PSA: Violence against Women is Still Happening

Leslie Tou, MPH

Population Health Service Fellow, 2nd Year

Wisconsin Department of Health Services

UW-Madison Lifecourse Initiative for Healthy Families

Madison, Wi

I’m angry.

Honestly, we- as public health professionals, as citizens, and as human beings- should all be angry. Lately, it seems like we actually need a reminder that women still experience violence at an alarmingly high rate.  Between Russia decriminalizing domestic violence and Trump’s new budget threatening to completely eliminate all Violence Against Women Act (VAWA) grant programs, you could be forgiven for thinking maybe it’s not an issue anymore. But the numbers don’t lie. 1 in3 women and girls across the globe experience gender-based violence [*] (1). That is over 30% of our world’s women and girls who will experience sexual, physical and other abuse in their lifetimes.  Here in the United States, more than 1 in 3 women have experienced “rape, physical violence, and/or stalking by an intimate partner in their lifetime” with 1 in 4 experiencing severe intimate partner violence.  And nearly45% of all American women (almost 1 in2) have experienced sexual coercion, unwanted sexual contact and other unwanted sexual experiences at some point in their lives (2).  What’s heartbreaking is that this already too-high number goes up for lesbians (46.4%) and bisexual women (a staggering 74.9%) (3).  And keep in mind that rape and sexual violence are some of the most underreported numbers we have (4). In Wisconsin alone, there were 5,609 injury hospitalizations and ER visits for women 15-44 because of intentional assault in 2014.  In that same year, in one single day, Wisconsin domestic violence programs “provided services to 1,949 victims and had 367 requests for services that went unmet due to lack of resources” (5). In short: violence against women is not only still an issue but happening to a distressingly large percentage of American women.  (I also want to take a quick moment to recognize that sexual and gender-based violence is not exclusive to women.  This affects men as well and especially affects the LGBT+ and gender nonconforming communities.  The fact that I chose to focus on women in this blog is not meant to detract from the realities of violence to these populations.)

So, how does the fact that almost half of all American women will experience some form of sexual violence victimization in their lifetime lead to the decision to eliminate all VAWA grant funds?  Funds that Kim Gandy (President of the National Network to End Domestic Violence) said “is truly the foundation of our nation’s response to domestic and sexual violence, stalking and dating violence”(6)? 

But this issue is about more than just numbers, shocking though they may be.  Just volunteer your time at any local domestic violence shelter, sexual assault agency, or any other organizations that work with survivors [†].  Words cannot do justice to the experience of listening to their stories of pain and fear and the lifelong ramifications (higher levels of depression, suicide attempts, anxiety, PTSD, as well as poorer physical health) that come with their experiences of violence, as well as their successes in their personal journeys of healing (7). These women have been through so much and have fought so hard.  They shouldn’t have to do it alone.  They should have spaces like DAIS or theRape Crisis Center to go to for medical help, legal help, for shelter, and for empathy and support from those who understand.Then there’s the economics.  The CDC estimates that intimate partner violence costs us $8.3 billion dollars a year (8). Each rape costs approximately $151,423 (9). Some of the best research we have identifies rape as our country’s most costly crime, at an annual cost of $127 billion (this is excluding child sexual abuse)(10). Yet we may be losing one of the only sources of federal funding that works to prevent these crimes- the 25 Office of VAW grants.  These grants provide evidence-based direct services, intervention and assistance for victims of sexual assault as well as training and prevention programs.  They cover everything from training law enforcement agencies to be more effective, trauma-informed responders, assisting with transitional housing for survivors, direct services to marginalized and underserved populations, providing legal assistance to survivors, and specifically supporting children, youth and elders experiencing violence and sexual assault (11). Without the critical, life-saving work of VAW grants, what is going to happen to the 74 million women who have or will experience some sort of sexual violence in their lifetimes(2)? We NEED these services. Many others have written about this (like this one, this one, or this one or even this one). But I truly believe this is an issue worth elevating at every opportunity.  We need everyone to understand that so many women suffer in the United States but our current government wants to completely eliminate a huge source of federal funding. 

Can we all at least agree that sexual assault and intimate partner violence (as two examples) remain a serious problem in the US?  If the answer is yes, why would we eliminate the funding?  In what world is that good math?  In what world is that the humane choice?  So YES.  I’m angry.  And you should be too.

 

1.            Ellsberg M, Arango DJ, Morton M, et al. Prevention of violence against women and girls: what does the evidence say? Lancet (London, England). 2015; 385(9977):1555-66. doi:10.1016/s0140-6736(14)61703-7

2.            Black MC, Basile, K.C., Breiding, M.J., Smith, S.G., Walters, M.L., Merrick, M.T., Chen, J., & Stevens, M.R. The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control2011.

3.            Center NSVR. Statistics About Sexual Violence2015.

4.            Thomas E. Rape Is Grossly Underreported in the U.S., Study Finds. In: The Huffington Post. 2013.

http://www.huffingtonpost.com/2013/11/21/rape-study-report-america-us_n_4310765.html

. Accessed February 23 2017.

5.            Violence NCAD. Domestic Violence National Statistics. In: NCADV, editor.2015. p. 2.

6.            Gandy K. Intimate Partner Violence Report Proves VAWA Works. In: Post TH, editor. The Blog. The Huffington Post2012.

7.            Carlson BE, Mcnutt L-A, Choi DY, et al. Intimate Partner Abuse and Mental Health

The Role of Social Support and Other Protective Factors. Violence Against Women. 2002; 8(6):720-45.

8.            Prevention CfDCa. Intimate Partner Violence: Consequences. Atlanta, GA. 2015.

https://www.cdc.gov/violenceprevention/intimatepartnerviolence/consequences.html

. Accessed February 23 2017.

9.            DeLisi M, Kosloski A, Sween M, et al. Murder by numbers: monetary costs imposed by a sample of homicide offenders. The Journal of Forensic Psychiatry & Psychology. 2010; 21(4):501-13.

10.          Miller TR, Cohen MA, Wiersema B. Victim Costs and Consequences: A New Look. In: Justice UDo, editor.: Office of Justice Programs; 1996. p. 35.

11.          Justice TUSDo. Grant Programs. United States DOJ. 2017.

https://www.justice.gov/ovw/grant-programs

. Accessed Feburary 23 2017.

[*]

As defined by the UN: gender-based violence is “physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or private life”

[†]

But really, you should probably look into volunteering because they are going to need all the help they can get if their programs are defunded.

My Observations on Job Applications and Interviewing – What I’ve Learned from the “Other Side” of the Hiring Process

Nick Zupan, MPH

Population Health Service Fellow

- 2nd Year

Wisconsin Division of Public Health

Western Regi

on

Office

Eau Claire City-County Health Depar

tment

Eau Claire

, WI

Through my fellowship experience, I have participated in many stages of the hiring process for a variety of public health positions.Experiencing the “other side” as the interviewer has given me a new perspective on approaching the hiring process as a prospective employee. Using this new perspective, I have come up with a few observations that may help you as you apply and interview for your next gig.

1.

Applicants have screened themselves out of an interview process by not answering questions fully. Some applications require you to respond to questions in an essay format. Essays I review are scored based on a rubric related to the job description, so a blank or one-sentence response results in a low score. The applicant who offers very little in their responses will not likely make it to the next round of the process. The same goes for other parts of the application. It may seem like questions on different sections of the application ask for the same information, but be sure to answer each question completely despite any potential redundancy.

2.

The same concept is true for responding to interview questions. One frequent occurrence is that candidates do not say enough in their responses to interview questions. One or two sentence responses are not sufficient.

The interview is a candidate’s chance to really explain their experiences and abilities. The interviewers should have a clear picture of who they are and the skills they bring to the position.

3.

Everyone is (at least a little) nervous during an interview.

What I have found is that nearly every candidate I have interviewed shows signs nervousness. Interviewing can be stressful, but I think that interviewers understand that you may be nervous and it shouldn’t count against you.

Although a candidate may be nervous, it’s not a big deal. The hardest thing to witness is a candidate who stumbles through the interview because they are distracted by their nerves.

4.

