Category: United Kingdom

Population Health in the United Kingdom was thoroughly explored as sixteen people from UAB embarked upon a sixteen-day journey to compare, contrast, explore and explain problems and perspectives associated with health and wellness issues in a variety of geographies. So where do we begin with so much to share? The following paragraphs are a recap of our many public health adventures.

Our global health journey began in UAB’s University Hall where we were greeted by Dr. Lisa McCormick, Meena M. Nabavi, MPH Program Manager, and fellow classmates. All had enthusiastic smiles and much anticipation after spending close to two years with minimal study abroad or educational travel opportunities due to COVID-19. 

Our time together in Birmingham, AL included a variety of speakers who spoke about various public health issues, which provided a strong foundation for comparisons in the UK. Guest lecturers and topics included the following:

• Amy Chatham, Assistant Dean for Undergraduate Public Health Education at UAB, took us through her work dealing with sewage and water treatment throughout the Blackbelt region of Alabama. 
• Meredith Gartin, Assistant Professor of Global Health in the Department of Health Care Organization and Policy at the UAB School of Public Health, spoke about culture as a social determinant of health along with health matters within the migrant and refugee communities.
• Kachina Kudroff, Prevention Manager at the 1917 Clinic at Dewberry, taught the group about HIV/ AIDs treatment and outreach.
• Carrie Leland, Executive Director of Pathways, spoke about physical and mental health issues among unhoused females in Birmingham, AL.
• Karen Musgrove, CEO for Birmingham AIDS Outreach and the Magic City Wellness Center, and Josh Bruce, Education Director for Birmingham Aids Outreach shared on the multiple entities within their organization:
  • Magic City Acceptance Center
  • Magic City Legal Center
  • Magic City Research Institute
  • Magic City Acceptance Academy
  • Magic City Wellness Center
  • Magic City PrEP

This was just the start to our newfound knowledge and a peek into the hard yet rewarding work of the course. Not only was the group evaluating the health of people, but also the health of the environment. Doctoral students provided all with the tools and training to conduct built environment assessments for Birmingham, London, and Aberystwyth. We examined housing, sidewalks, pedestrian safety, litter, and other aspects of the built environment.

“My favorite part of the trip was to be able to see how different each city/ town is compared to each other. London, England, and Aberystwyth, Wales are such walkable cities. We walked more on our trip than we each have in Birmingham! When we were not walking, we had the opportunity to navigate the public transportation system. We truly saw every part of London, even the underground” said student Mya Fluker.

She also noted that “people have places to go in London and therefore their sidewalks and public transportation are a priority. The attitudes of people living in London and Aberystwyth are very different from Birmingham. Being able to witness their differences with our own eyes was a once-in-a-lifetime experience. We will now never forget to ‘mind the gap’, not only when stepping off of the subway but also when solving the gaps in our healthcare systems and built environments.”

More than 4,000 miles later, the group gathered again to focus on public health from a London point of view. A variety of public health activities were conducted including the following:

• A walking tour of John Snow’s journey to discover the source of cholera
• Exploration of public health themes in artifacts at the British Museum
• Visit to the Queen’s Nursing Institute with lectures by the following:
  • Commander of the British Empire and Chief Executive Dr. Crystal Oldman talked about the role of nursing in public health.
  • Staff member Kendra Schneller, shared about public health issues among unhoused individuals. 
  • Professional Nurse Advocate Rebecca Daniels shared the need for people in healthcare to prioritize self-care.    
• An informational session on mental health and the Dove Self-Esteem Project with Stacie June Shelton, Unilever Global Head of Education & Advocacy and UAB MPH alumnus 
• A visit with the Terrence Higgins Trust (THT), UK’s largest nonprofit HIV and sexual health organization. Presenters included the following: 
• Laura Scott, Policy and Research Officer
• Debbie Laycok, Head of Policy and Public Affairs
• Ngozi Kalu, Research and Policy Officer
• Alex Sparrowhawk, Prevention Programme Officer
• Chamut Kifetew, Prevention Project Manager
• Stephan Gampenrieder, Head of Advice Service

On the second leg of our Study Abroad trip, we visited the seaside town of Aberystwyth, Wales. Taking the train from London to Aberystwyth was an experience all its own. It felt like being part of a Harry Potter film riding down the sloping hills and sheep-filled pastures of Wales all the while patiently waiting for the sweets trolley to make its visit to our train car.

We arrived in Aberystwyth on May 18th pulling into the station where the railroad ends. Jumping off the train, we were immediately greeted by the smiling faces of our Aberystwyth University hosts Marian, Sarah, and Ellie and by the not-so-friendly smell of sheep grazing in the nearby fields.

The heart of Aberystwyth is the promenade on the waterfront. Soft and pastel-colored row houses and storefronts line the pebble beach shore inviting students, friends, and families to take a leisurely stroll along its path. Like much of Wales, Aberystwyth wouldn’t be the same without its steep and hilly landscape. At the top of the hill is one of the town’s crowning jewels, Aberystwyth University. During our time in Aberystwyth, we stayed in the University’s bunkhouses getting a taste of classic dorm life.

For the students of Aberystwyth University, their exam season had just started to wrap up, but during our brief stint as Uni students we, fortunately, didn’t have to suffer through any exams ourselves. Instead, we had the opportunity to learn from some of Aberystwyth’s own professors about their work in the field of public health and community outreach. From a live-action demonstration of an oral glucose tolerance test courtesy of Dr. Rhys Thatcher to learning about how saving the rhinos falls into Public Health from Dr. Darrell Abernethy, students were truly immersed in the public health work being done in Wales. Other lecturers included Professor Paul Brewer, who provided insight on mining impacts on river systems, and Dr. Rachel Rahman, who shared her research on telehealth mental health services. 

While in Aberystwyth, we had the opportunity to explore the National Library of Wales. Led by head librarian, Dyfan Graves, we toured the historical building and the treasures housed within. Receiving the highest listed status, we were told that for the historical portion of the building nothing can be changed or even moved from its original position. The listing status of the building pairs well with the library’s dedication to preservation. At the Library, students had the opportunity to hold a 500-year-old Bible, one of the first-ever written in Welsh. We went on a behind-the-scenes tour to some of the library’s most secure stacks seeing their vast collection of manuscripts, photographs, maps, and even paintings.

