Share Public Health podcast transcript: Elizabeth Walsh, A Public Health Hustler

Ian Buchta Welcome to a collaborative episode of From the Front Row and Share Public Health, two podcasts produced from the University of Iowa College of Public Health. I am Ian Buchta, a host and producer for From the Front Row, a podcast produced by University of Iowa College of Public Health students, to share public health, to provide conversations in public health with established and emerging leaders in public health. I am thrilled to be partnering with the Midwestern Public Health Training Center’s podcast, Share Public Health, which connects you to public health topics, issues, and colleagues throughout our region and the country, highlighting that we all share in public health. Thank you for tuning in to this series of interviews with young public health leaders in our region.

Ian Buchta Do you want to introduce who you are and what you do?

Elizabeth Walsh Sure. My name is Elizabeth and I am a public health statistician with the city of Kansas City, Missouri. I work for a local city health department. The vast majority of what I do for my job is more practicing social epidemiology. I really spend a lot of time thinking about how somebody’s social context impacts their health. I do a lot of reading, writing, and statistical analysis regarding the impacts of racism, poverty, and geography in particular because those are huge issues within Kansas City, and how that impacts health. I’m doing a lot of other things here and there. I do policy work. I work with our local safety net providers because they receive a portion of city tax dollars to provide under-insured care. Then, there’s always that ten percent duties, or other duties as assigned, so I like to think of myself as a public health hustler within Kansas City, Missouri.

Ian Buchta Oh, that’s awesome. I like that description at the end.

Elizabeth Walsh Thanks.

Ian Buchta If you don’t mind, you were recently honored with being on the 40 under 40 by the de Beaumont Foundation, do you want to talk a little bit on what that is?

Elizabeth Walsh Sure, I would love to. The 40 under 40 in public health is an initiative by the de Beaumont Foundation to really elevate public health at the national level. There are a lot of 40 under 40 lists for other specific professions, notably like medicine, nursing, and other aspects of healthcare or in business, but there’s not really anything that focuses on our field. So, the de Beaumont Foundation thought and decided that they should elevate public health in this way and honor emerging leaders. I’m just really honored and can hardly believe that I’m a part of this list. It’s full of movers, shakers, some really innovative thinkers, and people with amazing backgrounds. I’m just so excited to be a part of this list and to get to know my fellow honorees. It’s been quite a thrill.

Ian Buchta Well, congratulations on that. Thanks again for taking some time. I’m sure you quite a few mediator requests, so thank you for taking ours.

Elizabeth Walsh Yeah, thank you.

Ian Buchta Thank you, Elizabeth, so much for coming and sitting down with us today. We’ve got a couple questions for you. First, we are really are interested in how does system-thinking inform your work?

Elizabeth Walsh Yeah, I’m not going to lie. I really had to Google that, so I had never used the term systems-thinking. So for the people who are listening who might also need to Google systems-thinking, my interpretation of it – and please correct me if I’m wrong – is just taking an approach where you’re looking at an entire organization and how different parts work together. Or an entire community and how different parts work together, with first just focusing on one component and one individual. Is that what you are getting at when you’re talking about systems-thinking?

Ian Buchta Yeah, really deconstructing the whole thing as you go.

Elizabeth Walsh Sure. That’s something that I think we are kind of innately taught in public health, especially those of us who are formally trained in public health. We’re taught to look at things at a community level. That’s really critical to the fundamental nature of our business, right? We like helping individuals. That’s a really feel-good feeling, but that’s more of a transactional approach, right? Helping one person at one particular point in their life is not going to-. Sometimes it does result in a meaningful change that does change their lives for as long as they live, but a lot of times it helps them out in that one moment. It doesn’t really give them a fundamental change that helps improve their life for good. When we take a public health approach or that community-level approach, we’re looking at the different ways that that community can change. So, you’re changing the lives of all those individuals. It’s more of a transformational approach. That is what systems-thinking is all based on, right? So for me, it’s just a fundamental part of my everday job.

Ian Buchta It’s really interesting to hear about your perspective on that as a public health practitioner. What is one thing that you would tell students when they start thinking about systems-thinking when they hear it in the classroom and they’re not sure what it would all do in their career? What would you tell them? Why is it so important?