Candidates often ask too few questions about the position or about the work environment. Asking questions helps determine if the job is a good fit and shows curiosity about the opportunity. In every interview that I have been a part of, we always ask the candidate if they have any questions, and some people don’t ask anything. I’m left wondering if the person is actually interested in the position. 

5.

Unfortunately, applicants don’t always present themselves professionally (in attire, actions, and the application materials submitted). Spelling errors and formatting issues in a résumé or cover letter can be a serious setback. I have seen a number of different quirks in résumés and cover letters that have impacted an applicant’s chance of being invited for an interview. Attention to detail and professional appearance of application documents can demonstrate interest in the position. 

6.

An applicant’s interactions outside of the interview are important too. We ask our reception staff, who greet and provide tours for candidates, to give their input on their interactions with interviewees. This can be crucial to evaluating how a candidate would fit in our organization. This also presents the applicant an opportunity to connect with other staff and determine their fit in the work environment.

7.

I think that prior to the interview applicants could do more research about the organization they apply to, the community it serves, and the types of programs it offers. This not only helps them figure out if the job is a good fit, it also demonstrates their interest in the position. It would be impressive to have a candidate reference our Community Health Improvement Plan, organizational structure, or information presented on our website.

8.

The old saying “It’s not what you know, it’s who you know” definitely applies to searching and applying for jobs in public health. By working on a regional or statewide committee (e.g. WPHA Annual Conference Committee) or reaching out to others at conferences/meetings, an applicant can establish connections to people in organizations that they’d like to work for. These networks can help identify opportunities, facilitate connections to those in hiring positions, and evaluate fit with an agency.

9.

When an employer makes a job offer, it is appropriate to negotiate benefits. Many times people accept the first offer that is made, but they always have the opportunity to negotiate (not only salary, but vacation, and other benefits). The employer may not have flexibility in negotiations, but it can’t hurt to ask. 

I hope that you find these observations helpful

!

This is not an exhaustive list, nor is it a strict set of rules. It is simply some advice that I want to share based on my own experiences.

Meet the Fellows

Current and former Fellows are working hard to improve the health of Wisconsin and beyond! To see Fellow biographies, visit the UWPopulation Health Service Fellowship Webpage. Read interviews with second-year Fellows and Preventive Medicine Residents here, and meet Fellowship alumni here.

The Fellowship is closely tied to the Preventive Medicine Residency Program at the UW School of Medicine and Public Health: Fellows and Residents participate in orientation together, and they plan and attend monthly meetings as one group. To learn more about current Preventive Medicine Residents, visit the program's "Meet the Residents" Webpage.

2016-2018 Fellows and Preventive Medicine Residents
  • Stevie Burrows, MPH: Public Health Madison & Dane County
  • Janine Foggia, MPH: Ministry Health Care and Marathon County Health Department
  • Britt Nigon, MPH: Wisconsin Division of Public Health
  • Diego Tamez, MD: UW Preventive Medicine Residency Program 
  • Janice Valenzuela, MPH: Wisconsin Division of Public Health and Wisconsin Center for Public Health Education and Training (WiCPHET) at the UW School of Medicine and Public Health
  • Fiona Weeks, MPH: Milwaukee Health Department and the Institute for Child and Family Well-being
  • Jasmine Zapata, MD: UW Preventive Medicine Residency Program


 
2015-2017 Fellows and Preventive Medicine Residents

  • Salmafatima Abadin, MPH: Milwaukee Health Department and IMPACT Planning Council
  • Kallista Bley, MPH: Forward Community Investments and the Wood County Health Department
  • Ashley Kraybill, MPH: Wisconsin Division of Public Health
  • Maria Mora Pinzon, MD: UW Preventive Medicine Residency Program
  • Beth Stein, MD: UW Preventive Medicine Residency Program
  • Leslie Tou, MPH: Bureau of Community Health Promotion at the Wisconsin Division of Public Health and the Lifecourse Initiative for Healthy Families at the UW School of Medicine and Public Health
  • Nicholas Zupan, MPH: Eau Claire City-County Health Department and the Western Regional Office of the Wisconsin Division of Public Health

 
2014-2016 Fellows and Preventive Medicine Residents
  • Jameela Ali, MPH: Wisconsin Center for Public Health Education and Training and the Wisconsin Division of Public Health Minority Health Program
  • Karina Atwell, MD: UW Preventive Medicine Residency Program
  • Stephanie Kroll, MPH:  Wisconsin Division of Public Health and Public Health Madison & Dane County
  • Bailey Murph, MPH: United Way of Greater Milwaukee
  • Bobby Redwood, MD: UW Preventive Medicine Residency Program
  • Evelyn Sharkey, MPH, MSW: Division of Disease Control and Environmental Health at the Milwaukee Health Department and the Community Health Improvement for Milwaukee's Children (CHIMC) project at the Medical College of Wisconsin
  • Hester Simons, MPH: Wisconsin Division of Public Health Minority Health Program and Centro Hispano

Want to find out what Alumni of the Fellowship program are doing? 
Check out our AlumniAlerts!


Your Winter Reading List: 9 Books for the Public Health Bookworm


As 2016 winds down and we settle into the cold weather months here in Wisconsin, those of us in the learning community thought now would be a nice time to share some suggestions for your winter reading lists. Whether you find yourself wanting to curl up next to the fire or you’re looking for a good read during those holiday travels, read on for recommendations of books that have inspired, informed, and challenged thoughts on public health issues ranging from housing, to data, to bias.


https://www.amazon.com/2-00-Day-Living-Nothing-America/dp/054481195X$2.00 a day: Living on Almost Nothing in America
by Kathryn Edin and H. Luke Shaefer                                 Recommended by Fiona Weeks, First Year Fellow 

I wouldn't say I "love" this book because it does inspire some serious discomfort around the realities of poverty in the United States. I also wouldn't say I love it because I don't necessarily agree with all of the interpretations or recommendations of the book. On the other hand, you could say I love it for these very same reasons. It sparks critical thinking and debate about the very essence of poverty and what it would mean to win the war on poverty. You should read this book if you think you know what poverty looks like; if you care about each person having the opportunity to live her life with dignity; or if you have any interaction with or work related to SNAP, WIC, TANF or other anti-poverty programs. This book opened me up to the importance of individual autonomy for family well-being and the real significance of sending the message through public policy that we trust individuals and parents to make smart decisions for their families. Poverty is perhaps THE most important social determinant of health. If you don't believe me, read the book.


Recommended by Stephanie Richards, Fellowship Program Lead

I couldn't put it down-- it was such an engaging read and also incredibly informative. If you're interested in housing policy, you should read this book. It helped me understand more about all that is working against poor, African American, people with disabilities, and other oppressed groups, particularly housing and law enforcement policies. This book was the UW Go Big Read book and I'm pretty sure I gave everyone in the learning community a free copy!


by Nicholas Kristof and Sheryl WuDunn
Recommended by Stevie Burrows, First Year Fellow

This book is phenomenal because it gives the reader a vivid look into the oppression and de-humanization of women in the developing world; however, it does so while simultaneously highlighting the women's intelligence, resilience, and determination to change their communities. In our world today--with constant media coverage-- it is easy to become desensitized to the suffering of others, but this book opened my eyes. It fostered in me a deep respect for these brave women and made me want to effect change in my own community. This book truly transcends a multitude of public health topics, but you should really read this book if you care about women's health, rural health, and global health. It also contains great illustrations of how social and economic factors, such as education, can improve the health of individuals and communities.


by Bryan Stevenson
Recommended by Salma Abadin, Second Year Fellow

This book personalizes the difficulties of inequities through storytelling - both from the perspective of being the one who experiences them and then from the side of the person attempting to dismantle them. While you quickly realize how disheartening this work can be, Stevenson creates hope and resilience in the midst of adversity. The quote from this book, or maybe it's from when I've seen Stevenson speak, that has stuck with me is "Each of us is more than the worst thing we've done." Imagine what that would look like if we all believed this? It's made me think more about respect, dignity, and what a fair and inclusive society actually looks like. Throughout this book, there is a clear call to action that the evolution of our criminal justice system to its present state affects all of us and it will take all of us to overcome it. Public health has the opportunity to provide a framework, lens, or even a goal for what we'd like the criminal justice system to be. It moves away from individual culpability to community action.


