Monday, May 23, 2016

What did we learn from those conferences? – Leslie and Salma report back.

 
 
Salma Abadin, MPH
Wisconsin Population Health Service Fellow – 1st year
City of Milwaukee Health Department
Data You Can Use
Milwaukee, WI

Leslie Tou, MPH
Wisconsin Population Health Service Fellow – 1st year
Lifecourse Initiative for Healthy Families
MCH Program at the Department for Health Services
Madison, WI

Hi fellowship community! As you can see, we had to get a little creative with our interview since we work in different cities. We both attended conferences in April and wanted to highlight our experiences. We came up with seven questions to share some of our learnings and how attending the conference has impacted our work. Please feel free to contact us if you have any questions or want more information on either conference!

Salma’s report:

What conference did you attend?
I attended the Midwest Convening on Racial Equity in Chicago, IL on April 25, 2016. It was hosted by the Government Alliance on Race & Equity (GARE), which is a national network of government working to achieve racial equity and advance opportunity for all.

How will the information presented at the conference help your work?
For me, sometimes health equity seems unattainable, but attending this conference really helped me see the possibilities of success around health equity. People across the country are invested in working with each other to advance equity and enhance success for all. GARE provided their published Racial Equity toolkit as a way to operationalize equity. It includes a worksheet that can be used at multiple levels. The overall questions are:

1. What is your proposal and the desired results and outcomes?

2. What’s the data? What does the data tell us?

3. How have communities been engaged? Are there opportunities to expand engagement?

4. What are your strategies for advancing racial equity?

5. What is your plan for implementation?

6. How will you ensure accountability, communicate, and evaluate results?

They also provided examples from Seattle, WA and our very own Madison, WI, two cities that have used the tool. The City of Seattle passed an ordinance in 2009 that required all City departments to use the toolkit, in particular for all budget proposals. In 2015, the mayor of Seattle required departments to use the toolkit at least 4 times every year, and hopes to include aspects of the tool in performance measures. Applications of the Racial Equity Tool in Madison included adopting a new mission, vision, work plan, and evaluation plan with a racial equity lens in the Clerk’s office and incorporating staff and stakeholder input, racial equity priorities and to guide goals and objectives for strategic planning at Public Health Madison & Dane County. The toolkit has been a great way to start having conversations with my colleagues in Milwaukee about what we can do to use a health equity lens in our work.

What were other attendees’ backgrounds? Any tips on networking?
One of the goals of the conference was to "further cross-jurisdictional, cross-community, and cross-sector strategies for racial equity with partners in housing, criminal justice, employment, education, transportation, public health, immigrant groups, and environmental justice." Attendees worked in many of these arenas through communities, businesses, nonprofits, and government. The workshops were small (no more than 25 people) and interactive, so there was plenty of time to network and introduce yourself. I also knew a couple of people at the conference and that helped in being introduced to their colleagues and people in their networks.

What were some of your favorite sessions/posters/presentations?
My favorite panel discussion was entitled "Eliminating Institutional Racism in Criminal Justice." The conversation focused on how policing and the role of police leadership are changing. Paul Schnell, Maplewood, MN police chief, emphasized that police officers’ role is to create and build a stronger community, which he sees as a fundamental difference in the culture of policing. The measure of success is not the number of incarcerated individuals, but rather if he and his colleagues serve and support communities to be stronger and safer. One other interesting comment was that the idea of power around safety and policing is being redefined. Power needs to be given up and redistributed, and police authority is ultimately given by the communities they serve.

Was it everything you were expecting or did you hope to get something else out of the experience?
To be honest, I did not know what to expect. What I appreciated was the focus on shared learning and finding new partners and frameworks to help support or improve your work. Presenters and organizers of the conference offered tools and strategies to take back home and use in our own work. I’m excited to see what the follow-up from the April conference will be like because I left wishing the conference was longer than a day.

Any other takeaways?
There are an incredible number of people dedicated to achieving health equity work and they are willing to help each other. Several people attended from Milwaukee and we are planning to reconnect in the coming weeks to debrief on the conference and brainstorm ways to collaborate with an equity focus. It’s energizing to know that many people in Milwaukee are ready to work together and make health equity a reality.

