities (Northern Region).  We have a $1 billion, 10-year initiative that focuses on building healthy communities where children are healthy, ready to learn, and safe.   The initiative selected 14 places across the state that had 1) poor health outcomes and social inequities, and 2) experience and interest in working together to solve community problems.  We started with a planning process that created a space for community voice to shape community priorities.  Each site came up with a community plan, which  guides the Endowment’s grantmaking on strategies that support efforts that meet the community’s priorities to improve health.

Moving to the foundation was an opportunity to further the work we’d started at the health department to figure out how to support efforts, which change the social conditions that create poor health outcomes.  The Endowment has an incredibly bold and big vision of what change can look like, which is exciting.

Often times, the residents that are most marginalized in our society are not included at the  decision-making table or processes that directly impact their lives. They need to be included in shaping the solution.  So equity and inclusion are core elements of how we think about this work.  A key piece is recognizing which issues are important to our communities – especially ones that disproportionately affect low-income communities of color – and then raising the profile of these issues within our communities.  Another piece is creating opportunities to educate policymakers about how these issues affect our communities and the health of our communities. Another key component of our work  is focused on power-building — building the leadership capacity of adults and youth to advocate on their own behalf. We also foster collaboration so that people from different perspectives can come together to develop policy solutions.

For example, in Fresno the young people raised the issue of school suspension and expulsion.  They felt that these disproportionately impacted young men of color and we know that suspensions and expulsions can contribute to a trajectory into the criminal justice system.  So we supported organizing to bring attention to these issues within their communities.  The Endowment’s statewide policy branch also realized that these concerns could be addressed through statewide policy.  State and local advocates worked together to identify positive school discipline practices and policies. One of those practices is implementing restorative justice, which can bring down suspension rates quite quickly.  After a lot of organizing by our local and state partners a number of state bills passed that addressed suspensions and expulsions in schools.

If you only think about health in the context of the doctor’s office, you miss opportunities to affect the many other factors that impact a community’s trajectory to good health, like school discipline policies and practices.

 I’ve heard you speak about “health equity practice.”  Can you tell us more about that?

Public health departments, as they stand now, are not really set up to focus on broader social conditions.  So when we think about transforming public health practice to address health inequities – what we call a health equity practice – we have two grounding principles.  First, in all the work that we do, we should think through how policies or practices impact health inequities.  This helps us think through where to focus first.  Second, we ask if there are processes for the people who are most impacted by these decisions, to have the opportunity to participate in shaping the solution.  Those perspectives and lived experiences are key to the conversation.  You need to think about both if you want to engage in practices to address health inequities.

Health equity practice is part of a broader public health move to change the social conditions that impact health.  Poor health outcomes often concentrate in particular places.  Place is where you live, work and play and shape the opportunities you have to be healthy and productive.  This analysis was key in leading us  to recognize we have to focus on changing the social conditions that create these inequities.  In health equity practice, we’re looking for ways to change policies and practices in institutions that work in education, housing, transportation, economic development, etc. so that everyone’s health can be improved. A core component of health equity practice has to be focused on creating and institutionalizing mechanisms for the most marginalized to participate in decision making on issues that impact their health and well-being.

Let’s say I’m working in a health department and want to widen my health equity practice, do you have any suggestions for how we might go about doing that?

I can share how we did it at Alameda County.  At the health department, we were very intentional about working directly with residents and community organizations in areas that had the lowest life expectancy.  These communities identified their priorities, and we partnered with them to bring in other partners to address  those issues.  So that’s one place to start.  In our work at the Endowment, as well, we’ve started with what communities, residents, and community based organizations identify as the priorities.

There’s an internal piece of this work and then there’s an external part of the work.  A big piece of equity and inclusion is understanding the historical legacy of racism and how that impacts our communities.  The health department invested in the development of a curriculum for all staff to understand these topics.  We covered: What is public health? What is the broader environmental and political context within which health is produced? And why do certain neighborhoods look the way they look?  What are the historical reasons or policies and practices that we, as a society, put in place, which created the opportunities for some and disadvantages for others?

This built a shared understanding within the health department. At the same time we worked with communities and learned from those experiences as well. If we don’t look at what we do as an institution and identify how we create barriers to inclusion and perpetuate inequities, we cannot reach our goal of achieving health equity. You don’t end up working with the community.  You think you’re doing things for the community, but really you’re doing things to the community.

