Share Public Health Transcript: Tackling Equity, Conclusion

Season 1 Episode 26

Hannah Shultz 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 into this ten-part series on health equity. Over the course of this series, we will discuss a broad range of topics connected to health equity. For additional resources and information, be sure to check the podcast notes or visit mphtc.org/healthequity.

Hannah Shultz Hello. My name is Hannah Shultz and I work with the Midwestern Public Health Training Center. I am very excited to be your host for this 10th episode of the Tackling Equity series. This will definitely not be our last episode discussing health equity, but it is the last one in our initial series.

Dr. Georges Benjamin “If everyone doesn’t have equal opportunity for health, then nobody has it.”

Dr. Denise Martinez “I knew since an early age not only did I want to be a physician but I wanted to help change and make medicine and health care better for all people.”

Mike Hoenig “Bottom line is to respect the preferences of the individual, and if you’re not sure, just ask.”

Dr. Michele Devlin “We are now well over 180 languages within the state of Iowa.”

Dr. Katie Imborek “One of the things that we really need to think about to be able to better serve these populations is figuring out how do we provide care to folks in their primary locations.”

“A lot of health disparities have to do with how the system is actually treating the patients and a lot of that was built on racism and homophobia and all sorts of things throughout many generations and systems of inequality.”

Danielle Pettit-Majewski “We’ve got a couple of ambulances and one of them is in Brighton and one of them is on the way to the university then there’s nobody in the city to respond if you dial 9-1-1.”

Dr. Paul Gilbert “The context shapes the behavior to a tremendous extent that we don’t always recognize.”

Quinney Harris “When we use racism as a health determinant, it allows us to consider a range of factors such as policies, societal structures, socioeconomic status, geography, transportation, housing, social capital, and labor practices that impact health outcomes.”

Dr. Paul Gilbert “Well that gives us hope too, that these situations aren’t set in stone, that we could change it, that there are tools that we could use to design healthier communities.”

Sarah Harstig ” I think about, in everything I do, what about health equity? That’s why I wrote it on a sticky note, it’s on my computer, how can I be more mindful of that?”

Dr. Katie Imborek “It’s just not true that LGBTQ+ people live in urban environments only.”

Dara Jefferson “Keep in mind that we’re the experts of our own communities and that we need to have a hand in our own healing.”

Cheryll Jones “Just say, what are some things you want to work on, and I had a child in the other day. He’s 14 and he said ‘I want to learn more about my medicines’ and ‘I want to know what I should do in an emergency.'”

Dr. Rima Afifi “When we focus too much on on behavior we actually victim blame.”

Hannah Shultz You’ve just heard clips from the previous nine episodes. Today we’re going to talk about themes and attempt to tie together some of the recurring topics from the series. Welcome to this last episode of the initial Tackling Equity Series. In today’s episode we’re bringing back several of the guests and hosts from previous episodes to discuss some of the overarching themes of the series. Joining me is Dr. Maria Bruno. Dr. Bruno is the executive director for Belonging and Inclusion and Assistant to the Vice President of Student Life at the University of Iowa. We heard from Dr. Bruno in the very first episode of this series. Dr. Bruno is a clinical psychologist and has worked with a broad range of populations. Her areas of expertise include trauma, training and supervision, and multicultural principles. In her time here at the University of Iowa, she has advocated for a more equitable, inclusive environment and infuses her work with an understanding of belonging as a basis for health. Dr. Bruno, thank you for joining us again.

Dr. Maria Bruno Thank you for having me.

Hannah Shultz We are also joined by Mike Hoenig. Mike Hoenig serves as a program coordinator for the University of Iowa Stead Family Children’s Hospital Center for Disabilities and Development. He coordinates trainings for Health Sciences Professional Training Programs, supports individuals with disabilities enrolled in the Iowa Leadership Education and Neurodevelopmental and Related Disabilities graduate training program, administers the program which supports the transitions of individuals with disabilities from segregated to community-based settings, and represents CDD on a number of initiatives which promote disability, inclusion, and awareness. He utilizes his first-hand experience of living with blindness and supporting a family member with mental illness to enhance training offerings. We heard from Mike on the Individuals with Disabilities episode and Mike has been really important in planning this whole series, so thank you for joining us Mike.