Elizabeth Walsh I think there’s a lot of things that were more in-school. We think, how am I ever going to possibly use that? Sometimes we’re right, right? For example, that math equation where the bumble bee is traveling between two trains, and how long does the bumble bee travel before the trains collide, or whatever. I’ve never used that type of math in my career. I’m a statistician and I’ve never used that type of math in my career. So, that was a valid question when I was in seventh grade. I think there are a lot of things where we learned this theory and that isn’t necessarily what we use in public health practice. But, having that knowledge base is something that gets in the back of your mind and you don’t even realize that you’re going to pull that up, especially when you’re talking about systems-thinking. We have a lot of jargon in public health, and maybe for another conversation we could talk about how we shouldn’t use jargon all the time. When we’re talking about that community approach, that’s really really important for what happens in public health. When you’re in class and you’re learning about these things, a lot of the times you’re being taught this theory and the basis for why these things are critical for public health practice. That doesn’t mean you’re going to be sitting in your office, thinking about this theory, and then asking. A lot of times they think what we learn in undergrad or grad school, or for somebody who is a grassroots public health profession, or in our life experience, that those things become innate within us. We pull on this knowledge that we were taught in class, but, it’s not applied in the way that we think it is. It’s just so critical and I wouldn’t discount it, definitely. Learn it and don’t blow it off, but know that there likely is value even if it’s the tiniest little bit. Does that make any sense at all? I don’t even know.

Ian Buchta That makes a lot of sense.

Elizabeth Walsh Okay, good.

Ian Buchta Change management is an essential skill for public health and most other fields. How can new professionals develop skills to manage change effectively?

Elizabeth Walsh I sort of disagree a little bit with that statement. I think being able to be adaptive to change is an essential skill in public health. Whether or not you need to have specifically change management skills really depends on what you want to do in the field. If you’re somebody that is happy working in the background and being mid-level in your career, that is perfectly okay. I totally understand that because once you get advanced a little bit more, you don’t get to do as much fun stuff. So, if you want to be somebody that just wants to do the fun stuff, I would say the important things to know is that public health is a field that is ever-evolving. Being able to adapt to change is really really critical. We cannot move forward if we stay stagnant. So, there are some aspects of change management and that whole idea of being able to morph an organization as time changes, as technology changes, as political ideologies and views change, and as cultures change, that’s really critical. Developing good, clear communication skills is a really important aspect of that. I can’t tell you, just in the ten years that I’ve been in my career how many times the lack of communication has caused issues within a team, between individuals, or within an entire organization. Those aspects of change management I would say are critical for any public health practitioner. Whether or not you need to have all the change management skills really depends on what your career aspirations are.

Ian Buchta Thank you so much. You bring up communication and one thing that is really important for public health practitioners – and maybe this is just for change management or just in general – is the ability the persuasively communicate our results. How have you seen persuasive communication as important in your career?

Elizabeth Walsh It’s definitely been a lot bigger component that I thought it would be. I’m a trained epidemiologist. I thought I was just going to go and crunch numbers, show people data, and change the world, like maybe find a cure for HIV, I don’t know. That’s definitely not where life has gone. Being able to demonstrate what your data says in a way that is relatable is really really important. Whether or not you think of that as persuasive communication is probably semantics. I was just at the National Association for City and County Health Officials Conference, where there is a general session. This is, by the way, available on the NACCHO website. It’s the second general session and it was titled “It’s Not Them, It’s Us”. It was all about how public health is not great at marketing themselves and not great at communicating to the general public. We are really good at talking within our own circle. We’ve really developed this great echo chamber, which is really nice for our egos and makes us feel good about ourselves, but we’re not so great about communication and marketing ourselves to the public. Soledad O’Brien who is like one of my favorite people in the world, sat on this panel, and was talking about storytelling, how the story is in the details, and how we can’t lead with data. We always want to lead with data, but we can’t. I really reflected on that. The best way that I can think about it is we have our data, and that’s critical, but our data is the rice, and in a really good poke bowl dish or maybe your favorite curry dish, it’s there and it’s really important for the dish to come together, but the yummy bits are the non-data parts. It’s the personal story. It’s the language that we use. It’s the way to make things relatable. Do we reference pop culture? Can we find a way to tie in the other night’s Bachelor in Paradise episode to something in public health that’s going on? Being able to do that is really an effective way to communicate whatever issue it is that we’re working on.

