Innovation Ecosystem

Duo named emerging leaders in public health

Dr. Nicole Alexander-Scott and Julian Rodriguez-Driz from the R.I. Department of Health named as one of 20 pairs of Emerging Leaders in Public Health Initiative by The Kresge Foundation

By Richard Asinof
Posted 4/10/17
The naming of Dr. Nicole Alexander-Scott and Juan Rodriguez-Drix as two emerging leaders in public health by The Kresge Foundation sets the stage for developing new strategies to integrate the concept of social justice into public health outcomes in Rhode Island.
How will the numerous databases around public health outcomes and health equity become merged as a transparent source of metrics around quality of life in Rhode Island? How does health equity and social and environmental justice concerns become part of the conversation around economic development? How can neighborhoods become engaged communities and participate in those discussions – around public transportation, around housing, around commercial real estate transactions, around new kinds of energy infrastructure? How will the development of neighborhood health stations become integrated into this new effort?
All too often, the political discussion gets lost in what seems a replay of a beer commercial: tastes great or less filling? Are you for it or against it? If folks can get you to ask the wrong questions, they don’t have to worry about the answers. For instance, if you want to have the greatest impact on improving third-grade reading results, the research shows that removing lead from the housing in the state’s urban core will achieve the best ROI with tremendous economic and educational benefits.
Similarly, if you want to reduce the rising death toll of drug overdoses in Rhode Island, which has reached 336 and counting for 2016, new clinical treatment protocols at emergency rooms can help. But addressing what some have called the diseases of despair, connecting the economic policies related to de-industrialization, may provide a more effective approach, one that doesn’t treat the symptoms but focuses instead on the root causes.
In turn, the willingness of both New York and California to raise the minimum wage to $15 is a powerful statement to address the root causes of health inequities and economic disparities. Will Rhode Island be next?

PROVIDENCE – Because it is a small state, Rhode Island has often benefited from having a statewide Department of Health to oversee its public health functions, instead of having 39 separate jurisdictions to squabble over resources, boundaries and jurisdictions.

That advantage played a part in The Kresge Foundation naming Dr. Nicole Alexander-Scott, the director of the R.I. Department of Health, and Julian Rodriguez-Driz, the agency’s Asthma Program manager, as one of 20 pairs of emerging leaders in public health in the foundation’s second cohort under its national initiative.

The initiative is part of the foundation’s strategy to accelerate community-centered approaches that promote the public health of local communities. Under the 18-month program, working with a resource grant up to $125,000, Alexander-Scott and Rodriguez-Drix are tasked with designing and implementing an action plan to expand the capacity of the agency, emphasizing the community’s role in public health in achieving social justice outcomes.

The initiative fits very well with ongoing efforts at the R.I. Department of Health to create 10 Health Equity Zones in communities across Rhode Island, addressing health disparities, based upon the needs of the communities to design programs to address their own local health priorities.

None of the resources provided by The Kresge Foundation can be spent on staffing; the priority is to build up a collaborative working relationship with other groups within the community, according to Rodriguez-Drix.

ConvergenceRI spoke at length last week with Rodriguez-Driz about how the new initiative will take shape in Rhode Island. Here is the interview.

ConvergenceRI: Rhode Island is the only statewide agency participating in the emerging leaders initiative, is that correct?
Yes. The others are municipal or county health departments, at the local level. They made an exception for us to apply.

The purpose is to supportive innovative leadership in public health at the local level, in a rapidly changing landscape, with many different challenges, to develop transformative, more sustainable concepts.

ConvergenceRI: What was the transformative concept that you pitched as part of the application process?
The concept that we pitched, with the two of us as co-leaders, was the integration of social justice into public health efforts, internally at the agency and externally with the public, building off of existing programs.

Under Dr. Alexander-Scott, the Department of Health has created a health equity framework, looking at population health goals.

Internally, I have helped to lead a social justice roundtable, looking at social justice related issues in the work that we do.

Together, we will be exploring how we, in our work as public health employees and officials, can intersect in reaching social justice goals.

ConvergenceRI: You are part of the second cohort. How will you interact with the first cohort selected by The Kresge Foundation as part of this initiative?
The initiative places a strong emphasis on relationship building, encouraging us to share developing ideas with our colleagues across the country, as well as with the first cohort.

The goal is to build a network of local-level public health transformations across the country. A third cohort will be selected later this year. I do expect that we would plan some potential site visits with health departments across the country.

ConvergenceRI: How will evidence-based, data-driven decision-making be integrated as part of the initiative?
When we pitched our idea, we said we wanted to look at how best to balance all the competing factors and political realities by making data-driven approaches.