Mike Hoenig Thank you for having me.

Hannah Shultz And our last guest this morning is Felicia Pieper. Felicia is a Master’s of Public Health student in the College of Public Health in the Community and Behavioral Health department here at the University of Iowa. She is specifically interested in how we teach health equity and instill social justice values in the classroom, research, and public health practice. Felicia was host for episodes on Native American health and immigration and has been involved in the planning of this series from the very beginning, so welcome Felicia.

Felicia Pieper Hi, thanks for having me.

Hannah Shultz So we started this whole series talking about definitions of health equity and why health equity is important for all of us to consider. Over the last eight weeks we’ve had conversations about race, disability, sexual orientation and identity, representation in healthcare, and many other topics. Today we’re going to attempt to bring some of those themes together. While the conversations we’ve had over those past weeks are important, we all have multiple identities and that impacts how we see the world and how the world sees us. About 30 years ago, Kimberlé Crenshaw coined the term, intersectionality to refer to the layering of oppression and experiences of injustice. For example, a woman of color with a disability experiences the world as a woman, as a person of color, and as a person with a disability, and as all of the above. Her experience is different than that of someone with different identities. In the LGBTQ episode, our guest Max mentioned intersectionality a bit, but we didn’t dive too far into this topic. I’d like to start our conversation today talking about this idea and thinking about the conversations we’ve had over the last several weeks and how those may be different if we are talking about individuals or groups with multiple oppressed identities, instead of talking about each of those individually.

Felicia Pieper I think because we live really messy, complicated lives, it’s really hard to parse out how different things affect our health, especially when the basis of our knowledge of health is research and research is opposite of messy and complicated; it’s procedural and systematic. So recognizing that there may be some gaps in our empirical knowledge because of just the nature of how we live our lives. I think this also speaks to the importance of listening to individuals and using alternatives – not necessarily alternative – but using more creative innovative research methods to be looking at these issues with health, but also just recognizing that at the core we should be listening to people and acting now even if we don’t have that empirical knowledge to really parse out a cause-and-effect or a certain identity that leads to a certain health outcome, but really just treating people as people.

Mike Hoenig Well I really like that and I’d like to sort of expand on that a little bit. We were fortunate enough through Inclusive Health and Wellness Iowa grant to create a number of videos and one of them actually did deal with serving diverse patients with disabilities. We actually had an African-American woman who did not have a disability but was the parent of a child with a disability and she did talk about how those multiple identities really intersected to create some unique and sometimes challenging issues in the healthcare system. For instance, there were all sorts of perceptions about her, stereotypical perceptions about her as as a woman of color, and then within the healthcare system as she went to various appointments. The other thing, too, is when we start talking about multiple identities, it can be very challenging for an individual who maybe introduces a new identity into their culture or into their way of being. So giving a bit of a concrete example, this woman who I’m speaking of talked about how disability is sometimes associated with shame in her culture or you also just try to get over it, you don’t discuss it and in these days when there are so many options for providing therapy, for providing peer support, mentoring, that sort of thing, there’s that an additional sort of cultural barrier that individuals have to face. So it was clear to me that this individual really had to battle a number of barriers both internally within her culture and externally as within the healthcare system to access the services that she needed for her son.

Dr. Maria Bruno I really appreciate what you stated. As I’m thinking about intersectionality, I just want to remind us that the word itself is an academic term. So when we are talking with people, patients, clients, helping individuals understand how they can best navigate the world, focusing on their personal strengths and their resiliency and their grit. So one of the the most important things as health care providers, in my opinion, is really listening and highlighting the importance of individual history so that we can better understand the people that we are working with.

