Community Engagement – Lister Hill Center for Health Policy

Boldly Opening Doors to Better Chances and Improved Healthcare

A BOLD grant was awarded to a program by MedsPLUS in collaboration with the Lister Hill Center for Health Policy and Jenkins Public Health Consulting.

By Miriam Calleja

The Building Opportunities for Lasting Development (BOLD) grant awarded by The City of Birmingham’s Department of Innovation and Economic Opportunity (IEO) accepts proposals from organizations, businesses, and public or private entities to provide programs or services to promote economic development to Birmingham residents. IEO aims to foster an ecosystem that thrives on innovation and opportunity. They provide resources to nurture talent, establish infrastructure to support the growth of women, minorities, and disadvantaged businesses, and focus on developing small businesses. Now in its sixth year, the BOLD funding program aims to create partnerships with community organizations that share IEO’s vision of making Birmingham a model of an inclusive and resilient economy.

BOLD’s objectives include overcoming barriers in development and prioritizing certain geographic areas that are deemed disadvantaged and that may often be overlooked. Working with data-driven and innovative approaches, they aim to provide funds for sustainable development.

One of the grants this year was awarded to MedsPLUS Consulting, an independent pharmacy and healthcare consulting firm that has a history of serving minority communities in Birmingham, particularly those who feel they have been mistreated and marginalized by mainstream healthcare and government systems.

The BOLD grant will provide finances for a two-pronged approach.

Three individuals will be trained to become community health workers, and a diabetes education service will be set up for sixty Birmingham residents. The project aims to overcome various barriers to employment opportunities by training workers to become pharmacy technicians who specialize in diabetes management while also setting them up for employment, which includes instruction such as resume writing and LinkedIn profile setup. It also targets the education of diabetes patients themselves.

The collaborators in this project are Dr. Dashauna Ballard, a Postdoctoral Fellow at the Lister Hill Center for Health Policy at the University of Alabama at Birmingham (UAB) who did her Ph.D. in Health Education and Health Promotion, MedsPLUS Consulting, and Jenkins Public Health Consulting (JPHC).

Dr. Dashauna met Dr. Pauline Long and Dr. Jennifer Campbell from MedsPLUS Consulting by chance over a year and a half ago at a Birmingham city meeting. Since then, they’ve collaborated and applied for a few grants together. They were able to prepare two scientific presentations when Dr. Pauline and Dr. Jennifer had the idea of a pilot program to offer a culturally-tailored diabetes self-management, education, and support services to the public. According to the American Diabetes Association, diabetes is a significant problem in Alabama, including Birmingham. Around 15% of Alabamians have diabetes, and less than 7% of people with diabetes have any formal diabetes education.

Overcoming Barriers

Dr. Dashauna set out to investigate the barriers that patients with diabetes face when taking care of their disease. She was able to boil it down to three main barriers. Even though diabetes education is available at health centers, hospitals, and doctors’ offices, many patients are not taking advantage of what is available. For many patients, the biggest hurdle was physically getting to the appointments, especially if they lived in the suburbs or couldn’t get into the city to be present for their appointments. Parking and transportation were the second type of issue they faced. Thirdly, there was a lack of knowledge on the accessibility of diabetes education. It became clear that diabetes education needed to be available closer to home. And so, for example, the service could be accessed from libraries within the community if these were found to be active sites in the chosen neighborhoods.

This is when their third collaborator, Jenkins Public Health Consulting, will come in. Brittaney Jenkins, CEO at JPHC, is a Certified Health Education Specialist and Public Health Practitioner who will engage and communicate with the specific community. This is a crucial step in detecting where help is needed most. They will assist in recruiting individuals for the health worker program and engage the community to recruit participants for the diabetes education sessions.

To conduct this pilot study, MedsPLUS culturally tailored a standardized program by the Association of Diabetes Care Education Specialists (ADCES). As part of the norms for the project, Drs. Jennifer, Pauline, and Dashauna agreed to have participants address them by their first name as a means of building rapport and trust in the communities for which they will be working. Dr. Dashauna and the Lister Hill Center for Health Policy then translated their pilot program work into research presented at scientific conferences. Dr. Dashauna completed the background research and processed the literature review so that the information obtained through the program could be published.