One of our favorite experiences in Aberystwyth was visiting the Aber Food Surplus. Dedicated to feeding the community delicious and nutritious food, the food bank is open for the entire community to use. We spoke with Director Heather McClure about her journey starting the Aber Food Surplus right after finishing her time at university. Passionate about people and feeding them quality foods, Heather saw a gap in her community’s ability to access nutritious foods at any pay scale. Partnering with local restaurants and grocery stores, the Aber Food Surplus takes good food that would otherwise be destined for the dumpster and gives it new life by feeding the community. At the food surplus, nothing goes to waste. Any food scraps or paper packaging is composted and turned into high-quality soil for the community garden helping to feed even more of Aberystwyth’s population. Lending a helping hand, while at the food surplus students helped chop veggies and cook up a yummy salsa. 

After three days of experiencing Aberystwyth, the group headed back to London for a visit to the Wellcome Collection, which is a free museum dedicated to health, well-being, and the human experience.  This non-profit establishment utilizes multiple mediums including live programming, exhibitions, broadcast, publishing, and interactive displays as a way to encourage and promote people to think more in-depth about how interconnected the institutions of art, science, and medicine are to life. We also discussed and finalized our assessments of the different built environments we explored, experienced, and evaluated. The class and study abroad session was wrapped up and finalized with an amazing farewell dinner in the historic Covent Garden area of the city.  

Planes, trains, automobiles, footpaths, sidewalks, gravel paths, and of course – the tube, we experienced them all during our fast-paced, public health experiences in the UK. We succeeded in learning a great deal about public health, while at the same time – sharing in amazing food, diverse cultural experiences, and loads of new expressions. Contacts, connections, and friends were made on this amazing trip. In an effort to share as much as we can about our journey, we have included student videos highlighting our favorite parts of the course.

Exploring Population Health will be back in May 2023! Stay tuned for more details!

After arriving in London yesterday after another trip on the trains, we began our last day filled with visits in the city. In the morning, we visited the Tower of London for a more culturally immersive experience and in the afternoon, we visited the Wellcome Collection to explore some of the major themes of our class–social determinants of health, population health, and health equity.

The Tower of London served as an immersive historical experience as we toured the once-booming political hub and learned about major events that took place in the tower that shaped world history. Georgi, our guide, told us how many historical figures, including some Queens of England, have been executed inside the tower’s walls. The Tower of London used to house the King and Queen of England when it was in its prime (about 300 years ago). Henry the VIII, who was King from 1509 to 1547, kept many exotic animals (lions, elephants, and monkeys) that have statues inside the tower today in their remembrance.

Georgi led us to the Crown Jewels, which are also kept inside the Tower of London. The Crown jewels are state-owned as they belong to “the Crown”. This means the royal family does not personally own much of the collection of jewels but instead passes it down to the family with the Crown. We were able to get a close-up look at the priceless collection, including coronation pieces that have been in use for hundreds of years.

After visiting the Tower of London, we had a brief lunch and then headed to the Wellcome Collection. The Wellcome Collection, opened in 2007, is a free museum that includes a library that showcases the collections of Sir Henry Solomon Wellcome, an American-British pharmaceutical company owner of the Burroughs Wellcome & Company who collected many medical and health-related pieces and artifacts. The collection showcases a fraction of Wellcome’s collection and presents different exhibits exploring medicine, health, and the human experience.

One of the free permanent displays of Sir Wellcome’s expansive health collection, ‘Medicine Man’ shows the diverse changes and perceptions about what medicine was, how it was approached, and what it meant to experience medicine over the course of history and between cultures.

The gallery explored various topics related to medicine like birth, death, sex, illness, anatomy, and more. One notable thing about the exhibit is how it has been put together. According to signs posted around the exhibit, the presentation of the work hasn’t changed, leaving it portrayed in a highly colonial and prejudiced mindset. But, the museum does something interesting. They’ve created the space for dissent and intervention through placards where artists, writers, and activists have a chance to respond to the colonial bias and present a new perspective that may lie closer to the truth.

Some notable pieces were those depicting the evolution of what human anatomy looked like as artistic rendering increased. Particularly interesting pieces were the pregnancy calendar and early forms of IUDs marking women’s health.

Another exhibition titled “In the Air” explores the relationship we have as humans to the air around us. It beckons the question: If air is something we all breathe, why is air quality still so poor in many areas of the world? The gallery starts with a brief history of the relationship between air and the earth that began billions of years ago, documents the coal smoke pollution that filled the air of London in the 17^th century that sparked activism against air pollution to modern-day protests against air pollution.

Air pollution is not a new concept. Efforts and advocacy to reduce air pollution date back to 17-century London in an effort to reduce the coal smoke from the use of coal in homes to produce heat. These magazines and books are early 20^th century efforts to present the evidence surrounding the effects of pollution on the environment. However, these were largely only circulated among scientific communities. 

Choked Up are an advocacy group of brown and Black teenagers living in areas of London highly affected by air pollution. They are fighting for clean air to be required by law. This group was formed in response to air pollution levels far greater than the World Health Organization guidelines. Their efforts include placing street signs across the city to emphasize the disproportionate impact of toxic air quality on people of color.

This photo collage shows the differences between the appearance of the sky in different parts of the world. It emphasizes the fact that though our airspaces may look different, we all share the same sky. The air around us is not confined by borders, and how we treat our air has an impact on those in other air spaces.

The Being Human exhibition explores what it means to be a human living in the 21^st century. It highlights advancements in medical technology, health inequities, and the ever-changing climate that influences our livelihood. The exhibit is broken down into four sections: Genetics, Minds & Bodies, Infection, and Environmental Breakdown.

The ‘Refugee Astronaut’ looks to a hypothetical future in which humans must leave Earth in a hurry, likely due to irreparable damage done to the planet.

The banner above was designed for the Standing Rock Protest against the Dakota Access Pipeline. The artist, Isaac Murdoch, is a member of a group of indigenous artists and environmentalists.

The devastating effects of climate change are already very present, but the potential for even more devastation is a sure future if things continue the way they are. These photographs show us what could be in the near future. The photos above show the potential impact of widespread flooding, wildfires, destruction of land, etc.

After finishing up at the Wellcome Collection, we separated for some free time before regrouping for our last group dinner where we finished up the course with a nice creme brulee.

Tomorrow brings around the final day of the trip where we’ll have a group discussion about what built environment differences we’ve observed across Birmingham, London, and Aberystwyth and prepare for the first round of departures. Stay tuned for our final course wrap-up blog where we share what we learned the most about and loved the best about this amazing study abroad course in public health!