by Nate Silver
Recommended by Nick Zupan, Second Year Fellow

This is a book on using data to make decisions and predictions. I think it’s great because it goes into using stats and analytics to make predictions, but also breaks down a number of fallacies in relying too heavily on data. If you’re a data geek like me and want to learn more about modeling, forecasting, and probability, you should check out this book. After reading it, I think I have a better understanding of how to utilize data for public health practice. I also learned some of the pitfalls of over-analyzing data. A data-informed or evidence-based approach is crucial to providing high quality public health programming and services. This book sheds light on how to extract the “story” in the data.


by Anne Fadiman
Recommended by Britt Nigon, First Year Fellow

If you’ve ever wondered about how the US medical system is perceived by those who are not familiar with it, or if you’re interested in thinking about bias in healthcare, this book is worth a read. It got me thinking more about historical trauma, medical anthropology, and the value of culturally-informed practice. It also opened my eyes to the realities of resettled populations and offered different ways of thinking about what happens when two cultures meet. To quote the author, “Our view of reality is only a view, not reality itself.”


by Elizabeth Pisani
Recommended by Leslie Tou, Second Year Fellow

You should read this book if you like reading nonfiction! Because even though it's from an epidemiologist and about public health- it's a fascinating read. It opened me up to how murky data is in reality and what the world is like for a sex worker.

by Daniel Kahneman
Recommended by Geof Swain, Medical Director and Chief Medical Officer, City of Milwaukee Health Department (MHD), site preceptor and MHD liaison

You should read this book if you care about human behavior and decision-making. To quote a review by Larry Swedroe of CBS News: Kahneman “clearly shows that while we like to think of ourselves as rational in our decision making, the truth is we are subject to many biases. At least being aware of them will give you a better chance of avoiding them, or at least making fewer of them.” A colleague of mine characterized it as "the most important book in the last decade, maybe more.”

by Dan Fagin
Recommended by Maria Mora, Preventive Medicine Resident

This book is very engaging and describes a world before the EPA and environmental regulations. You should pick it up if you would like to discover how corporations affect the environment, and how those regulations benefit you even if you don’t know it. It made me care more about risk communication and covered policy implications as well as the role of public health and the government in healthcare. It also contains a lot of history about epidemiology and public health – John Snow and more!

Note: This post is comprised of recommendations based on personal opinions and is not endorsed by any of the authors, publishers, or distributors referenced here. These thoughts are those of our learning community and do not represent the institutions or organizations associated with the fellowship. The views or opinions expressed in this post are not intended to malign any religion, ethnic group, organization, or individual.

Are you biased?

Maria Mora-Pinzon, MD, MS
Preventive Medicine Resident
School of Medicine and Public Health
University of Wisconsin - Madison
Twitter: @mariacmorap

Look at this picture:
DF-12054 – Kate Mara as Sue Storm and Michael B. Jordan as Johnny Storm face off against an incredibly powerful enemy. Photo Credit: Ben Rothstein - From: http://www.nerdreport.com/2015/08/06/fantastic-four-movie-review-paved-with-good-intentions/

What is the relationship between those two characters??
Are they friends?  Are they teammates? Are they family? Are they a couple?

If you know the movie - or the original source - you know that they are siblings. For some reason the only explanation for different skin color was that one of them was adopted, because siblings can’t be of different skin color, right?

Newsflash…. Yes, they can!, as seen in google or my own family picture


Now think about this: 
A father and his son are in a car accident. The father dies at the scene and the son is rushed to the hospital. At the hospital the surgeon looks at the boy and says "I can't operate on this boy, he is my son." How can this be?


 If you thought "This is an identification issue, maybe an Uncle? Step-father? God-Father?" before you said "The surgeon is the mother" then you might be biased about how a physician looks like. (You can find many examples of situations where these biases were used: #IlookLikeASurgeon #WhatADoctorLooksLike)

The point is, that we are all biased (it is OK, it happens, don’t feel guilty about it) and you can take a test (The Implicit Association Test (IAT)) to identify your biases (Race, gender, sexual orientation, weight, religion, and many more). You can read some research regarding this test here.

Bias occurs in everyone (Physicians too, e.g. here, and here). Although we are not sure WHY it happens, some experts believe it is related to our tendency to categorize, and that some associations (e.g. latino=lazy, black=bad, women=nurturing, women=homemaker) might be a result of our experiences, and media exposures (e.g. here, here, and here). What we know is that bias can affect behavior, so it is important to recognize them and make sure we don’t act based on those biases.

I am biased. What should I do now?


From the Project Implicit website:
“It is well-established that implicit preferences can affect behavior. But, there is not yet enough research to say for sure that implicit biases can be reduced, let alone eliminated. Therefore, we encourage people not to focus on strategies for reducing bias, but to focus instead on strategies that deny implicit biases the chance to operate. One such strategy is ensuring that implicit biases don’t leak out in the first place. To do that, you can “blind” yourself from learning a person’s gender, race, etc. when you’re making a decision about them (e.g., having their name removed from the top of a resume). If you only evaluate a person on the things that matter for a decision, then you can’t be swayed by demographic factors. Another strategy is to try to compensate for your implicit preferences. For example, if you have an implicit preference for young people you can try to be friendlier toward elderly people. Although it has not been well-studied, based on what we know about how biases form we also recommend that people consider what gets into their minds in the first place. This might mean avoiding television programs and movies that portray women and minority group members in negative or stereotypical ways”.

My personal take: Keep an open mind, what could be logical/normal for you might not be so normal for others and vice versa, avoid assumptions until you know the full story, and don’t act on your biases!

This blog was inspired by my attendance to a meeting titled Unlearning Racism hosted by YWCA Southeast Wisconsin, which was part of the monthly meetings of the Wisconsin Population Health Service Fellowship. At this meeting, we learned about the history of systemic racism and how biases affect behavior and lead to disparities in health and health care. If you would like to read about these topics check the following resources:



Health and Racial Equity at the City of Milwaukee Health Department from a Current Fellow, Former Fellow, and a Friend of the Fellowship

Salma Abadin, MPH
Wisconsin Population Health Service Fellow – 2nd year
Violence Prevention Research Coordinator - Milwaukee Homicide Review Commission, Office of Violence Prevention
City of Milwaukee Health Department
Milwaukee, WI

Anneke Mohr, MPH, MSW
Wisconsin Population Health Service Fellow 2011-2013
Health Project Assistant – Fetal Infant Mortality Review
City of Milwaukee Health Department
Milwaukee, WI

Marques Hogans, MPH
Friend of the Fellowship
Public Health Educator – Men’s Health Program
City of Milwaukee Health Department
Milwaukee, WI

How does the most racially diverse city in Wisconsin address racism and economic inequality to promote health equity? Recent events across the country have put the topic of race and equity at the forefront of national conversations.  Implicit bias is now a catch phrase of presidential debates and public radio.  For those of us working in Milwaukee, we are in the position of witnessing inequities first hand while struggling to get institutional buy in and a coordinated approach to address health and racial equity.  As public health professionals we recognize how important and necessary it is to integrate and operationalize health equity principles in our work. While there is some really amazing work happening nationally, regionally, and locally, we feel that there are opportunities for us to recalibrate and be intentional about aligning our work using an equity lens.

Earlier this year, we started having conversations around how we can bring more of a health equity lens to the City of Milwaukee Health Department (MHD).  We see the need in our work – violence prevention, maternal and child health, and men’s health – to address root causes of health outcomes.  African American women in Milwaukee experience pregnancy and infant loss at a rate three times higher than white women.  Changing individual behaviors will not reduce this disparity unless we also reduce poverty, discrimination, and the chronic stress that increases the risk for prematurity, the leading cause of infant mortality in Milwaukee.  The case is similar for violence across the City. Data from 2015 indicate that homicides and non-fatal shootings occurred about 4.5 times more frequently in lower socioeconomic status (SES) ZIP codes compared to middle and higher SES ZIP codes. Even further, black males ages 15-24 are victimized at a shooting rate of 1109 per 100,000 city inhabitants compared to white males at 9 per 100,000. For homicides, the victimization rate for black males is 187 per 100,000 per city inhabitants compared to 4 per 100,000. 


