A City in Turmoil, A Nation in Disbelief: The Flint Water Crisis

A City in Turmoil, A Nation in Disbelief: The Flint Water Crisis

“My people perish from a lack of knowledge”  –Hosea 4:6

 

Flint, Michigan is a place where many individuals once achieved their American dreams. General Motors was everywhere, and 70,000 men and women went to work at its plant and offices every day.  Folks could live in big houses, enjoy leisure at golf courses, and drive big cars. In fact, during the mid-1960s (1964-65), Flint had the highest per-capita income in America.

But today, Flint is a mere shell of its former glory. What remains are abandoned houses, lots infested with weeds, and warehouses lying vacant.  It’s a city with high unemployment rates, and where greater than 50% of the children live in poverty. Perhaps not surprisingly, in less than 50 years, the population of Flint has dropped from 200,00 to less than 100,000.

Amid these devastating statistics, there has emerged another crisis in Flint: residents being poisoned by the one commodity that is so precious to life – water. As has been well-documented over the past months, a major challenge now facing the Flint community is to identify which individuals – many of whom are children, pregnant women, and the elderly – are at the highest risk of lead contamination-related health problems, and determine how to identify and treat the outcomes of lead exposure. This is critical, because even after lead exposure ceases, the effects can last for years – or even become permanent.

Cities and states across the U.S. have had a long experience with lead contamination. For instance, the Centers for Disease Control (CDC) has reported increased lead levels in the drinking water in other Michigan cities. And more recently, similar concerns of potential lead toxicity have surfaced in North Carolina and Maine.  In all of these cases, the problems of lead contamination could have been foreseen, but water treatment decisions were being made based on cost and feasibility, and environmental regulations were being ignored. This makes the problems of water safety in Flint even more infuriating, says Rebecca Meuninck of the Michigan Network for Children’s Environmental Health. She has called it, “A real public health crisis with a real-life impact.”

And the “real-life impact” is significant. Clinical researchers have acknowledged the devastating long-term effects of lead exposure in childhood. Lead exposure causes deficits in intellectual functioning, academic performance, critical thinking skills, and motor-skills, along with decreased brain volume in adulthood. Researchers also have begun to explore links between childhood lead exposure and various risky behaviors in adulthood, including criminal activity, substance use, and even HIV-AIDS. Because there are no known ways to reverse the harmful effects of lead toxicity, many pediatricians, such as Dr. Mona Hanna-Attisha of Hurley Medical Center in Flint, emphasize prevention strategies and minimizing or eliminating environmental exposure.

We also cannot ignore the presence of racial and socioeconomic disparities in this public health crisis. According to the CDC and other health organizations, minority children and children in low-income families experience higher average blood lead levels. This is likely due to differences in living conditions, housing, and nutrition. Because calcium decreases lead absorption in the body, malnourished children face a greater burden of disease.

Presently, I am working with a group of researchers from the University of Michigan Flint, and a number of clergy, as we develop community based participatory research initiatives targeting parents, school officials, and residents of Flint in an effort to identify any abnormal behaviors, or signs of lead toxicity/contamination within young children. I am also working with Dr. Vicki Johnson-Lawrence, a Social Epidemiologist at UM-Flint, to develop a research model identifying life course issues of comorbidity (diabetes, stress, cancer, cardiovascular disease) as they relate to long-term health disparities. The Department of Public Health & Health Sciences at UM-Flint also has held seminars, and produced infomercials, to enhance public awareness of the specific effects of lead toxicity.

So the problem has been identified. But what’s next? To start, we need communities, public health officials, medical organizations, and the CDC to galvanize efforts to educate and develop behavioral interventions. Our elected officials also have to provide the necessary resources to help devise a solution that will provide hope and a brighter future. And residents need assurances that their water will be safe to drink, their streets will be safe to walk again, and their children will be safe and healthy. So let’s come together for the many thousands here in Flint, and other cities as well, and give the children a brighter hope for tomorrow.


Terry L. Thompson, DHA, is an Assistant Professor, Public Health and Health Sciences, University of Michigan-Flint. His research interests lie in the area of men’s health, specifically men suffering from Type 2 Diabetes.

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How Racial Categories Affect the Health Status of Mixed Race Young Adults

How Racial Categories Affect the Health Status of Mixed Race Young Adults

Since the 1967 repeal of anti-miscegenation laws in the United States, the number of interracial partnerships – and the resulting number of mixed race individuals – has skyrocketed.  According to the Pew Center, approximately 16% of young adults in the U.S. could be multiracial (two or more races), depending on the definition and how individuals are categorized in surveys. Yet, despite the increasing number of multiracial Americans, very little is known about the health outcomes and health patterns of this group in the context of health disparities. Through my research, I have sought to examine the health patterns of multiracial young adults, and to learn how changes in racial categories are related to health status.