Today was our last full day in Aberstwyth. The day’s activities included two lectures, a built assessment of a local residential section, and visiting a local not-for-profit (or charity) organization, Aber Food Surplus, a food sharing hub. 

The first presentation was given by Professor Paul Brewer. As a Fluvial Geomorphologist, Professor Brewer shared about his extensive work studying river changes and environmental influences on water-systems throughout the world. His presentation was entitled, “From Azancollar (Spain) to Zlatna (Romania), a European Tour of metal mining impacted river systems”. The lecture was illuminating on the environmental effects of historical metal mining and the spread of heavy metal contamination over time due floods. Lead (Pb), Cadmium (Cd), Arsenic (As) and Zinc (Zn) contamination along with the contamination of agricultural byproducts introduces a host of issues. These issues often are cyclical in nature due to the historical layers of contamination that have been deposited over time. The heavy metal contamination of the soil, livestock, and water can eventually lead to human consumption. Dr. Brewer delineated about the ramifications of climate change and increased rainfall being a key conduit for the proliferation of soil contaminations. The heavy rain events or flash floods are highly effective dispersal opportunities for contaminants to spread. This leads to sedimentation on local plant life and even being rooted under the soil over time as layer after layer of sediment settles. A detailed understanding is required to attack soil contamination and mitigate its damaging impact on the environment. The implementation of a geomorphological approach according to Dr. Brewer is an effective measure to identify and map contaminated locations so that they may be effectively managed.  

The second presentation given was by Dr. Darrell Abernethy. As a veterinarian-science researcher, Dr. Abernethy has spent his career exploring the relationship between animal health and human health. He explained that the relationship between the two are integrated and overlap at various sectors. He provided the example of zoonotic diseases and the public health concerns associated with diseases that begin with initial infections among animals and then makes the jump to infecting humans. An example of this includes Ebola, which has been suggested to begin with infected fruit bats. He also drew the connection between human and animal health in talking about the conservation efforts in Kruger National Park in Africa. Kruger National Park is primarily concerned with preventing poaching of the White and Black Rhino populations.  As Dr. Abernethy explained, to address the decline in Rhino population also means to address the poor quality of life among tribes and their communities surrounding the Rhino’s habitats. A major issue identified was the influence of poachers providing the communities with financial support in exchange for their compliance.  Rhino horns can be extremely valuable commodities to these communities. So to really conserve the Rhino population, you must first address the extreme poverty of the communities living near the preserve. 

Following our group lunch at the campus dining hall, we reconnected with Ellie (our Aber Uni guide) to make our way down the hill to conduct our built environment assessment and visit with Aber Food Surplus. We were able to identify that a majority of the homes in the area were townhouses, many with clear sidewalks and well-maintained front porches. The storm drains were much more adequate in Aber and London than Birmingham. Similar to London, the curb cuts were clear and present around the block in Abers residential areas. The variation in sidewalk style was fair overall with almost no litter in the neighborhood. The same could be said for the London assessment done.   

The last activity of the day was spent visiting with the Aber Food Surplus where we were greeted by Heather, a founding member. As a not-for-profit organization, Aber Food Surplus works to tackle food waste and promote positive community change through nutrition-centered advocacy and programs. Through their partnerships with local businesses and establishments, they collect food throughout the town and redistribute throughout the community, aiming to alleviate the amount of food waste produced and breaking down barriers to nutrition.  They also help to advance health equity by providing those in need with access to healthier foods, while also helping to improve individual’s self-efficacy with identifying and selecting healthier food behaviors. There are over 70 volunteers that make up their team. There is no clear number of people they serve individually because of the vast number of charities they support, but Heather estimates they serve around 250 community members per week. Aber Food Surplus also has a food composting and community garden project.  Our afternoon plans was to go to these community gardens to plant some seeds, however this was thwarted by the rainy weather.  So instead, we assisted Heather in preparing salsa using locally derived ingredients. So as we were learning about the organization and their mission, we also learned to make salsa! A handful of us (Rachauna, Yesi, Cassidy, Mya, Maya, Ritika) prepped, washed, and chopped up some tomatoes, green onions, and cilantro (coriander as they call it).  Prior to storing the remaining goods, we learned that the salsa would keep longer if it were cooked. Heather explained that this helps them to maintain food for a few extra days so that they can distribute it to more community members. Once the ingredients were cooked and seasoned, we all shared in taste testing our hard work on a slice of toast. It was a great experience and we learned so much about the great work occurring in the Aberystwyth community. To learn more about their ongoing projects and work, you can visit their website (www.aberfoodsurplus.co.uk).  

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Greetings from Aberystwyth, Wales, a quaint university town by the Irish sea. A change of pace from the hustle and bustle of London, colorful houses dot the mountains and small shops line the promenade.  Housed on-campus we are able to immerse ourselves within the culture of this college town, not dissimilar in the atmosphere to that of UAB.  Our day begins with a couple of lectures by Aberystwyth University faculty. Our first presenter was Dr. Rhys Thatcher.  Here science and history intersect as we are transported back in time to our evolutionary beginnings and its continued influence on our biological functioning.  Dr. Thatcher stressed several times during his presentation that inactivity is a main contributor to many chronic diseases. Demonizing obesity and advocating for weight reduction, our current diet, and health culture seems to miss the mark in the prevention of chronic disease implying causation where correlation is present. Undervaluing physical activity as a society, Dr. Thatcher remarked we would often be better served to “take our pill for a walk instead of swallowing it”. 

With the highest prevalence of diabetes in the United Kingdom at around  8% of the population, Wales still pales in comparison to the United States where 13% of its inhabitants are currently diagnosed.  Despite our advancements in healthcare, we have been unable to influence the age in which people develop chronic illnesses. We are simply just keeping people alive longer.  This represents a continued conundrum as the global population increases and healthcare costs continue to rise.  

Our second lecture of the morning presented by  Dr. Rachel Rahman discussed the use of telehealth in Wales. Many are still dealing with the aftermath of COVID, yet the one greatest advancement in healthcare during this time has been the expansion of telehealth. Being able to video conference with a practitioner for mental health or general medication refills without having to leave the comforts of your own home opens the doors to health access to many.  Wales, a primarily rural community,  has seen exceptional benefits to health access and patient engagement. This has also been noted within our own population back home in Alabama. 