We’ve been able to learn from many in the fellowship community, including both current and former fellows and preceptors, who have been able to share their resources and ideas. In particular, Carly Hood and Evelyn Cruz shared their trainings and presentations they developed at the Wisconsin Department of Health Services-Division of Public Health to educate staff on health equity using NACCHO’s Roots of Health Inequity curriculum. Geof Swain has shared his expertise and work around the social determinants of health and health equity, specifically the 7 Foundational Practices for Health Equity, which are built on the WHO’s Conceptual Framework for Social Determinants of Health. Geof has used the image below to show how the foundational practices could be mapped on the Triple Aim of Health Equity, three objectives developed by the Minnesota Department of Health to advance health equity. 


We’ve traveled to conferences, including the Government Alliance for Racial Equity’s Midwest Convening on Racial Equity and NACCHO, to learn from other health departments across the country as well. We took the opportunity to have a conference call with Jordan Bingham, the Health Equity coordinator at Public Health Madison Dane County to discuss what she has been able to accomplish in Madison as well as challenges she has endured. We’ve even tapped into local resources at the YWCA and met with the Racial Justice Director who facilitates the Unlearning Racism course in the Milwaukee area.

In all this gathering of information and learning, we’ve now asked the question “what do we do with it all?” We want to be purposeful in planning how our efforts fit into a mechanism that is sustainable but also want to hit the ground running with some of our ideas. In discussing our efforts to bring dialogue and strategies around health equity at MHD, we’ve been able to find other champions in the department who are supporting the effort, including Fiona Weeks, Erica LeCounte, Geof Swain, Angie Hagy, and Michael Stevenson. We are meeting in the next couple weeks to draft language around how we define health equity, health disparities and social determinants of health; identify current examples of work at MHD that already operates from an equity perspective; and brainstorm what MHD’s health equity framework or roadmap could look like.  As something to start in the short-term, we are collecting names of all MHD employees who have taken the YWCA’s Unlearning Racism course to start an alumni group that would meet regularly to discuss topics related to health, social and economic justice.

We know this work takes a lot of creative and dedicated minds, and want to extend the offer to anyone in the fellowship community (or reading this blog) who may be interested in getting involve to get involved! Please share your ideas, concerns, resources, and/or lessons learned with us!

What did we learn from those conferences? – Leslie and Salma report back.

 
 
Salma Abadin, MPH
Wisconsin Population Health Service Fellow – 1st year
City of Milwaukee Health Department
Data You Can Use
Milwaukee, WI

Leslie Tou, MPH
Wisconsin Population Health Service Fellow – 1st year
Lifecourse Initiative for Healthy Families
MCH Program at the Department for Health Services
Madison, WI

Hi fellowship community! As you can see, we had to get a little creative with our interview since we work in different cities. We both attended conferences in April and wanted to highlight our experiences. We came up with seven questions to share some of our learnings and how attending the conference has impacted our work. Please feel free to contact us if you have any questions or want more information on either conference!

Salma’s report:

What conference did you attend?
I attended the Midwest Convening on Racial Equity in Chicago, IL on April 25, 2016. It was hosted by the Government Alliance on Race & Equity (GARE), which is a national network of government working to achieve racial equity and advance opportunity for all.

How will the information presented at the conference help your work?
For me, sometimes health equity seems unattainable, but attending this conference really helped me see the possibilities of success around health equity. People across the country are invested in working with each other to advance equity and enhance success for all. GARE provided their published Racial Equity toolkit as a way to operationalize equity. It includes a worksheet that can be used at multiple levels. The overall questions are:

1. What is your proposal and the desired results and outcomes?

2. What’s the data? What does the data tell us?

3. How have communities been engaged? Are there opportunities to expand engagement?

4. What are your strategies for advancing racial equity?

5. What is your plan for implementation?

6. How will you ensure accountability, communicate, and evaluate results?

They also provided examples from Seattle, WA and our very own Madison, WI, two cities that have used the tool. The City of Seattle passed an ordinance in 2009 that required all City departments to use the toolkit, in particular for all budget proposals. In 2015, the mayor of Seattle required departments to use the toolkit at least 4 times every year, and hopes to include aspects of the tool in performance measures. Applications of the Racial Equity Tool in Madison included adopting a new mission, vision, work plan, and evaluation plan with a racial equity lens in the Clerk’s office and incorporating staff and stakeholder input, racial equity priorities and to guide goals and objectives for strategic planning at Public Health Madison & Dane County. The toolkit has been a great way to start having conversations with my colleagues in Milwaukee about what we can do to use a health equity lens in our work.

What were other attendees’ backgrounds? Any tips on networking?
One of the goals of the conference was to "further cross-jurisdictional, cross-community, and cross-sector strategies for racial equity with partners in housing, criminal justice, employment, education, transportation, public health, immigrant groups, and environmental justice." Attendees worked in many of these arenas through communities, businesses, nonprofits, and government. The workshops were small (no more than 25 people) and interactive, so there was plenty of time to network and introduce yourself. I also knew a couple of people at the conference and that helped in being introduced to their colleagues and people in their networks.

What were some of your favorite sessions/posters/presentations?
My favorite panel discussion was entitled "Eliminating Institutional Racism in Criminal Justice." The conversation focused on how policing and the role of police leadership are changing. Paul Schnell, Maplewood, MN police chief, emphasized that police officers’ role is to create and build a stronger community, which he sees as a fundamental difference in the culture of policing. The measure of success is not the number of incarcerated individuals, but rather if he and his colleagues serve and support communities to be stronger and safer. One other interesting comment was that the idea of power around safety and policing is being redefined. Power needs to be given up and redistributed, and police authority is ultimately given by the communities they serve.

Was it everything you were expecting or did you hope to get something else out of the experience?
To be honest, I did not know what to expect. What I appreciated was the focus on shared learning and finding new partners and frameworks to help support or improve your work. Presenters and organizers of the conference offered tools and strategies to take back home and use in our own work. I’m excited to see what the follow-up from the April conference will be like because I left wishing the conference was longer than a day.

Any other takeaways?
There are an incredible number of people dedicated to achieving health equity work and they are willing to help each other. Several people attended from Milwaukee and we are planning to reconnect in the coming weeks to debrief on the conference and brainstorm ways to collaborate with an equity focus. It’s energizing to know that many people in Milwaukee are ready to work together and make health equity a reality.

What’s the next conference you want to attend?
I’ll be attending the NACCHO conference in July in Phoenix, and the theme is "Cultivating a Culture of Health Equity." I’m interested to see what the similarities and differences are from the Chicago meeting to the larger, national conference. Stay tuned J .

Leslie’s report:

What conference did you attend?
I attended the Association of Maternal & Child Health Programs (AMCHP) 2016 Annual Conference in Washington DC in April this year.

How will the information presented at the conference help your work?
I’m new to MCH work at the state level and I thought this conference was a unique opportunity to hear about up-and-coming- innovative strategies from different programs across the country, as well as hear from the federal level on updates and current policies around Title V funding. Title V is critical as it is the only federal program that focuses on mothers and children. You can find more information here.


In my fellowship, I am dual placement: I split my time between the Lifecourse Initiative for Healthy Families (LIHF) and the MCH Program at the Department for Health Services. I love how overlapping the positions are- there is a shared vision of health equity among all mothers and children in Wisconsin at the heart of both placements but there are obvious differences in state public health work versus university initiative work. I loved that the conference covered both these perspectives- state, governmental work as well as the community grassroots approach and the challenges, limitations and advantages that come with each. I really appreciated going to different presentations and workshops and having great takeaways for both placements. 

What were other attendees' backgrounds and professions?
AMCHP is a large, national conference that is predominantly attended by state health departments, research institutions and other organizations working to "to improve the health of women, children, youth and families, including those with special health care needs".

State Maternal and Child Health Programs (MCH) are well-represented at this conference as there is a huge focus on Title V programs. This conference serves are an effective way for the Maternal and Child Health Bureau (MCHB) to directly interact with state and local health departments and address programmatic changes, issues, and share success and lessons learned. This was my first national conference for US-based public health issues and it was wonderful to meet MCH professionals from all over the country. 

