Profile

Shari Rudavsky

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                    [post_content] => In February of 2015, a press release from the Indiana State Department of Health reported that new cases of HIV had increased exponentially in Scott County. When Shari Rudavsky, a health and medicine reporter for the Indianapolis Star, arrived in the southern Indiana county, she saw “an ingrown community of substance users. Grandparents would share with their kids who would share with their grandchildren,” she told Public Health Post.

There was an attitude that you could share needles, that HIV/AIDS isn’t something that happens in Indiana. When sharing needles with people you’ve known your whole life, what could go wrong?

In March of that same year, then Governor Mike Pence declared a public health emergency; HIV infections continued to spread. According to Rudavsky, Pence had made no secret of his disapproval for needle exchange programs, but reversed his stance, approving a 30-day needle exchange program for Scott County. Social service agency workers, state health officials and CDC monitors arrived close behind the needle exchange program.

To report on the outbreak, Rudavsky drove down to Scott County regularly from Indianapolis. On her way there she would pass a collection of small towns with shuttered store fronts, an impoverished community with just one physician serving the area. That physician told her that he had 18 year olds coming to his office, asking him to sign disability forms. As Rudavsky said, “it was a culture of substance use.”
“But with public health, even people who you think might be ossified in their beliefs can be persuaded by the experts to do what those in public health say is the right thing.”  
When measuring public health outcomes, “Indiana counties do not fare particularly well,” said Rudavsky. “But with public health,” she said, “even people who you think might be ossified in their beliefs can be persuaded by the experts to do what those in public health say is the right thing.” For Indiana, the right thing was a needle exchange program. The HIV outbreak triggered a campaign promoting the importance of clean needles and the dangers of sharing them. Two months after the approval of the 30-day needle exchange for Scott County, a bill passed allowing counties to ask the State House to declare a public health emergency in their counties and request needle exchange programs. Now, this program has evolved so that counties can run needle exchange programs on their own, without going through the State House. Even with this progress, needle exchange programs are still controversial in the state, for moral reasons. According to the Chicago Tribune, two out of nine counties with needle exchange services recently ended their programs, citing an inability to reconcile the public health benefits with the moral questions surrounding distributing drug paraphernalia. In a state where public health spending often falls low on the priority list of legislators, health and medicine reporters like Rudavsky struggle to keep the public’s eye on the urgencies of the latest health issues. Reporting on public health and addiction, presents “a kind of human challenge,” said Rudavsky, “taking that [health] information and finding ways to apply it to readers in their own lives.” But that’s a role that journalists can help fill. “That’s why I’m a health journalist,” said Rudavsky. One way public health reporters can gauge their success is through increased engagement with their audience, listening to the public. Through her own writing, Rudavsky receives feedback from both ends of the political spectrum, reflecting “that it’s a sign that maybe we’re doing something right if we can anger both sides.” Photo courtesy of Shari Rudavsky.  [post_title] => Shari Rudavsky [post_excerpt] => PHP sat down with Shari Rudavsky, health and medicine reporter for the Indianapolis Star, where she has reported on Indiana’s important public health issues, including the recent HIV outbreak and the opioid crisis. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => shari-rudavsky [to_ping] => [pinged] => [post_modified] => 2018-03-07 12:02:29 [post_modified_gmt] => 2018-03-07 17:02:29 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_profile&p=3894 [menu_order] => 0 [post_type] => bu_profile [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

PHP sat down with Shari Rudavsky, health and medicine reporter for the Indianapolis Star, where she has reported on Indiana’s important public health issues, including the recent HIV outbreak and the opioid crisis.

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Sally Satel on the Opioid Epidemic

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                    [post_content] => The opioid epidemic is a public health crisis, with 42,000 overdose deaths occurring in 2016. This staggering number was higher than any other year on record. Public Health Post sat down with Dr. Sally Satel to discuss the opioid epidemic.

PHP: What do you think is missing in discussions about the opioid epidemic that’s motivated you to focus, at least, part of your current work on it?

Sally Satel: Well, those are two different questions. What’s missing is money. One of the things that got me really interested were the misconceptions about what addiction is. For example, it shouldn’t surprise you that when you revive somebody with Narcan that they walk away. That really shouldn’t be a surprise, but I think that the idea was people would just regain consciousness and say, ‘Please take me to a treatment program.’ It does happen, and for some people, it is a profound wake-up call, but, for a lot of others, it’s not. … A lot of people who have drug problems don’t want treatment, and when they do enroll, the dropout rates are really significant. That shouldn’t surprise you if you have a broader understanding of addiction as more than a medical problem.

I think it’s the medicalization of addiction that actually spurs me to clarify what I think are some oversimplifications of the phenomenon. If my choices are a crime versus a disease, I’ll pick disease. Is it a moral failing versus a disease? I think these dichotomies are silly, yet politically relevant. I think you should really ask the question, ‘What kind of disease is it?’ It’s a condition that’s responsive to contingencies. It’s a process that has a logic behind it that people use drugs for reasons. Also, people are highly ambivalent about giving up their drugs because they serve a function for them, even in light of all the danger and damage its done. When you medicalize it too much and when you call it, for example, a ‘brain disease,’ which is what the National Institute on Drug Abuse does, I think that’s highly misleading.

PHP: Do you think this reframing of addiction can help implement better policies or better treatments? How do you think it can help how we’re tackling the epidemic?

SS: Why does one have to define addiction? You have a problematic behavior that has biological dimensions. Of course, if you stop a drug, in this case opioids, abruptly, you’re going to have a withdrawal syndrome. But a lot of the kinds of solutions are not something that a department of psychiatry or public health has anything to do with. How are you going to give somebody hope if they live in a place where there is very little economic opportunity? That’s difficult. I think there are solutions, but they’re not solutions that we can bring about if you think of addiction as more of a symptomatic response to something that’s wrong. In the acute phase, it looks more medical because you can detox people with medication. That looks medical, but then, the further out you get, the more behavioral and the more social it often looks.