The topic arose from my lived experience as a Black woman of mixed heritage, and from my professional background as a social worker. Over the years, I have met many multiracial young adults who ascribe to various health beliefs based on how they racially categorize themselves, and how others categorize them. One example is a Black/White individual who stereotypically smokes menthol cigarettes to confirm that they are Black in social settings, but might not always self-report as solely Black when asked formally. This led me to question the health behaviors of multiracial young adults, and the role of racial categorization in population health research. I questioned if multiracial adults indeed engage in riskier behaviors, such as cigarette smoking or heavier drinking, when compared to their single race peers, and if there might be a difference in health service use. I also wanted to know if the way we use race in population health research was dependent upon how individuals self-report their race, and if changes in self-reported race were related to health status in adulthood.

In my experience as a social work researcher, I quickly learned that multiracial individuals are not included in most population health research efforts, and if multiracial is included, it is a single all-inclusive category. Accordingly, my colleagues and I conducted a series of studies to determine if a single all-inclusive multiracial category was sufficient to account for the health of multiracial adults, compared to single race young adults. In one study, we found that the single category masks a lot of the variation in specific multiracial subgroups. When we compared the primary care service use of an all-inclusive multiracial group to monoracial White adults, we found no difference in health service use. When examined by subgroups (e.g., Asian-White or Black-Native American) some multiracial subgroups (e.g., Black-White and Black-Native American) are less likely than White adults to report primary care service use in the past year. These disparities in health service use would not have been evident if only examining an all-inclusive multiracial group of adults.

In another study, I examined whether changing racial categories in adolescence was associated with differences in health in young adulthood. The study examined the change in race over time, and sought to examine the health status of multiracial individuals who switched race either from many races to a single race, from a single race to multiracial, or reported consistent multiracial categories at both times.  After a series of tests, the results showed individuals who switch from a single race to multiracial are less likely to report fair/poor health status compared to single race adults.

This collective research is an entry to gaining a fuller understanding of multiracial Americans and changing health patterns in our country. If the trend in selecting two or more racial categories to self-designate one’s race continues, we will need to change our approach to using race in health research. Now more than ever, health researchers must ensure that special subgroups of multiracial Americans are categorically included in health research, and not left out of the conversations to improve our nation’s health.

I often think about racial categories for my mixed race child, who is also of Hispanic heritage. I wonder how she will self-report her racial categories, and how her information will frame the discussion of race and ethnicity in our country. My experiences are not unlike tens of millions of other Americans who are either self-identified as mixed race themselves, or are parents of mixed race children. It is time that we reexamine the fluidity in racial categories as we build a culture of health in the coming decades.


Karen Tabb Dina, PhD, MSW is an Assistant Professor of Social Work at the University of Illinois at Urbana-Champaign. She received her PhD in Social Welfare from the University of Washington, her MSW from the University of Michigan, and her BA from Eastern Michigan University. She conducts research on the social determinants of health (e.g., race, gender, and income) and health disparities. 

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Equity. Contribution. Community: New Connections at 10

Equity. Contribution. Community: New Connections at 10

Anniversaries present an opportunity for reflection, celebration, and looking ahead to the future. As we reflect on a decade of service and the 10-year anniversary of New Connections, we commemorate our longstanding partnership with the Robert Wood Johnson Foundation (RWJF) toward building a network of diverse scholars and change leaders. We are delighted to introduce the 2016 anniversary year program theme: Equity. Contribution. Community: New Connections at 10!

Equity. New Connections has been instrumental in promoting and advancing equity in academia by supporting the professional growth of health and healthcare researchers and evaluators from underrepresented backgrounds. Many of these scholars are the first in their families to attend and graduate college. Since 2005, more than 800 scholars participated in career development opportunities – through leadership development workshops, mentorship, and networking – and we have awarded 138 grants to junior and mid-career researchers.

Contribution. New Connections’ contribution to the field and the academy are significant. The program’s scholars broaden perspectives in educational practices, in the health field, and at the Foundation to help build a Culture of Health for all Americans. Collectively, we add to the discourse on the value of diversity, noting how scholars of color enrich student learning, stimulate asset-based research and evaluation approaches, and improve health outcomes.

Community. New Connections adopted a highly successful and unique network approach to develop a community of scholars by investing in their professional growth – and increasing interdisciplinary cross-sector collaboration. Through convenings, scholars and researchers come together at an annual Symposium and Research and Coaching Clinic. These convenings facilitate opportunities for scholars to connect with senior researchers, who offer guidance and mentorship for the tenure and promotion process. In addition, our network members have established “new connections” with scholars conducting similar research. These relationships have evolved into collaborative partnerships for grant writing, publication, and moral support.

Throughout this year, you will have the opportunity to meet select members of the New Connections network through featured scholar stories on our website; publications and reports on the impact of New Connections; a dedicated blog series, focusing on our scholars’ research contributions to their fields; and more. You can follow program highlights on the New Connections social media platforms, and on our website.

We look forward to celebrating 10 years of New Connections with you!

