National Public Health Week: Centering and Celebrating Cultures in Health

It's National Public Health Week, and this month's episode features seven amazing guest speakers who talk about the daily themes of this year's NPHW.  The overarching theme for NPHW this year is Centering and Celebrating Cultures in Health.  Keep reading to learn more about the UB students, faculty, and community members that made this episode so engaging. 

Themes:
Community - Annamarie Malik 
Anna is a current Master of Public Health student, studying in the Department of Community Health and Health Behavior at UB.  She is currently working in the Dean's Office of SPHHP, assisting with outreach, recruitment, and communications.  Anna is passionate about health communications, nutrition, and food insecurity, and she hopes to find a job in the public health field when she graduates with her MPH this May.

Violence Prevention - Dr. Akua Gyamerah,  DrPH, MPH

Reproductive and Sexual Health - Danise Wilson, MPH
Danise has served as the Executive Director for Erie Niagara Area Health Education Center (ENAHEC) since 2016 where she works to create and train a diverse health workforce through career exposure programs, mentorship, and increasing understanding of cultural competency. She acts as a change agent for those within her community by addressing social determinants, educational opportunities, and practicing career exploration activities. 

Mental Health - Dr. Christine Linkie, MS, PhD

Rural Health - Dr. Frank Cerny, PhD, MD

Accessibility - Dr. Albina Minlikeeva, PhD

Food and Nutrition - Dr. Jennifer Temple, PhD


Resources:
National Public Health Week Website

Credits: 
Host/Writers: Sarah Robinson
Guests: Annamarie Malik, Dr. Akua Gyamerah, Danise Wilson, Dr. Christine Linkie, Dr. Frank Cerny, Dr. Albina Minlikeeva, Dr. Jennifer Temple
Production Assistant/Audio Editor: Sarah Robinson
Theme Music: Dr. Sungmin Shin, DMA 

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Transcript

Sarah Robinson  0:02 
Welcome to a special edition episode of Buffalo HealthCast, the official health equity podcast of the University at Buffalo's School of Public Health and Health Professions. This week, we're celebrating National Public Health Week. This year's National Public Health Week topic is Centering and Celebrating Cultures in Health. Our cultures have always shaped our health. We learn from the communities we're born in and that we build together. And for this National Public Health Week, we look to community leaders as our health leaders, we celebrate the unique and joyful ways different cultures focus on health, and we look to how we can learn from each other with humility and openness. Join us for this special episode addressing each daily theme of National Public Health Week. You'll hear from community members, faculty, and University at Buffalo students on topics like violence prevention, mental health, accessibility and more. Be sure to visit the show notes to learn more about each of our guests and the topics discussed in this episode. We hope you enjoy this special edition of Buffalo HealthCast as you celebrate National Public Health Week.

Annamarie Malik  1:07 
My name is Anna, I am a second year MPH student with a concentration in Community Health and Health Behavior. I also work as a teaching assistant for undergraduate public health courses, and a graduate student ambassador for the School of Public Health and Health Professions at UB. I think that the topic of community was chosen as a theme for National Public Health Week because community is an important aspect of public health. We know that many factors influence health, such as where someone lives and what their social circles are. Zipcode, or where you live can help to predict positive or negative health outcomes. So for example, some people living in a certain zip code can have a higher rate of certain cancers as compared to people living in a different zip code. The same goes for your social circle or the people that you interact with. If you surround yourself with people who make healthier choices, you are more likely to make those choices for yourself. So another example, if you are surrounded by friends and family who choose to eat healthier foods or participate in more physical activity, you are more likely to also make those choices for yourself. So eating healthier foods, participating in more physical activity, compared to if you surrounded yourself with people who did not participate in those things. Whether these are active or passive choices is another conversation. But if you surround yourself with people who make healthier choices, you're more likely to make those choices for yourself as a part of the community that you're a part of. So one thing that I want people to know more about this topic is that it can be what you want it to be. Community is defined as a group of people living in the same place or having a particular characteristic in common. So this can become something as broad or as narrow as you want. So for example, community can be defined as the people living in one zip code, or the people living in one city, or one town, or one state. Community can also be defined as the people working in one office, in one location, or the people having the same hair color. Again, something can be as broad or as narrow as you want. You can choose the community that you want to look at, based on what you want to define it as, which is something that I think is nice about the community and characteristics of communities. So things can be learned from looking at different communities and by defining communities in different ways. And sometimes there can be different observations that can be found. So one way that people can get involved in this topic is spending time volunteering in your local community. So by doing this, you're not only helping out in the community, but you're also making connections with the individuals that live there. So many times you learn about their lives and what goes on in the community, including what they are good at and what they can be struggling with. This can help in the aspect of public health because you can either be doing research on what the community, different health outcomes of the community, as well as different health behaviors of the community, you can be looking at the positive and the negative. And by being in the community, you're getting real data from real people with their real lives and what they are either doing good at or what they can be struggling with, what they may be needing help on, what they could be helping people with. Another way that people can get involved in this topic is by going to various community meetings. So this can include board meetings or block club meetings. Again, at these meetings, you make connections with the community and learning more about them in their lives.