PHP: What role do you think federal governmental policy can play in tackling the opioid epidemic, or do you think this is more of an issue for state or local policy?

SS: If you divide it into supply versus demand reduction, and if you think of supply as fentanyl and heroin, the illicit drugs, that’s DEA [Drug Enforcement Administration] and customs, which is clearly a federal function. Then, there’s the prescribing of painkillers, and every state has a prescription drug monitoring program. Almost half of states have laws or are about to have laws about prescribing limits. I understand where that comes from, and you can debate whether or not a state should be imposing those things. Demand reduction with a small ‘d’ is treatment. Demand reduction with a big ‘D’ is economic renewal and happier lives, which is beyond what we do. In the short term, I think they just have to throw money at it, and I think a lot of localities would do the right thing with money for foster care or substance abuse treatment programs. A lot of these communities have a sense of what they need, to the extent that it has to do with providing treatment. Money just has to be available.

PHP: Some states have been implementing marijuana legalization, and there’s some evidence that it’s helping. What are your thoughts?

SS: For people who are using marijuana as an alternative to opioids for pain relief, I know that it can be, for some conditions, a pretty good replacement. Or it can, at least, help a person use fewer opioids from their doctor. As for opioid addiction in the absence of physical pain, I know there’s some correlation, but I’m not sure what the causal relationship is. I could imagine that states that are, I’ll use the word, ‘progressive’ enough to have legalized marijuana are already states that have better treatment infrastructure.

PHP: Do you have any ideas about how we should better use our prison system to fight the epidemic?

SS: I’m all for diverting people, unless they’ve committed a violent crime. If we’re talking about people who are in drug courts, you would think that the supervision of the court, the incentives that they build into it, and medications would be an amazing combination, though there aren’t really good data on this yet. Obviously, if you’re incarcerated in the short-term and if you’re on methadone, it’s absurd to take someone off their medication. Then, if you’re incarcerated for a while, and you’ve been detoxed, then maybe vivitrol would be the right thing to put them on or maybe nothing at all. A lot of this is based on the individual. You could imagine certain patients going through a transforming experience in prison. For others, they’re in and out all the time. Anybody being discharged from a prison should have a better transition than they have now. But, again, if you’re at risk or if you think you’re at risk, then you should be given the option of being on medications as well.

This conversation was lightly edited for length and clarity.

Photo courtesy of Dr. Sally Satel. 
                    [post_title] => Sally Satel on the Opioid Epidemic
                    [post_excerpt] => Public Health Post sat down with Dr. Sally Satel, practicing psychiatrist at the Partners in Drug Abuse Rehabilitation and Counseling Clinic in Washington, D.C., to discuss the opioid epidemic.
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Public Health Post sat down with Dr. Sally Satel, practicing psychiatrist at the Partners in Drug Abuse Rehabilitation and Counseling Clinic in Washington, D.C., to discuss the opioid epidemic.

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Bobbi Taylor: Sex Work & Transgender Rights

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                    [post_content] => Bobbi Taylor describes themself as gender-queer, non-binary, pan/poly/bi-sexual partner and homemaker, community advocate and trans rights advocate. This detailed self-description is important. At a symposium on commercial sex work in November 2017, Taylor stated, “I bring these aspects of my identity up because, visibility is important, and nowhere is this more challenging for us as a society than in the areas of gender and sexuality.”

PHP fellow Madeline Bishop was fortunate to sit down to talk with Taylor to talk about the intersection of transgender rights and sex work.

PHP: Could you tell me about your work and where it fits into this larger conversation about commercial sex policy?

Bobbi Taylor: I come to this primarily through the Massachusetts Transgender Political Coalition and through the issue of sex work in the trans community and the intersection of those two, and how any trafficking initiatives impact people I represent and the communities I represent. The other organization I'm involved with is the Massachusetts Sex Worker Ally Network, and that is an organization of allies—academics, researchers, therapists, and others—working to support sex workers in the work they do and in their communities. And we come from a “decrim” perspective.

PHP: And what does that mean, "supporting" transgender folks in the sex work industry? What does that support look like?

BT: So, there's the whole issue of sex work being criminalized and people working in what is sometimes referred to as this “underground economy.” It's very difficult to be an advocate for yourself if you're in this work, which is why it's really important to have allies who can speak for you—to help things move forward—to get us to a point where we can get more visibility. And I think of it kind of like what's happened around LGBT rights where, back in the day when being "homosexual," that automatically put you at risk of arrest and imprisonment.

MB: And I'm curious, how do you engage people who are working in the industry—to find out what it is that they want you to advocate for?

BT: I meet people through the circles that I travel in. I meet people in the trans community. I meet people in society at large who work in sex work. And you know, you form relationships and trust and you start hearing their stories. You know, we have these social narratives of people who work in the sex industry: you're either trafficked or it's not something somebody in their right mind would choose to do.

MB: That's the perception.