What were some of your favorite sessions/posters/presenters?
One of my favorite sessions was a skills builder session on "Implementing Universal Adverse Childhood Experiences (ACEs) Screening at a Community Health Center", led by a team from Santa Rosa Community Health Centers in California. I was struck by how they really seemed to "walk the walk" on the importance of mental/behavioral health as well as physical health. The panel represented three different clinics- a pediatrics clinic, a large hospital clinic and one located within a public high school, all part of the Community Health Centers in CA- all who have implemented universal ACEs screening.

The fundamentals seemed to be truly patient-centered and trauma-informed. They had signs up in all their waiting rooms that let clients know right away all would be asked these 10 questions and no one was being singled out for them. They had warm hand-offs with behavioral specialists for patients who screened high and would need further services. I thought it was especially interesting that the pediatrics clinic talked about how they ended up screening the parents of the kids as well sometimes and connected them with behavioral clinicians at sister sites.

Overall, I walked away feeling really inspired that this recognition of the importance of trauma and mental health has become a reality in this community.  

Was it everything you were expecting or did you hope to get something else out of the experience?
Similar to Salma, I really had no idea what to expect. For a first time attendee, I thought I got a lot of out of the conference (especially considering it was so quickly rescheduled after DC’s Snowpocalypse 2016!) I’ve only attended a handful of conferences and these bigger ones always feel a bit overwhelming. On the other hand, because they are so large, there are so many great presentations to choose from. I can say I was actually excited to go to all the workshops and seminars I signed up for!

Any takeaways?
There really aren’t any magic bullets for most of our public health challenges. I can only speak for myself, but I walked away feeling both tired and uplifted (which I know sounds very contradictory).

On the one hand- this work is so hard! Trying to address issues at a population level is rightfully complicated as communities are dynamic, living entities with so many intricate layers and pathways. There are no quick fixes for issues like poverty, racial inequities, or childhood trauma. It was uplifting to see shared recognition and universal concern over these issues in public health communities and honestly, relieving to see how everyone is struggling with how to successfully affect change.

What is the next conference you want to attend?
The next conference I am hoping to attend is another MCH focused one- CityMatch and MCH Epi in Philadelphia this September: http://www.citymatch.org/conference/citymatch-conference/2015/Home




 



 
 
Ashley Kraybill, MPH
Wisconsin Population Health Service Fellow
Wisconsin Division of Public Health
Madison, WI

Hester Simons, MPH
Wisconsin Population Health Service Fellow
Wisconsin Division of Public Health
Centro Hispano of Dane County 
Madison, WI
 

 On February 7, 2016, we observed the 16th annual National Black HIV/AIDS Awareness Day (NBHAAD), a national initiative aimed at mobilizing communities around HIV testing and treatment in response to the growing HIV and AIDS epidemic in African American communities. Many organizations and people who participated on this day work every day to increase HIV education, testing, community involvement, and treatment among black communities. As Population Health Service Fellows, we have learned about various initiatives around Wisconsin that aim to address these issues.

But, why is this so important?

National Data[1]
·       African Americans are the racial/ethnic group most affected by HIV.
·       The rate of new HIV infection in African Americans is 8 times that of whites based on population size.
·       Gay and bisexual men account for most new infections among African Americans; young gay and bisexual men aged 13 to 24 are the most affected of this group.

Wisconsin Data (2014)[2]
Of the 226 new cases of HIV infection diagnosed in Wisconsin during 2014:
Reflecting national trends, young Black men who have sex with men (MSM) in Wisconsin continue to be the population most affected by HIV in Wisconsin. During 2014:
  • Young Black MSM accounted for almost one-quarter (22%) of all new diagnoses in Wisconsin.
  • Diagnoses in young Black MSM more than doubled from 2005 to 2014.
 City of Milwaukee Data (2014)[3]
  • Milwaukee is disproportionately affected by HIV, as it makes up just 10% of the state’s population yet has 53% of all statewide HIV diagnoses.







  • 2 in 5 Black MSM in Milwaukee are living with HIV

  • Reflecting national trends, young black MSM in Milwaukee continue to be the population most affected by HIV. One-third of new HIV diagnoses in Milwaukee occurred in Black MSM ages 13-29.


Context 
When considering health outcomes data, especially disparities data, it is important to consider the context in which people live. 
  • Wisconsin ranks last in the country in the overall well-being of Black children based on  an index of 12 measures that gauge a child's success from birth to adulthood.[4]
  • Milwaukee is the most racially segregated large city in the United States.[5](see map below) 
  •  While the infant mortality rate has dropped in Milwaukee in recent years, it remains among the highest of the nation’s big cities.[6]  The infant mortality rate is commonly accepted as a measure of the general health and well-being of a population.[7]     
  •  4 in 10 Blacks in Milwaukee live in poverty, compared to 1 in 3 Hispanics and 1 in 7 Whites.[8]  
  •  45% of Black adults have completed some college or more education, compared to 29% of Hispanics and 64% of Whites.[8]  





In a recent article, “5 Reasons Why HIV Disproportionately Affects Black People,” there is an excellent discussion about the social determinants of HIV:

“The question is why? Why do black people carry the burden of this disease, especially when it didn't start out that way? The easy answer would be to say that black people engage in riskier behavior so therefore they are more likely to contract HIV. While personal responsibility is now and always a factor, black populations do not engage in risk behaviors at any higher rates than other races and ethnicities. This gives way to the fact that there are broader concerns that make HIV significantly more difficult to face and overcome in black communities.”[9]

In the face of these challenges, the NBHAAD initiative leverages a national platform to educate, bring awareness, and mobilize the African American community to:
Get Educated about HIV and AIDS;
Get Involved in community prevention efforts;
Get Tested to know their status; and
Get Treated to receive the continuum of care needed to live with HIV/AIDS

So what’s happening in the Fellowship around these issues?
Hester Simons, a second year fellow, is placed with both the Minority Health Program at the Wisconsin Division of Public Health and with Centro Hispano of Dane County. We sat down to discuss her work around HIV/AIDS.

Ashley: What are you doing in the fellowship related to HIV/AIDS?

Hester: Through my placement with the Minority Health Program at the Wisconsin Division of Public Health, I had the opportunity to participate in writing a grant last spring to address the Healthy People 2020 Leading Health Indicator HIV-13: Knowledge of serostatus among HIV-positive persons.[10] This grant is a joint initiative between the Minority Health Program and the AIDS/HIV Program. The overall goal of the grant is to reduce the disparity in AIDS/HIV cases among African American, Hispanic/Latino, and American Indian communities in Milwaukee, Wisconsin by increasing knowledge of serostatus among HIV-positive persons in these communities. Basically, we want to make sure people who have HIV are aware of their infection so they can receive the necessary treatment.

Ashley: How does this grant relate to National Black HIV/AIDS Awareness Day?

Hester: One of the objectives to reach the grant’s goal is to increase the number of people among the target populations (Black, Latino, and Native American) reached through HIV awareness events. This year, the grant will support five HIV awareness days, the first of which was NBHAAD.

Ashley: What did this awareness day look like?

Hester: NBHAAD was celebrated in Milwaukee on February 8th at Milwaukee Area Technical College (MATC) in the Student Center. The goal was to bring the information and services to people rather than asking them to come to the services. This was a collaborative effort put on by UMOS and several other organizations. It was estimated that more than 1,000 people came to the event and received information. Testing for HIV and sexually transmitted infection (STI) were provided for free and 3,500 condoms were distributed. Almost 50 people were tested for HIV and almost 40 were tested for STIs.  The success of this event was clearly a result of the hard work and thoughtful collaboration of the partners involved.

Ashley: What has your experience been like as a fellow working on this project?

Hester: This project has been a great learning experience! I’ve been given the opportunity and support to take a lead role in the writing of the grant application and its subsequent implementation. It has also given me the opportunity to merge my passions for health equity and HIV. The first six months of the grant have involved a lot of planning and figuring out how we can make the best use of the resources available through this grant. Two important elements that we continue to build into our implementation plans are 1) the need to evaluate our efforts and adjust them accordingly and 2) the need to elicit feedback from the groups we hope to reach with our work and those who are most affected by HIV.