Dr. Akua Gyamerah  4:32 
Hi, my name is Dr. Akua Gyamerah, and I'm a social medical scientist in the Department of Community Health and Health Behavior at UB. Our research really aims to understand multi level and intersectional determinants of health disparities among racial, sexual and gender minorities, including how historical and social structural factors such as racism, violence, and criminalization shaped disease outcomes among marginalized groups. My current research examines how experiences of gender based violence impact alcohol use among trans people and cis women in The Bay Area and how intersectional stressors impact mental health and HIV treatment outcomes among sexual and gender minorities in Ghana, West Africa. So why do we think this topic of violence was chosen for National Public Health Week? Well, the United States is home to pervasive violence with various violence outcomes, reaching epidemic proportions and reflecting significant disparities in outcomes, including racial and ethnic disparities and disparities in religion, sexual orientation and gender identity. And other forms of violence highlighted under this theme include gender based violence, police violence, sexual violence and domestic violence. I wanted to talk about just a few statistics just to highlight the scale of the problem. But in the United States, over 1000 people are killed yearly by the police, with black people three times more likely to be killed than white people. Mass shootings have nearly doubled since 2018, with 647 shootings reported in 2022. And as of February of this year, about 95 reported so far. Among undergraduate students, and we're talking about college campuses, like our own, about 26% of females and 7% of males experienced rape and sexual assaults. And of course, we need more data on how LGBTQ students also experienced these forms of violence. In terms of intimate partner violence, one in three women and one in four men have experienced some form of intimate partner violence. And we see disparities related to race when it comes to these statistics, with 45% of black women and 40% of black men reporting experiencing intimate partner violence. For lesbian, gay and bisexual individuals, they experience violence rates higher than straight counterparts. My own research with my colleagues at San Francisco Department of Health found that one in two trans women in the San Francisco Bay Area have experienced transphobic hate crimes with black and Latinx trans women more likely to experience deadly forms of violence, such as assault by a weapon. So these statistics paint a particular picture, which is that there are multiple crises related to violence across the country, and across different social groups that reflect and exacerbate existing social inequities. So what is one thing I want people to know about this topic, given the realities that I just described? I think the key takeaway from this topic is that violence is so pervasive and normalized in this country that it is actually not publicly understood as a key predictor of adverse negative health outcomes. It is just seen as what is, what happens in this country, another mass shooting, here we go again. However, violence is linked to adverse health outcomes. It is both an outcome of social inequalities but also a producer of more social inequalities, right? And because of that, it is a key public health issue that is in need of redress. So, violence is a historical and social structurally produced problem, one that does not only manifest in direct and behavioral ways that we are accustomed to talking about, such as, let's say, physical or sexual violence an individual may experience from another individual, but it is also something that is experienced in distal and indirect ways as well. Right? We often talk about behavioral violence, such as mass shootings, but less about structural violence, and structural violence - I'm going to focus on here, on structural violence. Structural Violence is a term coined by Norwegian sociologists Johan Galtung, and liberation theologians decades ago, that describe ways that our social structures such as the economy, our laws, the political system, religious institutions, and ideology, and so other social cultural factors, prevent individuals, groups and societies from meeting your basic needs and reaching your full potential. And usually it is the most marginalized among us, that are kept from meeting their full capacity and their full needs because of these forms of structural violence. So for example, we talk a lot about individual mass shooters, individual forms of violence, etc. But little conversation, we have little conversation about the political climate, which encourages and normalizes such violence. Now, I want to pause here and focus on the ongoing backlash and attacks against transgender people across the country as an example of this structural violence. Over the past few years, we've witnessed over 400 anti-LGBTQ bills introduced across the country, and 15 anti-trans bills specifically that have been passed into law. These attempts and successes in criminalization is just an example of the structural violence that then cause marginalized people like transgender individuals to experience shortened life outcomes, physical violence, including murder, and blocked access to health care, including gender affirming care, and so forth. The discourse of eradicating transgenderism is what leads to the behavioral violence of massacres of LGBTQ people like that of the Pulse Club massacre in Orlando or Club Q in Colorado Springs recently, or in the case of racist rhetoric and policies, the racial segregation that allowed for white supremacists to massacre black people right here in Buffalo last year. So in addition to kind of understanding and seeing the relationship between behavioral violence and structural violence, also, I want to talk about the need to be critical about how behavioral violence and data related to it is used to also justify structural violence, such as how crime statistics are used to increase police surveillance and violence that then lead to, you know, racial disparities, for example, in police killings. So how can we get involved in addressing these issues or talking about these issues? I think one key thing is that to address violence, at its roots, we need to denormalize both behavioral violence and structural violence and become more sensitized to both. In order to address a problem, we have to recognize that there is a problem. And if we've normalized something, we do not recognize it as an issue, but rather a factor of society. But if we want to see violence, we need to see violence as both an effect and a problem that needs to be addressed. So that's one thing I want to I want to say. I think we also, as people in public health, as professionals of public health and students of public health, we need structural solutions, like social welfare programs that work to eliminate the socio economic inequalities for what I've described as structural violence. Programs like this have shown to reduce behavioral and community violence, and other forms of violence that may produce, right? So we need positive programs, programs that contribute to building up rather than breaking down, programs, social welfare programs that help eliminate social economic inequalities, can then help address violence that are produced by these forms of structural violence. We also need to eliminate laws that dehumanize marginalized groups such as these anti LGBTQ bills that are being proposed and implemented, laws that dehumanize minorities, racial and ethnic groups, such as, you know, anti immigration laws, the violence at the border, laws that can incarcerate people for, you know, acts that are a product of needing to survive, right? So petty crimes, etc. We need to change laws like that, and move funding from criminalization to funding to social programs that help people thrive and help communities thrive. Right. So, you know, I think these are some of the examples of how we can actually shift our focus from implementing structural violence policies, to investing in policies that bring resources, bring funding into our communities to help folks meet their needs, and thrive and so forth. So those are kind of the two things I think we need to do to address the issues and ways that we can get involved kind of advocating for policies like these. Thank you so much, and Happy National Public Health.