The Welsh deal with many of the same barriers as Alabamians when it comes to finding healthcare in rural areas. Long drives to dentists, specialists, birthing care, and even just general practitioners can lead to decreased wellness and overall satisfaction with the healthcare system.  However, with universal access to general services through the NHS, the Welsh continue to have a leg up on Americans, where financial barriers continue to hamper access to basic care services. The successful uptake and satisfaction with telehealth services present many opportunities to address health inequality and impact the social determinants of health. 

To finish off our first full day in Aberystwyth, we strolled down the winding university walkways to the National Library of Wales. Housing a plethora of irreplaceable and one-of-a-kind artifacts, we were led on a behind-the-scenes tour that many locals of Wales themselves have not experienced. Upon arrival, we were greeted by our friendly local guide, Dyfan Graves, who presented and discussed the library’s history and the contents of its many shelves and humidity-controlled rooms.  Walking through private “staff only” corridors we encountered meters upon meters of tall shelving with stacks and stacks of ancient or important books, maps, art, or other precious artifacts important to Wales. We entered a climate-controlled room with CO2 fire suppression systems that hold items such as the early 15th Century manuscript of Chaucer’s Canterbury Tales. Our guide allowed us to hold one of the oldest Welsh bibles (1588) in existence. This bible predates the King James Version and it is felt that this work played a key role in the preservation of the Welsh language. 

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Journeying upwards on a spiral staircase, we continued our culturally rich journey to an immense art gallery containing historical and recent image depictions. Poignant and humbling photos illustrating the realities of healthcare workers and patients during the COVID-19 pandemic can be viewed on its walls. Displaying the powerful emotions of stress and solidarity during this unprecedented time, this art brings us back to the importance of population health in a unique and visceral way. Often individuals don’t recognize that healthcare professionals walk away from many of their experiences with a variety of feelings that over time can lead to professional burn-out, compassion fatigue, and depression.

To close out this culturally immersive experience we learned about the unique connection between Wales and Birmingham, Alabama.  Going back in time to the deep south, on September 15, 1963, in the midst of segregation, the 16^th Street Baptist Church was bombed in Birmingham, Alabama. The bomb exploded before Sunday morning services at the predominately African American church that served as a gathering place for many civil rights activists. Claiming the lives of four little black girls and injuring a multitude of other people, this tragic event captured the attention of Wales. In a display of friendship and solidarity, Wales commissioned a Welsh artist by the name of John Petts to design a stained glass window to be displayed in the church upon its restoration. His final illustration is that of an African American Christ with the right hand pushing away hatred and injustice and the left offering forgiveness with an overarching rainbow representing diversity. Petts accompanied the image with the words “You do it to me”, based on a verse from Mathew 25:40 that spelled out the Christian message of brotherly love: “Truly, I say to you, as you did it to one of the least of these my brothers, you did it to me”. It remains in the church to this day, a forever memorial to 14-year-old Addie Mae Collins, Cynthia Wesley, Carole Robertson, and 11-year-old Denise McNair whose bodies were found beneath the rubble in a basement restroom. 

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Our first day in Aberystwyth was an intense learning and cultural experience. Understanding the significance of what makes people unique is imperative to provide appropriate services to improve both wellness and wellbeing within this community. Much like in the United States, culture can vary greatly from one region to another and you must take care not to group everyone within one homogeneous unit.  Thoroughly enjoying this immersive experience we cannot wait to see what tomorrow will hold and what more we will gain from this collaborative experience. 

Approaching matters from a public health viewpoint often relies on the perspective of an outsider looking in. In our own environment, it is difficult to see the nuances and minor differences which exist across various communities. Looking at it another way, when we are part of the forest, we often do not realize the slight differences amongst the trees. It would be easy to believe that visiting another English-speaking country would be more of the same, but as you will soon find out, that is definitely not true!

The classroom today consisted of two distinctly different organizations, however, as we quickly found out, much of their approach to public health issues is quite similar. Stop one was the Terrence Higgins Trust.

Walking into the Terrence Higgins Trust (THT), the UK’s oldest HIV and Sexual Health charity, we were greeted by a vibrant atmosphere and a chipper staff. Southern-style hospitality was extended with a wide array of snacks and beverages served. Of course, instead of our beloved Alabama staple of sweet tea, we were offered a variety of English-style hot teas and “biscuits,” or cookies as we know them.

Friends and family of Terrence Higgins, often referred to as “Terry,” originally established this now national trust after he passed away due to AIDS-related health complications. Forty years later, the trust still stands and has grown to serve communities across the UK. Specializing in HIV and Sexual health, THT works with the UK’s National Health Service (NHS) and other charities, with a goal of bringing increased equitable access to sexual health care across all races, genders, sexual identities, and geographic locations.

Students learned about one of the UK’s primary health goals for HIV, the 95-95-95 target by 2030; meaning, that 95% of those living with HIV are diagnosed, 95% of those with a diagnosis are receiving treatment, and 95% of individuals in treatment have an undetectable viral load. In 2022, the UK is certainly on track to meet this target with current reported levels showing 95% diagnosed, 99% in treatment, and 97% with an undetectable viral load; however, the numbers don’t tell the whole story.

Stigma and fear still dominate much of the space around sexual health. In the US and UK, stigma against sexual health remains pervasive. Healthy forms of prevention are often seen as promiscuous behaviors, causing many to fear visiting the UK’s sexual health services, which are provided by the NHS. Focusing on advocacy and fighting stigma, the THT brings a voice to those too scared to speak for themselves.

Much like communities in the US, progress most often begins in more urban environments. Most of the progress in HIV prevention and treatment in the UK is taking place within London’s 32 boroughs, leaving many surrounding less dense areas with little or no options for local healthcare. THT Research and Policy Officer Ngozi Kalu described this phenomenon as a “postcode lottery.”

The geographical disparity between cities and towns is brought to light as many in the HIV-positive community have suffered negative experiences meeting with their general practice (GP) doctor. In more rural areas, like Cornwall, some even described the experience of being told there is no HIV in their community, while actively seeking treatment for themselves.

For many across the UK, such stigmatized interactions are at the forefront of their experience, pushing many away from seeking treatment. This disparity is seen further in members outside of the LGBTQIA+ community, as many others who may be HIV positive do not know their options or how to access this specific type of care.