Ian Buchta Yeah. You have to do that in a way that is relatively organic because I think we’ve all seen when either businesses or organizations try to pull off the popular message. We see it go completely off the rails.

Elizabeth Walsh Oh yeah, I mean, it’s very obvious when somebody’s trying too hard, right, either individually or organization-wide. The other thing is that storytelling and communicating well is a skill that can be learned, but is also something that if you are not good at it, that is okay. Work on it, but also make sure to stay humble enough that if you realize you are not the right person to communicate the message, don’t do it. Let somebody else who is either better or more appropriate do it. There is no sense in trying to muscle through something because the message is going to get lose. Then whatever your goal is, you’re just not going to be successful.

Ian Buchta Great. Yeah, that’s an interesting point because you often hear oh, if you don’t know this skill, just go and teach yourself it. It’s interesting to hear that piece of advice of we can collaborate.

Elizabeth Walsh Oh, for sure, yeah. That’s the value of being part of a team. Everybody has their specific talents. Some people are better at some things than others. Let those people who are good at those things shine. Communication and humility are probably the two most important skills anybody can bring to their job.

Ian Buchta Awesome, thank you so much. What advice do you have for students considering public health and students embarking on their careers? You’ve hit on a couple points of advice in the last couple minutes, but were there other ones you want to highlight, or anything you want to expand on?

Elizabeth Walsh I would say I’m sure all students have heard this before, you don’t get into public health for the money, right? We get into it because we’re these bleeding hearts that have a passion for social justice and improve the lives of the community. This is something I need to work on. So, this is advice I do want to give because I need to hear it myself as well. Be careful with soapboxes. It’s really easy when you feel like you’re coming from a good place and the right place, and you’re doing something for the right reasons, to get on a soapbox. Again, going back to communication, that’s a really easy way to turn somebody off. Really work on being aware of what the community that you’re serving looks like. That doesn’t matter if you’re in public health practice or if you’re going into research. So when it’s research, just the community you’re trying to help. Be very conscious of what that community looks like because that really will influence how you approach your work. Also, have fun. Public health can be fun too, so enjoy it.

Ian Buchta Great, thank you so much. I’m new to public health obviously, I’ve barely even graduated yet, but every day is something new and interesting in my study. I think that’s just the coolest. It’s the first time ever for me to have found a field like that.

Elizabeth Walsh Oh, good. You’re in the right field.

Ian Buchta Yeah, I hope so. One question I have is, and you mentioned you do social epidemiology, why is racism still relevant to public health?

Elizabeth Walsh Ah, that’s a funny question because somebody would ask me that in a meeting, and I would ask why do you think it’s not relevant to public health? When we look at the data, and I’m sure Iowa City is no different, but in Kansas City, when we look at our data and we map it, we see the same pattern every single time. It is the same six or seven zip codes with the highest proportion of Black and people of color living there, and they all have worse outcomes. When we look at this data – and this is Kansas City, Chicago, Twin Cities, probably Iowa City, and the entire United States – Black people are getting sick and dying at a disproportionate rate than white people. How can race not be a critical component of public health? It just is, and that is something we created, right? We created that. That was hundreds of years of creating these structures so that a certain group of people does not do as well as another group of people. We have done that and it is up to use to undo it. It’s not up to them, it’s not up to them over here or across the street, or in urban areas. It is not up to them, it is up to us. It’s a responsibility that I think very seriously of and it’s a responsibility that I hope more and more public health practitioners can take very seriously.

Ian Buchta Great. With that, with that idea of communication, how would you change your message when talking to non-public health practitioners? Would you change your message to people who might not be as well-versed in the data of public health? How would that look for you?

