Title: What is Health Equity, Anyway?
Host: Alexandra E. Samarron
From the Southwest Health Equity Research Collaborative and the Media Innovation Center at Northern Arizona University, this is Fairness First, a podcast dedicated to exploring issues of health equity in the Southwest – with a special focus on health equity in Northern Arizona. Here, we believe that good health starts in our homes, neighborhoods, schools, work, and other places that we find ourselves spending time in our communities. Most importantly, everyone deserves a fair opportunity to be as healthy as possible in their community despite where they live. I’m Alexandra Samarron, your podcast host.
The Southwest Health Equity Research Collaborative is a grant-funded initiative of the Center for Health Equity Research at NAU. We are researchers who want to build awareness about the social issues impacting the well-being of communities in the Southwest. In this podcast you’ll be able to hear researchers and community leaders talk about community programs and research projects dedicated to create healthier, inclusive and equitable communities.
What is Health Equity anyway?
On this episode, what is health equity anyway? we’re going to break down the term ‘health equity.’ Maybe you’ve heard this term on the news, at work, or maybe you’ve never heard about it, and that’s okay, we got your back. Later, we’re going to hear from researcher, Dr. Samantha Sabo from the Center for Health Equity Research at NAU to help us define health equity. But first, we turned to our community to learn from their point of view what are the ingredients to make a healthy community and what ‘health equity’ is [TRANSITION MUSIC].
[Short interview with Olga, Flagstaff community member]
OLGA: Pues para empezar no se que quiere decir equidad, quisiera saber que significa equidad para poder responderte la pregunta correcta, entonces qué significa equidad, sabes tu? Para que me digas? [LAUGHS].
HOST: To begin our podcast, we turned to our community to learn from their point of view what are the ingredients to make a healthy community and what ‘health equity’ is. You were listening to Olga, a Flagstaff Community member who has experience first hand health challenges as a product of gentrification and housing inequality in Flagstaff. With a smile on her face, she said that to begin with she doesn’t know what equity is and asked me if I knew. I attempted to explain what health equity is, and believe me this was a rough process. I stumbled and it took me some time to think of examples. Finally, i got it and Olga began reflecting on her own experiences in relationship to health equity and she said…
OLGA: Pues te voy a contar una experiencia que pase hace este años.Yo sufría mucho de dolores de cabeza hiba al doctor seguido porque pues necesitaba medicamentos cuando me encontraron un tumor en el cerebro me dijeron que pidiera ayuda a ahcccs para poder aplicar y recibir una operacion y remover el tumor.
HOST: Years ago, Olga began to experience intense headaches. She kept going to doctors appointments and taking medication; until finally medical providers found a cerebral tumor. Then, she was told to apply for ahcccs to get surgery and remove the tumor. She went to ahcccs and she was not able to apply due to being an immigrant and for not having any dependents.
OLGA: Seguía yo con los dolores de cabeza y entre en un momento que ya no me aguante y pues me operaron gracias a dios pero ahí en ese momento digo donde esta la igualdad o el mismo derecho, soy ser humano.
HOST: Olga said that her headaches kept coming up, she couldn’t tolerate the pain anymore, and had to go into the emergency room and get surgery, but in that moment she asked herself, on quote “where is equality or having the same rights as others, I am a human being. Personally, I felt discriminated against simply for being an immigrant.”
HOST: Before ending the interview, Olga wanted to share another of her experience connected to inequity.
OLGA: Vivíamos estables en una comunidad era un lugar muy tranquilo vivimos ahí por muchísimos años hasta que llegó una carta de desalojo tuvimos que perder nuestros hogares y de ahí empezamos a vivir demasiadisimo estrés, todas las familias.
HOST: In November of 2018, Olga and her family received an eviction notice. Olga said that they lived in a very stable community, and a peaceful place for many years in Flagstaff. Until they had to lose their homes. After having to leave her community, Olga said that many of the families began to experience high levels of stress, and illness. Olga explained that she noticed those highly affected by stress and illness were women. She thinks because most of them, and this is including herself, kept organizing and fighting to keep their homes, but just like that, they were taken away.
OLGA: En el tiempo que estamos viviendo ahorita Flagstaff se está sobrepoblando demasiado y pienso que en Flagstaff están haciendo solo dormitorios para estudiantes, para personas individuales no para familias entonces ahí tiene que ver mucho la salud porque como familia tratamos de buscar un lugar donde nos vamos a meter con nuestros hijos y con nuestra pareja…
HOST: Olga said she thinks that right now Flagstaff is over-populating a lot and she said that there’s a lot of housing being built only for students, for individual people, but not for families, and so she thinks that health is connected to that issue because families, she said, try to find a place to live with their children and partners.