What’s the next conference you want to attend?
I’ll be attending the NACCHO conference in July in Phoenix, and the theme is "Cultivating a Culture of Health Equity." I’m interested to see what the similarities and differences are from the Chicago meeting to the larger, national conference. Stay tuned J .

Leslie’s report:

What conference did you attend?
I attended the Association of Maternal & Child Health Programs (AMCHP) 2016 Annual Conference in Washington DC in April this year.

How will the information presented at the conference help your work?
I’m new to MCH work at the state level and I thought this conference was a unique opportunity to hear about up-and-coming- innovative strategies from different programs across the country, as well as hear from the federal level on updates and current policies around Title V funding. Title V is critical as it is the only federal program that focuses on mothers and children. You can find more information here.


In my fellowship, I am dual placement: I split my time between the Lifecourse Initiative for Healthy Families (LIHF) and the MCH Program at the Department for Health Services. I love how overlapping the positions are- there is a shared vision of health equity among all mothers and children in Wisconsin at the heart of both placements but there are obvious differences in state public health work versus university initiative work. I loved that the conference covered both these perspectives- state, governmental work as well as the community grassroots approach and the challenges, limitations and advantages that come with each. I really appreciated going to different presentations and workshops and having great takeaways for both placements. 

What were other attendees' backgrounds and professions?
AMCHP is a large, national conference that is predominantly attended by state health departments, research institutions and other organizations working to "to improve the health of women, children, youth and families, including those with special health care needs".

State Maternal and Child Health Programs (MCH) are well-represented at this conference as there is a huge focus on Title V programs. This conference serves are an effective way for the Maternal and Child Health Bureau (MCHB) to directly interact with state and local health departments and address programmatic changes, issues, and share success and lessons learned. This was my first national conference for US-based public health issues and it was wonderful to meet MCH professionals from all over the country. 

What were some of your favorite sessions/posters/presenters?
One of my favorite sessions was a skills builder session on "Implementing Universal Adverse Childhood Experiences (ACEs) Screening at a Community Health Center", led by a team from Santa Rosa Community Health Centers in California. I was struck by how they really seemed to "walk the walk" on the importance of mental/behavioral health as well as physical health. The panel represented three different clinics- a pediatrics clinic, a large hospital clinic and one located within a public high school, all part of the Community Health Centers in CA- all who have implemented universal ACEs screening.

The fundamentals seemed to be truly patient-centered and trauma-informed. They had signs up in all their waiting rooms that let clients know right away all would be asked these 10 questions and no one was being singled out for them. They had warm hand-offs with behavioral specialists for patients who screened high and would need further services. I thought it was especially interesting that the pediatrics clinic talked about how they ended up screening the parents of the kids as well sometimes and connected them with behavioral clinicians at sister sites.

Overall, I walked away feeling really inspired that this recognition of the importance of trauma and mental health has become a reality in this community.  

Was it everything you were expecting or did you hope to get something else out of the experience?
Similar to Salma, I really had no idea what to expect. For a first time attendee, I thought I got a lot of out of the conference (especially considering it was so quickly rescheduled after DC’s Snowpocalypse 2016!) I’ve only attended a handful of conferences and these bigger ones always feel a bit overwhelming. On the other hand, because they are so large, there are so many great presentations to choose from. I can say I was actually excited to go to all the workshops and seminars I signed up for!

Any takeaways?
There really aren’t any magic bullets for most of our public health challenges. I can only speak for myself, but I walked away feeling both tired and uplifted (which I know sounds very contradictory).

On the one hand- this work is so hard! Trying to address issues at a population level is rightfully complicated as communities are dynamic, living entities with so many intricate layers and pathways. There are no quick fixes for issues like poverty, racial inequities, or childhood trauma. It was uplifting to see shared recognition and universal concern over these issues in public health communities and honestly, relieving to see how everyone is struggling with how to successfully affect change.