Hannah Shultz Yeah, thank you all. A couple of things that sort of jumped out at me – this is definitely a very academic conversation we’re having right now, and one of the things that we’ve been trying to do throughout this series is give concrete examples about what practitioners can do to change their practice. Felicia, you started by saying that we should act and maybe not wait for the empirical evidence, which is a pretty radical thing to be saying as you’re sitting in a University building. I appreciate that. Mike, thank you for bringing those examples in. Maria, thank you for the reminder that we need to be focusing on the people we are working with and interacting with instead of falling back on the theory and academic world that many of us find ourselves in. Another topic that came up several times, especially in the episode that we focused on the social determinants of health, is the difference between health behaviors and health choices, and the idea that sometimes we all act in ways that may not benefit our health or may not lead to the most positive health outcomes, but those aren’t necessarily about personal choices. This was most prevalent in the social determinants of health episode because that discussed a lot that really focused on the social and environmental factors that influence our health, but I wanted to open it up a bit more. We also, in the Native American health episode, that came out a lot and the immigration episode it came out as well so I wanted to open that up to the three of you. When we’re thinking about health outcomes, going back to being in an academic setting, we like to point to the things that people can do to take steps to be healthy, but we know that we have messy lives and that’s not always possible. How can we think about this idea that health behaviors aren’t always the choices we want to be making for our health and how can we shape our practice or encourage our colleagues to shape their practice to keep that in mind?

Dr. Maria Bruno As a clinical psychologist we really use a lot of theories that are focusing on stages of change in motivation and so one of the things that we often think about is where is the individual at? Do they want to make changes for themselves, first. We really try to be very – well I really try to be very client centered – and like I mentioned earlier, really understanding my clients and where they’re at. So we talk about values and we talk about things that they might not consider could impact their health behaviors. We talk about family, is a big one often in the Latino community where being around for your family is very important, and so when we connect giving options and ideas of how to make healthier choices, we connected back to, if you make these choices then you will have better health outcomes which could possibly give you a longer lifetime with your family. That is one of the ways that were able to connect some of our individuals with developing healthier habits.

Mike Hoenig I’d like to take this into a little bit different direction and just think about some of the barriers to health choices. I’ve loved that, the connection to being with your family longer. I think that’s definitely client and culture-centerd as well. In terms of working with people with disabilities, I was fortunate enough a number of years ago to be a part of a group which taught a class called Living Well with a Disability Across the State of Iowa, and so we did talk a lot about healthy choices. One of the things that we talked a lot about was increasing physical activity and constantly two barriers came up. So the one of them being transportation, being able to get to a rec center or a gym or any of those kinds of places, a fitness center. The other issue that we ran into a lot was attitudes of providers, that they would just simply say, people . . . in a couple of situations that I can remember that actually did overcome the transportation barrier and then receive the attitude, “well we don’t, we’re not equipped to deal with people like you” and that just presented yet another barrier and in some cases really discouraged individuals from getting out. So, you know, I guess in terms of recommendations to health care providers and other providers that would be working to help, for instance, with enhancing physical activity, to be creative, and to seek out resources that are out there to serve all populations. I think in terms of just opening up, opening up their thought processes to figuring out if there is not an easy way for somebody to get to their site, what solutions could there be? Could there be ride-sharing? In this world of technology that we have, could there be some sort of training that could occur via virtual environment so that a person that could not easily get out of their home at least learn some ways of being more active within their home environment? I think there are many and this is just one of a number of things which came up during those courses that I realized- we’re on a time limit so I’ll stop at this point.

Hannah Shultz Thank you Mike, the beginning of your response that really made me think about the need for persistence. If you’re constantly coming up on barriers that spaces aren’t welcoming to you or even able to serve you, you have to be really really persistent to keep finding that and make it a priority. I imagine that can just be exhausting and eventually people are going to give up even if they have the best intentions of trying to be active or trying to have a different social environment, so thank you for bringing that in.

Felicia Pieper To take a step back, I think it’s also helpful to think about ourselves in these spaces and how we might act and how we might make choices and whether those choices are really active or passive and just having empathy with the individuals that we work with. For example, I may be very passionate about physical activity and working out and I incorporate that into my life, maybe overcome barriers to make that happen, but I may also not be getting my dental wellness checkup like I should. So also keeping in mind that health overall may not be a priority to people but also even the individual sectors that we work in are not going to be of the highest importance to every person that we’re talking to.