Elizabeth Walsh I don’t think I would change the message based on profession. I would probably message based on how comfortable I thought people were with talking about racism. This is something that we are working on within our own health department. There are some people who are very well aware of how racism, bias, and the structures impact the health of the community, disadvantaged people of color, and advantaged white people. There are other people who don’t quite get it yet. The two women that lead this initiative within the health department have done a really good job of taking different approaches. We’ve done a lot of talking about all different types of advantages and disadvantages, whether they are race, sex, and religion. Talking about how they celebrate all of these Christian holidays that we get off from work and school, but how many Jewish holidays do we get off from work? None, right? So, that’s a religious advantage that many Christians have. They’ve done a really good job about taking this slower approach. We tried to take this one where we were like okay, we’re just going to sit down and have some honest conversations about race. That didn’t work, so observing that was a really good lesson for me. So, when I go out into the community and talk about these issues I have to be very aware of my audience. I have to tailor my conversation depending on how comfortable people are or where people are at in my conversation. It’s a difficult conversation and it is something that has to be approached very thoughtfully.

Inan Buchta Thank you for that. So what can we do? You’ve mentioned you go out and talk to people in the community, but in general, what can we do about racism from the public health perspective?

Elizabeth Walsh I would say the first step is acknowledging that race and racism factor into all aspects of health. I could show you the data that shows this. Whether we’re looking at social economic status, income, education, gosh, I don’t even know, geography, where people live, or any health outcomes such as low birth weights, deaths, or violent crimes. All of this is the same – I want to swear – it is the same path. Just taking that first step to acknowledging it sounds really really simple, but a lot of people have to get to that part first. Then, after that, don’t be afraid to be very honest in what you’re saying. One of the things that frustrates me about how I was taught to talk about race in grad school was that I was taught, as an epidemiologist, just to say oh well, Blacks experiences is disproportionate with whatever the outcome is. It was never Blacks experience this and it’s because of this racist policy that was probably put in like a hundred years ago or whatever. I think that is one thing that we need to get a little bit braver about in public health. I realize that some people listening to that might be really annoyed by the fact I said that we have to be brave, but in full disclosure, I am a white woman, so it does require a little bit of bravery and courage because you don’t know for sure how onboard people will be with you. We just have to get comfortable having these uncomfortable conversations. The other thing I would say is recognize where your colleagues and stakeholders are at in the spectrum of being able to have this discussion. We talked about that a little bit earlier. I have to look at the audience that I’m talking to and really understand where they are at, and change my approach based on that. Depending on people’s perceptions, your conversation will go a little bit differently, but man, just that first step of acknowledging that this is the underlying thing. It’s going to take a long time to dismantle it, but just because it’s going to take a long time and be difficult doesn’t mean it’s not a worthwhile endeavor.

Ian Buchta Thank you for that. If you got to spend one minute with every public health professional who is about to graduate and you had to tell them one thing that they should do to interpret data better when looking around racial issues, what would you say?

Elizabeth Walsh Oh gosh, there’s so many things I don’t know. I feel like I’m still learning. Everyday I learn something new and I really learn from my colleagues. I would say know what your biases are. That will help you. That’s not just when you’re looking at race. That’s when you’re looking at anything. Know what your biases. If you want to go more in-depth on race, there is a great project out of Harvard called Project Implicit. You can take an implicit association test. That will tell you where you are at with your biases with Black people, Arab names, and gays and lesbians. It is a great test. You have to have some humble moments with those tests, but that’s a really great place to start if you want to start addressing bias.

Ian Buchta Great, thank you for that. So one another question I ask everyone is what is one thing that you thought you knew, but later you realized you were wrong about?

Elizabeth Walsh Man, again, there’s so many things. Since we’ve been talking a lot about race, I really thought I knew what racism was. I thought that I knew what was up. I mentioned earlier that I’m a white woman. I was raised in rural Iowa. So, I didn’t have a lot of experience with people who were not white or Christian. I had a lot of biases that I didn’t even realize existed. Then, I took this class and it was basically how racism makes people sick and my eyes were so opened. It was a very humbling moment. I did a lot of self-reflection after that and became very horrified by many things that had come out of my mouth before then. But, it’s been a really great thing. It’s really driven a lot of my work. That’s probably the biggest wake-up call moment that I’ve had for my career. I was completely wrong.

Ian Buchta On “From the Front Row”, we did a series this spring on why does place matter and thinking about issues of geography. I’m interested to hear your perspective on how you think place matters in public health.