I don’t want to underestimate the importance of this step.  It requires leadership and willingness for honest self-examination.  It also requires a willingness to understand how our processes have impacted our populations.  It helps the organization understand hurdles to the work and what it means to build authentic relationships with the community and residents.

For the external work, when figuring out how to begin engaging residents and community organizations, one step we took was to tap into the assets of our own staff.  At the health department, our staff came from all over, including many from these very communities. We created opportunities in-house for staff to talk to us about what was going on in their neighborhoods.  We showed them the data, but we also wanted their reflections about : What’s going on?  If you were going to talk to somebody, who would that be? Are there organized groups there? Are there CBOs we should link with?

Honestly, I think we sometimes forget our staff and our internal resources.  For example, community outreach workers are in many communities, and they became essential for putting us in contact with folks whose houses they regularly visited.  Through those kinds of connections we could begin to go out, meet people, create opportunities, and pull people together for community meetings.  In many of our communities, particularly our most marginalized, historically things have not changed.  There’s a lot of distrust of systems– appropriately so as there has been a history of broken promises.  Part of the process is developing a relationship with residents and getting a better understanding about what the realities are.

We also wanted to think about the assets of local communities.  So we visited a lot of churches, for example.  In one of our communities, we reached out to a school principal to coordinate efforts around fielding a community survey to identify priorities.  Every year, the principal asks her teachers to go out and meet her students’ parents because she wants her teachers to understand the community that her students live in.  We wanted to do a community survey.  We already had a group of residents who shaped the questions in our survey.  So she teamed her teachers with our health department staff and community folks to administer the door-to-door surveys together.  That was a powerful partnership – with residents and between public health and the educational system.

This work is really big and can sometimes feel overwhelming. I think it’s important to break it down and figure out where to start.  The truth of the matter is that there are multiple entry points into this work depending on where your health department is and where the communities are.

Jack Geiger, MD, M.Sc., ScD

J Geiger - for collageIntroduction

Dr. Jack Geiger and colleague Dr. Count Gibson are often credited as the pioneers of the community health center movement in the United States. Dr. Geiger was active in the Civil Rights movement in the early 1940’s and, after completing his medical training, participated in the Freedom Summer in Mississippi in 1964. Within the following years, Dr. Geiger helped organize residents in Bolivar County, Mississippi, and in the Columbia Point Public Housing Project in Boston, MA, to establish the nation’s first two community health centers. The health centers were funded through the Office of Economic Opportunity, the agency directing the so-called War on Poverty. The early health centers provided important medical services but also addressed the social determinants of health such as poverty, unemployment, malnutrition, and environmental health issues. There are now over 1,200 health centers nationwide, which were modeled after these community health centers.

Career in Profile

  • 1941-1943 – Studied Liberal Arts at the University of Wisconsin
  • 1943-1946 – Military service
  • 1947-1950 – University of Chicago, Division of Biological Sciences
  • 1950-1954 – Science and Medicine Editor, International News Service
  • 1954-1958 – Completed MD, Western Reserve University School of Medicine
  • 1958-1959 – Intern, Harvard Medical Service, Boston City Hospital
  • 1959-1960 – Completed MSc in Epidemiology, Harvard School of Public Health
  • 1959-1961 – Postdoctoral Research Fellow, Social Science in Medicine, Harvard University
  • 1961-1962 – Instructor in Preventive Medicine, Harvard Medical School
  • 1962-1963 – Assistant Medical Resident, Harvard Medical Service, Boston City Hospital;
  • 1963 – 1964 – Senior Resident in Medicine, Harvard Medical Service, Boston City Hospital and Research Fellow, Thorndike and Channing Laboratories
  • 1964-1965 – Clinical Assistant, Harvard Medical Service, Boston City Hospital; Assistant Professor of Public Health, Harvard School of Public Health
  • 1965-1966 – Associate Professor of Preventive Medicine, Tufts University
  • 1965-1971 – Project Director, Tufts Comprehensive community Action Program; Director, Division of Community Health, Tufts University School of Medicine
  • 1966-1969 – Professor of Preventive Medicine; Director, Division of Community Health, Department of Preventive Medicine, Tufts University School of Medicine
  • 1969-1971 – Professor and Chair, Department of Community Health and Social Medicine, Tufts University School of Medicine, and Chairman, Ambulatory Care, Tufts-New England Medical Center
  • 1971-1978 – Professor and Chair, Department of Community Medicine, State University of New York at Stonybrook, School of Medicine
  • 1978-1997 – Professor and Chair, Department of Community Health and Social Medicine, City University of New York Medical School
  • 1983-1984 – Senior Fellow, Center for Advanced Study in the Behavioral Sciences, Stanford University
  • 2004-2007 – Visiting Professor of Epidemiology, Mailman-Columbia School of Public Health
  • NOW:  Arthur C. Logan Professor of Community Medicine, Emeritus, City University of New York Medical School

