Share Public Health Transcript: Harnessing the Power of Public Libraries

Trish Hull: Welcome to Share Public Health, the Midwestern Public Health Training Center’s podcast, connecting 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 where we explore the benefits of strong partnerships between public health departments and public libraries. This project is a partnership with the network of the National Library of Medicine, Greater Midwest Region, the Public Library Association, The Prevention Research Center for Rural Health, and the Midwestern Public Health Training Center. We’re so happy you’re listening and learning along with us.

Noah Lenstra: Hello everyone, my name is Noah Lenstra and I am a Professor of Library and Information Science here at the University of North Carolina at Greensboro. In 2016, I started an initiative called Let’s Move in Libraries, and that has been the primary catalyst to my work on public library, public health partnerships.

Trish Hull: Hi, my name is [Trish Hull 00:01:18], I am a library manager in Salt Lake County for Salt Lake County Library Services. I am manager of the Kearns branch which is a large branch [inaudible 00:01:28] just newly built with a lot of interesting elements to [inaudible 00:01:32] create space, create kitchen, and our emphasis is really improving the health of our community. And I’ve been involved in public health for many years working with our local group, local public health groups, our local community partners to really work to improve health. The communities I have worked and lived in have very poor health outcomes, and so we feel like the library plays a big role in trying to help our communities get active, reduce diabetes, heart disease, all kinds of health issues that are prevalent in our very diverse communities. And it really doesn’t seem to matter what your diversity is, if… low income makes a big difference in your health outcome, and that’s what we… the problems we deal with, and why I’m so interested in public health and how we can work together. So Noah, thank you for coming on to our podcast. Could we start this with you describing your involvement with public health and public libraries?

Noah Lenstra: Yeah, I’d be happy to. So, my work has primarily been at the research policy and advocacy level, so as a professor here in North Carolina, I got interested in some of the innovative health programing the libraries were offering. Things like yoga classes, falls prevention classes for older adults, a lot of things focusing on physical activity and reducing health disparities around as you said, things like obesity prevalence. And as I looked at that programming, I pretty quickly realized that most of it was being developed through collaborations of one sort or another. Whether it’s with the local YMCA, the health department, parks and recreation, cooperative extension, SNAP-Ed, implementing agencies, the list goes on and on. So, it was really… it grew out of my interest in trying to better understand, where are all these new programs coming from? And the answer, perhaps unsurprisingly is through collaborations, through community partnerships. And so as I understood their topic and how it developed [inaudible 00:19:41], I became really interested and thinking about how do we better support this work. We know that these collaborations are thriving in multiple communities, even though in COVID, but there’s really not a lot of discussion about that outside of local communities where the work is happening. So how do we raise the conversation from just idiosyncratically local partnerships and to a national movement? And that’s what the advocacy element of my work derived. And [inaudible 00:04:20] just to add really quickly, I have a particular interest in rural communities, so I’m actually on the partnerships’ committee for the Associations for Rural and Small Libraries, and I grew up in a rural community. And so, I’m particularly interested in how do we do this work in rural communities where the needs are often the greatest, but the resources are the smallest. And so that’s me in a nutshell.

Trish Hull: Why do you think these partnerships make sense? What about public health and public libraries makes them good partners?

Noah Lenstra: Yeah. So that’s a great question, and I really… I think it’s a perfect storm that’s been brewing from both sectors converging, and so on the public health side, there’s the concept that’s been around for a while now called Public Health 3.0, and it essentially focuses on fostering and supporting rural multi-sector public health work. So the idea is that public health professionals are not necessarily doing the work by themselves, they’re really harnessing community partnerships to foster [inaudible 00:05:25] health and address social determinants of health. So that’s on the public health side. On the public library side, I think we now… This is not new to public librarians but I think we’re recently recognizing that libraries are multipurpose community centers that really do a lot. And I’ll just share a quick quote that illustrates that. So, [Sarah Campbell 00:05:48] who is the executive director of the Portland Public Librarian in Portland, Maine in a recent webinar, she said the following. “Libraries are quintessential sharers. By definition, sharing is central to how we operate”, and that pretty much everything a public library does is done through partnerships in the community. So, increasingly, we know that the partnerships are where it’s at, but there’s really… there continues to be a lack of understanding, I think, in the public library profession at large about partnerships. We know partnerships are important, buyt there’s not a lot on them. There’s a lot on community engagement and community needs assessment, but there’s a [inaudible 00:06:34] of understanding of the process of starting, forming, sustaining, and if need be, ending community partnerships. So that’s the public library side. So there’s… Hopefully I… But that’s why I think they make sense. It’s… There’s this convergence on both sides to the recognition that multi sector coalitions and multi sector work is where it’s at, and what we’re both trying to figure out how to do this. Because it’s new in some senses for both of us.

