Silos, Streams, and Social Justice

Dr. Adewale Troutman discussing the stream
analogy at the CPH. 

A highly-regarded professor in the Department of Community and Behavioral Health tells each of her students that engaging in a reflective process is one of the most important practices you can do as a public health professional. Well...it is now officially post-graduation time and I am finding myself reflecting on my transformation over the past two years. As I prepare to take my next steps out into the world of public health practice, I am thoughtfully considering the lessons I have learned and how I can apply those lessons every day for the rest of my career. 

Last week, I was privileged to attend a lecture by Dr. Adewale Troutman, past president of the American Public Health Association. His presentation, entitled “Health Equity: Moving from Theory to Action, Taking it from the Textbook to the Street,” was inspiring to me as a young professional about to take what I learned in graduate school and apply it to the streets of Detroit, Michigan. There were three themes that resonated with me throughout his speech, all of which were woven throughout the curriculum and my practical experiences at the University of Iowa College of Public Health.

Silos

The first theme that Dr. Troutman talked about was this idea of silos and how we can begin to break down the barriers between research and practice, academia and community organizations, and public health and medicine. As someone who is starting the next step of my journey in the world of medicine, I hope that I can teach my fellow classmates to move beyond the medical model of health and to examine the multitude of factors that may be affecting their patients' health at the individual, interpersonal, organizational, community and policy level (socioecological model, anyone?). It is my greatest wish that we as professionals can begin to break down these silos and start playing nicely in the sandbox. Collaboration is a valuable tool. I have found in my LEND training that interdisciplinary evaluation and discussion of a problem (whether it be a single client or a state-wide system) is the most effective and efficient way to achieve a positive outcome. The health problems that our future generations will face are complex. It will require a diversified skill set and many different perspectives to ensure that we achieve the goal set by Dr. Troutman and APHA: to close the gap in health [income, education, access to care...] in one generation. 

Streams

The next theme that was discussed was the idea of moving upstream, from treatment of disease to prevention and promotion of overall health and well-being. Dr. Troutman used the stream analogy in a way that I thought was very thought provoking. He said that there are four places in which to focus our efforts - all of which are necessary but no single one is sufficient. First, we can move upstream and focus on the root sources of disease and excess death (e.g. social determinants, racism). I read an recent article about how there is a growing movement of "upstreamist" doctors who are no longer satisfied with simply giving a drug to manage disease. It is encouraging to see physicians working with public health to try to change the environment for their patients. The second place in which we can focus our efforts is to 'teach them how to swim,' meaning helping communities gain the skills to self-create a healthy environment to live, work, and play. Community-engagement and research that is participatory and community-based is a great way to start this process. Third, we need to continue to help people drowning downstream and to do our best to treat individuals facing disease, help those living in poor conditions, and prevent excess death. Finally, we need someone overseeing and coordinating all of these efforts to ensure that research is applied and that we are seeing both the forest and the trees. 

Social Justice

The final - and arguably most important theme - that Dr. Troutman discussed in his lecture is social justice. The definition of social justice is that all people deserve equal access to societal power, goods, and services. This implies that all people deserve the opportunity for optimal health and that health is a basic human right and a matter of human dignity. Our job is to make the systems fair and accessible for all. Troutman also talked about changing the rhetoric in which we as public health practitioners talk about social justice - moving from understanding health disparities (differences that exist) to advocating for health equity. Today, health status is based on so many factors: race, socioeconomic status, disability status, and even zip code. There are even implicit provider biases and attitudes that impact how health care is delivered. In order to wholly practice the idea of social justice, there needs to be a paradigm shift to a mentality that is, at its core, human-centic. As Troutman said in his lecture "There is no 'them' - only 'us'."

As my time in the MPH program comes to a close, I am left with two overwhelming feelings: apprehension and empowerment. I am nervous about how much I can really do to help communities and families - after all I am just one person. I worry about the stressful environment that children are being born into and the growing list of determinants that will affect their health throughout the lifespan. However, I also feel empowered and I refuse to let these challenges deter me from trying. I will continue to spread the word about public health in order to create a collective consciousness about the issues. I will continue to focus my efforts on early intervention and helping kids get off to a healthy start in life. I will continue to collaborate with my classmates (now colleagues) who remain in the world of public health and other health disciplines.

My first blog post talked about diving in head first to something that scares me. At least now I know that I am prepared to enter the waters of public health with the tools and life supports to stay afloat. Thank you for reading.

Selfie at graduation with Dr. Parker (our Department Head) and Dr. Woods-Jaeger.