The project aims to get several research publications that will establish evidence-based benefits from their pilot program and then scale it up to help more people across the state of Alabama. The background research found evidence to justify the project’s structure and methodology. When the program launches this January 2024, Dr. Dashauna will oversee the data management, the quality of data collected, and how that data is reported. Her role is to ensure success, i.e., that the project achieves what it sets out to do so that more patients with diabetes can be educated and empowered, and more health workers can be set up to work in the field.

Better Opportunities

The three community health workers will be chosen from the Birmingham area. They will benefit from a twelve-month apprenticeship to get health worker training and become licensed pharmacy technicians by the end of the program. MedsPLUS will then either employ the workers or set them up for meaningful employment elsewhere in the same field. While no healthcare background will be required since MedsPLUS will be conducting the training, the individuals will be chosen on criteria that assess their soft skills, an essential and sometimes overlooked aspect of healthcare.

“This type of apprenticeship will allow them to see the community health worker side and the pharmacy technician side and to get professional development so that they can go on to do what they would like to do,” said Dr. Pauline, referring to the case study they made for their grant, of a young recently-graduated high schooler from one of these geographical areas, who is not sure what to do next in career terms.

The training will be conducted by Connection Health, a non-profit organization that recruits, trains, and deploys community health workers. When the individuals have completed 120 hours of training and become entry-level health workers, they will start their diabetes training through the Association of Diabetes Care and Education Specialists (ADCES). These two phases will prepare them to go into communities and assist pharmacists or diabetes educators with facilitating their courses. In the fourth quarter of 2024, they will undergo professional development training to get their pharmacy technician license.

A Promising Future

This project is an excellent example of how community engagement can help change different populations’ health prospects. By coming together, the Lister Hill Center for Health Policy at UAB, MedsPLUS Consulting, and Jenkins Public Health Consulting have employed their specific skills to improve countless people’s lives through skilled outreach. This robust program is a promising start that will elevate the quality of life of many. And this is just the beginning. Once the research shows improvement, the three players can scale their program to help more individuals across Birmingham obtain health worker training and control their diabetes for improved health.

Cool Green

Ariann Nassel, our Director of Geospatial Data Visualization, partnered with Cawaco RC&D Council and The Nature Conservancy in 2020 to develop Cool Green: Healthy Greening and Stormwater Opportunities for Jefferson County, Alabama. This web map application assisted representatives of the broader Cool Green project by providing an interactive narrative that eventually led to the Jefferson County Department of Health funding a public health improvement program in targeted areas that would benefit from planting trees. These areas predominantly have populations that are at risk of being negatively impacted by extremes in day and nighttime temperatures; trees will help to mitigate the effects of urban heat in these areas.

Check out the project by clicking this link!

Why Are You Yelling? – The Significance of Protests

January 31, 2020 by Sara Harper, LHC Student Intern

Intro

Last Saturday, January 25th, I participated in an anti-war protest, organized by the Birmingham chapter of the Party for Socialism & Liberation, in response to political strife over the assassination of Iranian General Qasem Soleimani. As the rally ended a passerby approached to question the group’s intentions. He commented, “I just think there are better ways to get your message across, because this,” he motioned to the group surrounding him, “is going to burn out.” His comments weren’t unfounded; social movements can fizzle without a strong group organizing and keeping advocates accountable. Regardless of the outcomes, protests have been essential to the formation and vast changes America has undergone throughout history.

It Isn’t Just Yelling

Sure, people who protest seem pretty angry. We are! Protesting is the most outward and public way that advocates can voice opinions on the platforms they feel passionately about. However, public protests are only one tool in the advocacy kit. Protesting is by no means the end-all-be-all to any movement; it just happens to be the loudest and most visible form of advocacy. It’s easy to overlook the organizing power behind rallying a large group of people who are willing to stand in solidarity against whatever they believe to be unjust. Protests are the metaphorical tip of the iceberg for advocates who spend the majority of their time planning, recruiting, and participating in hands-on work related to their movement.