What led you to get involved with the creation of the community health center movement in the United States?

We all stand on the shoulders of others. The contemporary community health center, and the development of community-oriented primary care, was really developed in – of all places – apartheid South Africa in the mid-1940’s by Sidney and Emily Kark and their colleague physicians and others. There were more than 70 community health centers in South Africa serving Africans, Indians, and some poor whites.

In 1957, at the beginning of my senior year in medical school, the Rockefeller Foundation – which had heavily funded the Kark’s work along with the South African government at the time – gave me a scholarship to go for four months to study and work at the Pholela Health Center and an urban Zulu housing project health center called Lamontville in Durban. That experience changed my life. It taught me about community health centers and set me on the path to get what I thought was the appropriate training for global health, particularly in the third world.

I had been in civil rights work since I was a teenager starting in 1942. In 1964, at the end of my training, I went to Mississippi as part of  the Freedom Summer with an organization that about twenty of us from across the country had started called the Medical Committee for Human Rights. It was created to be the medical arm of Freedom Summer and the Civil Rights Movement at its peak. That month in Mississippi, I had the chance to take a long look around and realized that I didn’t need to go to Africa, Latin America or Southeast Asia. All those problems existed here in the rural South, the urban northern ghettos, in Appalachia, in the Native American Reservations – not at the same absolute level but certainly at an unacceptable and hideous level, relative to the health of the rest of the population. With my colleague, Count Gibson, who was then chair of Preventive Medicine at Tufts Medical School in Boston, we kept coming back to Mississippi.

At a meeting in December of 1964 with many folks from the Freedom Summer and Indigenous Civil Rights Workers, sponsored by the Delta Ministry of the National Council of Churches, I said what really needed to happen in this country was the development of community health centers that would serve identifiable populations in need. I’d remembered my four-month time at Pholela and Lamontville, and thought we should bring that model here. We would use the principles of community-oriented primary care and population health to deliver services and, although we didn’t use the words at the time, address the social determinants of health.

There was a brand new federal agency – the Office of Economic Opportunity, the so-called War on Poverty – and that gave us our window of opportunity to first convince them to do this, and to make it a part of their community action program and to develop this new model of delivery of healthcare services. In January of 1965, I made my first approach to the people at OEO. After a lot of struggle and convincing, the first grant for the first two community health centers in this country – in rural Bolivar County, MS, and Columbia Point, a public housing project at the edge of Boston – was approved.

How hard was it to launch the first two health centers in the United States?

Columbia Point Health Center in Boston was relatively easy to open. Mississippi took a lot longer. It took a while to identify the site, and then to convince the Poverty Program, which was very nervous about working in place like Mississippi. We also had to deal with concerted opposition by the state Governor, the state public health department, and the state medical society, and all of the other forces aligned.

Despite the fact that their own data showed an overwhelming need – huge, third world level infant morality rates in the African-American population – they recognized that this was a very different model and it would directly empower impoverished black populations as partners in the delivery of their own health services, thus bypassing all the gatekeepers and mechanisms of control that the white power structure had up until then exercised.

How did the new model of care directly empower the populations you were serving?