Ashley: Thank you so much for all the work you have done and for telling us about it!
_______________________________________________________________________
Want more information?
Wisconsin Minority Health Program website: https://www.dhs.wisconsin.gov/minority-health/index.htm
NBHAAD web page: http://nationalblackaidsday.org/
Wisconsin AIDS/HIV Program website: https://www.dhs.wisconsin.gov/aids-hiv/data.htm
CDC’s HIV surveillance web page: http://www.cdc.gov/hiv/statistics/index.html
General Information about HIV prevention and care services in WI: https://www.dhs.wisconsin.gov/aids-hiv/index.htm
Blog Post: “Hunted by the State: HIV, Black Folk & How Advocacy Fails Us” http://brownboispeaks.com/2015/12/18/hunted-by-the-state-hiv-black-folk-how-advocacy-fails-us/

Sources
[2] Wisconsin AIDS/HIV Program (2015). Summary of the Wisconsin HIV/AIDS Surveillance Annual Review: New Diagnoses, Prevalent Cases, and Deaths Reported through December 31, 2014. Retrieved from https://www.dhs.wisconsin.gov/aids-hiv/data.htm
[3] Wisconsin AIDS/HIV Program (2015). Wisconsin HIV/AIDS Surveillance Annual Review 2014 – Addendum: City of Milwaukee. Retrieved from https://www.dhs.wisconsin.gov/aids-hiv/data.htm
[4] Annie E. Casey Foundation, Race for Results, 2014 (using 2010-2013 data).
[5] The Persistence of Segregation in the Metropolis: New Findings from the 2010 Census. JR Logan and BJ Stults, March 24, 2011 (using 2010 census data).
[6] Annie E. Casey Foundation, Kids Count, 2014 (using 2013 infant mortality from CDC).
[7] CDC Infant Mortality fact sheet.
[8] American Community Survey, 2010-2014 Estimates.

Lindsey Borleske [Intern]


How are you involved in the Fellowship?
I hold a student help position within the Fellowship. I work with Stephanie, Lesley, Marion, and Shor and assist with whatever tasks they need completed in the office ranging from preparing materials for Site Visits to organizing notes, etc.

What's your educational background?
I am currently a sophomore here at University of Wisconsin-Madison. My major is International Studies and I am also pursuing a certificate in Middle East Studies.

What are your long-term plans, in terms of your career?
I think human connection is key to making a difference. I would love to live abroad for some time after graduation to live and learn about different cultures. The area I am most interested in policy between the United States and the Middle East. Career wise I want to discover methods through which the United States and Middle Eastern governments can implement better policies to alleviate tension and human rights violations in that region of the world and teach how gaining appreciation for other cultures can lead to more effective policy making.

What are your favorite things about living in Madison?
Being raised in Madison, I've gotten to experience much that this city has to offer. My favorite thing about Madison is going to the Memorial Union on a summer evening with friends and dancing to the many different bands they have performing during the summer season. I also love the fact that Madison has many parks and paths throughout the city so that you can stay active outside all seasons of the year.

What do you like to do for fun?
In my free time I am a choreographer for the Madison Metropolitan School District for Madison East High School's Show Choir. I love being able to dance and share that passion with younger students at my Alma Mater. I love traveling, working out and spending time with my family here in town. 

Dissemination of Health = Engagement of the Community



Maria C. Mora Pinzon, MD, MS
Preventive Medicine Resident, UW-Madison, 2015-2017








 On December 14-15, 2015, I had the opportunity to attend the 8th Annual Conference on the Science of Dissemination and Implementation sponsored by Academy Health and the National Institutes of Health.  The theme of this year’s conference was Optimizing Personal and Population Health. 

After two days of inspiring speakers, I feel motivated and encouraged for the future of health. I know there are still opportunities and challenges of integrating evidence-based practice and service delivery, but we are on the right path, and I hope that I can share what I learned with you.

These were the most common words used on Twitter in relation to the conference:

The major takeaway of this conference was “Engage your community”. In public health we know that the community is an important part of our work: they are one of the so-called stakeholders, but sometimes they are not at the table were decisions and plans are made. Dr. America Bracho (Executive Director of Latino Health Access) was the keynote speaker of the conference, and she gave wonderful examples of how to engage your community. They live the data and are the experts on the situation, and we need to see them as such. In her organization the “promotores” (health promoters) are leaders from the community that were recruited in the organization for their heart, then they were trained for their job. Check out her TED talk.  Here are some other examples of true community engagement: Grandmothers of Nepal, Gates Foundation, and particularly Melinda Gates’ work in contraception. 

What do all of these initiatives have in common? They asked the community what is important to them and worked together towards a goal. These examples are not about organizations going to a community and saying: You have a problem and here is how to solve it. They are about organizations going to a community and saying: What do you think of your community? Do you think you have a problem? How to you think it can be improved? Let us help you.

To put these ideas into practice, go beyond your comfort zone and engage your community in all stages of your research (Planning, Institutional Review Board (IRB), Dissemination, Implementation, Evaluation), as well as other experts (economists, social workers, anthropologists, journalists, lawyers, policymakers, sociologists, statisticians). There are people out there that can improve your work, and we need them to improve implementation research and health overall.

Another speaker was Dr. LaMar Hasbrouck (Executive Director of The National Association of County and City Health Officials – NACCHO), who said: “If you think that public health departments are important, please quantify their value”.  We need to prove that what we do in public health matters and that things are better because we are here. Because of that, it is important to engage experts early in the process of research/implementation of any initiative. We need to quantify what we do and the outcomes we get, Even if we show improved outcomes, we also need to show that those outcomes are cost-effective to the society and the economy overall. And whatever you do, don’t lose the human side of your research, don’t lose the history, because histories compel and relate to others in ways that data will never do.

There is so much to be said but there is not enough time, so find below some other thoughts and links for more information:
  • Equity is not equality. Work with your communities to decrease disparities, since some populations will need more investment than others to improve their health outcomes. Work with your policymakers to make sure that they understand that dividing resources equally might not be appropriate (one-size doesn’t fit all).
  • Learning communities (of practice) are not research communities (of discovery); the former uses a feedback tool, where data is analyzed and introduced back to the system to improve it, as shown in the graph below (The Knowledge-to-Action Framework).
  • You don’t need a randomized trial to show that your intervention works.  Sometimes researchers are not the ones applying the intervention, or randomization is not possible (e.g., living wage, health insurance coverage). Even in those cases you can quantify and estimate the value of your intervention. Work with people in academia, including statisticians, to identify the best way to evaluate your program and get the word out.
  • Sustainability is key, and it relies on leadership (#champions) and resources. You can assess the sustainability of your program using an online tool: https://sustaintool.org/
  • If we need “Translation Research” to disseminate your work, maybe it was not in the right language to begin with. The language of your research results is key; publishing in academic journals is appropriate, but your research needs to reach those that live it.
  • Policy has a significant impact on people’s lives. If you want to see a change, don’t forget to involve your policymaker or government representative. 

For more information, you can check Twitter with the hashtag #discience15, the blog for the conference, or the conference presentation slides at http://diconference.academyhealth.org/agenda/slides.  

Happy Holidays!

Fellowship Alum Research: Impact of Childcare Availability on the Health Care Workforce

Fellowship alum Carrie Henning-Smith recently led a study highlighting the importance of access to good childcare for encouraging a strong health care workforce in rural communities. Carrie graduated from the Fellowship in 2009 and is now a research associate at the University of Minnesota Rural Health Research Center.

Public health communication: what to do when that reporter calls?

Stephanie Kroll, MPH

Population Health Service Fellow, 2014-2016

Fellowship placements: Public Health Madison & Dane County and Wisconsin Division of Public Health

In public health, we need to be able to effectively communicate with the general population, policy makers, and others in our community.

Often, it is better if you are proactive and reach out to the media to publicize a story.  However, sometimes you have to be reactive and respond to requests from the media.  I am still learning how to do this well, but I thought I would share some resources and tips that I have gathered over the course of my fellowship!

A

month ago

, I was able to participate in a TV interview.  A reporter contacted Public Health Madison & Dane County because there was an

article

on the teen birth rate in Milwaukee, and she wanted to report on the rate in Dane County.  We had

about

two days to prepare for the interview.  Below is the script that I used (developed by my coworkers).  I highlighted the points featured in the

televised interview

 (based on her editing). She asked me questions (off camera) for about thirty minutes in a conference room and filmed my responses.

Overall, it was a great experience!   