BT: That's the perception. It's much like the way that being gay, lesbian, or bisexual used to be talked about. There's us “normal folks” and then there's "them"—there's "the other." So part of what I really work for is striving for those stories that bring these two together. So that we can put a face to people, in a sense, who are in sex work. Hear stories, understand why they're doing what they're doing. Demystify it. And overcome people's prejudices and stereotypes.
The role of journalism I see is both getting the stories out—stories that shed light on why people engage in sex work, that help to demystify it—and to destigmatize it.  
MB: What are some of the most common or outlying reasons that people get into sex work? BT: There are a lot of reasons. A lot of times, we talk about [audible sigh] people in marginalized communities. For example, in the trans communities, there are very high rates of discrimination—barriers to employment, education, housing—that make getting jobs very difficult. Sex work for some folks is a way to get by day-to-day, put food on the table, pay their bills, sometimes even go to school, secure housing, things like that. MB: The same reasons... BT: The same reasons... MB: ...people get any kind of job, really. BT: Exactly. Yeah. MB: And specific to the transgender community, what are some of the challenges or barriers you see that you're trying to overcome? BT: One area where there's some overlap is, for example, in the area of documentation. With the immigrant community, [lack of] documentation is a huge risk factor, and in the trans community, in a different way, documentation becomes a risk factor. MB: How so? BT: In terms of being outed, in terms of your identity as trans. So if I have documentation that identifies me as male, but I'm presenting as female. But I for example want to go into a shelter, I wind up in a shelter that's not appropriate to the shelter that I identify with. MB: There's only a male dorm and a female dorm. BT: Right. And that becomes even more problematic in correctional situations. MB: And, my last question, what do you see as the role of journalism in advancing your work? And what do you see as the role of research in advancing your work? Public health research. BT: The role of journalism I see is both getting the stories out—stories that shed light on why people engage in sex work, that help to demystify it—and to destigmatize it. I guess that's really the word that I'm looking for—to destigmatize it. The role of research—I would love to see more research on attitudes around sexuality and sex work. And what the barriers are to decriminalization and to better understanding what we're up against there, in terms of people's belief systems and how to address that. This conversation was lightly edited for length and clarity. Feature image: Bobbi Taylor, speaking at the Boston University School of Public Health Dean's Symposia "Understanding Commercial Sex Policy: A Global and US Perspective" [post_title] => Bobbi Taylor: Sex Work & Transgender Rights [post_excerpt] => PHP fellow Madeline Bishop talks with trans rights activist and educator Bobbi Taylor about the intersection of transgender rights and sex work. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => bobbi-taylor-sex-work-transgender-rights [to_ping] => [pinged] => [post_modified] => 2018-03-01 07:42:59 [post_modified_gmt] => 2018-03-01 12:42:59 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_profile&p=3772 [menu_order] => 0 [post_type] => bu_profile [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

PHP fellow Madeline Bishop talks with trans rights activist and educator Bobbi Taylor about the intersection of transgender rights and sex work.

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Barbara Brents on Sex Work, Stigma, and Nuance

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                    [post_content] => Barbara Brents moved to Las Vegas nearly 30 years ago to begin her first job as a professor. Her research was focused on policy and aging, but she also had a strong interest in gender and feminism. She soon began to notice that students in her classes worked in the sex industry. Some were open about their work, others less so. “The first people that came out were dancers and stuff and I think that’s not uncommon in college settings,” Brents said in a recent interview for PHP.

Learning more about the sex industry from women who were working within it expanded her perspective. “They were telling me very different things than what I had thought growing up in the Midwest,” she says.

When her colleague, Kate Hausbeck Korgan, approached her with an idea to research Nevada brothels. Brents agreed and, after several years of research, they published a book based on interviews with women who worked in the sex work industry. Since then, she has continued to research legal brothel systems in the U.S. and around the world, studying how the exchange of sex for money actually works, public attitudes, and the implications of policies that regulate sex work. More recently, she is interested in the ‘demand’ side of the exchange.

As for whether or not commercial sex should be legalized or decriminalized, she says, the answer is complicated. “There’s no ‘one size fits all’ in this system.” But Brents has a firm stance that criminalization does not work. “I think that whatever we choose has to think first and primarily of the rights of the individuals that are in it, and there are a lot of individuals who choose to do this.”
As for whether or not commercial sex should be legalized or decriminalized, Brents says, the answer is complicated. “There’s no ‘one size fits all’ in this system.”  
Over the past three decades, she says, acknowledgment of the industry’s diversity is increasing. For instance, there is a very strong difference between being trafficked and working as a high-end escort. And one of the most important strengths that public health and journalism can both help bring to the conversation, Brents says, is nuance. For instance, [ictt-tweet-inline]a policy that helps victims and survivors of sex trafficking might actually put sex workers in danger.[/ictt-tweet-inline] One recent example is the shutdown of the adult services subsection of the classified advertisement website, Back Page, in early 2017. The website was known for facilitating the sexual exploitation of children and was condemned by the United States Senate. Its founders and executives have been accused of money-laundering and pimping in California and have fought numerous lawsuits. Closing this section of Back Page has likely been useful for fending off traffickers. However, it also removed extra layers of security between sex workers and their clients since it eliminated the option to pay for services with credit cards, says Brents. In general, the ability to conduct business online allows workers to “vet” clients, especially if customers are willing and able to use a credit card. “[It] sets up the exchange much more like how normal services are delivered,” she says. The criminalization of sex work also means that workers need “mechanisms to stay out of the eye of the police,” according to Brents. Many women employ “spot pimps” to help ensure their safety, for instance. And it means that workers who experience sexual violence are often afraid to report the crime, since they may face the possibility of arrest or sexual assault victimization by the officers themselves, according to the Huffington Post. Even if sex work becomes more widely decriminalized, Brents says the stigma of the industry will still keep workers from accessing services and resources that could protect their health and safety. “You’re still at the mercy of the service provider who’s going to make judgments on you, because that stigma is not going to go away… stigma that’s deep in our culture.” As a self-described feminist, one of her driving questions is, “Why is it [that] the highest paying job possible for women is so stigmatized?” she asks. She explains that one reason for the stigma is the misinformation that has historically been disseminated by the media. “I think if journalists can look at evidence, and pay attention to peer-reviewed articles and reports and methodologically sound studies, that can go a long way to understanding the nuance.” This also means that public health can play a major role in changing public perceptions, protecting the rights of sex workers, and contributing to a more nuanced understanding of the sex work industry. “My hope is that public health workers have always been more understanding about the stigma surrounding sex and taken a harm reduction kind of approach to these things,” she says. “I'm hoping that you all will see that providing good services to people, not just targeting people to arrest, is going to be a lot of help.” Photo courtesy of Barbara Brents.  [post_title] => Barbara Brents on Sex Work, Stigma, and Nuance [post_excerpt] => PHP sat down with Barbara Brents for a discussion on whether or not commercial sex should be legalized or decriminalized (it's complicated) and how journalists and public health professionals can contribute to a more nuanced understanding of the sex work industry. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => barbara-brents-sex-work-stigma-nuance [to_ping] => [pinged] => [post_modified] => 2018-03-01 07:43:26 [post_modified_gmt] => 2018-03-01 12:43:26 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_profile&p=3601 [menu_order] => 0 [post_type] => bu_profile [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

