Taking Notice

Josh Havumaki

As part of the International Health track of the Epidemiology program, I often forget that direct impact can be made locally through simple means. In fact, anyone can “practice” public health through top-down or bottom-up approaches. Some examples of the different approaches are discussed in the first 3 paragraphs here.

Due to the struggling economy, tent cities are cropping up all over the states. In fact, just a short distance from SPH, is a homeless community called, Camp Take-Notice (CTN). Renown intellectuals, Cornel West and Tavis Smiley recently visited the camp as part of their Poverty Tour of America. Last week, a couple of friends and I decided to take an impromptu trip to the area to speak with the residents and understand their daily lives.

Travis (left) and Sabri (right) preparing to fix the stairway leading to CTN

The camp is cozily nestled in the woods between two major highways on the outskirts of Ann Arbor. Each of the fifty or so residents have private tents and sleeping bags. Heaters are provided in the winter – though most residents migrate somewhere warmer. There is a common area with a large tent complete with propane stove and kitchen supplies. Another tent on a wooden platform provides additional tools for maintaining the camp. Most of the residents are either working part-time or actively looking for work and a few have been able to save enough money for an apartment in town.

Once we arrived, introductions were made and we were put to work fixing-up a dirt stairway leading from the road to camp. Afterward, we were invited to join the residents for dinner – provided by a local church. When dinner was finished, we took a quick tour of the camp and joined their weekly meeting. The meeting is a chance for residents to air grievances, praise each other for helping out and make requests for necessities. Overall, it was fascinating explore this alternative to homelessness and how community can alleviate suffering.

Travis and I on the stairs

Most businesses in Ann Arbor don’t hire homeless people. The residents of CTN have stability, community and a semi-permanent place to live. Additionally, the skills they develop through their work maintaining the camp are transferable. However, the stigmatization of homeless people is difficult to contend with and employers will not consider hiring them without a proper address.

Regardless of background and future career goals, all of us here at SPH have the opportunity to look at both the global and domestic determinants of health. Public health issues exist everywhere - so stop by, help out and above all take-notice.

Dr. Martin Luther King, Jr. Day Health Disparities Lecture

Carrie Rheingans

The U-M School of Public Health was the lead organizer of this year’s annual health disparities lecture in honor of the Reverend Dr. Martin Luther King, Jr. Day Symposium on campus. Each year, many of the health science schools (Public Health, Social Work, Medical, Nursing, Pharmacy, Dentistry) work together to bring a speaker to discuss an aspect of health disparities. This year’s speaker was Dr. Sherman James, Susan B. King Distinguished Professor of Public Policy at Duke University, a former SPH faculty member and one of the founders of U-M SPH’s Center for Research on Ethnicity, Culture, and Health, one of the first centers of its kind in the United States. The annual MLK Symposium is one of my favorite things about being a U-M student: classes are officially canceled so students can attend the multitude of events celebrating the work of MLK. I got to attend two more events in addition to the health disparities lecture: Shirley Sherrod’s keynote and a screening of Bilal’s Stand, a community-made film about a friend of mine from the Detroit area who struggled with deciding whether or not to attend college or take over the family taxi business.

Shirley Sherrod MLK 2011 Keynote Address in Hill Auditorium

Dr. James’ lecture focused on health disparities in the Civil Rights era and today. He started by showing many images of public places in the US South, highlighting how they were related to health disparities then and now. Then he started talking about specific issues, one of which was maternal and infant mortality rates. In the Civil Rights era (1960), Black women died giving birth at a rate of 31.7 women per 100,000, while White women died at a rate of 22.9 per 100,000 (Chay et al., 2003). This relates to today, where here in Washtenaw County, Black babies are three times more likely to die before their first birthday than White babies. I’m doing my social work field placement at the Washtenaw County Public Health Department, where they have a campaign about this very issue, called the 3X More Likely Campaign. Michigan Radio, the University of Michigan-based National Public Radio station, recently did a story about this disparity (and interviewed my supervisor!). The suspicion is that babies are being born with very low birth weights, because they are being born premature. According to the Washtenaw County campaign site, Black women may have their babies early as they age because of the chronic, low-level stress that has been building up over the duration of their lives. This really highlights the need to continue studying the social determinants of health.

Dr. Sherman James' MLK Memorial Health Disparities Lecture

Internship at the Washtenaw County Health Department

Carrie Rheingans

You know you’re a public health dork when… you leave a two-hour meeting at your internship with your head buzzing about the possibilities of health promotion programs in your community. For my social work field placement this academic year, I’m placed at the local health department, Washtenaw County Public Health. On my first day of orientation to SPH, I remember hearing someone say that if you’ve seen one local health department, you’ve seen ONE local health department – meaning that each local health department is so different from the next that there aren’t many generalizations that can be made about them. WCPH is fortunate to be able to do many health promotion programs that are in addition to their mandated public health duties as required by state or federal regulations.