Trish Hull: So let me ask you. You’re a professor, a library school professor, do you teach a class on this? Have you created a toolkit? Do you have a plan to help those new librarians and then maybe we can figure out a way to share it out towards all librarians who are in that, although, I will say, when I get started in this, the first few times I would talk to public health people, they were the ones who would say, “Oh. Public libraries, we never thought of that.” And so, once we got that relationship started, the collaborations have just come out of the woodwork. They just can’t stop coming to us saying, “Hey, what about this now? Hey, we got some money, how about this? And the funny part is, you guys get all the… the public health side gets all the money, public libraries don’t have the money but we have the reach that public health is looking for.” So I think it’s… I agree with you, it’s so critically important. But how do you tell your students to create these partnerships, and what would be a good first step for libraries to do?

Noah Lenstra: Yeah. So thanks Trish. Those are some great points and I want to start by just commending you all in Salt Lake County for the work that you did. So I actually attended a session on suicide and overdose prevention that featured your director [James Cooper 00:08:23] at the 2020 meeting of the public library association, and I was impressed by what you just said. It starts with relationships. You can’t do anything if you don’t know each other. That’s the foundation of any partnership. And James, at the conference, he talked about how pretty much everything that Salt Lake County Library has done grew out of a program that the library did in collaboration with Healthy [inaudible 00:08:49], it focused on CPR classics at the library, so, you do one thing and things snowball. That’s the nature of the beast, and things can snowball in all kinds of directions, but it really starts with relationships and compelling people using those carrots and sticks to get to know each other because that’s foundation. So to your question about my teaching. So, work in progress. This is something I’m currently working on. I do teach a class on advance leadership and management that focuses on project management and libraries. And most of the projects, I try to encourage my students to do through partnerships if they’re working in a library currently. But I recognize this is something we and librarian information science need to do better at, and so, I would say it continues to be a work in progress. My hope is to, based on one of the research projects that I’m doing currently, have at least a rudimentary toolkit available hopefully in the fall, hopefully by fall of 2021, focused explicitly on partnerships around the promotion of healthy eating and active living, which is the main thrust of my research currently. But yeah, I certainly take your point Trish that we also have a lot of work to do in alliance education and we’re trying to get there as well.

Trish Hull: I had an interesting conversation recently with a group of health… well, health people in all sectors, and we were talking about through the pandemic, we weren’t able to do health fairs and get out there and meet the public. And as we were talking about effective ways to get information out, we realized health fairs really were not very effective as far as getting to the public, but they were hugely effective in networking. That we liked more the time we spent walking from booth to booth meeting all of those different health groups and then creating those relationships, and for us that was the more important part of those health fairs. So, it seems silly to go to… create a health fair for us to meet each other, but that might be an interesting way [crosstalk 00:11:11] for… to meet each other.

Noah Lenstra: And Trish, if you don’t mind, I’d actually like to just jump in on it because I completely agree, and that’s actually been one of the central findings, and what I hope to be a central component of the toolkit is, a health fair is a really low stakes way for folks to get to know each other. So librarians going to health fairs, librarians hosting health fairs, it’s one of the easiest and best ways to begin to build relationships and I’ve seen it play out again and again in communities across the country. And so, my advice for public health folks is, if you’re doing a health fair of any sort and you’re not including your library, what are you thinking? What’s going through your head? And, how can we change your perception because… So, health fairs and then what I’ve seen grow out of those low stakes getting to know each other is librarians getting involved in health coalitions. So the example of [inaudible 00:12:10] in Salt Lake County, so librarians actually serving on committees, getting involved in that multi sector work so it becomes… And that’s really the key I think, it’s not so much about one-to-one partnerships between local health departments and libraries, that’s not really the answer. I think it’s more about libraries getting in the mix and getting invited to be in the mix as it relates to multiple sectors of society working together to improve health outcomes.

