As 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.