From the very beginning, one of the most important components of the health center effort – along with the doctors, nurses, public health nurses, and sanitarians and environmental engineers and social workers, and the all other kinds of people that we had managed to recruit and assemble – was what we called community health action, which was really community organizing.  We did careful and prolonged and solid community organization – rather than just picking existing community leaders who tended to step forward and say “Looking for the community? Here we are.” – and organized ten different community health associations in the ten major areas of our 500 square mile piece of Bolivar County. That took time, explanation, and innumerable meetings for people to begin to understand what we proposed to do, and to assess their own health care needs.

What were the most successful interventions at Mound Bayou/Columbia Point?

Simply to deliver medical care but also hospital care in two small black hospitals that existed in Mound Bayou, the town where we were physically based, but with satellite centers at ten different points throughout our target area – to people who had never before seen a physician under the old plantation system. The cotton sharecropper system had collapsed and been replaced by mechanization, and there was profound poverty and profound unemployment. There was widespread hunger. There was widespread unemployment. People were squatting on the land in old plantation shacks and they had no significant prior access to medical care, except for the work of some fraternal organizations that had built those two small hospitals and in effect sold health insurance for 25 cents or 50 cents a week.

To deliver medical care to populations living in those circumstances would have been simply to send people back from the health center into environments that determined overwhelmingly that they would be sick and hungry and burdened with the same illnesses all over again. They were drinking water from the drainage ditch or collecting water in old pesticide drums. They were often living in housing that wasn’t fit for human habitation.

So I would say that our second most important intervention was a series of environmental interventions. We dug protective wells. We built sanitary privies. We thought we would start vegetable gardens as a way to start to combat hunger, and hopefully we would get maybe 100 families to do that. We were sitting on some of the richest topsoil in the United States. A thousand families raised their hands. What emerged from that, as a partner to the health center, was a 500-acre, triple crop, irrigated vegetable farm that grew thousands of tons of greens, potatoes, sweet potatoes, lima beans, peas, kale – you name it – over the next several years. Those thousand families and members traded their labor for shares in the crop – nutritional sharecropping.  But this was a different kind of plantation because with both foundation and governmental help, the Farm Co-op was, as the name indicates, a cooperative. The people who worked the land owned it. We virtually eliminated malnutrition in our target area.

Is there a success that you are most proud of?

There are now more than 1,200 community health centers in the United States delivering care at 9,000 different points of service around the country and taking care of something like 22 million people. And of course that’s not me, that is thousands and thousands of people working in those community health centers and their supporters. The community health center has become the backbone of the healthcare safety net in this country. That’s something that I don’t think we even dreamed of when we were starting those first two health centers.

How far do you think we’ve come, as both a nation and the community health center movement specifically, in addressing social determinants of health?

In the first years of the health centers, it wasn’t rocket science to figure out that medical care alone was insufficient. But national political administrations changed and there were efforts by both the Nixon administration and later, in particular, by the Reagan administration, to block grants to health centers, to hand them back to the states, including the southern states, to remove the direct pathways to community empowerment. While those efforts were beaten back, often by Republican congresses in the face of those presidential efforts, community health centers, starting in 1975 and to some extent ever since, have been increasingly restricted to simply the delivery of personal medical services – primary, preventative and curative care – rather than other kinds of interventions. Although, I should add that many health centers found state, local, philanthropic or other funding sources to undertake efforts to continue doing such additional things themselves.

What has happened now, and that is beginning to happen, is that community health centers and indeed hospitals and other health delivery organizations, are going to have to do this by collaborative efforts with other organizations – with public health agencies, with housing departments, with transportation departments, with county executives – to mount, in collaboration, the same kind of interventions.

What is the most persistent public health problem today and what is your ideal solution?

That one is easy. One word: Poverty. That comes before any specific disease identification, HIV, Malaria, malnutrition, you name it. Because they all are linked to poverty, attended by poverty, spread from centers of poverty. One of the things that is very poorly appreciated is that when the War on Poverty, and the whole series of efforts that it represented – the health programs, the Job Corps programs, Head Start – all of the other things that the Poverty Program did in the 1960’s and 1970’s, when the Poverty Program began, the poverty level in this country was roughly 22%. That’s when Michael Harrington wrote “The Other America” and put this on our national agenda. Twenty-two percent of the population of the United States – a fifth – was in poverty. Ten years later, that proportion was 11%. That is a phenomenal success and should be a guideline for the fact that we need to continue that kind of effort and re-launch it now.

