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.