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Central City Gentrification and Place-Based Health Initiatives

Central City Gentrification and Place-Based Health Initiatives

Increasingly in U.S. cities, developers, investors, and businesses are collaborating with municipal officials to redevelop and gentrify heavily populated cities at the center of large metropolitan areas (Glaeser & Shapiro, 2001Frey, 2012). They aim to attract a young professional and “creative class” demographic that has expendable income for activities such as eating at trendy restaurants, perusing galleries, and patronizing coffee shops, bars, and cocktail lounges. Yet despite such intentions, this redevelopment model conflicts with setting a fair and adequate baseline of living conditions for majority residents in these central city areas – typically the poor, working-class, and communities of color.

In 2011, the major central cities of the country’s largest metropolitan areas grew faster than their combined suburbs (Frey, 2012). In fact, one-third of the U.S. population was living in central cities, which was fueled by a three percent increase from 2000 to 2010, the highest proportion since 1950 (Census, 2012). According to the U.S. Census, these demographic changes are partially fueled by people flocking to the downtown areas of these cities, which are increasingly becoming a place to work and live. For instance, between 2000 and 2010, metro areas with five million or more people had increased double digit population growth rates within two miles of their largest city’s city hall, more than double the rate of these areas overall (Census, 2012).

These demographic trends are certainly appealing for some central city stakeholders, who are mostly interested in “bringing back” people to downtown areas who could afford and reap the benefits of redevelopment. “A common theme for the White population from 2000 to 2010 was population increases in the central areas of many of the largest principal cities…” (Census, 2012). Indeed, we are seeing some reversal of the legacy of white flight. The Latino population also increased in each of the 20 largest U.S. central cities during the same period. Unlike whites, however, Latinos have traditionally been central city dwellers, especially the low-income and immigrants who often live in long-standing gateway neighborhoods near downtown areas. At the same time, many central cities with the largest African-American populations, such as Detroit and Chicago, saw a decline in the African-American population.

Some activists in local communities are contesting the merits of residential and commercial gentrification. As well, the CDC suggests that the increased cost of living associated with gentrification can directly affect the health of existing residents. For example, gentrification limits residents’ access to affordable produce and public open spaces for physical activity. Furthermore, the increase of more expensive housing options reduces residents’ opportunities to continue living in their neighborhoods. These residents are at risk of being displaced from their dwellings and their longtime social networks, which can further affect their health and well-being.
While gentrification continues to spread to central cities throughout the U.S., a number of federal and philanthropic initiatives are pushing “placed-based” initiatives – comprehensive neighborhood planning – to optimize land use and increase the coordination of various health services available to local neighborhoods, some of which are in central cities undergoing gentrification. The Department of Housing and Urban Development’s Choice Neighborhoods, the Robert Wood Johnson Foundation’s Communities Creating Healthy Environments, and the California Endowment’s Building Healthy Communities are among the funders of place-based initiatives.

Yet, if placed-based initiatives are to reach their maximum potential in central cities, local government, developers, businesses, planning and urban design enterprises, and local community leadership must address the politics of community redevelopment associated with gentrification. They can begin their efforts by supporting existing residents and their allies in pursuing social justice and health equity. Social justice in health focuses on leveling the playing field among populations, such as changing living conditions, policies, and social arrangements that expose some groups to unhealthier environments, and providing the same opportunities to make health-promoting choices as those enjoyed by more advantaged groups (Freudenberg, Klitzman, & Saegert, 2009). Social justice in health is also a matter of addressing health inequity – the avoidable, unnecessary, socially produced, and unfair differences in health status among populations (Whitehead & Dahlgren, 2007).

But, pursuing social justice and health equity requires that we ask critical questions about gentrification and place-based initiatives:

  • How can place-based health initiatives for majority central city residents (mostly low-income and communities of color) be effective, while some stakeholders are more interested in increasing land values, commercial revenue, and attracting an otherwise different consumer and resident demographic?
  • What types of federal or philanthropic support can support a movement among public health and urban scholars to examine the outcomes of health and urban improvements among the most vulnerable in central cities undergoing gentrification and place-based initiatives?

This blog focuses on place-based initiatives, health, and gentrification, yet it is not exhaustive. My hope is that the views shared here elicit a growing and continuous support for the most vulnerable residents in central cities undergoing, or in threat of, gentrification. And, I am eager for healthcare philanthropies, the federal government, and scholars to expand the scrutiny of these community development activities and associated outcomes.

This blog is based on the previously published article: González E. R. and M. Mouttapa. 2014. Urban Revitalization and Health Justice: Questions and Recommendations. Californian Journal of Health Promotion, 11 (2), iv-vii. 

Erualdo R. González is an Associate Professor in the Department of Chicana and Chicano Studies at California State University, Fullerton. His research examines community development, community planning, urban politics and governance, and healthy communities. He focuses on the intersection of these topics with race, ethnicity, class, and immigration, with an emphasis on Chicana/o-Latina/o communities. González is the author of the forthcoming book Latino City: Urban Planning, Politics, and the Grassroots (Routledge).