The Power to Protect

PSA from the American Academy of Pediatrics

In honor of National Infant Immunization Week and the recent media coverage on the measles outbreaks, I thought I would write a short post about the POWER OF VACCINES. As someone who believes in protecting our most vulnerable population - children - it seems like a no brainer that parents in the developed world would choose to vaccinate their children. However, as we learn in our health behavior courses, vaccination is a complex behavior. It depends on parents' perceived susceptibility of their child getting the disease, the perceived severity of the disease itself, and the real or perceived costs and benefits of vaccination (our old friend, the Health Belief Model). Oh, and cues to action like this lovely public service announcement!

According to the Centers for Disease Control and Prevention (CDC), we have reached several significant milestones related to vaccine-preventable diseases:

• Through immunization, we can now protect infants and children from 14 vaccine-preventable disease before age two.
• In the 1950s, nearly every child develop measles, and unfortunately, some even died from this serious disease. Today, few physicians just out of medical school will ever see a case of measles during their careers.*
• Routine childhood immunization in one birth cohort prevents about 20 million cases of disease and about 42,000 deaths. It also saves about $13.5 billion in direct costs.

*However, as many of you have read in the news recently, measles is now worrisome reality in the U.S. Since the new year, measles has infected 129 people in 13 states, the most in the first four months of any year since 1996 (CDC officials). So what's the culprit? I am sure there is a multitude of complex factors leading up to this outbreak, but perhaps a lack of herd immunity (due to low vaccination rates) is part of the problem.

Everything you need to know about vaccines by German Lopez

Herd immunity is "when a critical portion of a community is immunized against a contagious disease, most members of the community are protected against that disease because there is little opportunity for an outbreak. Even those who are not eligible for certain vaccines—such as young infants, pregnant women, or immunocompromised individuals—get some protection because the spread of contagious disease is contained." (vaccines.gov). The infographic on the left is helpful in understanding this concept. 

So how do we protect again future measles outbreaks? Measles can be prevented by just two shots of the combination MMR (measles, mumps, and rubella) vaccine. There is even a helpful vaccine schedule for parents to help keep them all straight! 

There is a paradox that we learn about in the MPH program that says "when public health works, nothing happens." Universal immunizations for children is one of the Top Ten Public Health Achievements of the 20th Century. It is my sincere hope that the popular press and pervasive myths of the 21st century do not unravel all the hard work that public health has done to protect our most vulnerable populations from communicable diseases.

Making Change Happen on Capitol Hill

"Don't just throw pillows at your television. Engage to make a change!" (staff person for Senator Grassley)

Cherry blossoms were blooming at our nation's capital!

Disability advocates, myself, and several interdisciplinary LEND (Leadership Education in Neurodevelopmental and Related Disabilities) Trainees and from across the country came together last week for the annual Disability Policy Seminar held in Washington, D.C. At the Disability Policy Seminar, attendees were armed with the information needed to help educate our Members of Congress and their staff on the priorities of the ID/DD community. One of the most important lessons that we as young professionals learned from the Seminar and Hill Visits was the importance of engaging with the legislative process in order to create change for individuals with disabilities. As a current LEND trainee in the field of public health, I was impressed with the collaboration between multiple organizations (American Association on Intellectual and Developmental Disabilities, The Arc, Association of University Centers of Disabilities, National Associations of Councils on Developmental Disabilities, Self Advocates Becoming Empowered, and United Cerebral Palsy). It is rare to see so many groups with differing missions come together to work towards a common goal and bring a united front when working on key policy issues.

The opening presentation entitled Forging a Path Toward Bipartisanship featured such notable panelists as former U.S. Senator Pete Domenici, Former U.S. Representative Tony Coelho, and several staff members from the Bipartisan Policy Center. This session highlighted the importance of using commonalities and personal stories to get things done in Congress. The panelist also stressed how vital it is to identify new disability champions in both parties, especially with all the new faces in Congress. With several important pieces of legislation coming down the pipeline, such as the ABLE Act and Combatting Autism Reauthorization Act, it has never been more important to advocate in a bipartisan manner. In addition, we learned that future legislation, which hopes to garner bipartisan support, should be developed in a bipartisan manner.

Iowa LEND trainees with disability and public health
champion, Senator Tom Harkin. 

Another highlight of the conference was hearing from the speakers representing Self Advocates Becoming Empowered - their slogan is "nothing about us, without us." In particular, Claudia Gordon, who served as the liaison between the disability community and the Obama Administration, delivered an inspiring speech (through sign language) that made each person in the audience feel like they could make a difference as an advocate. The seminar left LEND trainees feeling prepared and energized for the Capitol Hill Visits on Wednesday. For many of us, this was our first time advocating for something we each care deeply about – the Combatting Autism Act (which funds our wonderful program). After meeting with the staff of Senators Harkin and Grassley, we were surprised by how accessible the whole process was and encouraged by the fact that each of our voices were heard and taken seriously. LEND is all about becoming leaders, not only in our disciplines, but also in the communities that we serve. The Disability Policy Seminar empowered each of us to take on this role as future leaders in healthcare.