PHP sat down with Barbara Brents for a discussion on whether or not commercial sex should be legalized or decriminalized (it’s complicated) and how journalists and public health professionals can contribute to a more nuanced understanding of the sex work industry.

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Cheryl Sbarra

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                    [post_content] => PHP sat down with Cheryl Sbarra to talk about her career in public health law and specifically her interest in tobacco control. Her journey started with a part-time position in 1994 drafting bylaws on tobacco sales and second-hand smoke. She’s tussled with the tobacco industry over the ensuing decades over a variety of tobacco control issues. The Massachusetts Tobacco Control Program (MTCP) was formed in 1992 with the goal of reducing smoking in the state. Ultimately, it took the MTCP more than a decade to finally pass a statewide ban on smoking in workplace, which includes restaurants and bars, with overwhelming support from the State Legislature and then Governor Mitt Romney. Massachusetts was the sixth state to pass such a ban. Ms. Sbarra’s advocacy efforts were crucial to the passage of this legislation.

Ms. Sbarra is now the primary legal resource for local health boards throughout Massachusetts and still works on tobacco control regulations.

On her early efforts with tobacco control in Massachusetts

I came on board really pretty soon after the [MTCP] program was formed and what the Department of Public Health did was to grant money to municipalities that promised to work on tobacco control issues. So, the first issue was youth access. We helped take the state law that prohibited sales to minors and turn it into a local board of health regulation or town bylaw or city ordinance so that it could be enforced. We had a law on the books but the police were the enforcing agency and they didn’t do any enforcing. We started with a no-brainer. The second-hand smoke stuff got controversial, so we did the youth access stuff first. Once we were able to establish the youth access piece, we were able to go back to the board and say you know, we shouldn’t be smoking in restaurants. And most people intuitively didn’t want to smell secondhand smoke.

On the difficulty in sounding the alarm on secondhand smoke

Science never really catches up to what we do in public health. Take, for example, concussions and kids playing football. You know that the science is eventually going to prove a strong causal connection. But we’re trying to regulate a little bit ahead of that science. Because if we wait until all the science comes in, we’re going to have missed years or decades maybe worth of good public health initiatives. We just can’t wait. And that was what happened with secondhand smoke. We knew and we had a lot of good evidence. We didn’t have the official Surgeon General’s Report when we started doing this work. You don’t go into a restaurant smell a cigarette, go out and drop dead, so how can you say secondhand smoke causes death and disease? This was the tobacco’s industry’s trap. Instead of looking at restaurants or bars as workplaces, we singled them out as restaurants and bars. If you asked anyone whether they should smoke in your office, even back in the 90s, there were a lot of people who would’ve said no, you shouldn’t smoke in an office. But we let them. It took us ten years to figure out the right approach.

On Operation Bar Hop

There were some pretty nasty meetings. They [the tobacco industry] funneled all their money through the Mass Restaurant Association and other front groups that would follow us into Board of Health meetings and scare people into thinking that their restaurants were going to go bankrupt because the 10% of people who smoked at the time weren’t going to go. We kept hearing this testimony that …they’ll lose all of this business. One thing we did was called Operation Bar Hop. We actually went around in teams of two, one night in Boston and we counted the number of smokers. We would go to Boston Billiards, we went to different bars in different parts of the city. And one of us would go in and one would record. You would go into a bar and it smelled like smoke and if you looked around there were just two people smoking. We brought that testimony with us to Cambridge and Somerville when they were looking to become smoke-free. Photo courtesy of Cheryl Sbarra.  This year, the Activist Lab presented the Gail Douglas Award to Cheryl Sbarra in recognition of the outstanding work that she has done not only at the Boston University School of Public Health, but also on behalf of Massachusetts Association of Health Boards, whose members contribute to the frontline work of providing the conditions by which people can be healthy.  [post_title] => Cheryl Sbarra [post_excerpt] => PHP sat down with Cheryl Sbarra, public health lawyer and director of Make Smoking History, about her fight against tobacco and what it took to sound the alarm on second hand smoke. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => cheryl-sbarra [to_ping] => [pinged] => [post_modified] => 2017-11-17 07:16:53 [post_modified_gmt] => 2017-11-17 12:16:53 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_profile&p=3293 [menu_order] => 0 [post_type] => bu_profile [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

PHP sat down with Cheryl Sbarra, public health lawyer and director of Make Smoking History, about her fight against tobacco and what it took to sound the alarm on second hand smoke.