HOST: To conclude our conversation Olga said on quote, “if we work on a health project it should focus on the well being of families and families having access to a safe place to live so then this is what health equity means to me.” [TRANSITION MUSIC]
[Short Interview with Julio Quezada, Clinic Manager at North Country]
JULIO Q: if there’s access to health care if there’s access to insurance you know even transportation I think there’s so many things when it comes to what makes a community healthy. I think sometimes people could look from the outside in and say wow that’s a really unhealthy community. And the people there that are really working to make it you know a tight knit place could actually feel the opposite. They could feel you know community pride they could feel like there are some resources and things going on. I think in general if you ask anybody at any socioeconomic status I think we all kind of have an idea on what is healthy. But then there’s barriers to getting to that point or reasons why you’re not making those choices.
HOST: We Interviewed Julio Quezada, Clinic Supervisor for the North Country Health Care integration Clinic and the Mobile Medical Unit available at homeless shelters in Flagstaff.
JULIO Q: health equity I mean I can honestly say that I’ve never really heard of the term, but as far as equity I mean the biggest thing is just making sure that everybody kind of has the same benefits and access to reaching optimal health you know making sure that you can get to the doctors making sure that it’s available making sure that you feel welcome there. You know at North Country we definitely we have the sliding fiscal program that helps people that are uninsured. But then what happens when you have to refer that individual to a specialist.
HOST: Access to affordable care was an issue Julio pointed out to describe health equity. He said that in his experience, some patients may not have access to health insurance that would allow them to afford more expensive health care services like surgeries. Julio also added there may be other individuals who do have access to health insurance to cover more expensive services. In this case, according to Julio when we talk about health equity, there’s a need to balance access to care among different populations.
JULIO Q: We don’t put ourselves in other people’s shoes and say you know what does that person not have that I do have. And so you know it kind of it changes from like equality because equality would be everybody has the same thing. if I don’t have free health care service and nobody else gets free health care or access to the health care but it’s how do we how do we make it equitable where it could be similar for everybody across the board.
[Short Interview with Darrell Marks, Flagstaff Highschool Native American Counselor]
DARRELL M: So starting with the family and community what makes it healthy for me is communication and respect and understanding the relationship with one’s self and their environment and how that individual or community would promote wellness. And that wellness could be in how we speak to one another the ways that we’re listening.
HOST: That was Darrell Marks. He’s an academic advisor for Native American students at Flagstaff High School. He believes a healthy community is one in which diversity is honored and regarded as a strength. Are the histories, values and voices of historically marginalized groups in the community, being heard and included into the community’s policies and programs? Are community leaders questioning who is given a platform to speak and who isn’t? this also translates to his work with high school students …
DARRELL M: I need to be ready to support and help guide them to the resources that are needed to address all of the their other needs all of their other health requirements so that we can get back to the focus of this is your academics and we want to make sure that we’re promoting that excellence in you and then supporting you to to achieve your best.
HOST: As for health equity?
DERRELL M: Health Equity for me translates as an individual’s mental social emotional physical and spiritual well-being being honored and recognized that that equity means that if an individual holds those four aspects of their being the emotional the mental as the physical and the spiritual as an important part of their being that they’re afforded an opportunity to care for that.
Debunking Health Equity: Dr. Samantha Sabo
So we’re trying to break down the idea of health equity. There have been many attempts, especially within the public health sector to define health equity. According to the Robert Wood Johnson Foundation health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education, housing, safe environments and health care. Now, we’ve invited Dr. Samantha Sabo who is a researcher with SHERC at NAU. She has experience examining the social and political context of chronic disease among immigrant communities. Her experiences related to topics of health equity can help us understand what health equity work looks like, and define concepts like health disparities and the social determinants of health.
HOST: Hi, Dr. Sabo. Thanks for being here with us.
SAMANTHA S: Thanks for having me, Alexandra.
HOST: Nice. Yes, we’re excited to have you. So Dr. Sabo, before we start to talk about health equity, could you they define what health disparities are and what are the social determinants of health for those of us who do not know what that is.
SAMANTHA S: Sure. And there’s a lot of jargon in public health. So health disparities are it’s really simple, it’s just the differences between death. Disease and other conditions health conditions between populations. So all health disparities are is that there’s a difference between the two groups of populations. That’s really what that is. The social determinants although are all of those things around us in which we live grow work learn to play that make it possible for us to be healthy or make our health worse. And those are the things that can predict many times how healthy you’re going to be able to be or not be.