This feature was interviewed, transcribed and partially edited by our guest editor, Ted Henson.

Emma Rodgers, MS

Emma RodgersAs a Program Coordinator for the Partnership for a Healthier Bronx at Bronx Health REACH , Emma Rodgers helps to lead a community-based coalition that is working to reduce disparities in health outcomes in the Bronx. Emma attributes her passion for her work to the people, organizations, and spirit of residents and leaders in the Bronx and her family’s positive and negative experiences in the US health system. Emma’s recognition that stress is a major factor in the health outcomes of residents in the Bronx and her conviction for involving communities at the forefront of public health strategies to reduce health inequities contribute to our great respect for her and her work. Emma’s experiences reflect the opportunities and challenges of sustaining coalition-based work to address persistent health inequities.

Career in Profile

    • 2004 – BA in Government from Smith College, Northhampton, MA
    • 2004-2006 – Marketing Coordinator, John Wiley & Sons, Inc., New York City, NY
    • 2006-2008 – Associate Director of Planning and Buying, HN Media & Marketing, New York, NY
    • 2009-2010 – Intern, Division of Violence Prevention, Boston Public Health Commission, Boston, MA
    • 2010 – Graduated with a M.S. in Public Health from Harvard School of Public Health, Boston, MA
    • 2010-2012 – Borough Organizer, Bronx Smoke-Free Partnership, New York City Coalition for a Smoke-Free City, Bronx, NY
    • 2013-NOW – Adjunct Professor, Bronx Community College, Bronx, NY
    • 2012-NOW – Program Coordinator for the Partnership for a Healthier Bronx, Bronx Health REACH, Institute for Family Health, New York, NY

What inspires you and the work that you do?

I would say it’s the resilient and magnificent residents and organizations of the South Bronx. The South Bronx is the poorest congressional district in the country. We’re the hungriest, most obese, most overweight – all of these things that say it’s a terrible place to live, to go to school, to work, raise a family. And yet there are so many amazing people and organizations doing wonderful things. This includes community members who recently became Zumba instructors and are advocating to improve their local park.  There’s also an affordable housing provider who, in addition to creating a new green, mixed-use development that will have a rooftop farm, supermarket, music and recreation center and affordable housing, is also looking to promote bike lanes, and to create a business improvement district. It is really an exciting time in the South Bronx. I feel very privileged to be part of this community and blessed that residents and organizations have included me in their families and in the work that they’re doing.

A lot of your work involves engaging community members and it follows a community organizing strategy. What inspires this approach to your work?

Historically, residents of the South Bronx and other low-income communities have not been involved in most aspects of public health programs. Outsiders, much like myself, would come into the community, identify the needs and the solutions, and implement programs without ever consulting the community. The community is an afterthought, a box that you check when you’ve done focus groups to make sure your program is on the right path. The community is never part of the process and more importantly, they’re never leading the process. In turn, many of these programs have not addressed the real needs of the community, never included culturally appropriate activities and materials, and the programs were unsuccessful and/or unsustainable. Doing true community-based public work might be frustrating to researchers and funders, because it takes longer – ten years, not two, like most grants. However, at the end of the day, it is my experience that these programs are much more successful, because the community is empowered and the real, root causes of these health issues are identified and addressed. Community residents know their community best, not me. At the end of the day, I go home to a different borough and no matter how many years I work in the Bronx and how many degrees I have, I always remember that. My job is to listen and support Bronx residents and organizations in any way that I can to make sure the health of Bronx residents improves.

What is a career success that you’re particularly proud of?