Trish Hull: Yeah. That’s really true. I think sometimes, people go into library school thinking, “Oh, it’s all about the book and having people come to the library”, and helping them get a understanding that it’s way more than that, and they got to learn that you can be part of that coalition and offer to be the secretary, or the note taker, or maybe even be a president or vice president, take a leadership role. And I like your advance leadership and management course isn’t just for that in a library, it can be in coalitions, it can be throughout the community that you become that leader, and then it kind of… What the… There is a back and forth, it helps public health, but then it helps libraries because if you’re in a situation where you need money [inaudible 00:13:27] or a tax, some kind of tax… people are coming to vote on a bond or something, or a tax increase, that’s the word. Sorry. It’s really good to have public health say, “Hey, these are our great partners. This is important. You need to support these libraries”, instead of just, “Oh, we’re all about the book.” And we are, we’ll always be about the book and information, but that partnership has become so critical in sustaining the needs of libraries.

Noah Lenstra: Yeah. And Trish, let me just followup because I completely agree and I think one of the reasons why there’s some resistance within libraries is there’s this perception that libraries are being asked to take on ever more roles, we’re getting nothing back in return. And I think exactly the way you framed it is wonderful. I think it’s really about seeing that you’re not just giving, you’re receiving and really see how these partnerships really in a fundamental way contribute to the bottom line of public librarians in precisely that way. Now you have folks in the health department who are going to go to your city council, or your county commissioners and talk up the library, do that in both public and behind the scenes ways. And so, I’ve seen this in my work, so I’ll just give quick examples from a rural community in Eastern North Carolina, where when the library director took over the library in 2012, this particular library, it was dying. There was a real concern that it was going to be absorbed into a regional library system and cease to be a municipal library. And beginning around 2014, the library director said, “The key to our future is getting involved in the community”, and so that included working collaboratively with parks and recreation on helping them support their annual Couch to 5k initiatives, bringing library materials to the Couch to 5k runs. And the library director actually participated in those runs. It involved working with a cooperative extension to bring cooking classes to families, it involved working with the local school district to begin summer meals, and there was… so much that snowballed from that. And fast forward eight years later, this dying library successfully raised the funds that it needs to build a brand new building that’s going to be completely state of the art. [crosstalk 00:16:00] That’s the story we need to be saying. It’s not about, “You poor librarian are being asked to do more with less money, this is your future. You can choose to accept if you want but there’s no alternative. In my opinion, this is where it’s at, this is where it’s going and let’s get on board with that.”

Trish Hull: That’s… Yeah. Absolutely, I really like that story and I think that’s important for all of us to learn. So, let’s talk about rural libraries for a minute more because I think that’s a really important aspect. Most rural libraries really do have poor funding. They struggle, they just don’t have the money that maybe urban libraries do, or larger county library systems. And we’re fortunate in that, but how can public health… My question here too is, does public health have the same problem in rural areas? Or are they funded better than libraries are, and is that a way…? How can they help each other besides what you’ve just described, and what do you see is the biggest challenge for those rural libraries? [crosstalk 00:17:14][inaudible 00:17:14] and rural public health?

Noah Lenstra: Yeah. No, I think that’s a really great question, and I’m trying to think about the most concise way to respond to it because I have a lot of things bouncing around in my head. I think I’ll just give an example. So another rural community here in North Carolina that I’ve been working with for the past couple years, and this particular library had a really close working relationship with the local health department. And this is one of the most economically impoverished parts of the state, kind of foothills of Appalachia, the community is so poor that all school children are automatically eligible for free lunch and breakfast. And so, high needs and… But yeah, I think a key to their success was actually a third party. So the library and the local health department, they didn’t get connected, again in that one-to-one sense, they got connected because of a multi sector community foundation that was focused on improving health outcomes in the county. And so, that community foundation was the one that connected the health department to the library. The partnership began around the library becoming a summer feeding site because there was such high prevalence for food and security in 2015, and it was so successful that the following year, the health department started working with the library to distribute market box. The health department ran a mobile farmer’s market. So transportation is of course a big issue in rural communities, so they didn’t have one farmer’s market, it was taken around the county. And so, folks… the hundreds of kids who got free summer meals at the library each summer, the families also got market box that they could use to get free produce from the mobile market. And the relationship really became so close that during COVID-19 when the world turned upside down, I asked the health department in an interview, “Tell me about the challenges that you’ve had working with your library”, and his response to me was so profound. He told me, “What challenges we have had, we’ve addressed as a group.” So this was no longer a library program, this was no longer a health department program, this was a community program that had the involvement of the health department and the library. And so, yeah, they figure it out together. And I think that’s… we have a lot of work to get there but I think if we could find ways to make that type of relationship more prevalent across America, our health would be so much better, and rural libraries in particular could use so much more with the funding and resources that they have.