THT Prevention Program Officer, Alex Sparrowhawk, asked us what to do “when equity fails.” Unfortunately, there is no simple answer, magic beans, or silver bullet to save the day. The main goals of the THT are to work towards increased equitable access to sexual health services through expanding health care access in local pharmacies, starting a National HIV Testing Week, and establishing a policy to help implement age-appropriate sex and relationship education in schools.

If you’re interested in learning more about the work being done in the UK by the THT, follow the link to help Pubic Health Give HIV the Finger.

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After our time at THT, we meet UAB MPH alumnus, Stacie June Shelton, MPH on the steps of St. Paul Cathedral. Stacie is Global Head of Education & Advocacy, Dove Self-Esteem Project at Unilever. Then group enjoyed a delicious lunch with Stacie at Samuel Pepys before heading to Unilever’s London headquarters. (As expected, this dining establishment served an amazing fish and chips lunch entree, which is a staple of the British dining experience.)

As is often the case in the U.S., the Unilever headquarters is also highly focused on security issues. All UAB guests were checked in through security and provided bright green stickers designating our status. Photography within the building was strictly prohibited.

The group gathered in one of Unilever’s many impressive and modern meeting rooms to discuss and learn more about Dove’s Self Esteem Project, which is a global outreach effort. Through this project, Unilever has data showing how this project, in partnership with UNICEF, has positively impacted multiple countries and helped young children in Brazil, Indonesia, and India with their self-esteem and overall body confidence. Although there are many different initiatives for those aged seven to 24, the main project group is young children from age 11 to 14. Looking back on some of our formative years during the same time frame, many discussed how impactful it would have been to witness media that acknowledges and promotes varied outlooks on inner and diverse beauty.

A positive relationship between self-esteem and body image begins with value in diverse beauty ideals. In order to achieve this, it is important to arm the next generation with tools to disarm toxic beauty standards. Dramatic change in standards, ideals, marketing, and thought processes must take place. Changing laws, media practices, and policies/practices of both government and non-government entities is necessary. One positive example of such change is the Crown Coalition which opposes discrimination against natural hair. [https://www.dove.com/us/en/stories/campaigns/the-crown-act.html].

Dove has a long-standing mission “to make beauty accessible to all women,” however, not all are aware of their important work in making traditional beauty ideals more inclusive and realistic. It was extremely impressive and impactful to hear about the amazing initiatives of Unilever from a UAB alumnus.

Shelton graduated from UAB with an MPH degree in health behavior. She worked for the Oregon State Department of Health and advocated for adolescent school health. She then turned her focus to International health, serving in countries including Kenya, Nigeria, and Sri Lanka. Currently, she is living just outside of London and enjoys the work she does as part of the marketing and communication teams on Dove’s Self Esteem Project. She shared that she is often the only public health specialist on projects, so is able to provide a unique and valuable perspective to the team. Stacie’s work is supported by Unilever and is part of their strategic goals, but a big part of her job is to serve as an advocate for her projects within the company and answer decision-makers’ questions such as “What, why, and how? What are the issues and their effects? Why should we push this initiative? How do we effectively get it across to the most vulnerable?”

With her impressive accomplishments and wealth of knowledge, it was a true privilege for the group to spend time with her. Her beliefs, ideals, and background were relatable and provided important insight into public health opportunities within corporations. Stacie June showed us what a career in public health could become.

Class time concluded with a glass elevator trip to the top of the Unilever building, where we experienced their newly constructed rooftop garden. From this spot, we were able to peer across the River Thames, one direction towards the Tower Bridge and London Tower, we were able to truly feel the beauty of London life and realize that our career dreams could become a reality.

And finally, we would like to share a more moving initiative of Unilever. The inner child of us all shed a tear from the emotional hook of the Dove Self Esteem Project: Detoxing Your Feed Campaign. [https://www.dove.com/us/en/stories/campaigns/detoxify.html]
One of the goals of this campaign is to promote media literacy and tackle the issue of why social media can have a negative influence on self-esteem.

We ask you, the reader, to share in our experience and consider how social media may impact your personal health. As a short experiential exercise, we ask you to take note of the first five to ten posts that show up on your social media feed. Ask yourselves these questions:
● How does this content make you feel?
● How often do you compare yourself to the people that you see online?
● Do you feel the need to change yourself in order to fit into a standard?

On a final note, we suggest you tune into the Appearance Matters Podcast! This captivating audio is the official podcast of the Centre of Appearance Research and is available on Apple, Spotify, and Audible.

Cheers!

On Monday, May 16, 2022, we had a wonderful time meeting with staff at the Queen’s Nursing Institute (QNI). Establish in 1887 by Florence Nightingale, who paved the way for modern nursing practice and training, the Queen’s Nursing Institute meets the community health needs of the more underserved parts of the United Kingdom population. Based in London, the QNI has an established interconnected network of community nurses that focus on care across the lifespan or “from sperm to worm” as Dr. Crystal Oldman, CBE, Chief Executive Director of the QNI, affectionately describes it.  (By the way, we asked Dr. Oldman the meaning of the CBE acronym.  CBE represents the Commander of the British Empire.  This is the highest-ranking Order of the British Empire award, other than knighthood or damehood.  It is given to individuals who have made significant contributions to their field through leadership and service.)

To explore population health and begin to understand some of the integral differences between US and UK population health outreach programs and practices, Kendra Schneller, lead of the Homeless and Inclusion Program of the QNI, provided an overview of her work. The Homeless and Inclusion Health Program supports the identification and meeting the health needs of those experiencing homelessness. In the UK, the homeless definition is broad, including the migrant population, sex workers, asylum seekers/refugees, and those who do not have secured residences of their own. Current and ongoing efforts regarding the homeless population of London’s 32 boroughs that the QNI aims to address include offering personalized health care and connections to a GP for further health needs, resource information for clinicians, and support specialist groups that advocate in support of this population. Their funding comes from a combination of sources including the National Health Services (NHS), acute trusts, and other charitable organizations. Some ongoing struggles to further this program and better meet the healthcare needs of this population include limited funding, lack of housing availability for rehousing, and structural difficulties that allow for transition away from homelessness. Kendra touched upon her hopes for the future, which strongly revolve around additional funding support and fewer institutional barriers.