HOST: Based on your work and experience can you define health equity and could you tell us what connects you to health equity work and what makes it meaningful for you at a human level.
SAMANTHA S: Sure it’s such an important question. So when we think about how disparities that’s really describing something it’s a script describing a difference and then the social determinants of all the things that make those differences Health Equity takes it to a whole other level and asks why those differences exist in the first place. So I sometimes define health equity by defining health inequity right. So if you think about those things in our lives in our society that exist that are systematic they’re unfair and they’re unjust. These things can be policies they can be procedures programs. Oftentimes we think of them as social inequality. So things in our society that make certain populations have better health outcomes and certain populations have worse health outcomes. So health inequity and a health equity lens really ask those questions of justice and why these disparities exist. So if you come from a neighborhood that has all of the resources and accessibility abilities to quality schools and quality parks and recreation and opportunities to live and thrive in an economy where your job is you’re paid fairly and it’s got opportunity versus in a neighborhood maybe that hasn’t had that much investment that doesn’t have a lot of job opportunities that the school systems may not be what they should be. So those questions of inequity get to you can start to ask those questions of why those inequities exist and how do you start to unravel them for us to be able to figure out how to. Level the playing field and create opportunities for people to live their best life.
HOST: Dr. Sabo also shared that at the age of 16 growing up in California and the San Joaquin Valley, she remembers living in a nice neighborhood and going to suburban schools, but around her and all within her community, there was another operating system. A large agribusiness industry paired with the labor and day to day lives of migrant farmworker families. It was until she worked as a grocery bagger that she had the opportunity to interact with many migrant farm workers visiting the store she worked at. Here she engaged in conversations and learned about migration stories of why people leave their own country to come to the US and make a living for their families. Her experience growing up in a farmworker community lead her to be committed to working with farmworker families in the U.S. to solve issues of health inequity.
SAMANTHA S: That was really a profound experience for me to be able to hear the stories of a tremendous overcoming of adversity of the human condition at a very early age and I became extremely committed to that population given I was in California and migrant farm worker labor was really around me. That’s what I liked to do. That’s what I wanted to do I wanted to connect on a very human level as you say to be able to understand from their perspective what it was. What were the solutions that they had in mind to to resolve whatever issue was going on for them and that issue might have been in health issue. All right. But as we talked about the social determinants all the things that surround health the quality of your housing and where are my kids going to go to school. How am I going to pay my light bill ls and how am I going to get to the doctor because I’ve incurred an injury at my job. All those things I wanted to understand and I really wanted to work really hard alongside the individuals that were experiencing those disparities. So that’s what connected me at an early age. And so then coming from California and being able to come to Arizona and be in the U.S. Mexico border region and be in very rural spaces here in Arizona having the wonderful opportunity to be surrounded by 22 Native nations who you know I feel very honored to be able to work alongside to figure out what to do together.
HOST: Yeah. No that’s wonderful that you kind of ended on that note. I’m thinking about especially in research thinking about how to do health equity work and how to work in community and with especially with those directly impacted by home equity. So it kind of follows into our next question which is how important do you think the differences in power especially in research. How do you think those differences in power are important when working in community and conducting health equity work.
SAMANTHA S: Power you can define it as who’s at risk to lose what and who’s not risking much at all and in research I can you know move through spaces that allow me to ask questions. I will always have a paycheck. I’m protected ultimately in conducting my job which is to do research when I work with community members who don’t experience that level of privilege or that level of opportunity to be protected and safe when asking important questions around social justice or the whys behind why is this the way it is. I think I’ve learned over time to just operate with extreme care and humility and. Compassion and I oftentimes don’t take the lead in certain things so I have my skill set. I have my my little research skill set toolbox that we all bring to the table. But my philosophy of doing health equity research is to be led by community members who are the experts in the room and who should hold that power to be able to say how we’re gonna move when we’re gonna move and what topic we’re going to explore together. Versus me in my office with my own ideas of what’s going on in the world and making something up and deciding this is what I’m going to do for you without ever consulting whether or not you wanted me to do that thing. But I think race related to your question when you’re trying to engage individuals who have experience you know systematic unjust unfair practices for their entire lives and then you’re engaging in a conversation about justice and rights and power you have to go in with knowing that you don’t know anything that you have a small skill set and you are there to learn and you’re there to serve.
HOST: Once Dr. Sabo helped us understand how differences in power may look like in research, she also explained that when engaging in conversations of power when working in community, health equity values such as humility, intentionality, transparency, trust, and mindful language are fundamental in conducting health equity work.