Trish Hull: That sounds really amazing and I like how that third party helped bring them together and recognized the library was a… could play a role there. I have several questions. One is, how do we… do you think we can get our leadership to recognize this and to support people going out and making those connections? It doesn’t have to be the director of the library, it could be on a branch level, it could be a librarian, it could be anybody who makes that connections and brings it forward, but, do you think that there’s a problem with leadership not recognizing the importance of this?

Noah Lenstra: I think there can be. I think you’re absolutely right, there can be. Just thinking about that same Appalachian foothills community, before COVID-19, a lot of rural communities in Appalachia, there was extremely high rates of opioid overdoses. And so, the library wanted to have Naloxone on site, and also train staff in administering Naloxone. North Carolina like a lot of states have legislation that basically protects public employees from liabilities if they need to provide Naloxone to people experiencing overdoses. But the county commissioner who controls the library were extremely opposed to this. They felt this was not at all something libraries should be doing, or no public library should be doing, so they basically quashed it. They basically said, “No, you’re not doing this.” The library director to her credit said, “Well, even if we can’t do this as an institution, I’m going to do this as private citizen. I have the right to have Naloxone in the library as a private individual. I’m within my rights so I’m just going to do it.” And so… And honestly, I think that director and her willingness to work around the rules is remarkable. And I think in the communities I’ve found, this is… there’s always going to be concerns, there’s always going to be push backs, but if we have librarians who are gung ho to that level… Yeah, you find a way to make it work. That’s kind of… Public librarianship is all about finding ways to make things work given the resources and constraints you have. So I think just firing up public librarians about public health I think really… It’s not going to solve everything, but it can go a really long way I think and I’ve seen it in my research. If that makes sense.

Trish Hull: Yeah, I registered in the research piece, what kind of research are you doing on public health?

Noah Lenstra: Yeah, so it’s case study based. So, my approach is really to do deep dives, so right now I’m doing deep case studies in 22 communities across the US focused on the types of partnerships that they’re doing, mostly focused on healthy eating and active living. But in North Carolina, I’m also looking at broader health outcomes, so looking at things like opioid overdoses and mental health. So… But yeah. And I think that case study approach, for me, I think is really important because the heterogeneity from community to community is so broad that I think really the only way to understand this is to go dive in at first into particular communities and come up with some of the general trends that you’re seeing. So some of those trends include like I said before, multi sector coalitions and the importance of intermediaries often in sparking relationships. So it’s not necessarily health departments and librarians spontaneously connecting, but perhaps a community foundation or a third party organizing a health fair that invites both entities, or partnerships for children is a common one that I’ve seen bringing together librarians and health department personnel. The other thing that I’ve seen in my research, and one of the things that I really love is the opportunity to talk with partners of librarians, so people in health departments and other organizations that have worked with librarians for multiple years. And as I talk with them about their experience working with librarians, one of the things that I’ve found is that over time, there’s an evolution in thinking about libraries. Unsurprisingly oftentimes, people before they have thought about libraries, they just see them as book depositories. Yeah, that’s a widespread stereotype and misperception. Over the course of working together and getting to know libraries, they then typically would see libraries as resources. They’re stable, they’re trusted, people trust librarians, they’re always there. And then based on that recognition, the public health department or other partners will begin to see libraries as spaces to utilize. So, “Oh, the library is trusted, so we can use the library as the space for food distribution, we can use them to lever Naloxone, we can use them for programs, we can use them to host our coalition meetings.” But over time, over time, eventually in many cases, they get to what I see as the highest level which is true partnership. So the library is not merely a resource, it’s not merely a space to do whatever you want to do, the library is an institution populated by librarians who can be the ideal community partners to help you figure out how best to serve your community. And one of the example that I like to share comes from Maryland, where the library… the librarian in this community of Maryland have worked collaboratively with the local health department on community coalition in this really high needs community adjacent to Baltimore. So it would have a lot of the same needs that you’d see in Baltimore, Maryland. And so, very high needs in the library and very high levels of food insecurity, lots of food deserts. And so, as part of being on the same coalition together over multiple years, the librarian have become a true community partner. And one of the manifestation about that is that the coalition decided, “We need a food pantry in this community. There’s no food pantry easily available, let’s start one.” And they quickly realized, “Oh, we’re going to need a lot of volunteers to make this work. And so, how do we manage these volunteers?” And the librarian raised her hand and said, “We can’t do anything without volunteers.” And the health department’s like, “What? I didn’t know librarians had expertise in volunteer management.” But of course they do. And so basically the volunteer management plan for this new food pantry was a partner… Yeah, something that was collaboratively developed. But just thinking about that, the library is not just a resource, it’s not just the stable trusted safe space, it’s not just a space to use to do whatever you want to do, the library is librarians who are partners, who could help you figure out. And I’ve seen health departments get there in particular cases, but I know in talking with people in public health in general that there is a vast gap that needs to be filled. And so if asked me about LIS education, I would actually like to see libraries more explicitly in masters of public health programs. And I’d also like to see libraries more explicitly more part of the structure of the American Public Health Association. And one way I think we can do that, so within APHA, they actually have a caucus on public health in faith based communities, based on the recognition that churches and faith based communities play such a vital role in public health. And I think there’s a space for a similar organizational entity around public libraries given everything that libraries currently do, and it would really highlight at the national level the opportunity associated with more explicitly including public libraries and public librarians, more specifically as public health partners.