Moving towards understanding the culture of nursing in the United Kingdom. Rebecca Daniels, one of the first Professional Nursing Advocate (PNA) graduates in the UK’s relatively new PNA program, spoke about the role of PNAs and the current state of affairs regarding nurse wellbeing in the work environment. Practicing based on education from an adapted curriculum of the “Resilience Model of Supervision”, PNAs work to cultivate an environment that prioritizes the mental health and emotional well-being providing a safe space for nurses to release and develop strategies to handle emotionally draining work experiences. The goal is to prevent and better manage compassion fatigue and the general emotional nature of the role—something made apparent during the recent COVID-19 pandemic. Still, in its infancy with only 3000 PNAs currently certified in the UK, the program hopes to certify a net 5000 PNAs by the end of 2022. Daniels spoke about some of the difficulties PNAs face which include resistance from nurses to engage with PNAs because of already dense work responsibilities and obligations. In concluding the discussion, Daniels expressed hope for unifying standards across PNA certification programs to ensure program validity and hope to fully assist nurses in their workplace plights.

Dr. Oldman concluded the presentation with an open discussion about the QNI, NHS, and the greater UK healthcare network. The closing discussion centered around similarities and differences across the current US and UK healthcare including international nursing shortages, a problem verified by the International Council of Nurses (ICN), workplace burnout, and changes wrought by the pandemic. In discussing future directions of healthcare, Dr. Oldman touched upon a need for leaders and advocates from the nursing profession at the forefront of health policy and decision-making:

“If you’re not at the table, you’re on the menu.”

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Speaking of menus, following our visit to the QNI, we stopped for a group lunch in the Covent Garden area in London’s West End. While eating lunch, the class noted the conservative use of salt in the UK. Fittingly, Dr. McCormick shared some insightful commentary from Dr. George Howard, Distinguished Profession in the UAB SOPH, who recently read the blog and shared how “the UK has successfully dramatically reduced hypertension through policy changes and partnerships with food companies” to reduce consumer salt intake through processed and prepared foods. This intervention led to a decrease in stroke, hypertension, and related heart disease. Dr. Howard expressed interest in observing outcomes of similar intervention work in the United States to lessen the health burden of heart disease in the Stroke Belt.

It was a lovely day! Stay tuned for tomorrow’s blog update with a visit to the Terrence Higgins Trust and Unilever.

Team 3: Grace Albright, Rachana Kuthuru, and Ritika Samant

Introduction: Today, students collaborated to travel to the British Museum using London’s Underground (aka. The Tube). Once we arrived, we checked in with Dr. McCormick to receive our assignment for the day (More on that in a bit.)

Did you know the British Museum displays over 8,000,000 works/artifacts across 70 different exhibits in over 990,000 square feet? These artifacts represent 2 million years of human history, culture, and art, which attracts over 5,000,000 people annually. There are items here that you have probably heard about your whole life, including the Rosetta Stone, the Lewis Chessmen, sections of the Parthenon marbles, Hoa Hakananai’a from Easter Island, and other important artifacts from Ancient Rome and Egypt. It is quite frankly overwhelming, but we digress… Dr. McCormick asked each of us to identify five unique items from within the museum that relate to public health or healthcare or have some significance to the themes of our course: population health, social determinants of health, and health equity. Each student team was sent off to different areas of the museum to start and we were given 4-hours to undergo our exploration. We documented the location of each item, took photographs, and wrote brief descriptions of their relevance to public health or healthcare.

Here is a sampling of the items we found:

“Cradle to Grave” is a 14-meter display that is located in the middle of the Wellcome Trust Gallery: Living and Dying.  “Cradle to Grave” by Pharmacopoeia documents and reveals over 14,000 drugs which is the current estimated average prescribed to individuals living in the UK during their lifetime (http://www.pharmacopoeia-art.net/articles/in-sickness-and-in-health/).   The display also included photographs and other medically related artifacts documenting one woman and one man’s life course. 

Apollonia was a colony founded by the Ionian Greeks in 610 BC. The picture above is a terracotta pipe that was recently found near Kalfata on the coast of the Black Sea.  The pipe is in two sections, flanged at one end so that the next pipe slides in to form a tight fit.  As you can see from the image, the two sections are coupled using lead (Pb) to seal the pipe joints from leaks.  This pipe was part of a large water system that provided clean water to the people of Apollonia.  We have learned from our studies how important clean water is to the health of any population.

Tara is the goddess of compassion, one of the more famous Buddhist goddesses. When we saw this display, we thought of all the healthcare and public health workers during the COVID pandemic.  This unprecedented time has led to many leaving their positions because of stress and burnout. Compassion fatigue reached an all-time high as the public health workforce was overwhelmed with wave after wave of COVID-positive patients.  For those who work in the field, we have to remember that we cannot be of service to others if we are not prioritizing our own health.

In Babylonia and Assyria, many devices were designed to protect people from evil and disease.  Objects, such as the model clay dogs above, were buried beneath palace doorways in order to prevent misfortune and protect from disease.

This figure is of a mother breastfeeding her child and represents the beginning of a life nurtured and cared for by a family. According to its description, it depicts the bond between the mother and baby.  Maternal and child health is an important part of population health.  Improving the health of mothers and children determines the health of the next generation.

As we have discussed over the past several days, London was a dirty and disgusting place in the mid-19^th century.  Bottles such as these would have been filled with fine perfumes allowing the wearer some reprieve from the stench filling the streets. In 1858 this “great stink” finally led to much-needed reform in the city’s sewage system leading to even greater public health improvements and a significant reduction in waterborne illnesses and death.

Public health is everywhere, often showing up in unintended places. In this instance, the Sackler family has a wing dedicated to them at the British Museum. This family, once known as prominent art philanthropists and leaders of the pharmaceutical company Purdue Pharma, are now more known for their association with the opioid epidemic. Many institutions went so far as to have the Sackler name removed from architecture wherever possible.

To conclude the day, we gathered for a “high tea” at The Great Court Restaurant. The concept of “high tea” was introduced in the 1840s by the seventh Duchess of Bedford, Anna Maria Russell. The growth of industrialization influenced the timing of daily meals. As the time between meals grew longer, the Queen’s ladies-in-waiting were hungry in the middle of the afternoon.  Therefore, the concept of afternoon tea was born (which includes a biscuit or scone with butter and jam with a cup of hot tea.) Anna’s habit of having a mid-afternoon indulgence became a British tradition.  High tea is a bit more lavish than traditional afternoon tea and includes in addition to scones and tea, small finger sandwiches and small bites of delicate cakes and other confections.  While the class did not engage in the formal attire of upper-class society of the 1800s, it was a great experience shared among peers.