Hannah Shultz Yeah. Another topic that is related to this that came up in one of our last episodes which was about rural health or place matters was we talked about access to healthy food, so we talked with Danielle Pettit-Majewski in Washington County, Iowa about finding places to get food. In Washington County [inaudible], they have three grocery stores that all have fresh produce and healthy food options, but that’s not the case in the whole county. Even if people do have access to healthy foods, it requires having the time to prepare it, the money to buy it, the skills to do so, a home that has a kitchen with electricity or gas, or whatever you need to prepare the food, so even if someone wants to be making healthy food and preparing healthy food for themselves or their families, there can be many other barriers preventing that from happening. We can think about that and a variety of behaviors from eating to physical activity, which we’ve talked about and many others that even the most well-intentioned plans can go awry if the setting isn’t there to support those decisions or support those behaviors.

Dr. Maria Bruno Felicia, I really appreciated you and your perspective in terms of how do we increase access for folks. When we think about health, we often think about food and physical activity, but we forget about just like going to go see an eye doctor, an ophthalmologist, or going to go to the dentist, like you mentioned. Just some of the things that I take for granted because I have really good insurance, but I know that a lot of folks that I work with don’t have that same opportunity as I do. So how can we continue to advocate for individuals to have access to these kinds of services. Thank you for mentioning that.

Hannah Shultz Now we get into housing a little bit in the place matters episode as well, talking about things like rental inspections being a public health initiative which is often, you know, that housing, health, two different things, but making sure that rental properties don’t have mold or don’t have radon, and if they do, they have mitigation systems in place and making sure that the people who are inhabiting those homes are not going to be made less healthy because of their home environment. So there are a lot of different things that go into our health that we have varying levels of control over. So we’re going to change focus just a little bit here. Since the focus of the Midwestern Public Health Training Centers is on training the public health workforce, we’re going to talk a little bit about what that means. In several episodes we talked about the importance of representation in health professions and building an inclusive workforce. Dr. Martinez shared a story about her grandmother being scared to go to the doctor because she was a Latina woman and not being sure she was going to get culturally appropriate care. Dara Jefferson shared in the Native American episode that she was the only Native sexual assault advocate in Iowa. Dr. Imborek and Max shared about the success of the LGBT health clinics they work in, so we have several examples of people working within their communities and for their communities to help shape their health, help shape health outcomes. We also talked a little bit about the importance of training the people who are already working in public health to have more cultural sensitivity and more cultural awareness. I want to talk a little bit about moving beyond just the recruitment. It’s clearly very important that we recruit more underrepresented people into health
professions, but we also want to make sure that those people are welcome and stay in those professions. What do you see as some of the biggest challenges to doing this and what can be done to overcome these challenges? Dr. Bruno, I’m really interested in your views on this topic since this is one of the focuses of your work here at the University of Iowa is making sure that we have a place where people can feel like they belong and are included in the campus environment.

Dr. Maria Bruno Yeah, this is a question that I probably have the most emotional response to and the reason that I state that is because in my 10 years here at the university, we’ve done a fairly decent job of trying to recruit staff and faculty of color. However the challenge continues to be how do we support staff and faculty of color so that they could not just survive but thrive. I think it’s very challenging to know what everyone is going to need, but I think one of the things that I’m hopeful for is – just like students, right – finding different touch points or places where these individuals can feel like they have a community, feel like they have a support system, feel like that people will have their back when they are going to bring up a concern or share something that might not be a popular opinion. It is very challenging, oftentimes, to be the only one of whatever identities are in the room, and then to recognize that you’re sitting in the midst of really – how do I say this – . . . you’re observing practices that continue to perpetuate the oppression of other folks. So being the person who highlights that or brings it up, but also trying to learn a balance, not to be seen as a troublemaker, provocateur, or the person who’s responding emotionally, or the person who only cares about certain populations is a delicate balance. So one of the things that I have found to help me thrive and be successful is to really develop genuine and vulnerable relationships with individuals who hold different identities than myself and engaging with them and holding them accountable to be the individuals who speak up versus myself all the time and that seems to work really well. I hope that folks can either take that initiative or be vulnerable and speak up for other identities and may become true allies to other folks while also recognizing that you don’t always – as a person of color – you don’t always have to say yes. So pouring out when you’re over filling from your glass is what I’m thinking of. I know we’re socialized to think ‘oh is your glass half full or half empty?’ For a person of color, I would ask is your glass over filling and if it is, or overflowing, then I would encourage you to pour out and when it starts to run low, let other people come so you could refill.