Trish Hull: That’s really interesting and I’d like to talk to you more about that because I think that’s really critical. I know that we’ve gotten involved with the national… the Network of the National Libraries of Medicine. We’re still working in that library world, right? With the medical library association, so we’re combining that health and library piece… public library piece, but we’re still in that library world. And to move out of that into the public health association itself, that sounds like a really awesome way to do that. I want to look into that more. I loved your stories, I think that it’s really important. You said that libraries are a trusted place. During the pandemic, one thing that our library… we had a lot of people that were home, right? Who couldn’t go into buildings and work, and the health department was slammed, they needed all the help could get. And so we had librarians going out as health ambassadors to different restaurants to give them information about COVID and the safety requirements and what they needed to do to stay open. We had… Utah was partially opened and so a lot of places… but they had to follow some strict requirements. But what was so fascinating was when the librarians who spoke these languages, they were going to maybe Asian restaurants, Spanish restaurants. And so we had librarians who spoke those languages and were going out to talk to them, when they saw… they heard the word, health department, they got very like, “Oh no. Uh-oh.” Because for them, a health department visit is not a good thing, right? [crosstalk 00:30:08] But then she’d say, “No, no, no. Library. Library.” And then they’d go, “Oh, okay.” And so, then they would listen to us and get the information they needed because we weren’t the scary health department, even though we were. We were the library. So it just… it was really funny is my… I had one librarian who was very involved in that, she’d come back and tell me stories and it was pretty funny how the fear just immediately drained away when they learned they were librarians. So, I think that’s really critical. I’d like to talk to you a little bit about diversity and libraries in public health. We’ve done a couple of, and we’re starting another one here where we’re trying to bring in community members from diverse populations into the library itself in order to give accurate health information. Because sometimes, when people walk in, if they see me, middle aged white librarian, I’m not as relatable to them. Have you done any research on that? Have you been able to have any partnerships to see about bringing in diverse population so that we can get this information out and really make a difference?

Noah Lenstra: Yeah. No, that’s a great question. I’m trying to think about that, the best way to respond to it. I think the… So the example that comes to my mind and it’s really a powerful example of that reach, so one of my communities that I’m working with is in Maine. And so, in this Maine community, the partner was the central… Anyway, it was a health coalition. The name is escaping me but they received funding through a university to be a [SNAP-Ed 00:31:54] Implementing Agency. So, SNAP-Ed Implementing Agencies, one of the things they’re charged to do is to do a lot of classes and programs on nutrition and other health things for people who receive SNAP benefits. And a couple of years ago, through that coalition work, they got connected to the public library. And so… Unfortunately, they were only able to do a few classes before COVID arrived, but the classes that they did in early 2020, according to the person from SNAP-Ed, she told me, “I’ve been doing these for a while here in this county and the class of the library go the most diverse participants I’ve ever seen at any SNAP-Ed program I’ve ever done. Everyone from Iraqi to refugees that had recently resettled in the community to older adults, even teenagers.” And so, she was blown away, she was like, “This is… I’ve never seen anything like this. When I go to do classes at community centers, or public housing complexes, the library truly is a space that brings in everyone.” Like I said, I’ve been doing case studies so I don’t have any quantifiable data about the reach of libraries for these public health partnerships, but I would say anecdotally, I’ve definitely heard both from librarians and from public health partners they’re working with that there’s a widespread perception that they’re dramatically increasing their reach to vulnerable communities by working with librarians.
But I also think to you point Trish, I think that is something that deserves a closer study really, and honestly, I think one of the biggest things that I think we need is better framework for evaluation. So… I’m sure you know in Salt Lake County, and I know this as well that the idea of evaluation and assessment in public libraries is not great, even on the best day. And so… We can count people that come to programs, but we’re really not… It’s in part a funding issue, it takes time to do evaluation, and we certainly don’t have the skills to do a full blown public health assessment, which is something much more complicated than I even knew about because it’s not my universe. But one of the things that I’ve been working on currently… So, I’m part of a group called the Physical Activity Policy Research and Evaluation Network, which is funded by the Center for Disease Control and Prevention. And one of the things that we’re talking about currently is trying to figure out a way to do better evaluation of, in particular, programs that the public libraries do relating to increasing physical activity, specifically in rural communities. So I think like a lot of the things that we’ve been talking about, this is another area that needs better research, evaluation and assessment. But I honestly believe we’re not going to get to that stage of really being able to quantifiable say, “Here’s how libraries are increasing the reach of health departments”, until we first begin that conversation about… Yeah, because it’s… That’s kind of I see it’s a little bit further down the road. We first need to do some preliminary work focused on building awareness. And so, as you know Trish, within the library world, the lead health actors and the Network of the National Libraries of Medicine which is part of the National Institute of Health… And they’re great, I have no beef with them, but to my money, I think the better entity to be reaching out to is the Center for Disease Control and Prevention. So, through attending a conference called The Act of Living conference first in 2019 and then I attended again in 2020, and I’m planning to participate in the virtual conference this April, I’ve gotten connected with a lot of people in the Center for Disease Control and Prevention. And there’s huge interest in libraries within the CDC, but there’s currently almost no inter-institutional linkages, so I see this… reaching out to the CDC which at the end of the day is really the main federal entity focused on public health in America, is something I think urgently needs to be done.