 

Bibliography

“Census Data Show Hispanic Boom; Blacks Leave Cities for South, Suburbs.” (March 2011).

http://www.pbs.org/newshour/bb/government_programs-jan-june11-census_03-24/.

Freudenberg, Klitzman, & Saegert (2009). Urban health and society: Interdisciplinary approaches to research and practice. San Francisco: John Wiley & Sons.

Frey, W. (2012). Demographic reversal: Cities thrive, suburbs sputter. Brookings, Available

at: http://www.brookings.edu/research/opinions/2012/06/29-cities-suburbs-frey.

Glaeser, E., & Shapiro, J. (2001). Is there a new urbanism? The Growth of U.S. Cities in the

1990s. NBER Working Paper No. 8357.

Mather, M., Pollard, K., and Jacobsen, L. A. (2001). “First Results from the 2010 Census.” The Population Reference Bureau.

http://www.prb.org/Publications/Reports/2011/census-2010.aspx.

Populations Increasing in Many Downtowns, Census Bureau Reports. (Sept 2012).

https://www.census.gov/newsroom/releases/archives/2010_census/cb12-181.html.

Suro, R. and Singer, A. (2002). Latino Growth in Metropolitan America: Changing Patterns, New Locations. The Brookings Institution.

Whitehead, M. & Dahlgren, G. (2007). Concepts and principles for tackling social inequities in health: Levelling up Part 1. Copenhagen: World Health Organization.

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How Empowerment and Education are Helping African-American Women Fight Back against HIV/AIDS

How Empowerment and Education are Helping African-American Women Fight Back against HIV/AIDS

The statistics are well-known. African Americans bear the heaviest burden of HIV of all racial ethnic groups in the United States, says the U.S. Centers for Disease Control and Prevention (CDC). And, the burden of this disease is carried squarely on the shoulders of African-American women. Their rates of new HIV infections are significantly higher than white women, and nearly five times that of Hispanic/Latino women. Adding insult to injury, 2011 CDC data show that almost 75,000 African Americans are living with HIV unaware.

Through my work as an HIV/AIDS advocate over the past decade, I’ve learned that the “why” is a little more complicated than the “what” when it comes to breaking down these inequities. And these inequities have fueled my passion to stem the spread of HIV/AIDS in communities of color. Through research and community interventions, I’ve learned that a lethal mix of economic, social, cultural, biological, environmental, and behavioral factors contribute to the HIV/AIDS devastation in communities of color.

Looking at the statistics along with the contributing factors makes it easy to assume that the future for infected African-American women is grim. What these facts and figures underestimate is the ability of African-American women to turn the tide on this deadly disease. The statistics downplay the resilience of a group of women that continues to thrive in the face of many other challenges. Through progressive and thoughtful interventions like Project THANKS and DASH, African-American women infected with HIV/AIDS are using empowerment and education to manage their diagnoses.

Project THANKS (Turning HIV/AIDS into New Knowledge for Sisters) is an evidence-based intervention that uses a community-based participatory and empowerment approach to prevent and manage the multiple conditions of HIV and other chronic diseases among African-American female HIV+ substance abusers. The goal: help women manage and improve their health when faced with complications associated with substance abuse, HIV, and other chronic diseases such as diabetes and hypertension. The program is targeted to meet the unique personal, familial, and cultural needs of women of color.

Project THANKS is a collaboration with Dr. Meena Mahadevan, Associate Professor of Nutrition Sciences at Montclair State University. The program is implemented over seven group sessions, and each session incorporates techniques that help the women set realistic goals, monitor their progress, and serve as sources of social support for one another. The program incorporates peer-facilitation and group mentoring techniques as well. At the end of each session, the women are encouraged to partner with a peer, and devise “action steps” or strategies that they can implement on their own. Because of participation in this program, dozens of women have stopped using drugs, become active participants in their own health, and maintained an optimal health status despite the complications of HIV and related illnesses.

Another intervention leverages the close relationships between infected mothers and their daughters to break the cycle of HIV/AIDS. Project DASH (Divas Against the Spread of HIV/AIDS) is a mixed-methods study that explores the relationship and communication characteristics between daughters and their HIV+ mothers, as predictors of sexual behaviors and HIV risk of the daughter. The objectives of the study are to: 1) explore the experiences of HIV+ minority women in New Jersey in accessing and navigating the healthcare system, 2) examine the relationship and communication characteristics between daughters and their HIV+ mothers and its impact on HIV prevention; and 3) serve as an intervention that targets mother-daughter sexual communication as a methodology to reduce HIV risk.

The preliminary results of Project DASH have tremendous potential to identify additional drivers of HIV/AIDS in urban communities, and examine specific elements of the mother-daughter relationship that can protect daughters against HIV risk and modifiable risk factors.

The findings from both studies suggest something very powerful: providing comprehensive services that include culturally sensitive education components, in addition to strengthening an individual’s existing personal, social, and environmental support networks, can improve health outcomes among African-American women living with HIV.