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Credited by: Porsha Edwards, Alliemarie Humphries, Catrell Johnson, Yesi Villanueva

Modern London, a sprawling city of over 9 million inhabitants, is the epicenter and shining jewel of the British Isles. As we walk down the bustling streets, one becomes acutely aware of their surroundings. Entering a park, we step aside for the joggers and are ever mindful of the bicyclist as they wiz around the curb. Children play and a yogi enjoys his practice. The city is alive, healthy, and happy. Down the cobblestone streets, we march noticing the inherent lack of refuse and debris.  Pristine white buildings greet us, a testament to the architecture of the early and mid-19th century. What these walls could tell us, what history they hold.

What I have described to you is merely the first five minutes of our walking tour of London. Though busy it is a beautiful and clean city, however, its history is far from pristine. As we will learn from our tour guide, this great city has undergone many trials and tribulations to emerge as the triumph that we have described today. This history provides us a window into the past (and present) of this sprawling metropolis and hopefully gives us a vision of its future.

Our first guide, Charlie Forman sets the scene for us. It is the 1850s and London is a dark and dirty place.  Having tripled its population over the last 50 years, it is a city that is most literally busting at the seams. The buildings on this block are painted grey to hide the smog and smut that stain their walls. Refuse and waste fill the streets and in the height of summer, the stench of human excrement is overwhelming. Thousands die yearly from disease, smog, and occupational hazards. Episodic cholera outbreaks paralyze the city and the medical theorist of the era struggled to make sense of it all.  Then, this now refined city was on the brink of self-destruction.  As our second tour guide of the day, Dr. Barry Walsh, Public Health England retiree and medical microbiologist, would go on to say, “The city was drowning in a sea of its own feces.”  So what happened? How did this cesspool of grime become the city we see today?

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The 1850s were really a turning point for London and the health of its dwellers. On August 31st, 1854, with one discarded dirty diaper, an epidemic is unleashed. Within days, 100’s will have died, and when all is said and done, over 600 will have lost their lives to the ravages of Cholera. However, out of this tragedy, a cornerstone of public health is born. John Snow a physician and soon-to-be founder of epidemiology bursts onto the scene determined to discover the cause of this ailment and spare future victims. Through vigorous data collection and epidemiological mapping, he is able to isolate the source of the ongoing infection, the Broad Street pump. Within its clear and crisp waters lay in wait a deadly bacterium, Vibrio cholerae.  Removing the pump’s handle and stopping the epidemic in its tracks, John Snow revolutionized public health practice that day, although it would take many decades before his true brilliance was realized. Dying somewhat unrecognized four years later, Dr. Snow would never see the significance and wide-reaching impact of his groundbreaking work.  (For more information on John Snow and the Cholera outbreak of 1854 read Ghost Map by Steven Johnson.  We did!)

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A mere four years after John Snow removes the pump handle another crisis will hit the city. Cue the summer of 1858, also known as the “big stink”. Thousands of pounds of raw sewage flow into the Thames daily. Baking in the sun, a smell of epic proportions reaches the noses of London’s elite as Parliament is shut down due to the overwhelming stench. A city in uproar, change has to happen. Enter a bright young engineer Sir Joseph Bazalgette.  Designing a complex network of undergrown sewers (and with much support from Parliament), for the first time in London’s history waste is successfully transported away from the Thames and the drinking water of the London populous. While imperfect, this system dramatically reduced water-borne illness and death and paved the way for many future public health initiatives to come.

Fast forward 170 years or so and we are back on the modern streets of London. It is now 2022 and Queen Elizabeth II is soon to celebrate her platinum jubilee, the first of its kind in British history.  Universal healthcare is in place and London occupants now have access to clean water, parks, and all manner of recreational activities. The streets are now much safer and smog is a memory of the past. So where do we go from here?

Public health as a profession is very much a retrospective and prospective art. Often the sins of the past are doomed to be repeated if they are not acknowledged and recognized. Where infections and daily hazards once killed, chronic diseases such as heart disease, diabetes, and cancer have arisen to take their place. Public health still has an important role to play in the prevention and management of this new era of illness.  Just as in the mid-19th century, we now must show ingenuity and curiosity if we are to prevail.  Just as John Snow and Sir Joseph Bazalgette sought to improve the population’s health so must we as public health providers and students through utilizing all the tools of the past and creating innovations for the future. History shows us that the work of public health is never done, it is just beginning.

We learned so much today on our first walking tour of London! After, we headed to South Bank for a boat tour on the River Thames and a spin around the London Eye.  Both of these experiences gave us the opportunity to think more about 1850’s London and what it must have been like for people living at that time. Stay tuned for the next UAB SOPH blog post where we will be heading to Bloomsbury to explore the British Museum.  Also, if you are not already, make sure you are following us on the SOPH’s Instagram where we are taking over and posting throughout our travels.

Peace, Love, & Go Blazers
Jane Vines, Jonathan Baker, Jamia Haynes & Cassidy Stoddart

We have arrived in London!  After a long flight across the pond, we boarded a coach with Dr. Aaron Hunter.  Dr. Hunter is an evolutionary palaeoecologist at Cambridge University focusing on the “history of science.” You can find out more about Dr. Hunter on his website at AFossilHunter.com. 

Dr. Hunter took us on a tour of central London giving us a great orientation to the city and its history.  We were able to see and visit important cultural sites including the Palace of Westminster (Houses of Parliament) and Big Ben, Westminster Abby, Buckingham Palace, St. James Park, Hyde Park, Kensington Palace, etc.  We learned about London’s extensive royal parks and greenways and discussed how important these are to those living in the city.  We even drove over the Waterloo Bridge, where Georgi Markov, a Bulgarian dissident writer, was assassinated in 1978 after being stabbed in the leg with an umbrella containing the lethal poison ricin.

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Driving around London, we noticed many road and sidewalk improvements underway in preparation for the Queen’s Platinum Jubilee early next month (Similar to what we have seen in Birmingham ahead of the World Games.)  These improvements will enhance walkability and safety, as well as improve overall neighborhood conditions in Central London.  Several students during the tour commented on how “clean” and free of rubbish the streets and sidewalks of London appear.  Dr. Hunter explained that British and neighborhood communities in general pride themselves in keeping common areas clean.  “It is part of the culture,” explained Dr. Hunter. 