Trish Hull: So that’s really fascinating. You just took me in a lot of different directions there. I think that data is really critical, especially when we are trying to talk to our… whoever we report to, our government entities maybe, or administrations or whatever, if you’ve got data, you can really sell your program or whatever it is that you need to do. So, I would really love to see your research out there, published, so that we can use that. But even if that’s just the case studies, that can be really helpful too. A lot of times, city councils really get case studies better than just numbers, so it helps to have both, but… I had a question a little bit about data and then I want to get to the CDC point. The part that we struggled with… So I did a partnership with the health department and they wanted those numbers. And it was, did having these community wellness liaison who was Hispanic, and another one was from a Pacific Island community, they wanted us to know numbers. So, how many Pacific Islanders came in to the library, and how many used the library more? And they wanted us to dig down into this data, but we were like, “Wait a minute, we’re a public building. I can’t ask people coming in what their race is, what their gender is, what their age…”, we’re totally not that group and they really struggled with trying to get this hard data. And there was a little bit of a conflict between public library values and health department values because they have no problem asking people all that data and information, right? And so, we were trying to help them understand our privacy lines and freedom of information lines and they were trying to get their data. So, do you see a solution to that in any way?

Noah Lenstra: Oh, gosh. That is a very tricky wicket for sure. One thing that I’ve seen some libraries think about is to really have kind of memoranda of understanding that really make it explicit of who’s actually doing this program, and so… I’ll give one example. So, in one of the communities in Illinois, after working with the local health department, they realized that they really can’t… given food sanitation laws, they can’t do the type of food cooking classes and serving that the department wanted to do. And so, their solution was to actually do it outside. They had a mobile nutrition van, and it’s like, “Well, based on our understanding of the law, we can’t actually do this in the library given food… we don’t have the equipments to do this type of food program, but I guess I have to review with the city council or you can do it in the parking lot because that’s not seen as kind of… because that’s not seen as… even though it’s owned by the library, it’s seen differently.”
So… No, I think… I really think those things, they have to be negotiated on a case by case basis. But I think where I see success are really those negotiations, where they occur, they really emanate out of a place of trust and mutual understanding. And so, I think there’s going to be… that’s something that I think is going to have to be idiosyncratically local. But, I think the best thing is to have that mutual understanding like, “Here’s our values, here’s your values, here’s what you need, here’s what I need, let’s work together to find a middle ground that’s [inaudible 00:40:08] going to be mutually beneficial for both of us. And if both actors are committed to the partnership, you’re going to find a way to do it. Yeah. That would be my thought on that question.

Trish Hull: So, how do you think we could build a relationship with the CDC, getting back to that? Because I find that fascinating and I’ve got partnerships with a lot of people, but I don’t think I’ve ever really interacted with the CDC [crosstalk 00:40:35] at all.