Here are some of my reflections and lessons learned

...

  • Things to consider before doing an interview: 
    • What is the subject and focus of the interview, and why did the reporter contact you?
    • Is the subject currently in the news? How controversial is the subject?  What is your organization's stance on this subject?
    • Who is the reporter? What news outlet does the reporter work for, and who is its audience?
    • Where and how will the interview be conducted (e.g., in person, on the phone, radio, video), and how long will the interview take?
    • What is the message you want to get across?  What frame will you use?
    • Do you have a media relations staff member you can work with?
    • I was very nervous, but I tried to just jump right in and practice, practice, practice!  The more you can prepare beforehand, the better!
      • Practice with your coworkers.  Make sure you have a conversational tone and don't sound rehearsed.  
        • Think through what questions the reporter might ask. Your coworkers can help you brainstorm about questions you might get during the interview.
          • Be aware of your appearance.  Think through what you will wear the day of the interview.  Think about your posture/body language.
          • Stick to the script and always circle back to your main point. 

·

2nd Year Fellow Interview: Evelyn Sharkey

Evelyn Sharkey, MPH, MSW

Population Health Service Fellow, 2014-2016

Fellowship Placements: City of Milwaukee Health Department and the Community Health Improvement for Milwaukee's Children (CHIMC) Project

What were you up to prior to your Fellowship?
After college, I joined Teach for America and taught high school science in Baltimore, MD, for 2 years. Teaching and living in Baltimore was an invaluable experience that has really shaped what I want to do with my career/life, first with helping me decide to go back to school for public health and social work. I got my MPH and MSW degrees from the Brown School at Washington University in St. Louis, which is where I was right before moving to Wisconsin for the Fellowship.

What inspired you to take the Fellowship route rather than a different type of job/school/etc.?
I decided to take the Fellowship route—the Wisconsin Population Health Service Fellowship in particular—because of the mentorship, support, and peer network provided by all of the staff, faculty, preceptors, and fellows involved. I’m so appreciative of the opportunity the Fellowship provides to hone my skills and gain experience in the areas of public health that I think will best prepare me for the next stage in my career.

What are your main areas of interest within public health?
My main area of interest in public health is epidemiology, and how it can be used to address health inequalities and inequities.

What is one thing (or many!) that you are working on right now in your Fellowship?
I recently started a secondary Fellowship placement with the Community Health Improvement for Milwaukee’s Children (CHIMC) project, a community-based research study that aims to address disparities in immunization rates among children in Milwaukee. I’m excited to add this placement, which ties in nicely with the immunization-related projects I’ve worked on at the City of Milwaukee Health Department (my initial placement).

In addition to my work with CHIMC—which will mostly involve conducting a survey of the immunization practices and policies of daycare agencies in Milwaukee and analyzing enrollment, recruitment, and outcomes of the overall CHIMC initiative—I’m continuing my work with the City of Milwaukee Health Department. Right now I’m conducting an analysis of disparities in rates of gastrointestinal illness among children in Milwaukee, overseeing the provider- and public-focused activities of a HPV vaccine grant received by the Immunize Milwaukee! Coalition, and working with a public health practicum student on a consumer food safety survey.

Do you read a public health journal/blog/website regularly?  If so, what?
I’m particularly interested in communicable diseases and emergency preparedness, so I regularly read news from the University of Minnesota’s Center for InfectiousDisease Research and Policy (CIDRAP), and I receive daily e-mail digests from the Program for Monitoring Emerging Diseases (ProMED) of the International Society for Infectious Disease.

What do you like best about living in Milwaukee?
Summer is a great time to be in Milwaukee—there are so many festivals and special events (it is the "City of Festivals," after all!). Also, I’m a big fan of going out to eat all year long, and Milwaukee has some great restaurants; some of my favorites are Beans & Barley, Honeypie, and Purple Door Ice Cream (not technically a restaurant, but it has delicious ice cream).


Alumni Alerts

Check out what former Fellows are doing now! (Keep checking back for more posts in the upcoming months)

 2004-2006 Alumni
Alison Gustafson, MPH, PhD
Benjamen Jones, MPH

 2006-2008 Alumni
Casey Schumann, MS
Morgen Alexander-Young, MPH

 2007-2009 Alumni
Carrie Henning-Smith, MPH, MSW
Suzanne Gaulocher, MA, MPH, PhD

 2008-2010 Alumni
Evan Cole, MPH, PhD
Samantha J. Perry, MPH

 2009-2011 Alumni
Marisa Stanley, MPH

 2010-2012 Alumni
Katarina Grande, MPH
Paula Tran Inzeo, MPH
Kelli Stader, MPH, RD, CLS

 2011-2013 Alumni
Emma Hynes, MPH, MPA
Kristen Audet, MPH, JD

2nd Year Fellow Interview: Jameela Ali

Jameela Ali, MPH

Population Health Service Fellow, 2014-2016

Fellowship Placements: Wisconsin Center for Public Health Education and Training (WiCPHET) and the Minority Health Program at the Wisconsin Division of Public Health

Madison, WI

What projects are you currently working on?
At WiCPHET, I'm creating a series of online modules addressing cultural awareness for public health professionals. At the Division of Public Health's Minority Health Program, I'm creating a cultural awareness toolkit for public health professionals that will highlight specific populations and their cultural beliefs as it relates to health and treatment

Why did you decide to pursue a career in public health?
I was inspired to help people live healthier and have a better quality of life by influencing and changing things on a systems level.

What made you decide to join the fellowship program as opposed to other career or educational options?
After grad school, most of my experiences were in hospital administration or with nonprofits whose missions were somewhat related to public health but not exclusively. I had come across the fellowship opportunity three years in a row and finally the third year, I decided to apply because it was important for me to gain more direct public health experience (such as local or state government) with the flexibility to choose projects and create my own path for two years. That is not always the case with a regular job, and that's what makes this fellowship so unique. 

What has been your favorite part of the fellowship so far?
I've really enjoyed the monthly fellowship meetings. It's a great opportunity to connect with the fellows as well as other professionals in the field. I always walk away from the monthly meeting have learned something new and/or feeling inspired. 

What is one of the most important things you have learned over the course of your fellowship so far?
Patience is always necessary but especially so when trying to effect change on a system level. Perseverance is another important one. 

If you could travel anywhere in the world, where would you go and why?

Long road trip out west. International travel is great but there is something to be said for exploring our own country and its beautiful natural parks. 

Benjamen Jones, MPH - Waukesha County Public Health Officer [Alumni]

Ben Jones, a 2004-2006 Wisconsin Population Health Service Fellow,
who is now the Waukesha County Public Health Officer
Ben was a Wisconsin Population Health Service Fellow from 2004 to 2006, with a placement at the City of Milwaukee Health Department. He received Bachelor of Science degrees in biochemistry and Spanish at the University of Wisconsin-Madison in 2000, and a Master of Public Health from Drexel University in Philadelphia, Pennsylvania, in 2004, with a concentration in epidemiology and biostatistics.

Of his experience at the City of Milwaukee Health Department, Ben emphasized the unique opportunities provided to Fellows: “Coming in as a Fellow, they understood that it’s a post-masters, and that you have a lot of education already, and that it’s supposed to be a learning experience. They afforded me opportunities I would not have otherwise had. I was allowed to pick projects that interested me and that benefited the department.” Ben also appreciated the flexibility afforded to Fellows—during his Fellowship, he was able to take a public health course at the University of Wisconsin-Madison while still working at the City of Milwaukee Health Department—and the ability to bounce ideas off a mentor and other Fellows.

Upon completing the Fellowship in 2006, Ben stayed with the City of Milwaukee Health Department for another year, as the Health Information Specialist in the communicable disease section. In fall of 2007, he accepted an epidemiologist position at the Public Health Division of Waukesha County’s Department of Health and Human Services, an opportunity that allowed Ben to continue working in epidemiology and gain supervisory experience. In June 2013, Ben was named interim health officer of Waukesha County, and in August 2013 he was officially named health officer.

In his time with Waukesha County, Ben has had the opportunity to gain experience in public health emergency preparedness and response, including response to H1N1 in 2009, as well as outbreaks of hepatitis A, measles, and meningococcal disease. This work has reinforced the importance of working with community partners outside the traditional realm of public health, including police and fire departments, medical examiners, and hospital systems. Ben thinks public health has an important role to play in bringing diverse partners together in these situations: “I think we can utilize public health to open the doors and bring people to the table who maybe historically weren’t at the same table.”