One of the primary goals of the initiative that I’m funded under is to create a borough-wide coalition. Much of my time is spent engaging partners, residents, and city agencies in other parts of the borough where my organization traditionally didn’t work. Last year, I was really proud of the work our group did around increasing access to healthy food. Many areas of the Bronx are food deserts or food swamps. Although fantastic new supermarkets are popping up every year, many communities still do not have access to healthy food in their neighborhood – bodegas and fast food restaurants are their only options. When I started my job, I had very little experience working in the food arena. Our funders wanted us to continue to “adopt” bodegas to transform them into healthy food retailers. However, despite the lack of healthy food, this initiative didn’t make much sense to me as our organizations didn’t have the capacity to help hundreds of individual bodegas and there already seemed to be a lot of organizations doing this work. Instead, we felt we would be much more helpful if we tried to coordinate the existing bodega work, which seemed abundant, but disorganized. It was common for two organizations in the same neighborhood to be doing similar programs, yet neither would know about the other. So, for the last year, I’ve spent a lot of time identifying which groups were doing the work, what resources each group had, what were the most successful programs, and how we could all work together to reach more people and create better programs. To my delight, most of the community groups and city agencies that I reached out to were thrilled to partner with other groups and be part of our larger coalition’s efforts. These organizations met monthly for almost a year, developed joint evaluation tools, shared best practices and many of the groups are now working together on joint bodega initiatives. Although there were many bumps in the road, this was a big win for the Bronx and my program.

What are some challenges that you’ve encountered or that you may continue to face in your career?

Funding is a big challenge. Despite the fact that community organizing is once again “hip” thanks to President Obama and many grant applications require community engagement, there is still very little funding for the work that I do — the pot of money is getting smaller and smaller and many of these larger initiatives are just not being funded at the same level. For many years, Bronx Health REACH was primarily funded through the REACH program (Racial and Ethnic Approaches to Community Health) at the CDC (Centers for Disease Control and Prevention). That was a very large grant that supported a very large staff and our partners for many years. In 2012, we became a sub-recipient of the Community Transformation Grant from the NYC Department of Health and Mental Hygiene; however, this was significantly less funding, supporting only a few staff members. To top it all off, we just received word that the grant will end next fall, two years before it was expected to end.

Another major big challenge is that I’m not allowed to do policy and advocacy work, because I’m funded through the Affordable Care Act. All I can really do is educate people about different health issues and programs and hope that these community groups and residents will take their concerns to their elected officials and they will create legislation or increase funding for health programs. This is very frustrating, because I know that legislation is an extremely effective way to improve the health of a large community – a population-based approach is more effective and cheaper than going door to door. Also, it’s a lot to ask people who have kids, 3 jobs, and other major life stressors to do this work in their very limited free time. I understand why my funding prohibits me from working on policy. However, again, for people who have been doing this work for a long time and know what works, it’s very frustrating.

Finally, from an organizing standpoint, it’s hard to create a coalition when the “peaks” in your campaign are fairly small – an event, creating a curriculum, etc. Advocacy campaigns are exciting, have clear goals – they are something concrete that your community partners can rally around. In some ways, I think our coalition members are not as active right now, because there isn’t a specific campaign that we’re all working on together.

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

Having the community at the forefront of what we do, especially in low-income communities. I think that in addition to making our programs more successful, you can’t morally do a program without having the community be at the forefront of the work. Also, again, it is important to increase funding for programs that focus on reducing health disparities in our country. I feel very privileged to live and work in a city where public health is a priority. Although much progress has been made, it is maddening how different a child’s life can be in one neighborhood versus the next. It’s unacceptable. I am hopeful though with our new Mayor. Finally, there continues to be limited funding for mental health programs and continued stigma around mental health issues in general. In the communities where I work and among my own family and friends, there is such a great need for mental health services. Despite increased attention these last few years, we have a long way to go.

Is there a persistent public health problem that still concerns you?

The challenge in many ways is that a lot of the health issues that are important to me and to others are rooted in poverty. The head of the Bronx District Public Health Office once famously said, ‘The Health Department shouldn’t be called the Health Department. It should be called the Department of Poverty Reduction.’ If we could possibly solve that problem, so many things would be fixed. It’s going to be a long time before an equitable society exists, but I’m encouraged by conversations with community leaders and organizations and grant applications that require public health groups to engage multiple sectors in their work and develop programs that properly address the root causes of health inequities in this country. My most exiting and impactful programs are those that include schools, housing providers, transportation and other sectors.

On the flip side, one of the big successes is tobacco control. The 50th anniversary of the Surgeon General’s report was released in January. When you think about how far we’ve come in this country – especially in New York City — with regards to smoking, it’s pretty amazing. The Bronx is tied with Brooklyn for the second lowest youth smoking rate in New York City at 6.7%. This is a real bright spot for the Bronx and the country.