Noah Lenstra: No, it’s… It is in a way, it’s… For librarians, it’s [inaudible 00:40:43]. The conversations I’ve had with CDC folks, they have never interacted with libraries or librarian [inaudible 00:40:50], so it’s very new. So I’ve been working with their physical activity division, and so, they have an initiative called Active People Healthy Nation, really focused on… their goal is to help 27 million Americans become more physically active, and there’s a big national campaign. And so, they’ve been featuring some stories of librarians on their website that I’ve been feeding them. And so, they’re really interested in thinking about how libraries could be more a part of this. So what’s in the physical activity group, they actually have a working group on the built environment, so I’ll be speaking to them about libraries as a key part if the built environment and policies just as an environmental change in October.
But yeah, so the entry point is that one of the CDC’s big initiatives that predates Active People Healthy Nation is something called Connecting Safe Routes to Destination. And so, the idea was people should be able to get to places like libraries not only by jumping in the car but by walking, or bicycling, or using a wheelchair. Because we know and the CDC knows that ultimately changing physical activity behaviors is not just like offering a yoga class, it’s really changing the built environment to make physical activity the easy, obvious and fun choice. And so, there’s big interest in libraries being accessible for people however they want to get there. You don’t need to necessarily jump in a car to get to a library. And so… Yeah. I think there’s… That was where my connection with the CDC began because they had libraries as part of their Connecting Safe Routes to Destination initiative, and from there, it’s just snowballed into a broader conversation about public libraries and the promotion of physical activity across the country.

Trish Hull: Can you connect us to how a local library, or library system could connect to the CDC? Is that through their health department? Or could it be… How is the CDC structured? Is there somebody I could call in Utah that maybe they have [crosstalk 00:43:15][inaudible 00:43:17]. I’m not even sure that many of us know how the CDC… I know they’re in Washington-

Noah Lenstra: No. They’re actually… They’re in Atlanta [crosstalk 00:43:26]. Yeah. Yeah. Yeah.

Trish Hull: Didn’t know that obviously. [crosstalk 00:43:30] So, how could I as a local person connect? And maybe this again, through public health? Maybe they have those connections with the CDC?

Noah Lenstra: They might. The CDC like the National Institute for Health, which is more focused on the health care side, so I see NIH… They both do public health, but National Institute of Health and The Network of National Libraries of Medicine, is essentially health care. That’s their main focus. The CDC is public health, NIH is more traditional clinical care and then seems adjacent to that, and so… Yeah. SoC CDC being the main national public health entity in the US is extremely broad and complicated, and so… But one thing I’ve been promoting… So I was in the Active People Healthy Nation campaign, they’re actually encouraging community champions to join them. And so, I could probably share a link afterwards, but you can actually join the Active People Healthy Nation campaign as a community champion, or as an organization to get connected to the resources that they’re giving out to really encourage people to be more physically active, and to really work collaboratively to like I said, change the built environment and educate [inaudible 00:44:50] to make physical activity the easy, obvious, and fun choice. So… But there’s other divisions. They have… I’ve also had some conversations with folks in their nutrition. So they have… There’s a big focus on obviously nutrition and food. There’s sections of CDC focused on health equity, there’s a lot of different sectors of the CDC. I’m not sure if… Yeah. So, to your question about, how do we get connected to them, I think that’s… that is a… that might be a longer conversation. I think… So, since I work at the national level, I’ve just been working individual contacts. So I’ve over the years moved from individual people from the CDC that I met at conferences trying to really extend their awareness of libraries. And the CDC’s awareness of libraries, at least the people I talked to before I got connected to them was pretty low, probably the about the same as your typical librarian’s knowledge of the CDC. So there was a pretty stark lack of mutual understanding.
Yeah. I don’t know where to end that. The CDC is based in Atlanta, most of their staff is in Atlanta. They have staff across the country, they’re interested in libraries… Yeah. I don’t know if I have really recognition or good advice for a local someone in Salt Lake County like yourself to directly reach out to the CDC. You could do it through your health department. Probably the better of that would actually be to work through a state agency, so, the Utah… I’m sure Utah has an office of rural health, so I would say probably your state contact would be better avenue if you wanted to get directly connected to the CDC. Because I think local health departments are probably also… they probably get information from the CDC but are not directly connected to them would my understanding, but I may be wrong because it’s not my universe.

Trish Hull: They probably… Yeah. We do have a state department of health. So, it’s interesting. As you were talking I thought, “We’re librarians, we can figure it out, right? We do know how to research and find answers to things.” But I really like that idea of that connection. I think… And I love the NLM and we’ve worked so long with them and they provide some great funding for us and we want to keep being good partners with them, but again, going back to those partnerships, what do you think are the defining characteristics of a successful partnership? How can the public health person out there listening, and the librarian out there listening, what characteristics can they develop to make that a successful partnership?