Danise Wilson  13:36 
My name is Danise Wilson, and I am the Executive Director of Erie Niagara Area Health Education Center, AHEC for short, where we focus on diversifying and educating future and current health professionals, while increasing health literacy within medically underserved communities. Reproductive and sexual health was chosen for National Public Health Week because we know that health is not just the absence of disease. Creating a positive and respectful approach to sexuality and sexual health must be a public health matter if we are to achieve optimal health. Women and men should be provided with early education, resources and access to ensure that they have safe, informed, affordable reproductive options of their choice. Good reproductive health increases overall wellbeing, decreases poverty, increases economic growth and ultimately impacts generations to come. One thing I will want people to know about reproductive and sexual health is that it was reported that 25 million abortions were performed in unsafe conditions. And of that number, 3 million were between the ages of 15 and 19. It should be a public health priority to ensure that everyone is able to avoid pregnancy until they're ready, to terminate an unwanted pregnancy, and have a safe, full-term pregnancy if they choose, regardless of socioeconomic status, societal norms, gender relations, sexual preference and laws. What can you do to get involved in this issue? Get involved! You should reach out to your local, state and elected policy makers and encourage them to support comprehensive sexual and reproductive health legislation, you should join and consider donating to organizations who are in the reproductive health space such as Reproductive Health Access Project, Sister Song, Physicians for Reproductive Health, and Centers for Reproductive Rights. Together, we can make a global impact on sexual and reproductive health and rights.