SAMANTHA S: So I don’t have a recipe for any of this but I think building trusted relationships is one of those one of those key qualities or elements that you’d want to try and explore and building trust is a long term commitment. I think as researchers we get so excited and we want to help in so many different ways and sometimes that leads to over promising or creating expectations that might not be able to be realized given what we know about our society in general and the way that resources are distributed, it takes a collective it takes long term commitment it depends, like some some research projects or with organizations who are serving individuals experiencing health disparities. So when I work with the agencies or organizations like a public health department or a nonprofit or a health care center, there’s different types of conversations that you would have with that organization because it’s institution to institution so it’s figuring out how best to coordinate services or coordinate a project that is going to benefit or impact a population experiencing health disparities.
HOST: I think especially when working with directly impacted community members. Yes you have to rethink how you’re going to talk and how you’re going to. Move through space and just build those connections. It just looks very different. And I think that’s the that’s kind of the purpose with this podcast is to really think health equity beyond academia and know that it happens to people every single day and that’s part of their lives and inequity. It’s very present. And so how can we engage in conversations that are more inclusive and more approachable, and that’s what we want. So it’s exactly what you’re talking about.
SAMANTHA S: In health equity research it’s not enough just to know you have to act. You have got to have a sense for what you’re doing has to. It has to make something shift. And I think if I don’t have that mindset going into something and we’re not having those conversations early on, then we could lose our focus and we could lose our eye on the prize. Because a lot of what we do can impact policy it can impact the ways that the everyday way things are done normally. We can change these processes through through research and sharing that research in ways and putting it in the hands of people that can do better in the positions of power to be able to make decisions about what it is that needs to change to make people healthier.
HOST: In this episode, Dr. Sabo helped navigate a conversation about health equity. What is it? How does it look like? To finalize our conversation, she encouraged researchers, organizations and other agencies to actively work and create relationships with individuals experiencing inequity, and to build bridges across different sectors, so that we work towards healthier and more equitable communities.
SAMANTHA S: So to be able to do health equity Work and Health Equity Research. It requires us all to bridge our disciplines bridge our ways of speaking about things. Bridge our comfort zones get out of our bubbles though we think Oh we’ll just stay here and it’s safe here. But no you need to you know actively work to make connections with individuals experiencing inequity with organizations that are serving those populations in different ways than you do and really trying to build that that collective capacity to be able to talk about health equity in a way that that moves us all forward because a topic like health equity is so large and looming and it is so nebulous in the sense that you can’t you can’t always touch it and you can’t always feel it but it’s basically just trying to remind us that throughout time in this country and throughout the world there have been policies and procedures and ways of doing business that distribute resources equitably and that does that mal distribution of resources can actually make you very sick. [TRANSITION MUSIC]
HOST: Thanks for all your knowledge and we appreciate you being here with us.
SAMANTHA S: Thank you Alexandra. Let’s keep going.
There are many definitions for health equity. One definition by the Robert Wood Johnson’s Foundation is that Health Equity means that everyone has a fair and just opportunity to be as healthy as possible. Today, Dr. Sabo explained that health disparities are differences in health conditions and death between groups of people, the social determinants of health are all the things or systems around us in which we live, grow, work, learn and play that make it possible for us to be healthy or make our health worse. But health equity asks the question why those unfair and unjust differences in health exist in the first place.
You’ve been listening to Fairness First, dedicated to Health Equity in the Southwest. A podcast to explore what are the social determinants of health, and what can we do to build healthier, fair and inclusive communities in the Southwest. Brought to you by the Southwest Health Equity Research Collaborative Initiative and the Media Innovation Center at Northern Arizona University.
We want to hear from you. Visit us on Facebook at NAUCHER. Instagram at NAU.CHER. Follow us on twitter at CHERArizona or send us an email at SHERC@nau.edu (Spell SHERC). Tell us what you like, what can we do better, or tell us what topics you want to listen to in our podcast.
The Southwest Health Equity Research Collaborative Community Engagement Core and the Media Innovation Center at NAU, produced this episode. It was edited by Aldric Meints. Music from https://filmmusic.io, song titled “Fearless First” by Kevin Macleod, Licensed by http://creativecommons.org . Special thanks to NIMHD grant # U54MD012388 and Northern Arizona University’s Southwest Health Equity Research Collaborative, for funding this podcast. Thanks to our Fairness First team, Carmenlita Chief, Dulce Jimenez, and Kelly McCue, from the Community Engagement Core, and Brian Rackham Director of the NAU Media Innovation Center. Thanks for making this podcast possible. I’m Alexandra Samarron. Thanks for listening.