Elizabeth Walsh It absolutely matters. Granted, I take a city perspective because that is the jurisdiction that I serve. We see all types of advantages and disadvantages disbursed by geography. We see that with urban versus rural as well. I can’t tell you how frustrating it is as a rural kid to see natural disasters and then see all of the funding and attention go to the nearest big city that got hit. Then you think about all of the other people that aren’t getting hardly anything. Cognitively I understand it because there’s only so much money to go around, but it just feels so unfair. I wish it didn’t matter so much, but it does. Recognizing that and knowing that resources are going to have to be used in a way that creates the most equity or creates the least inequity is the most critical decision. It’s not always going to be fair. I think place also matters because that’s part of how we identify ourselves. One of the first questions that we ask when we meet each other is we find out where people live or where people are from. We always identify ourselves as being from a geography. So I think culturally that’s so relevant for us, so it has to be relevant in our public health practice as well. That was three different answers, but I stand by them all.

Ian Buchta What do you think we should do in context of place? What can we do to improve the situation that we have and that we see ourselves in front of?

Elizabeth Walsh Man, I’m not sure I one hundred percent know what we should do. It’s one of those things where in Kansas City, we are really trying to figure out a way to keep people where their home is. So in Kansas City, that’s very much a neighborhood thing. In rural areas, that might look a little bit different. But, we have some neighborhoods that have severe disinvestment and are severely distressed, and we are trying to figure out a way to reinvest in those neighborhoods without displacing the residents that already live there, either through gentrification – so rich white people moving in, we’re seeing everybody else move out because they can’t afford homes anymore – or for any other number of reasons. We have not figured out how to do that. Our new mayor has formed an affordable housing task force, so I’m very hopeful. That’s really difficult especially when you get into the weeds about economics and development incentives, and all of that. I do not have a good answer for you. Perhaps there is a public health student that would like for that to be their research project and then they can tell me what the answer is. I would like that very much.

Ian Buchta Well, I will make sure that everybody who hears that will get working on that as much as I can at least from this end. Of course, a million-dollar and maybe a Nobel question because I think the person who solves that is going to change the field. Anyways, moving on to our last question, if time and resources weren’t issues, what would you like to see happen in public health?

Elizabeth Walsh If time and resources were not issues, I think every public health person would run for office and then we would take over the world and make it a better place. Gosh, if we had all the resources in the world, can you imagine what we could do? There would be no STD epidemics. I wish we would stop spending so much money on the food code. I know it’s important, so I’m not saying don’t spend money, it’s just a wish, okay, nobody freak out. Honestly, I would just love us to be better at policy. I think we’re getting there. I think in the past ten or fifteen years that public health has really recognized that that’s where the most sustainable long-term change would be. Having really good political advisors and people who are well-trained and passionate about policy. Those people are not cheap and public health needs to be able to pay them in a way that can really help us get some work done. And then, Medicare-for-All. How could I forget about that? Medicare-for-all. I was tapping the desk as I was saying that. Those two things, there we go. Made it, and finally answered your question.

Ian Thank you so much. Great. Well, this has been very interesting radio from my end at least. Thank you so much for giving us some of your time.

Elizabeth Walsh Oh, you’re welcome. Thank you for having me on here. I really enjoyed it.

Ian Buchta Thank you for joining us today. Special thanks to our guests and to members of our planning committee Sonja Armbruster, Hailey Boudreau, Katie Brandert, Ian Buchta, Maya Chilese, Stacey Coleman, Brandon Grimm, Suzanne Hawley, Abigail Menke, Melissa Richlen, Hannah Shultz, Laurie Walkner, and Kristin Wilson for guidance in creating this series, and to the de Beaumont Foundation for creating the 40 Under 40 list and connecting us to the impressive honorees. Funding for this podcast is provided by the Health Resources and Services administration. Please see the podcast notes for an evaluation and transcript. This podcast is brought to you by the University of Iowa College of Public Health. If you want to hear more of either of the two podcasts that are collaborating today, you can find links to our shows in the show notes. Don’t forget to subscribe. Alright, have a wonderful week everybody.

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