Jim Bloyd, MPH

JB 1As an undergraduate at San Francisco State University, Jim discovered public health through a Sociology of Medicine course.  His interest further blossomed as a volunteer in San Francisco General Hospital’s Emergency Room, where he observed that the health problems he witnessed were not rooted in biomedicine, but in social factors like hunger and malnutrition.  He switched career paths from medicine to public health.  Currently with the Cook County Department of Public Health in Chicago, Jim has been heavily involved in Place Matters, a national initiative to address the social, economic and environmental factors that influence health inequities.  Jim’s experiences highlight the challenges and opportunities of working within a local health department, as well as the need to maintain social justice as a central tenet of public health.

Career in Profile:

  • 1988 :  Studied Spanish and Health at San Francisco State University, California
  • 1990:  Studied Behavioral Sciences and Health Education at University of California Los Angeles, School of Public Health
  • 1990-1991: Implemented tobacco use prevention programs in East Los Angeles as a Health Educator for the County Department of Public Health, California
  • 1991-1993:  Worked as a Health Educator at the Lake County Health Department, Illinois
  • 1993- NOW Leads community health improvement planning activities and assists in fulfillment of agency strategic goals as the Regional Health Officer for the Cook County Department of Public Health, Illinois
  • 2007- NOW:  Studying at the University of Illinois at Chicago, School of Public Health as a DrPH Candidate

What is a career highlight for you?

In Chicago, we recently hosted a Place Matters action lab that succeeded in several ways.  Our Place Matters for Health -report in Cook County showed that folks who live in Census tracts where the median household income is $55,000 lived 14 years longer than people who lived where the median income was $12,000 or less.  This underlines the point that the solution is not just to educate people from poorer neighborhoods. There is a whole constellation of living conditions and stresses that follow income lines.  That’s the real issue.

Related to that, in the metropolitan Chicago area, structural racism shows up as patterns of residential segregation. We found that quality of education and educational attainment are stratified by race.  We found that opportunities are also segregated, so that 80-90% of Blacks and Latinos live in low opportunity neighborhoods in metro Chicago.  Public health relates to life expectancy inequities, chronic illness inequities, and we need to work with individuals to increase their collective power.  We need to find ways for individuals and communities to change policies, which will create healthier places for them to live.  Ultimately, we need to wrestle with privilege and segregation and unfair distribution of resources of all kinds.

The report is an example of issues I hold dear, and it was given a very strong vote of approval by our agency’s leadership.  It was a team effort.  There were many people, locally and nationwide, who were working on this national initiative.  It was fun, exciting moment at the end of a lot of hard work.

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

Trying to see the work in public health as process. Trying to be patient.  Trying to listen to other people more, and trying to understand that other people are coming from other perspectives, and to feel okay about challenging perspectives that I need to disagree with, and find a way to disagree that is still effective.  I think a challenge is to try and understand my personal responsibility for challenging racism and privilege, especially in the area of race, but in other areas as well.  I may not have played a role creating these systems of privilege, but I can feel good about taking responsibility for challenging and opposing these systems of privilege.

Especially in large, local health departments, it’s a challenge to work in a bureaucracy. You may have more resources, but I can’t say that we’re as flexible, or that we operate as quickly, as I would like.  However, many community leaders and residents welcome discussions on the social determinants and injustices as a way to explain their daily experiences.  They want to know what we, as a health department, can offer them beyond behavior change trainings and education.  Folks have setbacks in their careers, but I’m learning to say, “OK, this is just one day or one battle.  Or maybe there’s a battle I choose not to fight, and I’m gonna choose to work on this.   I’m learning to avoid burnout by not spreading myself to thin.”  This is a time of diminishing resources, so it’s a challenge to keep that perspective in order to keep being effective, keep generating resources for social justice and public health.

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

It’s important to make social justice more apparent in the work that we do, and it’s always a challenge.  When it comes to the big picture, health inequities are the most important part of public health.  I try to take an explicitly anti-racist, community engagement, social determinants approach to addressing health inequities.

What is a persistent public health problem that concerns you?

