Sara Satinsky

Sara Satinsky
Senior Research Associate
sara[at]humanimpact.org

Sara Satinsky first joined Human Impact Partners as a graduate student intern and then in 2011 as staff.  Prior to joining HIP, Sara worked at The University of North Carolina at Chapel Hill on projects that bridged public health and city planning, such as measuring the quality of pedestrian and bicycle master plans, and evaluating the national physical activity plan.  With a strong interest in and commitment to many aspects of supporting people in reaching their greatest potential for health, she also brings half a decade of communications experience that was largely around HIV/AIDS prevention and treatment campaigns.  Sara completed dual master's degrees in public health and city and regional planning from The University of North Carolina at Chapel Hill, and a Bachelor of Arts in anthropology from Tufts University.

Tell me what you’re for, not what you’re against

“What can I do?” It’s the question we at Human Impact Partners are asking ourselves, each other, and pretty much anyone who will discuss it — and one that we hear swirling in the streets during these post-inauguration days.

A powerhouse panel took on this question at a recent Commonwealth Club event in San Francisco, titled “Movement Leaders on Civil Rights in an Uncivil Time.”

The diverse minds that night included Lariza Dugan Cuadra of Carecen SF, Rashad Robinson of the Color of Change, Abdi Soltani of the ACLU of Northern California, Tom Steyer of NextGen Climate, and moderator / KQED host and anchor Mina Kim.

From left to right: Lariza Dugan Cuadra, Rashad Robinson, Abdi Soltani, Tom Steyer, and Mina Kim at The Commonwealth Club event on February 1, 2017.

Here are salient points from the conversation that we pass along and adapt for fellow health-loving folks also searching for answers to what they can do. The list starts broadly, then hones in on actions specifically for public health.

1) First take a step back, and recognize what is going on today.

Currently, there is a broad-based undermining of fundamental rights in the US — the right to vote, to a free press, and to decisions based on scientific fact, for example. It is an undoing of what people of this country and some of their ancestors have struggled over centuries to create. This undermining of rights will affect our health. To that end, stay tuned for resources in the works by Public Health Awakened about what the 100 Days Plan means for health.

2) The way out is not the way we got here, to paraphrase Rashad Robinson.

We need change. What does that change look like? Panelists described it as activism between elections. Activism now. For public health folks the word “activism” can sometimes be iffy. In my work life, one way I interpret that is in advocating for health.

Change also means building even more people-centered movements, and grassroots activity with constant face-to-face interactions starting now, not just 2 weeks before an election, as panelist described. It means showing our values and who we are in a visceral way. And it means holding the instigators — and enablers — of harmful policies accountable. Recent focus has centered on actions by the highest office of this nation. But panelists emphasized that there are actions at other levels that shape our day-to-day lives. That means an opportunity to reach out to and hold accountable Senators, members of the House, and governors, as well as district attorneys, for example.

3) So, how do we interpret this specifically for health? What can public health do?

Identify 1 action to take today in support of public health. For example, if you’re interested in a specific issue, find out one organization working on that topic and how to get involved. For example, there is work quickly coming together on topics like immigration ,including a resource put together about 9 actions health departments can take to support immigrant rights. If that’s an area of interest for you, find 1 action from the guide that you can take. If a different interest area speaks more strongly to you, see if a group already exists and reach out to that group working to protect and promote health in the years to come. If that group doesn’t exist, talk with friends, colleagues, social media contacts, or other circles about how to help start it.

Call, write, or visit leaders to make clear there is a need to protect health. Elected officials respond to constituent concerns. We in public health have the added bonus of being able to bring sound evidence to leaders. We have a responsibility to continue to do that. Even if working in a city or state where you believe the Congressperson, district attorney, etc is already interested in protecting health, there is value in reaching out — you can ask if they are publicly stating that position or what actions they are taking to bolster it.

Get informed. As policy changes are rapidly proposed, it’s important to stay current. Whether it’s about local, state, or national issues, we need to know what’s going on to figure out how to respond in support of health and health equity, or how to act proactively before the next event.

Pace ourselves. We should prep for the marathon, not the sprint. It starts now, and continues for years. Self-care will be critical to sustaining ourselves over time. Set the expectation of yourself that you can’t show up for every event. But go when you can. It not only cues elected officials and decision-makers, but shows support to the people most immediately affected by recent decisions.