Noah Lenstra: Yeah. So that’s a great question. So a few things come to mind. I think probably first and foremost is just that open relationship based on trust. So a relationship that’s characterized by a lot of give and take, if people have new ideas, they immediately think of the encountered point in the library or in the local health department. That example that I shared about the starting of a food pantry in Maryland is a great example of that. So, yeah. There should be opportunities for people to pitch ideas to one another, brainstorm, and really that all comes down to trust and relationships. I think there should be opportunities for librarians and public health professionals to see each other on a regular basis, and so, that can be done through individual meetings. But I think it happens a lot more effectively through multi sector coalitions, whether it’s a partnership for children or a health alliance. In one of my communities, the local hospital actually has something called the Area Community Partnerships, where they bring together nonprofits on a regular basis to talk about the overlaps among the work they do around health promotion. United Way is also another common one, so… I mentioned… When we first started talking, I started talking about the Portland public library in Maine. And at that library, a United Way coalition have been the primary way that the library has got connected with health department folks. So just give and take, trust, mutual understanding, opportunities to engage with each other on a regular basis through things like community coalitions… Yeah. Those are probably the things that I would say characterize successful partnerships. Trust and opportunity for regular engagement.

Trish Hull: So I really like that, I think the coalitions is a huge way. Another interesting way that I’ve been involved is through our local chamber, the chamber of commerce. And… Because a lot of time you’ll have hospitals, [inaudible 00:50:02] clinics, and all different kinds of health groups, I haven’t seen a lot of public health people involved in their chambers. And I think that might be a really good way for them to get involved too, but it does provide that opportunity to see people face-to-face.

Noah Lenstra: Yeah. And Trish, that’s a really excellent point and I’ve heard that as well. So it’s been less… So with chambers of commerce and downtown development associations, you’re right. A lot of libraries in my interviews, they talk about chambers and DDAs being really important for forming partnerships but it’s usually not with health departments, it’s usually with say like with the local yoga studio in town. That’s been a common thing I’ve heard [inaudible 00:50:41] someone starting a kickboxing or a yoga club or whatnot, and the librarian meets them at the chamber of commerce meeting, they’re like, “Hey, you’re trying to start your business and we’re trying to promote healthy lifestyles. Why don’t you come down to the library and do a demo of you…”, whatever, yoga, kickboxing, whatever it may be, or local… if you’re starting a new restaurant, do a cooking class. So chambers have been a really great way for libraries to connect with the business community and to bring new opportunities for folks to engage in healthy habits, through programs solicited by the business community.

Trish Hull: Do you have a vision of where you would like to see public libraries and public health in the future?

Noah Lenstra: Yeah. Really, what I would like to see is a scaling up of some of the places that are really closely tied together. Wouldn’t it be wonderful if the CDC and the Institute of Museum and Library Services have the same open lines of communication that we know already exist in local communities. So yeah, so thinking about, how do we scale this up? How do we move from things happening in particular places across the country to a true national coalition? And there’s a lot of work to do, a lot of work to do. And it’s not just on public health. I’ve been working with the National Recreation and Park Association where they also know that there’s huge opportunities associated between park and recreation agencies working with librarians, but they also know it’s something they don’t know a lot about, so… YMCA is another great example. We know YMCA is a frequent library partner, but I also know talking with someone from YMCA’s headquarters in Washington DC that they’re largely oblivious to that fact. So, it’s really, how do we scale it up? How do we move from local partnerships that are doing amazing things, and relationships that are rich and have endured across years to something that’s more national in scope. That’s really my vision for libraries and librarians to truly have a feet at the table at the national level, and conversations about the future of health in America.

Trish Hull: Wow. That’s a really… I think you just encapsulated the whole conversation. We go from the small little rural library that actually thrives after having almost dies because of a partnership and a coalition, and we know that it works on the broader, maybe more county level, the larger inner-city level, and then we moved to the national level. But I’d never even thought of that.

Trish Hull: That wraps up today’s episode of Share Public Health. We hope you’ll join us next week for that last episode in our miniseries as we talk with a group of public health and public library professionals from different organizations across the State of Iowa, who are engaging in public health and public library partnerships.

Thank you for tuning in to this episode of Share Public Health. Thank you to our host, Trish Hull, The Network of the National Libraries of Medicine, The Public Library Association, The Midwestern Public Health Training Center, and Prevention Research Center for Rural Health. This project is supported by the National Library of Medicine of the National Institutes of Health under award number, UG4LM012346. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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