Legislative Significance

The right to protest is not explicitly mentioned within the first amendment but has historically been covered by the right to assembly and the right to free speech. The first amendment gives American citizens the legal protection needed to organize and publicly voice their grievances. The broad nature of the first amendment protects all forms of voicing dissent, including hate speech such as the antisemetic chants heard at the 2017 Unite the Right Rally in Charlottesville, VA. While these views are not generally accepted, they are still legal to express in a public forum per the first amendment.

The first amendment usually supplies protections to more vulnerable populations who choose to speak out against injustices. The right to protest has been exercised by a myriad of labor unions and other workers’ groups who withhold their labor in order to force management to implement changes in wages, safety laws, or equality in the workplace. Major advancements in civil rights, women’s rights, and LGBT+ rights – and the laws now in place – have only happened because of large scale movements, organized by the people within these communities.

Social Significance

Protesting is a socially significant route to spread information and increase general awareness on topics, not only in America but beyond our borders as well. Protests typically garner media attention which, in turn, exposes a higher percentage of the population to said topics. Media can bolster a movement to numbers the organizers never expected. However, large movements can be seen as aggressive to the local governments who funnel resources towards dismantling the movement organizers. An example of this includes the FBI’s involvement with targeting prominent members of the civil rights movement, including (but definitely not limited to) Martin Luther King Jr. and Malcom X. Government involvement in the dismantling of social movements has a history of escalating situations like the Kent State Massacre in 1970, when authorities opened fire on students protesting the Vietnam war. The shootings resulted in four deaths, nine injuries, and an increased sense of distrust between the government and distressed citizens. Relations between police and protestors were escalated in 2014 during the Ferguson Unrest following the police shooting of Michael Brown. As we move forward, protests have become the forefront of fighting for social justice and voicing dissent against oppression. However, those in power who would rather maintain the status quo retaliate in their own way. This is the ultimate caveat of protests: Rarely does progress happen without fighting against a forceful hand.

Movements and Momentum

The United States will likely never be protest-free; the only reason we exist as a country is because we protested an imperial power and won. The last four years have seen some of the largest protests in American history, with some estimates showing 4.6 million people participating in the 2017 Women’s March! As long as we continue to recognize (and subsequently utilize) the power of organizing and the power of protests, we will continue our American tradition for generations.

The role of private sector in public health

April 23, 2020, by Aarin Palomares, Deputy Director, Global Handwashing Partnership (FHI 360)

There is often a misconception that the private sector has no role in public health. However, the private sector can be a valuable partner in addressing poverty, injustice, and inequality around the world. Especially in times of crisis, companies work in tandem with governments, public authorities, and other stakeholders to address public health issues and support sustainable systems.

The novel coronavirus (COVID-19) pandemic has created a humanitarian and economic crisis and provides a call to action for stronger and more resilient public health systems. Government leadership is crucial – that we know. However, companies and civil society organizations also play a vital role in working together to respond to this immediate crisis. For two years, I have worked for a public-private partnership housed at FHI 360. Private sector engagement, especially through public-private partnerships like the Global Handwashing Partnership, can play a significant role in developing both immediate and long-term solutions.

The business case for public health

faucet soap hand washing fountain preview There is a clear link between tackling public health issues and business motivations. Despite global progress, 5.3 million children died before the age of 5 in 2018. Diarrheal disease and pneumonia remain two of the biggest causes of child mortality, yet research suggests the simple act of handwashing can reduce mortality by up to 50%. The social issue is clear: too many children die before their fifth birthday. The business opportunity is equally clear for businesses like P&G and Unilever; both soap manufacturers are partners of the Global Handwashing Partnership.

Companies are often quite transparent about their commercial interest in tackling a social issue. The reality is that they need to be. As you can imagine, it can be difficult to portray these two objectives – saving children and increasing profits – without some resistance from those with a strong social public sector background. However, this transparency builds external credibility and the reassurance that these companies are invested in this issue beyond publicity. Because hand hygiene is inherently engrained in their business ambitions, it naturally aligns with their social goals.