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Abdul El-Sayed

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                    [post_date_gmt] => 2017-09-28 11:00:30
                    [post_content] => The infamous debt crisis and subsequent bankruptcy of the City of Detroit led to the extreme measure of privatizing the Detroit Health Department in 2011. A private nonprofit called the Institute for Population Health took over administration of public health services, using funds from the federal and state governments but not from the city. Detroit was the first city in the nation to privatize its health department, outsourcing all of its usual programming.

Three years later in 2014, Dr. Abdul El-Sayed was tasked with rebuilding the Detroit Health Department. His term at the Department is over and he is now running for governor of Michigan.

I chatted with him over the phone ahead of my visit to Detroit this summer.

On why he chose politics

I’ve always been committed to a set of values that means society should always first and foremost focus on their challenges. And I believe in equity. I believe in efficiency as a means of thinking about how we conserve our resources, and then evidence as a way of making complex decisions when you’re facing a challenging circumstance. I try to be honest about my feelings about all of those and I thought when I was in college I would be going to serve equity by being a physician. I thought I wanted to be a surgeon working in sub-Saharan Africa. I realized I was a lot more interested in the work of addressing the social determinants and I thought I would do that as an academic. My research was entirely focused on social determinants of health and health inequalities. And then I realized that I was getting further and further away from the kind of actual work that I was interested in that took me to med school in the first place. And then decided I was going to leave academia and go to public service. I got an opportunity to rebuild the health department as the health commissioner.
New York City invests $150 per person for public health a year, the city of Detroit invests a dollar. And I was hired to rebuild that department.  

On rebuilding the Detroit Health Department

I was hired to bring it back—to rebuild it. I walked into a department of five city employees, 85 contractors. We were running off of $1 million dollars of city investment a year. To make sense of that, New York City invests $150 per person for public health a year, the city of Detroit invests a dollar. And I was hired to rebuild that department. We rebuilt it on the well-being of kids. We thought a lot about how we could leverage health to disrupt intergenerational poverty. We thought a lot about how we could leverage health to disrupt intergenerational poverty — break down the kinds of barriers that children had to being able to learn and earn in Detroit — like we would want for any kid anywhere in the United States or in the world.  So, we focused on a number of outcomes that were critical in the transmission of intergenerational poverty — things like poor vision, asthma, lead, infant mortality, teen pregnancy, and malnutrition. I had been concentrating on one agenda item on a very large agenda, only to appreciate the fact that if we truly care about social determinants and health inequalities, we have to set an agenda that puts people first. Because really, good health has everything to do with access to a good job that pays a living wage that puts food on the table, that puts clean water in a cup, that puts clean air in lungs, that allows people to walk their neighborhoods unmolested and un-traumatized. That helps folks to know that they’re going to be able to have a stable roof over their heads. That’s the work of public health and that’s also the work of public service.
In fact, we cannot talk about public health without talking about politics and we cannot talk about politics without talking about public health.  

On the intersection of politics and public health

Politics is the system by which we make decisions about how we allocate scarce resources in society. Health is the consequence of how we allocate scarce resources in society. I think the way we have to approach our politics has to be with a focus on what the impact on well-being across communities would be based on our policies. I think those two are indelibly linked. In fact, we cannot talk about public health without talking about politics and we cannot talk about politics without talking about public health. And I see them as intertwined in really important ways. And one of the advantages I have as a potential governor is a focus and preoccupation with what the consequences of what we do as a society are going to be on the lives and livelihoods of real people. Because I’ve seen those lives and livelihoods up close and personal as a doctor. And I also appreciated exactly what local policies and politics can do in communities like Detroit. To me, when I come to make tough decisions, and working with state government or government generally about those decisions, my focus is always going to be on, ‘what is this going to do to the well-being of those people,’ because if that’s not our least common denominator then we’re getting it wrong. Feature image courtesy of Abdul El-Sayed. [post_title] => Abdul El-Sayed [post_excerpt] => PHP fellow Qing Wai Wong speaks with Abdul El-Sayed about his term as Health Director at the Detroit Health Department and his decision to run for governor of Michigan. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => abdul-el-sayed [to_ping] => [pinged] => [post_modified] => 2017-09-29 00:17:20 [post_modified_gmt] => 2017-09-29 04:17:20 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_profile&p=2908 [menu_order] => 0 [post_type] => bu_profile [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

PHP fellow Qing Wai Wong speaks with Abdul El-Sayed about his term as Health Director at the Detroit Health Department and his decision to run for governor of Michigan.

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DLIVE

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                    [post_content] => Dr. Deborah Sims and Dr. Brack Bivens followed 263 patients admitted for trauma to the Henry Ford Hospital in Detroit in 1980 and 1981. After five years, 114 of these patients had experienced another trauma that brought them to the hospital and 52 had died. Sims and Bivens concluded that urban trauma is actually a “recurrent disease related to lifestyle, environment, and other factors of its victims” rather than an “acute episodic event.”

Decades later, in the same city with the highest death rate in the United States for children up to the age of 18, and homicide the number one cause of death for those 15 to 34 years old, Dr. Tolulope Sonuyi, Ray Winans, and Calvin Evans launched Detroit Life is Valuable Everyday or DLIVE. This organization attempts to interrupt the cycle of violence described by the Sims and Bivens study.

Dr. Sonuyi, an emergency medicine physician at Detroit Medical Center Sinai-Grace Hospital, saw night after night that many of the victims of violence he treated were cycling in and out of the Emergency Department. He wanted to change the business-as-usual attitude of dealing with preventable violence trauma and its associated morbidity and premature mortality. For Dr. Sonuyi, “it became impossible to ignore the foremost public health crisis for Detroit youth and young adults because you are seeing it in some shape or form on a daily basis, whether at work or in the community.”