Our division meeting included updates on a number of health promotion programs, from smoking cessation and healthy eating to biking to work and substance use prevention. It was reassuring to hear a lot of terms I’ve been learning in my graduate studies, and to see how health programs operate in my local community – instead of just reading about it from research articles. One staff member gave a report from a presentation at  statewide conference she had recently attended in which a health communication campaign out of Jackson, Michigan was discussed. I had heard about this campaign before in my health communication course last fall – it was a final project option for some of the students in my class! It was nice to see it come to fruition and be lauded across the state. You can learn more about it on their website – Most Teens Don’t!

Most Teens Don't Logo

Another major topic of the meeting was a big grant we’ve been writing for the last couple weeks for the Michigan Department of Community Health (MDCH). It’s been a fun process being part of this grant proposal. The MDCH has funded 16 community organizations and local health departments over the last year to do planning in their communities for addressing health disparities among various ethnic populations. Washtenaw County was funded to work with African-Americans and Latinos, and we just submitted our proposal for the next phase of the grant – implementation. Even if we don’t get funded, it was a great learning experience to be able to work on developing the programs for the Latino-focused part of the proposal, as well as the evaluation plan. I got to apply what I learned in HBHE 651 (Program Development) and what I’m learning right now in HBHE 622 (Program Evaluation), in addition to many of the theories I learned in HBHE 600 (Psychosocial Factors in Health-Related Behavior) and SW 502 (Organizational, Community and Societal Structures and Processes).

Using Census Data as a Student

Carrie Rheingans

Tiffany’s recent post about the 2010 U.S. Census reminded me of some of the reasons it’s important to fill out your Census forms completely and properly. Just this year alone, I have had multiple class projects that use Census data – for project development, community profiles, and tracking health disparities. I also participated in a community education event in English and Spanish in Detroit that I wrote about last semester. I recently received my Census forms and thought I’d share them so you can see what they look like if you’re not filling them out at your household (see below). One thing I appreciate about the Census is that they are trying to make the forms accessible by those who do not speak English very well. This is very important for me as a person designing social work and public health programs, because there is such disparity in health outcomes between English-speakers and non-English-speakers.

Census Envelope (English only)

Census Form & Letter (mostly English)

Census Language Assistance Letter (multiple languages)

Unfortunately, the Census has not asked for races the same way across all times it has collected data, so it is sometimes difficult to determine trends. This year, the “Hispanic/Latino” category allows respondents to enter their ancestry, which will be very useful for my work next year in my new social work field placement (I’ll be working with local community partners to create a Latin@ community center in our county).

Key Terms for Speaking #HC Reform

MB Lewis

A heavy bag strains my shoulder these days as I lug around reams of articles and notes, hoping to catch a few minutes here and there studying for my first  U.S. health care survey exam. My mind swirls with loaded phrases that succinctly describe why our country needs health care reform, unless we want to sink under $2.5 trillion-plus annual spending in a system that doesn’t work.

Know what I mean? Parlez-vous HC-speak? Let me unload a bit:

• Sick care system: That’s a more accurate term for America than the ubiquitous “health care system,” because bigger money is made treating illness than keeping our population well.
• Being uninsured is bad for your health: So is being poor or a racial minority in a system plagued by health disparities.
• We’re #37: That’s where the WHO ranks us on population health, even though we spend 16 percent of our GDP on health care, much more than any country. (Want to sing it?)
• Paradox of excess and deprivation: Inequalities, especially deep divisions between haves and have-nots, drive our miserable overall health status.
• Geography is destiny: Your health outcome could depend on the number and kinds of doctors where you live, as well as on your environmental stressors.
• The worried well: The economically privileged people who utilize health care services extensively, because they can.
• A built bed is a billed bed: Infrastructure-heavy investments in hospitals and equipment drive “supply-sensitive” spending more in some areas than others.
• Technological imperative: Expensive diagnostic equipment, once purchased, likely will be used–and Medicare will be billed.
• Bending the cost curve: This is what the Obama administration hopes to achieve with reform. Costs will continue to rise, but maybe not at such a steep rate.