The intersection of poverty, disparities, and the social determinants of health are constantly at play. African-American women are naturally strong, even in the face of HIV/AIDS. They are playing up that trait to put survival into their hands. It is imperative that researchers and communities work together to educate and empower each other, as well as those infected, to reduce the prevalence of HIV.

Ndidiamaka N. Amutah, PhD, is an assistant professor at Montclair State University in the Department of Health and Nutrition Sciences. In this capacity, her research focuses on adverse birth outcomes for women of color, HIV/AIDS and women of color in an urban context, and community-based participatory research. To learn more about Dr. Amutah’s research, visit ndidiamutahphd.com.

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Community, Culture, and Health: An Interview with Bonnie Duran, DrPH

Community, Culture, and Health: An Interview with Bonnie Duran, DrPH

Bonnie Duran, DrPH, is Associate Professor, University of Washington, and Director, Center for Indigenous Health Research. She served as Chairperson of the New Connections Ninth Annual Symposium. We spoke with Dr. Duran during the Symposium.

Dr. Duran, what factors led you to a career in public health research, evaluation, and education?

I am a first generation college student. I started at San Francisco State, and was admitted through the Educational Opportunity Program (EOP).  My older brother, who was the first in my family to go to college, was an EOP counselor at the time. When I was a senior in high school, I was actually thinking of joining the military. He said “no, you are going to college.”

When I started as an undergraduate, I knew that health disparities were really bad. I did a lot of community organizing. But after I graduated, I wanted to do what all my white friends were doing, go to Europe. But I didn’t have any money. I bought a one-way ticket to Europe, and worked as a chambermaid, as a pizza cook, and as a waitress. There were a lot of expatriates, and they suggested that I go to Asia. I went to Asia, and I checked myself into a monastery to get used to the very unusual environment. I learned how to meditate and do mindfulness practices.

When I came back to the United States, probably 7 or 8 years later, I started graduate school at UC Berkeley. I found that my experiences in mindfulness meditation had made me a lot smarter, and I breezed through advanced statistics when I had once flunked college algebra. My graduate school faculty at UC Berkeley invited me to stay for a PhD. That was really useful to me.

Being a member of the native urban Indian community, I had worked in community health centers and community cultural centers, so I always knew that I wanted to work in that community. That’s what I’ve been doing.

 

Let’s talk about your work in Native American health.  What are some of your most recent projects? How are they important to Native American communities and other people of color?

I have two pretty big research projects. The biggest one is a psychiatric epidemiology study in 23 tribal colleges. There is a tribal college system in the U.S. There are 36 tribal colleges in the U.S., and one in Canada. They range from 100 people to about 2,000 people. Three-fourths of them are on reservation communities, which are the most rural and, in many cases, the most economically low-resourced places in the entire U.S. We are looking at the prevalence of alcohol, drug, and mental health problems, and we’re also looking at risk factors for those outcomes and protective factors. We’re doing community-based participatory research. All of our tribal college partners and native partners want strength-based resiliency approaches. They are tired of being stigmatized by mental health diagnoses. They really want to talk about what’s positive, what is helping people escape from situations with very little opportunity. So, we’re collecting a lot of data on strength-based positive assets at the local level.

In the other study, we’re working in six tribal colleges, and we’re implementing a brief alcohol harm reduction intervention. In Indian country, because of the drunken Indian stereotype that has been around since colonial times, many people think it is not ok for native people to social drink. Because of that, we have a bimodal distribution of alcohol consumption. We have the highest proportionate rate of abstainers of any ethnic group in the United States. And, we have some of the highest rates of binge drinkers and full-blown alcoholics. This harm reduction intervention is to try to teach people how to do social drinking, and how to reduce binge drinking. It is having an interesting impact.

 

How can we design public health programs for Native American communities that are culturally responsive and sensitive?

At the Indigenous Wellness Research Institute at the University of Washington, started by my dear friends and colleagues, Dr. Karina Walters and Dr. Tessa Evans-Campbell, we take evidence-based interventions, and we do a thorough cultural adaptation of those for the cultural context of our partners. We also do culture-centered interventions, things that people might have been doing for centuries based in indigenous or traditional knowledge, or problem solve things that people have come up with more recently, that may be culture-centered. We come at problems from two sides – from adapting evidence-based interventions and developing evidence and evaluation of culture-centered, community-based interventions.

Our research is all based on community partnership. Our partners tell us their theories of etiology of a problem, which usually have a huge amount of scientific validity. For example, in Indian country, we have this theory of historical trauma, that the reason health disparities and economic problems are so severe is because of the legacy of colonization. A lot of people thought, “that’s a lot of interesting folk tales that native people tell themselves.” But with the new field of epigenetics, it is absolutely true that if you suffer some type of material or food-based hardship one, two, or three generations before the current generation, it actually changes your genetic expression in this generation. For example, perhaps as a result of starvation a century ago, more people are prone to store fat in their body. Also, some alcohol-related and mental health problems are actually manifestations of epigenetic variation due to some of the terrible policies of colonization.