Once we were settled into our hotel, our home base for the next few days, we were off to the Cote Kensington, a nearby restaurant for a welcome dinner.  After an excellent meal, we returned to our hotel for a much-needed rest, and to prepare for the next day!

Lisa McCormick and Meena Nabavi

After three years of planning (and many delays due to the COVID-19 pandemic), I am happy to announce that 14 University of Alabama at Birmingham (UAB) graduate and undergraduate students are setting off to explore population health in the United Kingdom.  This blog will document our travels, activities, the people we will meet, and the things we will learn along the way.

As part of this experience, students will be traveling to both London, England and Aberystwyth, Wales.  While in country, we are planning to meet with university, government, and community partners and organizations to learn more about the structure and delivery of public health and healthcare services in England and Wales.  We will walk the streets of SOHO in London with public health experts and imagine what it must have been like to live in the city during Victorian times, before the implementation of sanitation and environmental health services.  Finally, we will learn, firsthand, about priority public health issues affecting communities in the UK, how these issues are being addressed, and strategies being implemented to advance health equity.  The sum of this experience will illustrate the interdisciplinary nature of public health practice and the need to add attention to the social determinants of health – the conditions in the social, physical, cultural, and economic environment in which people are born, live, work, and age.

Leading this trip is Lisa McCormick, DrPH, and Meena Nabavi, MPH.  Dr. McCormick is the associate dean for public health practice and professor in the Department of Environmental Health Sciences and Mrs. Meena Nabavi is a program manager in the Office of Public Health Practice in the UAB School of Public Health. 

Getting Ready

Before the students departed for the UK, they had an opportunity to meet with several public health practitioners and representatives from community-based organizations in Birmingham (AL) to learn about local public health issues and the programs and initiatives that are working to address them. These pre-travel presentations will allow students to compare issues and programs in the United States to those we will be learning about in the United Kingdom.

Monday, May 9^th

First, the students met with Dr. Meredith Gartin, associate professor in the department of Health Policy and Organization at the UAB SOPH. First, Dr. Gartin talked to students about culture and how culture can influence health behaviors and outcomes. She started by defining culture and discussed different dimensions of culture. When examining culture in a population, Jane Vines, an MPH Population Health student said “there is so much under the surface that you do not understand until you immerse yourself in the culture… that’s why immersive experiences like this course are so important.” Grace Albright, a Ph.D. student shared “What stuck out to me was how social norms are so ingrained into our culture that we don’t always think about them or even recognize them. Because culture is “learned” and “shared”, many of our “typical” health behaviors and customs are largely defined by those around us.”

Dr. Gartin then discussed her work with the Alabama Interfaith Refugee Partnership (ALIRP). We learned about common refugee populations and about those who come to Alabama seeking asylum. Dr. Gartin highlighted the difficulties, challenges, and barriers that asylum seekers and refugees have securing legal status and basic human services, including preventative healthcare.

Tuesday, May 10^th

Carrie Leland, MPA, executive director of Pathways, met with the students and introduced systematic barriers for people experiencing homelessness in Alabama. She provided several definitions of the term “homelessness” and discussed chronic homelessness and the services available in the community based on the Housing and Urban Development (HUD) definition. She also described Pathway’s programs, including their new emergency Childcare Center, which opened to mothers and children who are experiencing homelessness. After her discussion, Melissa Beck, an MPH Population Health student shared, “I was so impressed that Pathways had created childcare services for children, filling an important gap in the Birmingham community.”

 Ritika Samant, a Fast Track MPH student in Health Behavior noted after both Dr. Gartin and Ms. Leland’s presentations that “there is a trend in where public health interventions take place, especially in regards to the most vulnerable populations, which makes me wonder if there are more upstream approaches which can be implemented to address the social determinants of health.”

Dr. Amy Chatham, assistant dean for undergraduate education and assistant professor in the department of Environmental Health Sciences, discussed her rural health work in the Black Belt of Alabama, which focuses on sanitation, environmental activism, and health disparities. She described the lack of sewage treatment infrastructure in Lowndes, Wilcox, Perry, and Dallas counties (AL). People in these counties are still experiencing economic repercussions of the Black Belt’s history, and as such, there is not a tax base to support establishing basic environmental services that are important to keeping a community healthy. Dr. Chatham shared that people who live in rural Alabama have deep roots and ties to the region. Jonathan Baker, a public health undergraduate student said, “the people who live in these communities don’t want to leave their home, they have generational wealth in these properties.”

There needs to be more activism and action in these communities so that these problems will be addressed. Jane Vines summed it up best, “These are their homes, their history, and their heritage.. people in these communities shouldn’t have to leave to live.”

Later in the afternoon, students visited the new location of UAB’s 1917 Clinic at Dewberry and met with Kachina Kudroff, the prevention programs manager. Ms. Kudroff provided an overview of HIV in the United States, focusing specifically on the Southeast. Ms. Kudroff Kachina shared basic information on HIV transmission and prevention, discussed current treatment options and the importance of viral suppression, and challenges and barriers to accessing treatment for those living with HIV. Several students shared that they were impressed with the multidisciplinary approach to patient-centered care at the 1917 Clinic and how multiple services are co-located in the same building.  Maya Van Houten, an undergraduate public health student observed, “The 1917 Clinic is a one-stop-shop, where people can access needed services in one visit at one location in one day.”

Next, we visited with Karen Musgrove, Ph.D., CEO, and Josh Bruce, MPH, Director of Research of Birmingham AIDS Outreach or BAO. The mission of BAO is to enhance the quality of life for people living with HIV / AIDS, at-risk, affected individuals, and the LGBTQ community through outreach, age-appropriate prevention education, and supportive services.   BAO is able to accomplish this mission through several programs including the Magic City Wellness Center (which provides wellness and medical for the LGBTQ community), the Magic City Acceptance Academy (which facilitates a community in which all learners are empowered to embrace education in an LGBTQ-affirming learning environment), the Magic City Research Institute (improving the health of and service delivery to people with HIV, the LGBTQ community, and other underserved populations through collaboration, research, and evaluation), the Magic City Acceptance Center (provides a safe, supportive, and affirming space for LGBTQ young adults and their allies providing weekly supportive and social services to the LGBTQ community), and the Magic City Legal Center (provides legal advocacy for LGBTQ communities and community members impacted by HIV).

The students will leave Birmingham on May 12th and return on May 24th and will be blogging most every day!  Make sure you bookmark the blog and follow our adventures!

– Lisa McCormick and Meena Nabavi