What is the next conference you want to attend?
The next conference I am hoping to attend is another MCH focused one- CityMatch and MCH Epi in Philadelphia this September: http://www.citymatch.org/conference/citymatch-conference/2015/Home




 




Tuesday, February 23, 2016

 
 
Ashley Kraybill, MPH
Wisconsin Population Health Service Fellow
Wisconsin Division of Public Health
Madison, WI

Hester Simons, MPH
Wisconsin Population Health Service Fellow
Wisconsin Division of Public Health
Centro Hispano of Dane County 
Madison, W
I
 

 On February 7, 2016, we observed the 16th annual National Black HIV/AIDS Awareness Day (NBHAAD), a national initiative aimed at mobilizing communities around HIV testing and treatment in response to the growing HIV and AIDS epidemic in African American communities. Many organizations and people who participated on this day work every day to increase HIV education, testing, community involvement, and treatment among black communities. As Population Health Service Fellows, we have learned about various initiatives around Wisconsin that aim to address these issues.

But, why is this so important?

National Data[1]
·       African Americans are the racial/ethnic group most affected by HIV.
·       The rate of new HIV infection in African Americans is 8 times that of whites based on population size.
·       Gay and bisexual men account for most new infections among African Americans; young gay and bisexual men aged 13 to 24 are the most affected of this group.

Wisconsin Data (2014)[2]
Of the 226 new cases of HIV infection diagnosed in Wisconsin during 2014:

Reflecting national trends, young Black men who have sex with men (MSM) in Wisconsin continue to be the population most affected by HIV in Wisconsin. During 2014:
  • Young Black MSM accounted for almost one-quarter (22%) of all new diagnoses in Wisconsin.
  • Diagnoses in young Black MSM more than doubled from 2005 to 2014.

 City of Milwaukee Data (2014)[3]
  • Milwaukee is disproportionately affected by HIV, as it makes up just 10% of the state’s population yet has 53% of all statewide HIV diagnoses.







  • 2 in 5 Black MSM in Milwaukee are living with HIV

  • Reflecting national trends, young black MSM in Milwaukee continue to be the population most affected by HIV. One-third of new HIV diagnoses in Milwaukee occurred in Black MSM ages 13-29.


Context 
When considering health outcomes data, especially disparities data, it is important to consider the context in which people live. 
  • Wisconsin ranks last in the country in the overall well-being of Black children based on  an index of 12 measures that gauge a child's success from birth to adulthood.[4]
  • Milwaukee is the most racially segregated large city in the United States.[5](see map below) 
  •  While the infant mortality rate has dropped in Milwaukee in recent years, it remains among the highest of the nation’s big cities.[6]  The infant mortality rate is commonly accepted as a measure of the general health and well-being of a population.[7]     
  •  4 in 10 Blacks in Milwaukee live in poverty, compared to 1 in 3 Hispanics and 1 in 7 Whites.[8]  
  •  45% of Black adults have completed some college or more education, compared to 29% of Hispanics and 64% of Whites.[8]  





In a recent article, “5 Reasons Why HIV Disproportionately Affects Black People,” there is an excellent discussion about the social determinants of HIV:

“The question is why? Why do black people carry the burden of this disease, especially when it didn't start out that way? The easy answer would be to say that black people engage in riskier behavior so therefore they are more likely to contract HIV. While personal responsibility is now and always a factor, black populations do not engage in risk behaviors at any higher rates than other races and ethnicities. This gives way to the fact that there are broader concerns that make HIV significantly more difficult to face and overcome in black communities.”[9]

In the face of these challenges, the NBHAAD initiative leverages a national platform to educate, bring awareness, and mobilize the African American community to:
Get Educated about HIV and AIDS;
Get Involved in community prevention efforts;
Get Tested to know their status; and
Get Treated to receive the continuum of care needed to live with HIV/AIDS

So what’s happening in the Fellowship around these issues?
Hester Simons, a second year fellow, is placed with both the Minority Health Program at the Wisconsin Division of Public Health and with Centro Hispano of Dane County. We sat down to discuss her work around HIV/AIDS.