On a practical level, I’m concerned with cutbacks to public health infrastructure, staff and budgets.  It hampers our ability to do our job and to inform the public about the data we collect.  It’s even a challenge to inform the public about health inequities!  Despite the fact that the U.S. ranks among the wealthiest countries in the world, our political priorities mean that that public health is not highly valued.  Building a public constituency is challenging.  People fought for the creation of local health departments, and the public health workforce should not be afraid to take on the politics of informing folks. We don’t have a profit motive, we are accountable to the taxpayers, and I think that’s a very valuable thing.

If we don’t exist … people are paying for that now!  You see it in the widening inequities, premature deaths, chronic diseases, and this is especially true for people of color and low income folks.  We’re still approaching epidemiology through a biomedical risk factor lens.  We need to be evidence- or science-based, which requires a theory of change that can be tested and researched.  For those of us in the practice world, we need to reflect on our theories of change.  Nancy Krieger’s Epidemiology and the Peoples’ Health outlines non-biomedical risk factor-oriented theories.  These theories should guide our work.  Rudolph Virchow recommended that people need freedom from homelessness, illness and poverty.  Awareness of theories can – and should – affect our practice.  It challenges us to question our status quo positions, like our focus on individual behavior change that tends to blame the victim. This puts us in difficult positions, and I think that’s why people don’t think too hard about these alternatives.

What’s your ideal solution to this public health problem?

We have a lot to learn from community organizing and political analysis to understand power.  Who has power and who does not?  I would hire community organizers to challenge unequal or balancing relationships of power, which is called for by the World Health Organization.  A successful community organizer challenges the status quo.

At a practical level, community-based organizations like the Restaurant Opportunity Center (ROC) build power among marginalized people, low-wage earners and communities of color. They address racism and unearned white privilege. We need to build strong relationships with the ROCs and other labor-organizing efforts.  Local health departments can – and are – getting involved with foreclosure and anti-eviction movements, big box retail store and labor, even the 99% movement, equity, and Wall Street.  Public health can make connections to movements that move us towards social justice.  Social justice will lead to health equity, which allows everyone’s health potential to be fully realized.

Reflective: Looking Back On Volumes 4-6

Every four months we pause from conversations with public health leaders to reflect on lessons learned from their varied careers, and insights into persistent and emerging public health challenges.

We are Public Health has been honored to feature conversations with several groundbreaking, widely respected pioneers in the field.  The last three volumes highlighted Dr. Len Syme, father of social epidemiology, and Dr. Jack Geiger, a pioneer of the community health center movement in the US.  As Dr. Geiger acknowledged in his interview, “we all stand on the shoulders of others.”  The ripple effect of their unique contributions to our field is evident in the work of other featured practitioners such as Jim Bloyd, Dr. Sandra Witt and Dr. Bob Prentice, who are all working to operationalize Dr. Syme’s and others’ social determinants of health framework in communities and within government institutions.  Similarly, we see Dr. Geiger’s strategy of engaging, organizing and empowering community members to create their own solutions and successfully address public health challenges reflected in Emma Rodgers’ coalition-driven work in the Bronx, Laura Sanders’ advocacy for immigrants’ rights in Southeastern Michigan, Arnell Hinkle’s efforts to create youth-led and culturally appropriate nutrition and physical activity resources, Dr. Joe Zanoni’s work to improve the health and safety of immigrant day laborers, and finally in Dr. Joseph West’s community research on diabetes in Chicago’s North Lawndale network.

Drs. Syme and Geiger’s legacies extend beyond these amazing public health workers who continue to “stand on their shoulders”.  Their impact is also evident in current public health work and policies. These days, it is rare for public health students to graduate from any school of public health without a working knowledge of the social determinants of health. In the field, the determinants are widely considered just as critical to supporting and improving the health of communities and reducing health inequities as the delivery of clinical services. Additionally, community health centers are rapidly becoming the go-to places for many Americans to seek health care and community resources.  In the age of the Affordable Care Act, also known as Obamacare, these centers play a central role as the medical homes of low-income residents across the nation, and a growing number are finding creative ways to integrate the social determinants into primary care.

When we started this website we hoped that we would be able to feature public health’s well respected and renown pioneers. We are delighted to also see the connections between their groundbreaking work, and the current efforts of a diverse set of public health practitioners.  It is truly inspiring to witness the evolution of their audacious visions.

We are so excited about where the next three volumes will take us!  We look forward to reflecting on more trends in these public health histories.