DLIVE’s approach

DLIVE is a hospital-based intervention program, located in the Emergency Department of the Detroit Medical Center Sinai-Grace Hospital. Detroit Medical Center Sinai-Grace Hospital saw about 600 cases of violent trauma victims (gunshot or stabbing) a year between 2009 and 2013. The program looks to transform every acute trauma episode for victims ages 14 to 30 years old into a “teachable moment.” Perhaps the most important piece of the approach is led by the Violence Intervention Specialists — Winans and Evans — who have experienced trauma before and thus have an intimate understanding of the victims’ mindsets. These interventionists are called to a patient’s bedside and if the patient is deemed to be at a high risk of another traumatic event due to “circumstances and lifestyle,” and consent to participation, they are offered a place with DLIVE. DLIVE’s programming is guided by a trauma-informed approach which “looks to reduce contributory risk factors but also acknowledges the importance of mental healthcare and avoidance of re-traumatization.” Winans and Evans make sure to connect participants to resources to gain employment, access education, legal advocacy, and more. Their ability to truly transform trauma lies in their ability to develop and apply innovative engagement and outreach strategies. The advice and connections are personalized. As Evans puts it, “Don’t treat the individual like a perpetrator, treat him as a victim.” and includes contact with participants’ family member. Each month, participants of DLIVE also attend a weekly Trauma Peer Group.
Their ability to truly transform trauma lies in their ability to develop and apply innovative engagement and outreach strategies. The advice and connections are personalized.  
Currently, there are 45 individuals enrolled with a retention rate of 84%. Over 80% of the participants are either employed or in school. Their preliminary research data suggests that approximately 20% of individuals will be re-injured within one year without any intervention. To date, the repeat trauma rate for DLIVE is 0%. Unfortunately, a few of the instances when individuals did refuse the DLIVE intervention, they were either re-injured or killed in less than six months. Winans and Evans credit much of the success of the program to the close relationship DLIVE has with Detroit Medical Center Sinai-Grace Hospital and its staff. The program is housed in a small room off the main corridor by the Emergency Room stocked with two capable interns, photos of the DLIVE team and events, and posters reiterating the team’s approach to trauma (the Five P’s of Violence: Premature, Predictable, Pathologic, Public Health Problem, and Preventable). Much of the important work happens outside of that room. As Winans and Evans walk through the hallways of the hospital, it is clear that they have relationships with just about everyone, ranging from the cafeteria staff to nurses to the administrative staff. It makes it easy for Winans and Evans stop by a nurse station on a floor to discuss a few patients with the nurses whether they believe the patient would be a good candidate for a program like DLIVE. DLIVE is the only program of its kind in Michigan and is part of a larger network called the National Network of Hospital-Based Violence Internship Programs (NNHVIP) which has slowly grown over the past twenty years. There are 35 such violence intervention programs in the U.S., Canada, England, and El Salvador.

Impact of hospital-based violence intervention programs

The impact of NNHVIP programs is still being evaluated. Studies show both encouraging results and areas for improvement. For example, the Wraparound Project at the San Francisco General Hospital showed a reduction in the violent re-injury rate from the 8.4% to 4.9% over the last ten years for 466 participants. But Wraparound also found that addressing various social determinants of health, especially housing and education when needed, is crucial to reducing the risk of re-injury. Dr. Sonuyi notes that DLIVE would not be possible without the support of organizations from many different sectors within the Detroit community: Skillman Foundation, DMC Foundation, Blue Cross Blue Shield of Michigan Foundation, Michigan VOCA Program, and Flinn Foundation. Looking ahead, the DLIVE team hopes to change the approach to trauma and violence in other sectors such as education and criminal justice. Their goal would be to shift “away from maladaptive, superficial, and futile responses (i.e. school suspensions, wound repair and discharge, mass incarceration) to those that are trauma-informed and focused on holistic targeted intervention and prevention.” In the meantime, Dr. Sonuyi, Winans, and Evans will carry on their work with DLIVE, with continued support from Wayne State University Department of Emergency Medicine, breaking cycles of violence for more patients and expanding to another hospital in the coming year. Feature image courtesy of Detroit Life Is Valuable Everyday (DLIVE). From left to right: Calvin Evans, Dr. Tolulope Sonuyi, Ray Winans.  [post_title] => DLIVE [post_excerpt] => Detroit Life Is Valuable Everyday (DLIVE) is a hospital-based, community-focused violence intervention initiative that works with youth/young adults who have sustained acute intentional violent trauma. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => detroit-life-is-valuable-everyday-dlive [to_ping] => [pinged] => [post_modified] => 2017-09-27 07:01:55 [post_modified_gmt] => 2017-09-27 11:01:55 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_profile&p=3063 [menu_order] => 0 [post_type] => bu_profile [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Detroit Life Is Valuable Everyday (DLIVE) is a hospital-based, community-focused violence intervention initiative that works with youth/young adults who have sustained acute intentional violent trauma.

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Eldar Shafir: Policy in the Contexts of Scarcity

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                    [post_content] => Prior to his talk at Boston University, Eldar Shafir sat down with PHP Fellow Gilbert Benavidez to discuss the many faces of scarcity, the behaviors that stem from it, and how to craft effective policy to combat it. Here are some highlights from their conversation.

The Poor Are Not Just Short on Cash

They're short on sleep…they live in neighborhoods that are noisy and dangerous. They need more time to navigate and get anywhere with public transportation. There are physical hurdles, noise, and lack of respect, which happens to have a significant effect as well. Social connections are more complicated if people live far away and can’t reach other, etc. What happens is that a lack of money creates a lack of bandwidth. When you are struggling with not having enough, say money or time, you are also spending a lot of your cognitive resources managing it. From a policy perspective, that means when you see a poor client arrive, you have to keep in mind that not only do they have less money, they also have less bandwidth. So don’t give them complicated obstacles or demands, because they just don’t have enough bandwidth.