 

How can we make these types of interventions more sustainable?

One thing that I’m very proud of is the tribal communities that have developed better economic opportunities on the reservations, usually through gaming and other enterprises. But sustainability is an issue. We’re trying to work on sustainability. Most tribal communities, all of the so-called gaming tribes aside, are still 34, 40, 50 percent in unemployment. There are food deserts. It is still very difficult living.

 

You led a Symposium panel discussion on Community Engagement as a Path to Health Equity.  How can community engagement contribute to health equity?

Any authentic and contextually appropriate public health intervention, or economic or social intervention, has to be developed in partnership with local context, or it’s never going to work. I think an Institute of Medicine report says it takes 17 years between the time something is discovered scientifically, such as a treatment, to it becoming a primary care practice. And that treatment will probably change two or three years after its discovery, so we’re always probably two decades behind what best practices are at the moment. When we do contextual work, when we do our research within the environments that need the intervention, we can adopt it immediately if there is some efficacy to it.  And when you develop interventions in the community where you work, you can see the costs and benefits much more quickly.

 

What advice can you offer to New Connections scholars, and other health researchers, about how to reduce health disparities, and improve health equity, in Native American and other communities of color?

I think that you have to know the language of research, and write what’s going to get funded. And then figure out how to, in addition to abiding by that [research] contract, do the work that’s empowering and much more meaningful to communities at the local level. So there has to be a combination of knowing how to work the system, and working with our communities.

I also think there is so much knowledge and wisdom to be learned from our community partners. Being open to that bi-directional and multi-directional learning is really important. Also, a little bit of cultural humility is important.  We can’t think that since we have these fancy academic titles, we somehow are smarter or know what’s best for a community.

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Welcome to Our New Website! A Renewed Dedication to Diversifying Faculty in the Academy

Welcome to Our New Website! A Renewed Dedication to Diversifying Faculty in the Academy

Welcome to our new New Connections website! After months of planning and development, we are excited to share our new site, which will amplify the stories and successes of our network of diverse scholars. The new site offers greater access to pertinent program information, with enhanced features, such as a professional development calendar, a portal to our scholars’ research, and a blog.  Here is a rundown of what visitors can expect from the new website:

  • Our Scholars Stories page provides a view into the professional journeys of our network scholars. We are kicking off this section with the stories of Andrea Acevedo, Melody Goodman, Rodney Haring, and Kevin Nadal.  We look forward to sharing the stories of many other scholars in the coming years.
  • Our Funding Opportunities page provides an array of helpful information about our current and past awardees, as well as application information for upcoming Calls for Proposals. Also, check out our infographic that illustrates the size and scope of our program.
  • When you visit the Professional Development page, you will find information about our various career development and training opportunities to support you in meeting your professional goals. This includes information on publication support, webinars, our annual Symposium, and the Research and Coaching Clinic. This page also features an interactive Calendar to allow you to quickly navigate month-by-month program activities, and stay abreast of upcoming training opportunities.
  • We celebrate the work of our community of scholars on the Research page. This page will highlight our members’ research through scholarly publications, webinars, and presentations, which you can peruse by RWJF focus area categories.
  • Our Blog will include posts reflecting our scholars’ unique cultural perspectives on health and healthcare research, and evaluation practices. The blog also will showcase the work of our program staff in advancing institutional practices for underrepresented scholars. The blogs will provide tips, resources, and opportunities on funding, career development, mentoring, and networking. Additionally, the blog will serve as a platform for discussing hot research topics in health and health care practices that promote building a Culture of Health. If you are interested in contributing a blog post, please submit your ideas to info@rwjf-newconnections.org.

If you are visiting our site for the first time, and would like to join our network of scholars, sign-up for our e-newsletter, Opportunities of Interest. As a New Connections Network member, you become part of an integral support system to collectively enhance your career trajectory, the Network, the RWJF agenda, and the health care community.  Join us! We look forward to building a Culture of Health with you!

We look forward to your thoughts on our new website, so please feel to share any feedback.  We greatly appreciate your insights as we continue to tell the story of the New Connections program.

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Culture Counts: Considering Norms and Nuance in Latino and Asian Cultures

Culture Counts: Considering Norms and Nuance in Latino and Asian Cultures

Since the Surgeon General’s report asserting the importance of cultural, ethnic, and racial issues in mental health, long standing racial/ethnic disparities in mental health still persist. Although Latino and Asian Americans represent the fastest growing racial/ethnic minority groups in the United States, and there have been considerable advances in multicultural research in recent decades, there are major gaps in understanding cultural influences on the mental health, treatment needs, and help-seeking behaviors of Asian and Latino groups in the U.S. While there is growing acceptance of the importance of culture, Western cultural perspectives and mainstream methodologies dominate our training and approaches. Because culture is complex, we need to embrace multidisciplinary perspectives (e.g., psychology and public health), and multiple methods that illuminate how cultural norms affect help-seeking for mental health problems.