Hannah Shultz Thank you and I appreciate you saying you had an emotional response to this. I think a lot of the topics we’re talking about this morning and that we’ve talked about over the last nine weeks are very emotionally charged for a lot of us either because of negative experiences, [inaudible] experiences in which we may have made a mistake and are feeling a little uncomfortable about that so it’s really important this came out in several of the conversations we’ve had in the last couple of months, to be patient with yourself but also also always be working to be more inclusive in our work. One of the comments he made at the beginning about you might be the only person with that identity in the room reminded me of – I recently reread the “Unpacking the Invisible Knapsack” article, by Peggy McIntosh, which is available on the Midwestern Public Health Training Center’s website. After she has a- it’s a very brief article and at the end she lists several different effects of white privilege in her life and one of them is saying ‘I’m never going to be the only person of my race in the room speaking on behalf of my whole race’. I think that’s something that many of us really take for granted and it’s hard to imagine to be the only person speaking on behalf of our whole identity in some way, so thank you for bringing that in.

Mike Hoenig I’d like to comment on this, too, primarily from the identity of a person with a disability. It’s so apropos the discussion of are you the only person of this identity. Right now in my work, I’m looking to go to working part-time remotely, and of course that involves connecting remotely with the server, with the University of Iowa server, UI health care, in this case. So I’m running into some barriers with my home computer and my work computer talking, communicating, and that involved installing a particular screen reading program on the University of Iowa server. So this conversation has come up and somebody asked me last week, well surely you can’t be the only blind person on campus that needs Citrix? I said, well, I don’t know. I don’t. I don’t know how many people who are blind are on campus that need this accommodation, so my first thought about that was well, shame on us if I’m the only person. But then I thought, well, if I am at this point, this is a need. This service is provided to everyone else on campus who request that, I assume, that if their supervisors have approved them to work remotely, so it should be available to me as a person with a disability. I think ensuring that practices truly are equitable and doing that by being proactive and reaching out to the disability community, in this case, but all communities. I think another thing that the university can – and not just the University of Iowa but any employer, medical practice can do – is to think about hiring requirements. We’ve run into a situation recently in which a requirement of a driver’s license was posted in a job posting for a position that yes, travel was required, but did it require that the individual holding the position actually be the one to drive? Well no, and so I think examining hiring practices at the institutional level, but then at an individual level, I think it’s very important for people who are representative of what might be considered minority identities to be welcomed. Again trying to stay with concrete examples, shortly after I came to work at the Center for Disabilities and Development a group would always go down to the cafeteria and oftentimes I would go down and I didn’t know people, so I would just grab a table by myself and a colleague who ended up becoming a very good friend said you don’t have to sit alone, come over and join us. And an as simple act as that really made me feel welcomed and made me want to excel in my work, so that sense of belonging is so important for anyone. And certainly if somebody feels that they are representing a minority group, whether it’s a culture, disability, sexual orientation, that that not be a focus, but that people be welcome as individuals first.