Identify and practice saying what we in public health are for. And repeat it over and over again. Speakers at the event described a need for a bigger vision. We in public health can show that what we are trying to protect is fundamental to American values, and can communicate an optimistic, clean view for how the US should support health. It’s about saying what we are for instead of what we’re against.

Taking a step toward saying what we are for, here’s a go at it for Human Impact Partners.

We’re for keeping families unified. We’re for supporting a lifelong course of rehabilitation instead of confinement. We’re for rights to a safe and healthy workplace, and the ability to fight without penalty for those conditions when employers fail to provide them. We’re for a right to medical care coverage, regardless of age, health, or existing conditions. We’re for fairness, tolerance, and acceptance of our neighbors who immigrated more recently than we did. We’re for equity. We’re for health.

 

And we’re for getting to say all of this without fear for safety or livelihood — saying it at the ballot box and between elections. Because to paraphrase Tom Steyer from the event, voting is a part of democracy, and this kind of advocacy for health is patriotism.

As he added: Our backs are against a wall. If we are not showing up now, when are we?

Want to get involved? Join Public Health Awakened, an emerging movement organizing for health, equity, and justice — formed in response to the Trump administration.

Revocations in Wisconsin: Update on Report Release

 

Last month, we were truly honored to join partners WISDOM and EX-Prisoners Organizing in person to release the new report: Excessive Revocations in Wisconsin: The Health Impacts of Locking People Up without a New Conviction.

Despite frigid temperatures in Wisconsin, people came out. Across the state — in Milwaukee, Madison, Wausau, Eau Claire, and Green Bay — they came out.

Press event in Milwaukee, Dec 2016
Press event to release new research in Milwaukee — December 2016.

It’s a testament to the talented organizers working on the ground from our partner organizations, from Thrive Wisconsin health equity alliance, and others.

It’s also a testament to the urgency of this topic in Wisconsin, where nearly 3,000 people were put in prison in 2015 alone for revocation without a new conviction, for an average of 1.5 years and costing the state more than $147 million.

People came out to hear speakers like Paula Tran Inzeo and Dr. Geoffrey Swain summarize what the research finds—that it’s bad for individual and family health and doesn’t necessarily improve public safety to incarcerate people who break rules of their supervision but have not been convicted of a new crime.

People came out to share their stories—stories like that of Mark Rice’s about being revoked for reasons ultimately related to a mental health condition, stories of being on supervision, or stories of loved ones who experienced each of those actions.

And people came out to join WISDOM leaders like Rev. Willie Briscoe who called for action and David Liners who articulated a need to find other ways to hold people accountable for rules, in ways that support them, without focusing on incarceration.

As one editorial — among the nearly 20 news pieces or op-eds that have been published since the report — succinctly summarized, “The cost in both dollars and human lives is steep and unnecessary and unjust.”

To find the report and related materials to share, visit: www.SentBack.org

How Public Health Can Show Up (for Police Reform)

Image of body outlines on the street
Featured image: Mite Kuzevski, Protests against police brutality Day 20, Skopje, Macedonia. Flickr

A mandate of public health is to improve health equity, promote public safety, advance prevention, and strive for social justice.

With this in mind, as I process the results of the election and the uncharted, unprecedented future there is a whisper of a question that’s growing louder: what can public health do? We at Human Impact Partners work to carry out this public health mandate by partnering with movements on the front lines of policy change for social justice. Last year, we were privileged to partner with two knowledgeable and committed organizations—Ohio Justice & Policy Center and Ohio Organizing Collaborative—to research the health impacts of policing on Black communities and police officers.