The social case for private sector

Public-private partnerships provide an effective model for handwashing programs because they combine the health objectives of the public sector with the marketing and supply chain expertise of the private sector. While the private sector stands to gain market expansion, the public sector gains from resources of the industry. In the current context, for example, companies are leveraging their current supply chains to provide access to water, sanitation, and hygiene (WASH) through their products, laboratories, expert advisors, and key workers who are providing essential public utility services.

Moreover, through their social impact missions, companies can play a major role in developing and sharing rapid solutions with households, frontline health workers, and policy makers. Most recently, Colgate-Palmolive, Essity, P&G, and Unilever worked with public sector partners to develop communications materials in response to the growing need for WASH-specific guidance around COVID-19. This idea that a large company helping marginalized and vulnerable communities may seem foreign, but using local brands that communities know and trust can be an accepted approach to educate them about a topic like hygiene.

Reflections from a public health perspective

Over the past two years, I’ve grown to appreciate the value that private sector partners have to offer. Based on my experience, here are some of my thoughts on the role of the private sector in public health:

Broad coalitions are necessary to provide coordinated and unified programming. Coalitions that connect community networks, such as schools and community organizations, provide a mechanism to amplify messages and strategies to reach all individuals, even the most vulnerable. The Kenyan National Business Compact on Coronavirus is a good example of how these coalitions can support and amplify the work being done by the Ministries.
The private sector has a voice. Harnessing the power of private sector brands can achieve immediate impact. Most recently, the private sector constituency of Sanitation and Water for All called on all governments to take the lead and prioritize WASH during and beyond the COVID-19 pandemic.
The role of the private sector is crucial, now more than ever. To help countries solve their own development challenges, USAID developed a policy framework called the Journey to Self-Reliance. This calls for innovative financing beyond the more traditional aid mechanisms. Private sector engagement is essential to this framework.

Engaging with the private sector may be key to the innovative and sustainable solutions we often seek. Whether we like it or not, the private sector has a growing role in public health and human development, and perhaps they are doing more good than we give them credit for.

Reflections on Jury Duty and Civic Obligations

September 26, 2019 by Suzanne Judd, LHC Director

A few weeks ago, I had that wonderful American privilege of being selected for jury duty to the 10th Judicial Circuit Court of Jefferson County, Alabama. I say “wonderful” tongue-in-cheek since, like most of the people I was chatting with in the Jury Assembly Room, I had no desire to be there. Parking was a nightmare. They simply don’t have enough spots for the 400 jurors that were summoned to downtown Birmingham for the shot at being selected to sit on a jury. This was my second time in three months coming on a Monday morning to wait to see if I would be selected for a jury. Three months prior, I was dismissed because I had not lived in Jefferson County continuously for a year due to a six-month commitment in France. The disqualification didn’t make sense to me. Luckily, I was back 90 days later to try again. And this time, it was even better because Law & Order was on the television to keep me entertained while waiting. No lie!

Before jury selection began, we sat through a 30-minute explanation of what a great honor it is to be selected as a juror. The judge described how unique we are as Americans to be allowed to serve as jurors. In most countries, citizens do not decide the fate of other citizens. He described the jury selection process in Alabama, which is basically tied to being a registered voter. Really? Given all we know about voter suppression in Alabama, one can only assume the same factors affect the juror selection process. This was a fact that was tough for this former Michigander to digest since Michigan uses driver’s license lists to generate juror pools.

As I sat looking around the room, I wondered why I can’t, as a voter, be randomly selected to sit down with lawmakers for a week to express ways to improve society rather than sitting here waiting to be selected for a jury. My registering to vote enables me to sit on a jury to decide another human’s fate but does not provide me with the random chance to meet with the people for whom I voted? Honestly, I would rather sit down with one of my elected officials for one week. Nevertheless, I suppose jury service is important even if that means sitting and waiting.

Since I spent hours waiting, I began to meditate on the process for influencing elected officials to create and implement policies. At times it can seem like citizens don’t have much input. We can call, write, or email our representatives but that always seems so impersonal. Layers of bureaucracy obscure the tangible results of those efforts. If we want to occupy the same space as a candidate, there are town halls and debates but often those feel staged, lacking a real human connection between you and the candidate or elected official.