What is Scarcity?

It's heavily psychological. Scarcity of course is not having enough of something, but it's a behavioral perspective also. If you look purely at how much a person has, then you run into the classic critique that says, “what about the American poor…all of them have TVs. If you took them to New Delhi they would be middle class.” So clearly that’s not the point. The point is a psychological sense of scarcity where you basically cannot live a minimally acceptable life in the time and place in which you live.

Crafting Public Policy to Combat Perpetuation of Scarcity

In general scarcity is going to be a function not just of your income, but of how easy or difficult it is to manage it. Take two people with equal income: One of them has a system that has automatic deposits and payments, reliable arrival income every two weeks, and reliable public transportation, while the other does not have those things. Although the income is the same, one is going to be juggling scarcity a lot more than the other. So one way to deal with and reduce the scarcity tax is to help with the juggling. Those who need more help with the juggling, have less of it. For me, the Consumer Protection Finance Bureau, Elizabeth Warren’s thing, were it to succeed, would facilitate the struggle and everyday juggling that’s menacing the American poor.

Building Fault Tolerance into Social Programs

Everything from forgetfulness to showing up late to the office for a benefit. What we do right now, is if you’re late you’re punished, because you’re showing by being late that you don’t care. That’s a profound misunderstanding. The reason I’m late is because I don’t have child care, the bus is not reliable…any number of problems. You have to be tolerant of lateness, impose less demands in terms of filling out paperwork and showing up on time, all the way to reforming systems to make things easier. Medicare Part D was a great example. They gave them 45 alternatives and people couldn’t choose…and the data showed that. What you want to do is proof it for human failure. You could for example get a panel of experts and develop a list of five that would be the best choices for people. If you’re into that kind of thing, feel free to go to the next page and read the other 40…that would be a way of proofing.

A Colony in a Nation: Abundance vs. Scarcity

Chris Hayes wrote a book called A Colony in a Nation. What you have is a division. The increasing wealth and poverty is becoming more problematic. A really interesting impact is that everybody is made less happy by that division, not just the poor but the rich as well. So in that sense everybody loses. I think there’s less empathy, less concern, less institutional ways of dealing with it. You’re left out in a way that’s very, very problematic. I still, to this day, believe those in Washington have good intentions. But they’re so distant from understanding the lives, concerns and challenges [of the poor].

Co-founder of Ideas42 – Using Behavioral Science to Design Solutions

In general, it’s amazing. It’s been a fantastic success. Instead of being invested in publishing research, it’s about just trying to make the world a better place. They do things all over the place: everything from reminding students in college to reapply for FAFSA, to poverty, to poverty, to drunken driving in South Africa. Feature image: Eldar Shafir. Photo by Sameer Khan. Courtesy of the Woodrow Wilson School of Public and International Affairs [post_title] => Eldar Shafir: Policy in the Contexts of Scarcity [post_excerpt] => Eldar Shafir sat down with PHP Fellow Gilbert Benavidez to discuss the many faces of scarcity, the behaviors that stem from it, and how to craft effective policy to combat it. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => eldar-shafir-policy-contexts-scarcity [to_ping] => [pinged] => [post_modified] => 2017-09-01 22:37:25 [post_modified_gmt] => 2017-09-02 02:37:25 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.publichealthpost.org/?post_type=bu_profile&p=2162 [menu_order] => 0 [post_type] => bu_profile [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Eldar Shafir sat down with PHP Fellow Gilbert Benavidez to discuss the many faces of scarcity, the behaviors that stem from it, and how to craft effective policy to combat it.

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Karen DeSalvo

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                    [post_content] => Public Health Post sat down with Karen deSalvo at the symposium Building Healthy Cities: Boston and Beyond, at the Boston University School of Public Health, which brought together leaders in health to explore approaches for creating healthier cities.

On how her background informed her work at the U.S. Department of Health and Human Services (HHS)

KD: I have a relatively unusual background for someone who is in senior leadership in government. I come from a very poor family, my dad left when I was little so I was raised by a single parent. I put myself through college. I didn’t go to a fancy college, I went to a working-class college... and scrappy, I think, and southern. And there aren’t a lot of people who get through that gauntlet and end up in the Humphrey building. I’m thankful for all the opportunities that I had, but I also made sure that when I was at the table, I was lifting up the voice of the people who grew up on my street when I was a kid. I wanted to make sure that it wasn’t just a limited view on the world and the people we’re there to serve. I tried to make sure that every day, my work as a doctor, my work as a community advocate, and my work as the health commissioner was in my heart and mind in the work that I did. And some of the technique as a health commissioner in particular, learned from that mayor, I carried with me to HHS. Listening sessions and community engagement being a big part of that.

On Washington leadership and public health

I think the reality is that most, if not, nearly all health policy people and national health leaders in Washington do not know what public health is. And I got to the point towards the end of my tenure that I was probing, asking people questions just to see what kind of answer I get. And you invariably get an answer about public hospitals and Medicaid and community health centers, which is problematic because the Secretary of Health and Human Services has at their disposal an enormous array of tools that can impact health.
I think the reality is that most, if not, nearly all health policy people and national health leaders in Washington do not know what public health is.  
So, I think there’s an opportunity there once people understand it. But the truth is when you’re in the seat of Secretary, you spend a lot of time thinking about the ACA. Or now in this world, the ACA and the AHCA, and the responsibilities of running a federal marketplace, which is poorly funded so requires a lot of rolled up sleeves. Even as important as the CDC and the NIH and the FDA are in their various public health roles and the communicable disease work that is often at the forefront for the Secretary, the other kinds of public health work, the systemic, policy level change doesn’t always get the kind of attention…so, we have a lot of work to do. One of the last things I did was form a social determinants of health work group, I don’t know if it’s still in existence. We set a very high level work plan.