The lessons I learned from this research project can help answer a piece of the question, at least. Below are four specific ways that public health can show up to work on policing reform: 

  1. Collect data. Fill gaps in data nationwide about the mortality and morbidity attributed to police interactions. At the 2016 American Public Health Association meeting, we were honored to share reflections from the project in Ohio as part of a timely and thoughtful session on policing and public health data. Participants shared a collective sigh about the lack of mandatory, consistent, real-time data available nationwide from governmental datasets about police-involved incidents. In the meantime, non-governmental data from sources like the Guardian’s “The Counted” help fill gaps. There also are data reporting systems combing down the pike at a federal level, but they will continue to be voluntary. One approach that Dr. Nancy Krieger and colleagues are leading in Massachusetts calls for making police-involved deaths a notifiable condition. This is a great and actionable step well within the bounds of public health. More states need to work on making this happen. In addition to deaths, it will be important to capture the associated morbidity, as well as impacts to not only the individuals directly affected but those to households, families, and communities.
  2. Participate in local efforts. There are various ways that public health practitioners can participate in criminal justice reform work happening in their neighborhoods—the point is to participate. In the “Trust not Trauma” effort, staff from a public health department and from health policy groups joined the Advisory Committee guiding the project. Health departments also can lead making requests to police departments for data in a cross-agency cooperation. In a separate example of participating in local efforts, a pediatrician in the Bay Area of California played a large role in organizing fellow public health advocates to write a letter to the San Francisco Police Commission and Department about a public health response to violence during interactions with police.
  3. Fill research gaps. There is a new but small literature about how policing directly affects health. However, there are important gaps to fill, as described in this interview with Public Health Magazine. It includes direct connections from policing practices to not only physical, but also mental and emotional health. There are impacts to individuals involved in these interactions but also their households, families, and the public that witnesses events. The cumulative and long-term effects to these populations must be better understood if we are to grasp the full scope of impacts.
  4. Speak publicly, and often. Whether it’s being quoted in a press release—as a person who works at a public health department was in the Ohio project—or talking one-on-one with the public, legislators, law enforcement, media, or others, we in public health have a voice that is valuable, relevant, and powerful. So we need to speak. Work is building nationally both among professional organizations like the National Association of County & City Health Officials who publicly released a statement on Health, Racism, and Police Violence or the American Public Health Association’s statement on the Impact of Police Violence and Public Health, and in efforts by a variety of individuals to advance and publicize a collective vision to improve public health and criminal justice systems.

For more on the Ohio report, visit www.TrustNotTrauma.org.

This article was originally published on Public Health Post.

Dismantling the Bars on the Birdcage

The recently released Coming of Age in the Other America by Stefanie DeLuca, Susan Clampet-Lundquist, and Kathryn Edin asks the question: why do some kids in the poorest neighborhoods thrive and meet their potential despite overwhelming odds when others don’t?

As summarized in an excellently in-depth Atlantic article, which I am leaning on until I get my hands on a copy of the book, two separate factors stand out for those who thrive: their neighborhood or having an “identity project”, meaning a strong passion such as music, art, or a dream job. But there are important caveats to underscore. Living in a safer neighborhood or having an identity project can help, but either of these alone is not a 100% guarantee that a person meets his or her potential. According to authors, other factors can simultaneously pull down and overwhelm even promising students – things like the absence of a parent, living in overcrowded homes, or living in blighted neighborhoods. As The Atlantic article powerfully notes, “A journey from poverty to the middle class or beyond is a birthright of many of these kids, their shot at the American dream. But the research indicates they can’t just get there themselves. Like anybody, they need a little help.”

But what can that help look like?

Help comes in different forms and at different levels – but what is central is putting the emphasis on supporting people. For example, it comes at a policy level by society enacting incarceration policies that focus on uniting adolescents and parents rather than separating them. It comes at a resource level by investing in housing and public services for neighborhoods deeply and historically overlooked. And it comes at a personal level by providing individual support. One example of the latter is a promising program profiled in a two-part series in The New York Times. Thread is a Baltimore-based program that brings together teams of volunteers to support at-risk teenagers, through unconditional support 24 hours a day for 10 years, and by providing increased access to community resources.

Thread Program Model 

Thread

(source: Thread.org)

But there’s a larger idea also at work here. A colleague of mine wisely suggested, “structural problems need structural solutions.” When we look at structural solutions, focusing separately on schools, family, policing – one of these alone is not enough. It’s too easy to fall through cracks if you focus on only one. This same concept came up at a staff meeting recently. Looking at an article on structural racism by Andrew Grant-Thomas and john a. powell, there is a metaphor borrowed from Iris M. Young who borrowed it from Marilyn Frye. (Still with me?) In talking about racism the article says the following – and I include the full excerpt because it’s important language:

“If we approach the problem of durable racial inequality one ‘bar’ at a time, it is hard to appreciate the fullness of the bird’s entrapment, much less formulate a suitable response to it. Explaining the bird’s inability to take flight requires that we recognize the connectedness of multiple bars, each reinforcing the rigidity of the others. In confronting racism we must similarly account for multiple, intersecting and often mutually reinforcing disadvantages, and develop corresponding response strategies.”