Dr. Christine Linkie  15:48 
Hi, I'm Dr. Christine Linkie, and I'm a clinical assistant professor in the occupational therapy program of Rehabilitation Sciences in the School of Public Health. Occupational therapists work in psychiatric units, we work in community based mental health, we work in outpatient clinics, and it's all about function. Occupation means the things that we do to occupy our time. So it's all about helping people to develop the skills. But not only that, it's also to develop a sense of wellness and quality of life. I was asked why do I think that mental health was chosen as a topic for this podcast? I have two answers for that. But the first one is that, as probably a lot of people know, there's good evidence to show that mental health of young people and adults since the pandemic has really become more of an issue. And we see more people struggling with mental health challenges. So that's the first reason why I think and the first thing that I want to talk about for a minute. And the other reason that I think it may have been chosen is that for people who have serious mental illness, so that is like schizophrenia, bipolar disorder, and also substance use disorder. We are in need of services for them, and making sure that folks truly get the help that they need to live the full productive lives that they love. Let me talk first more globally about mental health and the pandemic. So when I was thinking about this, and the research is really showing that people are struggling more, one of the things that occurred to me is that we have reason to be hopeful. Because at the same time that people are struggling more, there are things that everyone can do, no matter what, where you live, or you know, whether you're in a rural area or in an urban area, there's things that everyone can do. So I am an Occupational Therapist, and in occupational therapy, occupation doesn't mean job. Occupation means how we occupy our time. And that can be everything from your morning routine to caring for children to going to a worship service, how you occupy your time, and there's research more and more to show that that - how we occupy our time, occupational engagement is linked to mental health and wellness. So that to me is very hopeful, because that means that all of us can be doing things ourselves and supporting each other in doing things that are meaningful to us as a way to improve our own mental health. And also keeping in mind occupational balance. So what is meaningful for me, and how occupied I am is going to be very different for someone else. Right? So keeping in mind occupational balance. And the other reason why I'm really hopeful is that there is research to show that in terms of caring for our young people, a meaningful relationship with one caring adult is a protective factor against developing mental health challenges. So to me that says that any of us can be that one caring adult. So that's something that we can do. So why am I hopeful about working with people who have serious mental illness and people who have drug abuse challenges? Well, for a number of reasons, first of all, our governor and our budget, our state budget, have dedicated increased funding for supportive services, and I think we're going to see that happen more. I also see that here locally in Western New York and across the state, there is more of a commitment to services and it's interdisciplinary. So it's occupational therapists, psychiatrists, social workers, counselors, and people who don't have degrees, all working together to support mental health services, and it's peers also. So peer-based services are really important too. So knowing the folks who work in these areas, and the commitment to it, I am hopeful. So in both of these areas, both for mental health on an everyday level, there's things that we all can do. And there's things that we can also support services for people who have serious mental illness and substance use disorders. So I encourage everyone to get involved, to take care of your own mental health and to take care of each other. If you or someone you know is experiencing a mental health crisis, that you can call 988. You can also go on the website 988.org. It's a really good resource where you can find different resources to support mental health.