On the importance of qualitative research

It’s really easy when you get in that bubble at HHS—that big concrete building—to lose touch with people’s voices in the real world. And the kind of people that come see you, there are lobbyists or people who are fancy and you could go to work every day as a policymaker for the people of this country and not even ever see poverty. And so, the idea that—and big data doesn’t help get you to that, it’s cold and disconnected—but qualitative research is real, it’s a touchstone. And the stories and what you gain from the kind of the assembly of all the stories into some shared themes.

On her work with social determinants of health

What the inclination for your staff to do is to invite people that they know will tell you what you’re doing is great. And that’s not exactly…what I don’t need to hear. I need people to tell me what we’re doing is not great, or how it’s not helping.  That’s the valuable conversation, I was annoying about the social determinants all the time, everywhere I could be. And about the importance of not letting the health care system crowd out the public health and social services infrastructure in this country, which has deep and tight connections with community and people and that we need to support them.

On the business case for addressing social determinants of health

Well, I think the near-term business case mostly has to be focused on health care costs, for lots of reasons. One it’s a focal point of attention, it’s a sixth of the economy. There’s a lot of waste in the system; there’s a lot of opportunity to save 750 billion dollars a year and reinvest that upstream in other determinants if we could sort out the ways to do that. So, there’s a lot to be gained if it’s done right. I think where the best business case can be made right now, where it’s not just a nice-y nice idea, is for payers who are highly at risk, like Medicaid managed care organizations or Medicare Advantage, where they are asking for this kind of resource. The health systems that are both a payer and a provider are also—because they are more at risk—they are also quite interested in understanding social factors. And governors, they make a strong business case because every dollar they have to spend on a Medicaid program because of unmet social needs is a dollar they can’t spend on the educational system. So those are constituencies that are paying a lot of attention. Feature image: Dr. Karen DeSalvo (middle) with Dr. Karen Murphy, Secretary, Pennsylvania Department of Health (left) and Dr. Karen Hacker, Director, Allegheny County Health Department (right). Photo courtesy Karen DeSalvo.  [post_title] => Karen DeSalvo [post_excerpt] => PHP sat down with Karen deSalvo, former acting assistant secretary for health in the U.S. Department of Health and Human Services, to discuss her work at the HHS and the social determinants of public health. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => karen-desalvo [to_ping] => [pinged] => [post_modified] => 2017-09-01 22:36:28 [post_modified_gmt] => 2017-09-02 02:36:28 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.publichealthpost.org/?post_type=bu_profile&p=2083 [menu_order] => 0 [post_type] => bu_profile [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

PHP sat down with Karen deSalvo, former acting assistant secretary for health in the U.S. Department of Health and Human Services, to discuss her work at the HHS and the social determinants of public health.

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Celeste Castillo Lee: A Pioneer in Patient Engaged Care

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                    [post_content] => Celeste Castillo Lee passed away at the age of 51 on February 9, 2017 after nearly 35 years of kidney failure brought on by the autoimmune disease vasculitis and having undergone peritoneal dialysis and hemodialysis and a kidney transplant (for 10 years). Celeste made an indelible mark on everyone who came into contact with her. She was a kind, cheerful, energetic, and passionate force in the lives of her family and friends. She made each of us feel special; we are better persons for having known her.

Celeste’s influence, however, extends well beyond her immediate circle. She helped countless others by devoting her professional and personal lives to developing and promoting strategies so that health care providers could better partner with patients and their families. A tireless proponent of patient and family-oriented health care, Celeste simultaneously assumed many roles: patient advisor, peer mentor, board member and advocate in numerous non-profit organizations, professional societies, and government agencies. Among her roles Celeste served as a faculty member at the Institute for Patient and Family-Centered Care, Program Manager for Patient Family Centered Care at the University of Michigan Health Care System, Board Member and Chair of the Patient and Family Partnership Council for the Kidney Health Initiative, and member of the Phase I National Patient Advisory Council for PCORnet. In 2017, she was awarded the American Association of Kidney Patients Medal of Excellence for her contributions. Her work has been commemorated in several ways, including the Celeste Castillo Lee Endowed Lectureship by the American Society of Nephrology and the National Kidney Foundation’s Celeste Castillo Lee Patient Engagement Award — the organization’s highest honor for distinguished kidney patients who, through their activism and involvement, exemplify Celeste’s legacy of putting patients at the center of all aspects of health care. Through her participation and engagement Celeste played a critical role in raising awareness and improving patients’ care experiences, a role she assumed up until the very end when, in opting for hospice, she continued to empower and educate others by explaining how she came to this decision. There is no doubt that Celeste’s impact on the quality of patient and family engagement in health care will endure. Feature image: video still from Celeste Castillo Lee – Kidney Health Initiative Tribute [post_title] => Celeste Castillo Lee: A Pioneer in Patient Engaged Care [post_excerpt] => Celeste Lee spent a lifetime raising awareness and improving the care experiences of patients, especially those living with kidney disease. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => celeste-castillo-lee-pioneer-patient-engaged-care [to_ping] => [pinged] => [post_modified] => 2017-08-24 23:06:16 [post_modified_gmt] => 2017-08-25 03:06:16 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.publichealthpost.org/?post_type=bu_profile&p=1994 [menu_order] => 0 [post_type] => bu_profile [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Celeste Lee spent a lifetime raising awareness and improving the care experiences of patients, especially those living with kidney disease.

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