What does the evidence say, and what types of data should be included in the decision-making? How can we in public health look at the data, gathering information and presenting it, bringing public health considerations into policy decisions.

ConvergenceRI: One ongoing conflict in Rhode Island concerns the proposal to develop a new power plant in Burrillville? How would your initiative around integrating social justice with public health concerns perhaps become part of that discussion?
The issue you raised is one where there are clear policy protocols around how we can participate.

The decision [about the power plant] will be made by the R.I. Energy Facility Siting Board. We have provided a draft advisory report on the potential impacts. We are planning to update that advisory opinion.

ConvergenceRI: The current epidemic of drug overdose deaths, having reached 336 in 2016, is an ongoing public health crisis. There are recent sociological studies that connect what are being called the diseases of despair – deaths from alcohol, drugs and suicide – with economic stress. Is this a topic that the initiative would consider looking at, in terms of social justice?
Absolutely. It’s not my area of expertise, so I do not feel comfortable making a comment. But within public health, the goal is to look as far upstream as possible, dealing not just with the symptoms, but to address the root causes.

There are a wide range of conditions of people’s lives that impact health outcomes, including economic inequality and racism. Our approach to this is to look at the process, to look upstream.

Dr. Alexander-Scott is much more involved in that area of work.

We will also be working at things around healthy housing, vulnerable populations, and incarceration. There are a broad range of [issues] where we see crises of public health and social justice intersect.

ConvergenceRI: What are the kinds of examples of public health initiatives around the nation that you are looking at as having potential to be replicated here in Rhode Island?
There are some really innovative programs, as part of the first cohort, such as in Kent and Seattle, Wash., with trauma-informed care.

Another innovative approach, developed in Alameda County in California, which is not a member of this cohort, but one that could be replicated here, is something called “Place Matters,” where the community has been active participants, working in collaboration with the health department in mapping and analyzing housing, gentrification and demographic changes.

ConvergenceRI: How does your work align potentially with the efforts to harmonize outcomes in population health outcomes statewide? Is there an opportunity to build a quality of life index and database for Rhode Island, based upon health outcomes? How will this effort align with the effort by the city of Providence to build a database around health outcomes?
The data analysis of what Providence is doing is at the neighborhood level. I do not know the status of that effort. I believe that the website is now live, with their indicators.

I don’t know precisely how that information could be merged with our efforts. But there is a strong emphasis on collaboration under the initiative. Potentially, it could align, given an emphasis that aligns with population health goals. There is a lot of ongoing work on health equity indicators, disease-specific data.

Merging databases is a technical barrier, how various databases can intersect and talk with each, and be updated, becomes complex around technology very quickly.

We are planning to develop measures about the work we are doing around social justice and how to measure success. How we do that is still in the initial stages, more as a process than a plan.

ConvergenceRI: There is new research published that correlates the impact of lead poisoning of children on third-grade reading levels, broken down for the African-American population in Providence as well as statewide for the Hispanic population. Is that something that could be integrated into your social justice initiative?
Absolutely. It’s about a process, taking that lens to look at a lot of the work that is already being done, such as removing lead from houses, one of those root causes of social justice impacts.

With housing, there are issues around removing lead and asthma triggers, housing insecurity, access to affordable housing. There are many, many issues of social justice around not having stable housing.

We will be looking to collaborate with groups around the work being done statewide, such as the R.I. Alliance for Healthy Housing, and with state Medicaid office, and their home stabilization services.

These are upstream factors that impact those downstream symptoms.

ConvergenceRI: How does your work connect with economic development activities in Rhode Island? How do the efforts around achieving social justice in a public health framework get heard within all the competing narratives?
Great questions. My background is primarily in public health, in community developing, in environmental justice.

Communications around strategies need to connect the dots and frame the issues in a way that people see that these are not separate issues. Public health and health outcomes and disparities are fundamental to economic development.

ConvergenceRI: In terms of strategies moving forward, how will your work on this initiative be proceeding?
We will be collaborating with numerous community partners in our strategy development. Our work is not going to be finished in 18 months; we are looking to put a plan of action in place that can help us with some of the challenges of integrating social justice and public health outcomes, to come up with concrete plans and idea to move forward and make it possible to achieve the health equity agenda.

As much as Dr. Alexander-Scott and I have been identified as the two co-leaders, the work would not have been possible without the support of the members of the Social Justice Roundtable at the Health Department, and to what we’re doing internally, across the department, in dialogue and discussions around health equity.


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