Felicia Pieper I appreciate that both of you touched on the higher level kind of policy, institutional level but all the way down to the individual and thinking especially about building relationships. Dr. Bruno’s use of the word vulnerable and I just want to highlight that these talks, again, are uncomfortable because of our culture, because of a lot of things, because of identities that we hold and also highlighting that uncomfortable comes from different places. Sometimes we are uncomfortable because we’re so personally connected to the issue and sometimes we’re uncomfortable because maybe we never been in a space where we’re talking about, for example, racism. So I think that what we can do no matter what space, whatever power level we’re at in the space that we’re in, we can also be focusing on how we’re treating people, so just focus on a growth mindset of thinking about ‘what can I learn more about and how can I implement that learning?’ Also recognizing that we can be working on higher level things, like hiring practices and institutional level policies, but also every single day when we show up we can be working on ourselves and making sure that we’re making people around us feel as safe and comfortable as possible.

Hannah Shultz Thank you all for that. I’m also thinking about many of us, especially in states like Iowa which are not super diverse, especially racially, might not ever see someone who’s not our socioeconomic status, the same race as us. We may live in spaces with a lot of people like us, we may work in spaces with a lot of people like us, and if you’re in a small town where that’s just how it is, trying to recruit more diverse people or underrepresented people to your organizations is a whole different ballgame, but for those of us who are in spaces or institutions where we can be thinking about actively recruiting people from other regions, other states, around the world to join us. We’re still in spaces that are one race, one socioeconomic status, who have all men in leadership or all women in leadership. We should be looking at what the environment we’re creating is and how we may be unintentionally excluding people. I think a lot of us think ‘oh well I don’t, I’m not prejudiced, I don’t have any problems’ but if the environment that we’re creating and maintaining are not comfortable for others to join us and stay there, it’s something that we should really be examining and figuring out how we can change that.

Dr. Maria Bruno As I heard you talking, I thought of something that we don’t often talk about. We usually talk about sense of belonging with folks that are different than ourselves, but also wanting to remind us sense of belonging with folks that hold the same identities as we do. An example of that is I represent one of three percent of all Latina women in the country to have a Doctorate degree. Within the Latina, community I am seen in a much higher hierarchy and so even trying to connect with people that look like me, I’m an outsider because of the level of education. My children are considered outsiders. So I just wanted us to remember that, right, because we often forget about that conversation as well. So how do we create spaces for when folks do come to an academic setting that they feel like they belong here, but also connecting them to the community so they have a community within the community as well.

Hannah Shultz Yeah that ties back to the very first conversation we had today about identities and also I think many of us who have been in academic settings for a long time don’t realize how unique academic settings are. There’s a whole different language, people interact differently, so it’s really important for people who might be new to academic settings or maybe have been out of academic settings for a long time that there’s a learning curve to coming back to that. A lot of people have heard about tenure before but don’t really understand what tenure means. What’s the difference between an associate and an assistant? What’s the GRA, what’s the TA, you know, all of these different acronyms that we use that are really specific to the language of institutions, and trying to welcome people in and help them understand that because it doesn’t take that long before you figure it out and you might forget what you didn’t know when you started, so being patient with yourself and with others is really key to fostering that sens of belonging. So a couple times this morning we’ve talked about the idea that this is a process, achieving equity is a very long process. We’ve been working at it for a long, long time and have a long way to go. We all work and live and exist in systems that benefit some people and disadvantage others and health equity is the result of an unequal system of policies and practices. That’s come up several times throughout the last few weeks, so we need to work at the individual level to understand these systems and how we contribute to them. We need to work within our organizations, communities, and political systems to build communities where all people have the opportunity to be healthy. We also talked about the need to be patient with ourselves and with others as we work to change our practice and work toward equity. We’re going to make mistakes. That came up several times. I’m right now thinking about the episode on building a diverse workforce when we talked with the women at the Lawrence Douglas County Health Department and they were very vulnerable and shared some of the mistakes that they made while making some health equity changes and the important lessons they’ve learned from that, to make themselves, their practice, their health department, and their community more equitable. So in each of these episodes, we asked our guests to share a couple of tips for action that we can all take right away to be more equitable in our practice. I’d like to open it up for you all now to share tips that you have, lessons you’ve learned in this work, maybe a time you failed, or even just a broad comment on this process of working to be more equitable.