So in thinking about the work you do and the structural challenges you are working to confront, consider: how are you working on dismantling multiple bars on the birdcage, and not just one?

 

Stress on the Streets (SOS): Race, Policing, Health, and Increasing Trust, not Trauma in Ohio

Today, Human Impact Partners released a report that examines a critical perspective undervalued in current conversations about policing: the health perspective. Shocking cases of mistreatment, injury, and death grab headlines and go viral on social media; this report fills in the less often discussed mental, emotional, and behavioral impacts of policing for communities of color and police officers.

Developed in partnership with the Ohio Justice & Policy Center and Ohio Organizing Collaborative, and with the assistance of a 14-member Advisory Committee, Stress on the Streets (SOS): Race, Policing, Health, and Increasing Trust, not Trauma describes how policing practices affect the health of black communities and police. The report draws upon research evidence in health and criminology from across the US, as well as new information from a survey of 470 residents in select neighborhoods of Cincinnati and Akron, eight focus groups that included police and community, and conversations with key informants.

The report shows that for many black people, the perceived color of their skin means more uneasy interactions with police than white people, and stress and anxiety that in turn result in poorer physical and mental health. Among black respondents, nearly 59 percent said they have stress specifically because of police encounters compared to about 40 percent of white respondents. The report also shows that for police, heightened stress and anxiety put officers at greater risk of cardiovascular disease, substance abuse, depression, and suicide.

Survey findings include:

  • About one in seven black respondents reported being stopped by police one or two times a day, and almost one in five reported being stopped one or two times a week. Only three percent of white respondents reported being stopped once or twice daily, and just another two percent said they were stopped once or twice weekly.
  • Among white respondents, almost 70 percent said they trust the police in their community either “somewhat” or “a lot” compared to about 40 percent of black respondents.
  • Nearly two-thirds of black respondents said they had feared police would injure or kill them, or had those fears for someone else in an incident they witnessed. The response from white respondents was almost the exact opposite – nearly two-thirds said they’d never had those fears.

The good news is the report finds that changes in policing models and practices can build trust between police and black communities, improving public health and public safety.

The report looked at four widely accepted models of policing, finding that the problem-solving approach in combination with community policing is most effective in reducing crime, building trust, and addressing inequities. The standard model is least effective for these outcomes. The report also finds that based on available information, Akron’s approach is similar to the standard model with some indication of community policing, while Cincinnati’s approach combines the community-oriented and problem-solving models.

The report assessed four specific practices getting a lot of attention these days – civilian review boards, body-worn cameras, department-wide performance measures, and training, supervision, and evaluation of officers. If fully implemented as described in the report, these practices can increase public trust, and some can reduce the use of force. If not properly implemented, these practices can actually lead to harms.

To improve public health and public safety – in Akron, Cincinnati, other cities in Ohio, and nationwide – the report makes five priority recommendations (the full report details specific actions for implementing recommendations and who can do them):

  • Publicly recognize the historical contexts that have shaped current relationships between the public and police.
  • Implement community-oriented and problem-oriented policing according to promising practices, with primary aims of improving public safety and building trust.
  • Fully implement the four specific practices described in this report.
  • Issue an annual State of Police report and identify, regularly collect, and publicly report department-level measures that include and go beyond crime statistics, and report statistics by race or ethnicity.
  • Match police department resources – including staff skill sets – to the responsibilities necessary to serve all communities and create MOUs with community-based organizations to fill gaps beyond the skill sets of police.

Visit www.TrustNotTrauma.org for a full electronic version of the report, executive summary, and appendices. Be sure to follow #TrustNotTrauma to find out more about any additional activities related to these findings.