Janet Chang, PhDIn the U.S., conventional wisdom usually dictates that if you have a problem, you should talk about it. This Western, individualistic model of seeking explicit social support is consistent with meeting one’s personal needs and exercising choice and control. However, it is at odds with Latino and Asian collectivist cultural norms that discourage disclosure of negative thoughts and feelings. Asian and Latino Americans may be reluctant to rely on family and friends for support, because they are concerned about how self-disclosure undermines their relationships and jeopardizes their social reputation.

Contrary to our intuitive assumptions about collectivism, it is surprising that Latino and Asian Americans may not rely on those closest to them. Relationship concerns and conflictual family environments make it challenging for Latino and Asian Americans to rely on family and friends. For example, utilizing quantitative methods, my colleagues and I found that strained family bonds contribute to help-seeking outside the family context. Although family and relationships are central to collectivism, we know little about how culturally specific norms in Latino and Asian contexts influence social support processes.

Social support is assumed to be positive, but my qualitative research demonstrates that it is complicated for Latino and Asian Americans who negotiate collectivist norms and practices emphasizing close social bonds. Collectivism paradoxically may decrease the use of social support in Asian and Latino cultures. When considering sharing their problems, Asian and Latino Americans appear to place different emphases on relationship priorities, with the former most concerned about losing face, and the latter worried about maintaining group harmony and making matters worse. These findings suggest that cultural norms related to social connections and help-seeking are nuanced.

Mental health is integral to health, but culture is inextricably linked to both. While structural barriers, like limited insurance coverage and access, are important, racial/ethnic disparities in health care often remain, even after researchers account for these barriers to care. Therefore, we need to continue to investigate and better understand cultural factors that help account for disparities. The ability to derive and develop culturally responsive interventions, and to reduce inequities in health care for Asian and Latino Americans, requires research and treatment approaches including qualitative and quantitative methods and multidisciplinary perspectives. These approaches help address the complexities of diverse cultures and the immense range of cultural variations. In health care, social connections may be leveraged as access points for care, but intervention and outreach efforts must be culturally tailored to the needs and norms of Latino and Asian Americans.

Janet Chang, PhD, is an alumna of the Robert Wood Johnson Foundation (RWJF) New Connections program, and an assistant research scientist at the University of Connecticut. Chang received a PhD from the University of California, Davis, and a BA from Swarthmore College. She studies sociocultural influences on social support, help seeking, and psychological functioning among diverse ethnic/racial groups.

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Let’s Get Visible: Fighting Health Disparities in the Filipino American Community

Let’s Get Visible: Fighting Health Disparities in the Filipino American Community

I grew up in a very typical Filipino American family. My parents were immigrants who both worked full-time jobs, and my lola (grandmother) babysat my brothers and me, while my parents were at work.  There was a Santo Niño (Baby Jesus) and Virgin Mary statue in the hallway to my bedroom. And we ate rice with every meal.

I grew up in a very typical Filipino American community. My mom forced us to call her friends “my aunties,” and we attended community gatherings at parks or community centers where the centerpiece was always a lechon (roasted pig). Most of my friends were children of Filipino immigrants, trying to balance what it meant to be an American kid in the 1990s, while pleasing our parents at the same time.

I saw a lot of things growing up. I saw gang violence and substance abuse and friends dropping out of high school. I saw family members getting heart attacks at early ages, and friends becoming teenage parents. I saw domestic violence, suicide, HIV/AIDS, and more. However, we never talked about any of it. It was just part of life.

Perhaps this is the reason why I became so interested in working with Filipino American communities. I knew that there were a lot of issues affecting us, but that there wasn’t much being done about it, even though we are the second largest Asian American group in the country.

When I read Fred Cordova’s Filipinos: Forgotten Asian Americans, I knew I had to be proactive about it. I wanted to be part of the generation that made sure that Filipinos were visible in every sphere. And because I knew anecdotally about health and educational disparities affecting our community, it was important for me to produce research that would support that.

Over the past 15 years, from my own research and from others’ work, I have learned the following things:

  • Filipino Americans have a higher prevalence of hypertension and cardiovascular disease than other Asian American groups, with a prevalence that is comparable to African American
  • Filipino Americans have a higher proportion of overweight or obese adults, in comparison to other Asian American groups
  • Compared with other Asian American groups, Filipino Americans have higher rates of diabetes than the general U.S. population, despite having a generally younger population
  • Filipino Americans tend to have a higher prevalence of alcohol, tobacco, and illicit drug use than other Asian American groups
  • Filipino Americans tend to have a higher prevalence of depression and suicidal ideation than the general U.S. population
  • While well-represented in medicine and nursing, Filipino Americans tend to be underrepresented in social sciences, psychology, education, and public health

What is disheartening about these statistics is that they haven’t really changed over time. While there are many organizations that have tried to address these disparities, their efforts simply aren’t enough. We need more researchers to continue to understand these disparities, while creating interventions to tackle these problems directly. We also need to examine how our cultural values and practices may enable some of these disparities, so that we can perhaps change them.