So where does that leave the average American who wants to be more involved? Advocacy is one of the key tools to ensure the laws our elected officials pass and the ways in which they spend our collective money are more representative of what we want as a people. Beyond simply contacting elected officials, an individual can advocate for their opinion by signing petitions, funding advocacy groups, and constantly pursuing information to stay educated about a variety of topics that face society. Advocating can lead to policies that mold society into something that is more reflective of what the majority of people would like to see.

On the upside, jury duty begrudgingly provided me with needed time and space away from the daily grind to think my own role in influencing laws and policies. I also began to wonder what was on the mind of others. So, in the absence of a random lottery system that grants me access to my elected officials, here are some areas of health policy that seem quite timely:

What are you doing? Let us know; we would love to hear from you.

Are there Dental Access Issues in Alabama?

November 4, 2019 by Conan Davis, DMD MPH

Do we have any issues to be concerned about regarding access to dental care in Alabama? Everyone has a dentist who can see them on short notice if they need, right? Wrong.

If you live in Birmingham or in one of the larger cities in Alabama, you might not have a problem being seen on short notice – particularly if you have dental insurance or out of pocket cash for treatment, but if you live in smaller towns or rural areas in our state, you might not be so lucky.

Alabama currently has only one county without a dentist: Greene County. However, about 80 percent of all the dentists practicing in Alabama practice in the 13 most urban counties. The other 20 percent practice in the 54 non-urban counties of Alabama; many of these smaller counties only have between one and three dentists. This translates to about one dentist for every 1800 people in the urban areas, versus one dentist for every 4100 people in the non-urban areas – a big difference.

This is the subject of a paper Dr. Stuart Lockwood and I are developing and hope to publish with the Lister Hill Center for al dentists.png Health Policy in the next few months. Dr. Lockwood and I are both former State Dental Directors with the Alabama Department of Public Health. We both have examined the teeth of thousands of children in Alabama to assess the state of dental decay and to make referrals to local dentists. We have seen many with excellent dental care and many without any need for treatment. However, we have also seen the evidence of neglected dental needs in many children. An even larger concern we have seen is the lack of access afforded to low-income adults with no dental insurance and no public dental coverage in Alabama. We will cover that connected subject perhaps in another post.

Dr. Lockwood and I have been engaged in studying the underlying issues for our widening gap between urban and non-urban areas concerning dental care access for many years. We developed a partnership between UAB School of Dentistry and the Alabama Dental Association to develop a strategy to correct the disparities we found in the more rural areas of the state.

Through this partnership, we wrote and were awarded a grant to do several things in this area. One was to take the available data on dental practices in Alabama and with the help of the UAB School of Public Health develop a GIS map detailing where all dentists’ practices are located in Alabama. The grant also allowed for rotation experiences in rural areas for dental students as a way to allow them to see dental practice life in these areas. We also provided significant financial awards to a few graduating dentists who agreed to practice in a rural area and also agreed to see a certain percentage of Medicaid patients for a specified number of years. Graduating dental students can have very significant school debt, and this was designed to assist them with that debt and help them establish a practice. The grants were planned to help “plant” dental offices in nine rural areas needing a dentist. Nine such practices came about through this grant program and they have successfully continued in those areas to this day.

I’ve worked with Dr. Lockwood and the state dental association on language presented to the state legislature and the Governor’s office for consideration of a similar state-based financial incentive program for new dentists willing to locate in a rural area. We hoped this would also encourage young dentists to choose a smaller town or rural area in which to practice. While all our legislators were favorable to the concept, funding has not been significant just yet. We continue pursuing this possibility.

Another issue regarding distribution of dentists involves the current ages of dentists in the rural areas. We will discuss these findings in some detail in our upcoming paper.

So – to answer the question, “Is it easy to find a dentist to see you on short notice anywhere in Alabama?” – no. However, many of us are engaged about this concern and working towards positive solutions for all Alabamians. We hope to be able to answer my question in the affirmative in the near future!

Conan Davis recently retired from his position as Assistant Dean for Community Collaborations and Public Health at the UAB School of Dentistry. He continues to research the inequities in access to dental care across Alabama.