Dr. Frank Cerny  21:21 
I'm Dr. Frank Cerny, Professor Emeritus in the Department of Pediatrics, School of Medicine at the University at Buffalo, and Emeritus Professor in the School of Public Health and Health Professions at the University at Buffalo. My career started as an exercise physiologist specializing in pediatric and pediatric diseases at Children's Hospital in Buffalo. I eventually moved to the University at Buffalo, and became Chair of the Department of Physical Therapy, Exercise and Nutrition Sciences. I retired from that academic career and research career and took up the task of looking at factors that were affecting our rural populations, as it regards to the intersection of poverty and health. I think the topic of rural health is critical as we discuss public health, particularly during this month where we focus on it. Rural health has been ignored for too many years, there's been very little public or private investment in our rural communities. That's resulted in a loss of hospital care, primary care, and certainly specialty care in rural areas. In my current role, as the executive director of the Rural Outreach Center, we've recognized the intersection between poverty and public health and health in general, such that the, what we are now calling the social determinants of health, are the same as the antecedents and consequences of poverty. So at the Rural Outreach Center, by addressing one, let's say, poverty issues related to transportation, and cash reserves, and housing and so on, we're ultimately addressing the public health issue. We've come up with a mechanism to address multiple issues that these rural residents are facing, and come up with a model where we put all of these things together into one package so that we're not addressing silos, we're addressing these issues in conjunction with one another very effectively. We are changing the situation of families and children in particular to try to break the cycle of rural poverty. So this lack of investment in our rural areas has resulted in a decreased availability of health care resources. And because of the rural nature of our population, accessibility is an issue, transportation. There's no public transportation in our rural areas. And for instance, in the area we serve, which includes about 45,000 people in poverty, 8500 of those people have no access to transportation. So transportation is a huge issue that we have addressed fairly effectively. What most people don't know about rural health is that the incidence, not the absolute numbers, but the incidence of most issues related to public health is higher in rural areas. The incidence of domestic violence is higher than in metropolitan areas. The incidence of chronic diseases is higher in rural areas, and that includes chronic lung disease, diabetes, and so on. The incidence of teenage pregnancy is higher in rural areas than metropolitan areas, all of these things come together to reach a point where the needs, the health needs in our rural areas are tremendous. But they're being inadequately addressed, leading to a large health disparity between health, health outcomes in rural residents and residents of metropolitan areas. So if we look at the the most common disease entities that we see in our rural areas, cancer, COPD, heart disease, and so on, a lot of this can be attributed, certainly to the lack of care. But the genesis of these disease entities comes from the fact that many of these rural areas are where they cite landfills, and there's a toxic runoff from those landfills. There's a large use of pesticides, herbicides and fertilizers that pollutes the both the air and the groundwater. These folks deal with wells with no fluoridation. So dental disease is a big issue. So we need to begin to pay attention to this population and those things that contribute to these health disparities. So what could what could you do? What could we do together? Number one, you can advocate for rural populations, there have been few people advocating for addressing these rural health disparities. In your professional involvement, you can ask for a seat at the table for people representing rural areas so that their voices are heard and their concerns can be can be shared. You can try to be a seat at the table and have a voice for rural areas, when policy, health policy and so on, health policies are being made. So these voices are heard and the more unique solutions to address these issues can be formulated.

Dr. Albina Minlikeeva  27:26 
Hello, my name is Albina Minlikeeva, and I'm a clinical assistant professor at the Department of Epidemiology and Environmental Health. I also teach in the undergraduate public health program, and involved in some disability-related work. Approximately 26% of the United States adult population report having disability. This population is disproportionately affected by various health disparities. They experience high prevalence of various behavioral risk factors, for example, smoking, e-cigarette use, unfavorable dietary habits, and insufficient physical activity. The findings of various research studies also found that people with disabilities are at a higher risk of developing heart disease, diabetes, depression, and high blood pressure. They also experienced oral health disparities. Altogether, these unfavorable health-related issues result in the higher mortality experienced by people with disabilities compared to people with no disabilities. They also are affected by the social determinants of health at a large extent, compared to individuals with disabilities. People with disabilities report having fewer friends, less social support, they experience environmental barriers, including inaccessibility of the buildings and lack of educational opportunities. This population is also at the higher risk of being unemployed, and receiving lower salaries compared to people with no disabilities. They also experienced a limited health care access. According to the CDC, only one in four adults with disabilities report seeing healthcare providers on a regular basis. And one in every five adults with disabilities report having their health care needs being unmet because of the cost of medical care. Stigmatization, ableism, implicit and explicit biases directed at people with disabilities can significantly affect their health. Public health plays a fundamental role in advancing health equity among people with disabilities through incorporation on various programs that are related to health promotion and disease prevention. The strategies that address various environmental and social factors affecting this population, promoting inclusion of people with disabilities through public health programs, and the participation in social activities can foster health equity and address health disparities in this population. Some ways to make contribution in promoting health equity among people with disabilities could be being a volunteer and helping local organizations, working with people with disabilities, attending local events that are hosted by these organizations, and also include people with disabilities in dealing with social activities and events. Together, we can make a difference and promote health by all individuals.