Advisory Committee members include the following (in alphabetical order; organizational names are included for identification purposes): Amy Bush Stevens of Health Policy Institute of Ohio, DaMareo Cooper of Ohio Organizing Collaborative, Erik Crew of Ohio Justice & Policy Center, Patrisse Cullors of Ella Baker Center for Human Rights, John Eck of University of Cincinnati, Victor Garcia of Cincinnati Children’s Hospital Medical Center and CoreChange, Raymond (Ray) E. Greene, Jr. of Altruistic Organization and My Brother’s Keeper, James Hayes of Ohio Student Association, Maris Herold of Cincinnati Police Department, Stephen JohnsonGrove of Ohio Justice & Policy Center, Camille A. Jones of Cincinnati Health Department, Iris Roley of Cincinnati Black United Front, Amaha Sellassie of Ohio Student Association and Sinclair Community College, and Susan Shah of Vera Institute of Justice.

Was “Race Together” Wrong?

Starbucks’ short-lived “Race Together” campaign, in which baristas wrote the phrase on coffee cups, generated lots of conversations – and lots of controversy.

Was it a good idea, but poorly implemented? Did it succeed, however slightly, in nudging the nation to talk about racism? Or was it a marketing move that prompted more talk about Starbucks than racism, and was not grounded in a plan for more significant action?

Whatever you think, it’s an opportunity to reflect and learn. Public health practitioners wrestle continually with this question: Should we talk about racism? If so, how?

In an open letter, Race Forward offers smart ideas on what we can learn from Starbucks’ campaign in the movement for racial justice. Their thoughts, as well as recent conversation with the Public Health and Equity Cohort that HIP has blogged about here, prompted some of my own thoughts, illustrated with examples gathered from public health colleagues.

  • Keep the dialogue – it’s how we reach hearts and minds and come to understand our role in serving the public.

Health departments and agencies nationwide are hosting public screenings and conversations around the Raising of America documentary, about how improving the social and economic conditions that shape childhood and childcare can create a safer, healthier, and more equitable future for our nation. The Kansas City, Mo., screening and conversation brought together multiple health departments, an organization that advocates for racial and economic equality, educators, legislators, clergy, and the public. The conversation ended with more than 90 people committing to take action.

  • Productive dialogue, particularly between people with different levels of power, is often accompanied by discomfort. But done in a supportive setting, it can be valuable for moving forward.

Since 2005, the Ingham County, Mich., Health Department has hosted Health Equity / Social Justice Workshops that use facilitated dialogue to have structured, strategic conversations among the health workforce and with interested community members. The dialogue builds the capacity of participants to talk about differences like race, class, and gender and their impacts on community health, as well as strategies to engage other individuals on these issues.

  • Beyond dialogue are structural solutions that require commitment to a larger, coordinated, long-term strategic plan that involves staff across levels and community partners.

In 2006, the Alameda County, Calif., Public Health Department launched the Place Matters initiative to address the social factors that shape health. As described in Public Health Reports, three factors created a strong foundation for the initiative: senior leadership dedicated to ensuring strong government-community partnerships and to building employees’ skills in advancing health equity; identifying inequities at the neighborhood level; and a strategic plan to achieve health equity that included policy change.

That strong foundation has translated into action. Alameda County Place Matters staff have provided testimony locally to successfully protect tenant housing rights. They have provided findings from data collection and suggested policy solutions to federal agencies, including U.S. Housing and Urban Development and Health and Human Services. And they continue to partner with community organizations to identify policy solutions to persistent problems of landlord retaliation, displacement, and deportation, as well as a lack of affordable housing that force people to live in unsafe and unhealthy housing.

Like Starbucks, public health practitioners are advancing conversations about race – hopefully, in more comprehensive and strategic ways. One place where we agree with the Starbucks campaign is in being impatient. We can’t wait for change.

Tennessee’s Jekyll and Hyde Moment: Should Pregnant Women Who Use Drugs Be Treated as Criminals?

We are re-posting an April 23, 2014 Scienceblogs.com blog by Sara Satinsky.

Should pregnant women who use drugs be charged as criminals or given help? From a public health perspective the choice is clear: provide treatment to help women quit drugs before their use harms their child.

Less than a year ago, Tennessee adopted a progressive policy to provide such treatment, but now is on the brink of taking a big step back. It could become the first state to criminalize pregnant women whose drug use harms a fetus or newborn baby.

Read more… 

Coming to a Doctor’s Office Near You: Root Causes of Health

Traditionally, doctors and other primary care professionals have focused on treating disease, with less attention on the structural, social, and environmental factors that may underlie illness. But there are encouraging signs that the medical establishment is taking a closer look at the root causes of health.