During this Asian American Pacific Islander Heritage Month, I’m thankful for my colleagues like E.J. David, Patricia Halagao Espiritu, Dina Maramba, Allyson Tintiangco-Cubales, and others – all of whom are part of the generation to acknowledge that there is a problem affecting our community. With their continued work, and the work of future scholars, it is time for us to address these problems, and fight against these disparities.

 

Dr. Kevin Leo Yabut Nadal is an award-winning professor, psychologist, performer, activist, and author, who received his doctorate in counseling psychology from Columbia University in New York City. He is the Executive Director of the Center for LGBTQ Studies at the Graduate Center (GC) at the City University of New York (CUNY), as well as an Associate Professor of psychology at both John Jay College of Criminal Justice and GC-CUNY. Dr. Nadal is president-elect of the Asian American Psychological Association and a trustee of the Filipino American National Historical Society.

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Toward Achieving Health Equity in Southeast Asian Refugee Communities

Toward Achieving Health Equity in Southeast Asian Refugee Communities

Asian Americans are the fastest growing racial group in the US, experiencing a 46 percent increase in population between 2000 and 2010. This growth is projected to continue, as Asian Americans are expected to account for 9.2 percent of the population by 2050. Given these significant demographic changes, it is time that we begin to identify and discuss health risks such as overweight, obesity, and obesity-related diseases among these communities.

Relative to other racial/ethnic groups, Asian American children ages 2-19 years have the lowest prevalence of overweight and obesity (as measured by body mass index). However, this estimate fails to consider three important caveats: 1) At similar body mass index, Asians have more body fat than other racial/ethnic groups; 2) Asians have increased risks for obesity-related diseases at thresholds lower than the minimum cut-point for adult overweight; and 3) Asians are not a monolithic group, and obesity outcomes differ across subgroups.

Channavy Chhay, Executive Director, CSEA

Southeast Asian refugee children (specifically Hmong, Cambodian, and Laotian) have higher obesity prevalence and exhibit more markers of type 2 diabetes and cardiovascular disease than other Asian subgroups and whites. These disparities also begin in early childhood, and Southeast Asian refugees are more similar to Latinos and African Americans with respect to obesity-related outcomes. Additionally, US-born Southeast Asian refugee children have higher prevalence of obesity than those who are foreign born. These findings may implicate refugee status and acculturation as risk factors for adverse health outcomes. However, we still do not understand why these differences in obesity outcomes among subgroups occur.

To begin to understand these differences, we looked to Southeast Asian communities to provide insights about their perceptions of the risk and protective factors for weight status among their children. We wanted to identify protective factors to really highlight cultural and community assets and strengths. Also, realizing that obesity results from more than individual behaviors, we were particularly interested in exploring their ideas within a framework that elicited cultural, community, school, familial, peer, and individual risk and protective factors. To achieve these goals, we worked with our community partner, the Center for Southeast Asians (CSEA), in Providence, RI. We believed that this approach would improve the cultural relevance of study findings and any future childhood obesity interventions resulting from this initiative. We worked with parents and grandparents to generate findings, as grandparents play key roles in household dietary choices for families.

Our research findings suggested that due to histories of severe malnutrition and food insecurity experienced prior to arrival in the US, Southeast Asians reported feeding practices that promote eating in the absence of hunger, and excessive eating because food is plentiful and cheap. Also, as Southeast Asian refugees acculturate to American lifestyles, they may adopt Western diets, sedentary behaviors, and physical inactivity patterns that increase risks for obesity and consume fewer traditional foods that reduce risks for obesity. Parents and grandparents also described the heavy consumption of white and/or sticky rice as contributors to obesity. Our findings also suggested that Southeast Asian children become more sedentary due to increased access to technologies, and due to the lack of cultural value of physical activity.

We believe that our findings provide important contributions to obesity and intervention research with Southeast Asian refugee communities. Future obesity prevention efforts could incorporate our study findings in the following ways:

  • Addressing refugee experiences with food insecurity and preventing eating in the absence of hunger,
  • Describing potential health risks associated with excessive rice consumption and suggesting alternative grains,
  • Integrating culture-specific activities to promote physical activity,
  • Providing nutrition education using Southeast Asian specific foods, and
  • Developing strategies for parents to help resolve the tension between children’s preference for unhealthy American foods versus healthy Southeast Asian foods.

This approach increases the likelihood that the interventions will be culturally relevant and appropriate, and demonstrate respect for Southeast Asian communities. We look forward to continuing our work with Southeast Asian communities, and helping to achieve health equity for this underserved population.

Akilah Dulin Keita, PhD, is an Assistant Professor of Behavioral and Social Sciences at Brown University. Her co-author, Channavy Chhay, is Executive Director of the Center for Southeast Asians.

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