Dr. Jenn Temple  30:33 
Hi, my name is Jenn Temple, and I'm a professor in the Departments of Exercise and Nutrition Sciences, and Community Health and Health Behavior at the University at Buffalo. I'm also the director of the Nutrition and Health Research Lab. And the work that we do in the Nutrition and Health Research Lab is really centered on understanding factors that influence food choice and eating behavior. And the recent work that we've been doing has really focused on lower income populations, and trying to understand factors that influence their food decision making, such as neighborhood food environment, home food, environment, and food insecurity. So I think the topic of nutrition and eating was chosen for Public Health Week because food and nutrition and eating are really the foundations of good health. And when people make poor eating decisions, or don't have access to healthy food, it contributes to chronic disease and also exacerbates health disparities. And so eating and equitable access to healthy food should really be the cornerstone of public health practice, and a public policy in order to ensure that people have the ability to live their healthiest lives. One thing that I want people to understand about food choice and eating is that it's really complicated. And there's a number of different factors that can influence the choices that people make about food and how much they eat, and that these factors can change across the lifespan. So one of my recently graduated PhD students, Amanda Ziegler, really focused on this for her dissertation work. She was trying to understand the decision making that adolescents are making when they're choosing their food. And one of the things that she found out is that there's a lot of different reasons that adolescents make food decisions. And so things like ease of preparation, preference, healthfulness, availability, time that it takes in their schedule, how hungry they are, things like that are are all kind of influencing one another and influencing the food choice that adolescents are making. And when we think about families, it can be even more complex, because families and parents, they're thinking about what they have access to, what they have time to prepare, what they have the knowledge to prepare for their families, they also might be thinking about what their kids will actually eat. So we hear from parents all the time that like, oh, I have one picky eater and one kid that'll eat anything. And all of these competing factors really make it really stressful for families to figure out what to prepare for their kids for meals. One of the other things that I would like people to know is really, it's very harmful to judge people. So one of the things we hear from lower income families all the time is that they feel very judged. Like for example, if they were taking their kids to McDonald's for dinner, they might get some looks from people or people might pass judgment on them for making their choice. But for a family that might have a limited amount of time, a limited amount of money, kids who are hungry and want food kind of right then and there. McDonald's might be the best choice for that family at that time. And it might be a way that can alleviate some stress that a family has about feeding their kids. And so it's really harmful when we judge people for these food decisions that they're making, also for their body weight. And, you know, where they're eating and how they're eating and how they're feeding their families. And so I would urge everyone to have have more compassion for people in these situations. In terms of what people can do to get involved with this issue, I think it's really important that we do everything that we can to improve access to healthy food for people in all communities. So in the Buffalo area, there are community gardens that people can help with, and maybe starting a community garden. We also have a mobile market program that is headed by Dr. Lucia Leone. So getting involved with that may be helping to get the word out about that or get involved, volunteer with some of that mobile market delivery. That could be helpful. And then I think just again, as I mentioned earlier, having more compassion for people that are living in lower income situations and maybe not passing judgment on the food choices they're making or their body weight. Even that alone, trying to reduce stigma, about weight and about people's food choices, that alone can help at least address some of the mental health burden that some of these things can bring up.

Sarah Robinson  35:07 
This has been a special edition episode of Buffalo HealthCast. Thank you to our amazing guests. Annamarie Malik, Dr. Akua Gyamerah, Danise Wilson, Dr. Christine Linkie, Dr. Frank Cerny, Dr. Albina Minlikeeva, and Dr. Jenn Temple. Be sure to visit the show notes to learn more about our speakers and the work they do in our community. This episode was produced by the University at Buffalo School of Public Health and Health Professions, and our theme music was written and recorded by Dr. Sungmin Shin of the UB Music Department. I'm Sarah Robinson, your production assistant and sound editor. To learn more about health equity in Buffalo, the US and around the globe, visit our website, linked in the show notes to find more episodes. Thanks for listening to another episode of Buffalo HealthCast.