At the Western Forum for Migrant and Community Health, held in Seattle in February, keynote speaker Dr. Rishi Manchanda, author of The Upstream Doctors, challenged his audience to think differently about the role health care providers have in addressing the social determinants of health. He compared the health care system in the United States to, of all things, a bathroom.

Not just any bathroom, but one designed and built for a mansion. A bathroom with an ornate fireplace, high-priced art, marble flooring, accent lighting – the works. As in this country’s mainstream medical system, he said, a person using the bathroom may not need those luxuries, but the contractors are determined to install it, and you’ll be charged for it. This over-the-top bathroom may lack a toilet, and the marble floor may be treacherous when wet, but doesn’t it look nice?

So may a patient in the typical hospital or clinic be put through – and pay for – a battery of unnecessary tests and procedures. Perhaps these bells and whistles resolve the superficial symptoms of an illness, but they do nothing to address its root cause. The patient returns to the environment or lifestyle that contributed to the problem, but before long he or she is back with the same complaint.

The keynote lecture was enthusiastically received, a sign that there are lots of doctors, community health clinic staff, and other providers who get it. To be sure, they’ve probably gotten it for a while. What has been less sure is how to address it in the traditional clinical setting, where they may see 20 patients a day for 12 minutes each. Pulling from Manchanda’s talk and other conversations I had at the forum, below are suggestions on where to start:

  • Learn from experience and incorporate what you’ve learned into your practice. Manchanda talked about a patient who visited numerous providers to no avail before it was determined that her symptoms were caused by mold in her home. The patient could not get better until the mold issue was solved. After this episode, Manchanda’s clinic added questions about housing conditions to their intake form.
  • Encourage administrators and management in your institution to address upstream issues. The practice in the U.S. of focusing community health clinics on root causes stems to as early as the 1960s with the pioneering work of Jack Geiger and John Hatch in the Mississippi Delta. Today, organizations such as HealthBegins seek to share useful and simple tools on how a clinic or practice can go about addressing these underlying factors that shape health.
  • Get involved in local community activities. There may be a plan taking shape to affect pedestrian and bicycle behavior in your community, or a policy on the table to provide paid sick days to workers. In both of these real-world examples, the medical community has lent valuable perspectives to how these changes could affect health.
  • Urge professional organizations to speak out on issues that get at the roots of health. There is power in the collective voice of expertise and experience. Professional organizations are a natural source for educating their members about how to address root causes. The organizations also can be a persuasive voice for health advocacy in decision making. Encouraging professional organizations to get involved in issues at the roots causes of health – through education, policy statements, or other means – is a step that all organization members can take.

What’s the takeaway for the broader community? Though focused on the medical community in this instance, these recommended strategies are general enough that they can apply to us all. And to a bigger point, whether we’re a medical professional, staff member in a provider’s office, public health practitioner or community member, the question starts with “What can I do?” But it doesn’t end there. We must push ourselves to stretch our thinking and say, here’s what in my corner of the world I can do.

Stop-and-Frisk: Not Only an Injustice, But Harmful to Public Health

Stop-and-frisk practices by the New York City Police Department are under intense scrutiny as the city awaits a verdict in a trial to determine if the program is unconstitutional and relies on racial profiling. The New York Daily News reports that eight of the 10 residents most likely to be stopped and frisked lived in a single Brooklyn precinct and were stopped “between 13 and 26 times over a two-year period – without a single arrest or summons among them.”

The Justice Department says that if the verdict determines that the practices were unlawful, it would strongly endorse appointing a federal monitor to oversee reform of the program. According to The Wall Street Journal, this would be the first time that the NYPD was assigned a federal monitor. Meanwhile, the New York City Council has taken its own action, passing measures to ban profiling and discrimination by the NYPD and assigning independent oversight to the police department.

This is a many-layered issue. As described in the New Yorker, one question at the core of the debate asks the following: Is stop-and-frisk a law enforcement success story that prevents potential crimes, or a racially motivated campaign that deprives citizens of their basic rights? Defenders of stop-and-frisk say it is responsible for record declines in crime in New York City. Yet the Center for Constitutional Rights says that in 2011, 87 percent of all those stopped were black or Latino, and nine times out of 10, did not result in a summons or arrest.