If there’s any single image that stays with me most from the hundreds of graphs in Professor Rich Lichtenstein’s lectures this month, it’s this one on what’s killing us now, instead of the infectious diseases of yore:

See that big yellow piece of the pie? Behavior patterns (the food we eat, the exercise we skip, the risks we take) exacerbate chronic conditions and bring us down. Years of lost life are a result, along with many unproductive disability-affected years.  I believe wider insurance coverage and Medicare reform are urgent national priorities, but so is living healthier any way we can.

Dia de los Muertos

Valentina Stackl

The group I am in, La Salud, had another successful event yesterday. We celebrated Dia de los Muertos, a traditional Mexican holiday which celebrates the memory of those who have passed. To give it a public health twist, we educated the participants on Latino health disparities on top of doing traditional dia de los muertos activities like making an altar, decorating sugar skulls and sugar cookies. 

One of the things I found the most interesting in were the statistics about cancer and Latinos:

The incidence and mortality rates of stomach, liver, and cervical cancers, all of which are related to infectious agents, are higher among Hispanics than non-Hispanic whites, especially among first-generation immigrants to the US. For example, the rates of stomach cancer incidence are at least 70% higher in Hispanics than in non-Hispanic whites. Also, Hispanics experience a two-fold higher incidence and death rate from liver cancer compared to non-Hispanic whites. Hispanic women residing in the US have about twice the cervical cancer incidence rate of non-Hispanic whites. The death rate from cervical cancer is 50% higher among Hispanic women than among non-Hispanic white women. 

Here are also some pictured of the event:

What is Public Health? See below!

Carrie Rheingans

This is something I found via other public health students on facebook   Feel free to repost! This is an initiative of the American Public Health Association.

“Let’s face it – as a nation we’re not nearly as healthy as we should be. Compared to other developed nations, we’re lagging far behind.

But it doesn’t have to be this way. With your help, we can make America the healthiest nation in just one generation.

Want to know more? Watch the Healthiest Nation in One Generation viral video today. Share the video with your friends and family and encourage them to get involved.

America can make this the healthiest nation in one generation. We all have to do our part. What will you do?”

And also from this site (I’m just copy-pasting, so I’m quoting it):

“Public Health is:

local clinics • healthy mothers and healthy babies • breastfeeding • vaccinations • clean, fluoridated water • car seats • seatbelts • traffic laws • prepared communities • clean air • mental health services • school nutrition programs • tobacco-free environments • safe workplaces • green communities • medical research • sex education • jogging trails and bike paths • safe and clean places to play • sidewalks • elderly services • city planning • healthy homes

Public health is: the promotion of good health and the prevention of disease.

Unfortunately, we’re not there yet. The United States may spend more on health care than any other country, but even our best efforts have failed to make America a healthier nation. Check the facts:

• U.S. life expectancy ranks 46th in the world, behind Japan, most of Europe, and also countries such as South Korea and Jordan.
• A baby born today in the U.S is more likely to die before its first birthday than in almost any other developed country.
• Nearly one in 20 residents in the nation’s capital are HIV-positive.
• All ethnic minorities, except Alaska Natives, have a rate of type 2 diabetes that is two to six times greater than that of the white population.

With your help we can reverse these statistics. It all starts with one. What will you do to help make America the healthiest nation in one generation?”

Valentina’s Story About Switching from HMP to HBHE

Valentina Stackl

The second the accounting professor let us out on Wednesday afternoon I marched straight into the administration office: “I would like to switch out of my program please.” I had literally been in HMP for three days and I was 100% certain that I had picked the wrong program. I had a sneaking suspicion since applying, but I was in denial, my idealism had gotten the best of me.

I wanted to believe that I would battle through economics and accounting and that I would dominate in the best management and policy program in the country. I hoped that I would then become a famous politician and fix the healthcare crisis in the United States. Yeah right. I very quickly figured out that I didn’t want to learn about structures and systems of healthcare, I didn’t care too much about the rules and regulations that would limit my abilities, all I wanted to was help individuals and groups of disenfranchised people. I decided that I would let others make the rules, others run the hospitals, others make decisions. All I want to do is to help those subgroups of people who need help to navigate through the barriers and limitations.

Once I realized that HMP was filled with incredibly intelligent, competitive individuals who’s interests were in running hospitals and insurance companies, who wanted to be advisors to politicians and physicians, I had to bail. Let them look at the big picture, I will not. Maybe that will make me less lucrative, less successful, less wealthy in the end- but I don’t mind.

This semester I was finally able to take mostly HBHE classes. I will be learning about racial disparities and injustices and will get the tools to stage interventions and design programs at a community level. This is what graduate school was supposed to be like: doing my homework and truly enjoying it, reading articles and actually seeing myself doing the things that I am reading about.