Mike Hoenig I think that one of the things that is most important to me in establishing equity and working toward it – because we’re never done – is listening and learning from others. We’re fortunate now – and Hannah you mentioned before that we sometimes are in spaces where everybody looks like us and has a similar background. We’re fortunate at CDD right now that we are really expanding and we have people coming in to work with us either as employees, as fellows who don’t look like us and have very different experiences and I have found that it’s been very very helpful for me to just have an open mind. It’s taken me a while to get to that point where I want to learn, I want to take what I’m learning and it not only to people that I’m working with it, but to new people who are coming in. I am just finding that as I do that, that I’m pleasantly surprised many times and then I look back and I’m a little embarrassed in saying ‘well, gosh I didn’t know this person could do that or I didn’t know that this person felt this way’, but it’s all a part of growth. I’m trying my best to give myself some slack, to say okay, you know, ‘I didn’t know that but I do now’. But just learning, listening, and being responsive to people from diverse backgrounds leading me and as I’ve done that I feel that, as a person, I’ve advanced but also in the work that I do at CDD.

Felicia Pieper I think, off of what Mike was saying, we can also . . . when we find ourselves in spaces that maybe aren’t diverse we can look elsewhere to get that learning. We have access, many people have access to a lot of different mediums, online, books, all sorts of ways that we can be learning about people who are different than us. That also might be a nice safe space for us to learn without having to then immediately respond or react. It’s kind of a place where we can sit and digest and kind of learn on our own without that fear of saying something wrong. But it works us towards being able to be a better community member, family member, partner, all the things that we’re striving for with health equity. I think, too, it’s very important as we’re learning to keep in mind that the goal is to create change and so as we’re learning, thinking about what can I do to make this actionable? Even if it feels like you’re in a position that doesn’t have a lot of power, there’s going to be some things you can take away from that new knowledge that you can do. So try to identify those actively and then implement them.

Dr. Maria Bruno To build on everything both of you have already shared, I would like to just say that often times we struggle with change or with difference because we are unfamiliar or we fear the unknown. So I would encourage people to choose to give trust to others. I believe it’s a choice. I know people have different philosophies, so because of that I would also encourage people to acknowledge that others may require time to trust you and that is okay. So therefore we can all engage in active listening, we can seek to understand before being understood, and everybody can do that without having to go out and look for any kind of resource. There’s no financial burden, it is simply being with folks and truly wanting to understand their experience.

Felicia Pieper I do just want to highlight that, again, this work is really hard and emotional and that throughout every level, we should be taking care of ourselves and checking in with ourselves, and checking in with the people around us to make sure that we’re all doing well and that we can continue to do the good work.

Dr. Maria Bruno I like that. And we can walk away and it does not mean that we don’t care about doing the good work. I know that’s a big struggle for folks who do the work.

Hannah Shultz Yeah absolutely. I think in public health and health care, these are caring professions where burnout is high and burnout is especially high when you may be the only person of your identity in the environment or where you are caring for communities and populations that may have special health or health care needs. It’s really important to be able to take a step back and make sure that you’re bringing your best to work or the best that you can to the work that you’re doing.

Hannah ShultzThis is the tenth episode in this series. We’ve talked about African-American health disparities, Native American health, immigration, place, people with disabilities, LGBTQ health, the importance of building an inclusive workforce. So we’ve covered a lot of ground in the last nine weeks, so thank you all for sticking with us and this will not be the end of this series. This is the end of the first ten parts of this series. We’re already planning additional episodes and interviews to come out later this summer. So thank you all to our guests for your commitment to this series and for being engaged over the past several months while we pull this together. Share Public Health is going to take a break next week, so check back on March 24th for another mini series on mental health.

Hannah Shultz Thank you for joining us today. Special thanks to Rima Afifi, Anne Crotty, Alejandra Escoto, Paul Gilbert, Kaci Ginn, Mike Hoenig, Kathleen May, Felicia Pieper, Melissa Richlen, Hannah Shultz, and Laurie Walkner. Theme music for Share Public Health is composed by Dave Hoing and Roger Hileman. Funding for this webinar is provided by the Health Resources and Services Administration. Please see the podcast notes for an evaluation and transcript.

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