Plaintiffs in the trial, who were stopped and frisked even though they were doing nothing wrong, spoke of the experience, as reported by NPR:

I remember squad cars pulling up. They just pulled up aggressively, and the cops came out with their guns drawn.  I think it left me embarrassed, humiliated and upset — all three things rolled up into one.

[They] threw me up against the wall, took everything out of my pockets, threw it on the floor, dumped my bag on the floor, my books and everything. I had the guns to the back of my head. Like, I didn’t want to look up or move because there were so many guns drawn. It’s scary.

This is not only a question of equal justice, but one of health. Discrimination, such as that described by these individuals, can increase risks for stress, depression, high blood pressure, cardiovascular disease, and even death. Last May, the American Journal of Public Health devoted an entire issue to the research on racial and ethnic discrimination and health. The immediate harm is done to individuals, but when such practices become the norm, they harm entire communities and our society as a whole. Police discrimination can have a disastrous domino effect: An arrest is reported to state agencies, which can mean loss of a victim’s license, leading to lost income, family hardship or homelessness.

As other major U.S. cities look to reduce crime rates, many have an eye on New York. Earlier this year, Oakland, Calif., hired the architect of New York’s stop-and-frisk program as a consultant for developing a similar effort. The verdict in this trial should be of concern not only to these cities, but to all Americans who value justice and improving public health.

“The need for change bulldozed a road down the center of my mind.”

Two recent articles in The New York Times got me thinking about the importance of leadership in public health.

The first reports that Florida Gov. Rick Scott reversed his position and, with six other GOP governors, came out in support of expanding Medicare. Just last year, he stubbornly opposed expansion, but at a news conference last week said: I cannot, in good conscience, deny the uninsured access to care.”

The second piece, a commentary by Mark Bittman, derides the historically ceremonial role of the office of the U.S. Surgeon General. The commentary essentially dares the current surgeon general, Regina Benjamin, to create an office with a more vocal, public and aggressive stance on public health prevention – for example, by centering the prevention discussion more on shaping our environments, which influence behaviors such as physical activity that in turn contribute to obese individuals. (Frankly, I think the commentary inaccurately framed the surgeon general’s discussion of environment as prevention in this report; though, the author’s overarching point holds that the SG’s office can and – as an office tasked with preventing our nation’s health – should take a stronger stand on addressing environmental contributors to health outcomes.)

Several relevant themes stand out:

First, public health is no different from other fields in that courageous leadership is key to change. An earlier guest post here described the importance of strong leaders and champions at health departments who create work environments where staff focus on local policy change. They do so with the vision that local policy change is a stepping-stone on the path to health equity.

Next, strong leadership in creating a healthier and more equitable nation sometimes comes from unlikely sources. Roman Catholic bishops have encouraged the expansion of Medicaid on moral grounds, in addition to political figures such as Gov. Scott.  Neither of these groups is a “public health” agency in name.  Yet, their decisions and actions have incredible ramifications for the public’s health.  Therefore, it is imperative that we engage leaders outside of obvious public health realms.

News sources suggest Gov. Scott’s motivations for the reversal range from the moral to the political.  Motivations aside, the willingness to change his earlier decisions demonstrated strong political leadership. It has the potential to dramatically alter the day-to-day experiences for our low-income brothers, sisters, neighbors, friends, and colleagues who may desperately need health care treatment and prevention services.

Third, we all have a responsibility to encourage and support our leaders in questioning the confines of their job titles.  If we take the example of the office of surgeon general, it is a largely ceremonial position.  As has been described elsewhere, administrations often use it to communicate important health messages to the public. Yet, there have been instances of past surgeons general who took bolder stances.  The commentary cites examples, such as Leroy E. Burney who in 1957 announced a causal relationship between smoking and lung cancer.  More recently, David Satcher made a controversial move of promoting sexual health, and separately he issued a landmark report on mental health.

For change to happen, it is incumbent upon us all to see within our own day-to-day roles where we may be stronger leaders by pushing the boundaries of our work and to encourage that same leadership among those in the position to do even greater good. For inspiration, here’s a quote from Maya Angelou that motivates me.  She says, “The need for change bulldozed a road down the center of my mind.”