Ashley: What are you doing in the fellowship related to HIV/AIDS?

Hester: Through my placement with the Minority Health Program at the Wisconsin Division of Public Health, I had the opportunity to participate in writing a grant last spring to address the Healthy People 2020 Leading Health Indicator HIV-13: Knowledge of serostatus among HIV-positive persons.[10] This grant is a joint initiative between the Minority Health Program and the AIDS/HIV Program. The overall goal of the grant is to reduce the disparity in AIDS/HIV cases among African American, Hispanic/Latino, and American Indian communities in Milwaukee, Wisconsin by increasing knowledge of serostatus among HIV-positive persons in these communities. Basically, we want to make sure people who have HIV are aware of their infection so they can receive the necessary treatment.

Ashley: How does this grant relate to National Black HIV/AIDS Awareness Day?

Hester: One of the objectives to reach the grant’s goal is to increase the number of people among the target populations (Black, Latino, and Native American) reached through HIV awareness events. This year, the grant will support five HIV awareness days, the first of which was NBHAAD.

Ashley: What did this awareness day look like?

Hester: NBHAAD was celebrated in Milwaukee on February 8th at Milwaukee Area Technical College (MATC) in the Student Center. The goal was to bring the information and services to people rather than asking them to come to the services. This was a collaborative effort put on by UMOS and several other organizations. It was estimated that more than 1,000 people came to the event and received information. Testing for HIV and sexually transmitted infection (STI) were provided for free and 3,500 condoms were distributed. Almost 50 people were tested for HIV and almost 40 were tested for STIs.  The success of this event was clearly a result of the hard work and thoughtful collaboration of the partners involved.

Ashley: What has your experience been like as a fellow working on this project?

Hester: This project has been a great learning experience! I’ve been given the opportunity and support to take a lead role in the writing of the grant application and its subsequent implementation. It has also given me the opportunity to merge my passions for health equity and HIV. The first six months of the grant have involved a lot of planning and figuring out how we can make the best use of the resources available through this grant. Two important elements that we continue to build into our implementation plans are 1) the need to evaluate our efforts and adjust them accordingly and 2) the need to elicit feedback from the groups we hope to reach with our work and those who are most affected by HIV.

Ashley: Thank you so much for all the work you have done and for telling us about it!
_______________________________________________________________________
Want more information?
Wisconsin Minority Health Program website: https://www.dhs.wisconsin.gov/minority-health/index.htm
Wisconsin AIDS/HIV Program website: https://www.dhs.wisconsin.gov/aids-hiv/data.htm
CDC’s HIV surveillance web page: http://www.cdc.gov/hiv/statistics/index.html
General Information about HIV prevention and care services in WI: https://www.dhs.wisconsin.gov/aids-hiv/index.htm
Blog Post: “Hunted by the State: HIV, Black Folk & How Advocacy Fails Us” http://brownboispeaks.com/2015/12/18/hunted-by-the-state-hiv-black-folk-how-advocacy-fails-us/

Sources

[2] Wisconsin AIDS/HIV Program (2015). Summary of the Wisconsin HIV/AIDS Surveillance Annual Review: New Diagnoses, Prevalent Cases, and Deaths Reported through December 31, 2014. Retrieved from https://www.dhs.wisconsin.gov/aids-hiv/data.htm
[3] Wisconsin AIDS/HIV Program (2015). Wisconsin HIV/AIDS Surveillance Annual Review 2014 – Addendum: City of Milwaukee. Retrieved from https://www.dhs.wisconsin.gov/aids-hiv/data.htm
[4] Annie E. Casey Foundation, Race for Results, 2014 (using 2010-2013 data).
[5] The Persistence of Segregation in the Metropolis: New Findings from the 2010 Census. JR Logan and BJ Stults, March 24, 2011 (using 2010 census data).
[6] Annie E. Casey Foundation, Kids Count, 2014 (using 2013 infant mortality from CDC).
[7] CDC Infant Mortality fact sheet.
[8] American Community Survey, 2010-2014 Estimates.