In terms of personal updates, Ben enjoys golfing and trying to keep up with his 3 year old son. His advice for current or prospective Fellows?: “Put yourself out there and try new things. Volunteer to take on new tasks, even if it scares you a little. You never know what doors are going to open.”

2nd Year Resident Interview: Karina Atwell

Karina Atwell, MD
University of Wisconsin Preventive Medicine Residency Program, 2014-2016

 Madison, WI

When did you start the Preventive Medicine Residency?
My Preventive Medicine Residency started in July of 2014. It is a two-year program, which includes getting my Master in Public Health. 

What have you done so far as part of your Residency?
The first year was spent completing my MPH degree, doing practicum work with the Wisconsin State Health Department, and continuing a small amount of clinical work at my former Family Medicine Residency Clinic, Wingra Family Medical Center, where I helped to teach resident physicians, see patients and lead QI projects. 

What were you up to prior to starting the Residency?
Prior to the Preventive Medicine Residency I was completing my three-year Family Medicine Residency training in the UW-Madison program. I graduated in June of 2014, just prior to starting my second residency and MPH.

What inspired you to apply for the Preventive Medicine Residency Program?
My interests in primary care, underserved communities and community health have always naturally fostered an interest in public and population health. The importance of better understanding, and gaining skills in, these fields was reinforced during my Family Medicine Residency where I was taking care of a diverse and underserved population within my primary care clinic and observing the inefficiencies of the health care system throughout all of my clinical training within the hospital and outpatient sectors. I was frustrated by my inability to make impactful change and decided to pursue focused training in public and population health to supplement my clinical skills. 

What are your main areas of interest in medicine and public health?
I am passionate about bridging the worlds of clinical medicine and public health in ways that foster more collaborative efforts for improvement at the levels of the individual patient and broader community and systems. I also want to engage in teaching and research as a mechanism to make awareness and skills in public health an expectation, rather than the exception for practitioners.

What is one of the most important things you have learned over the course of your Residency so far?
Meaningful change is always a team effort! 

What are you looking forward to doing in Madison this summer?
I grew up in Madison and always look forward to summer when the city comes alive after the brutal winter months. Going to farmer's markets, sailing on the lake and sitting on the Memorial Union Terrace will never get old.



2nd Year Fellow Interview: Stephanie Kroll

Stephanie Kroll, MPH

 Population Health Service Fellow, 2014-2016

 Fellowship placements: Wisconsin Division of Public Health, Maternal and Child Health Program and Public Health Madison & Dane County

 Madison, WI

What projects are you currently working on?  
I am working on many projects!  My main projects currently are: 1) a needs assessment around sexual and reproductive health in Dane County; 2) co-facilitating a Collaborative Improvement and Innovation Network (CoIIN) to reduce infant mortality in Wisconsin, focusing on criminal justice reform and tax credits; and 3) a process evaluation of the Perinatal Nurse Home Visiting program at Public Health Madison & Dane County.

Why did you decide to pursue a career in public health?  
I wanted to work on prevention and upstream indicators for health.  It just makes so much sense to focus there!  After I took my first public health class, there was no going back.

What made you decide to join the fellowship program as opposed to other career or educational options?  
I thought it was a great opportunity to explore different avenues of public health and to grow my list of skills and experiences. 

What has been your favorite part of the fellowship?  
Meeting so many awesome people working in public health!

What is one of the most important things you have learned over the course of your fellowship so far? 
If you feel uncomfortable, it means you will learn a ton!  Take risks!

What’s your favorite restaurant in Madison?  
Brasserie V!!

Meet the Preceptors, Faculty, and Staff

Part of what makes the Fellowship a rich experience is its one-on-one mentoring model. Fellows are placed with preceptors who act as mentors throughout the two years. Read about preceptors, past and present, here. Find out more about key Fellowship faculty and staff here.

Current Preceptors:

  • Nicole Angresano, Vice President of Community Impact, United Way of Greater Milwaukee & Waukesha County
  • Marisa Stanley, Infectious Disease Epidemiologist, City of Milwaukee Health Department
  • Evelyn Cruz, Minority Health Officer, Wisconsin Minority Health Program, Division of Public Health
  • Karen Menedez-Coller, Executive Director, Centro Hispano
  • Patrice Onheiber, Program Director, Equity in Birth Outcomes, Bureau of Community Health Promotion, Division of Public Health
  • Mary Michaud, Director of the Division of Policy, Planning and Evaluation, Public Health Madison & Dane County
  • Barb Duerst, Deputy Director, Wisconsin Center for Public Health Education and Training
  • Katie Pritchard, Vice President of Planning and Evaluation, Impact Planning Council
  • Katie Gillespie, Maternal and Perinatal Nurse Consultant, Maternal and Child Health Program, Division of Public Health
  • Lieske Giese, Director/Health Officer, Eau Claire City-County Health Department
  • Tim Ringhand, Regional Director, Eau Claire/Western Region, Division of Public Health
  • Traici Brockman, Primary Care Office Coordinator, Division of Public Health
  • Michele Mackey, Director of Client Resources & Community Change, Forward Community Investments
  • Kristi Rauter, Community Health Planner, Wood County Health Department
  • Deborah Ehrenthal, Lifecourse Initiative for Healthy Families Endowed Chair, University of Wisconsin School of Medicine and Public Health
  • Earnestine Willis, Kellner Professor of Pediatrics, Medical College of Wisconsin
  • Mark Wegner, Chief Medical Officer, Office of Health Informatics, Division of Public Health
  • Nasia Safdar, Associate Professor, Department of Medicine, University of Wisconsin School of Medicine and Public Health
  • Parvathy Pillai, Assistant Director, Preventive Medicine Residency Program, University of Wisconsin School of Medicine and Public Health
  • Patrick Remington, Program Director, Preventive Medicine Residency Program, University of Wisconsin School of Medicine and Public Health

Stephanie Richards, MPH [Program Coordinator]

What are your current positions?
Stephanie showing off her aerial skills!
I am the program coordinator for both the Wisconsin Population Health Service Fellowship and the Healthy Wisconsin Leadership Institute (HWLI). In addition to trying to be super organized, I've really enjoyed developing a social media plan for HWLI, helping to revise HWLI's evaluation plan, and participating in the Fellowship monthly meetings.
What is your educational background?
I earned my Bachelors of Social Work in 2009 from Calvin College in Grand Rapids, Michigan. In 2012, I finished my Master’s of Public Health at UW-Madison. I really value all the jobs I’ve had during my education and believe those are how I’ve learned the most.

Throughout the last 10 years, I’ve lived and worked at a homeless shelter, evaluated substance abuse treatment programs for mothers at risk of losing custody of their children and folks experiencing chronic homelessness, trained and coached process improvement collaboratives in 8 states, studied apps designed to support folks in recovery, worked with communities to help older adults stay in their place of choice safer and longer, and helped state departments of behavioral health change policies to make better use of technology in treatment. So, I am really excited to work with the Fellowship program because it is designed to help Fellows develop skills while doing super awesome work!

What are your long-term plans, career-wise?
Long-term, my dream job would maximize all of my passions and skills, i.e., using technology, quality improvement, and research to spread circus communities all over the world! In the shorter term, I’m really excited to dig deeper into the HWLI work and hone my skills with coaching communities.

What are your favorite things about living in Madison?
My favorite things about living in Madison are: 1) the Madison Circus Space (my second home) and my circus community, 2) bike-ability (I recently got rid of my car), 3) access to water and nature, 4) really good food and coffee (Johnson Public House, Sal’s pizza, Weary Traveler, Natt Spil, Forequarter, etc. etc.), and 5) outdoor events—summer music festivals, rooftop cinema, concerts on the square, etc. I moved here intending to stay for a year or two; it’s been 7, and I think you can see why! 

What do you like to do for fun?
Fly! I spend most of my spare time at the Madison Circus Space doing aerial silks, trapeze, rings, and pole. I practice yoga regularly and really love acroyoga or partner yoga. I also run a small business designing custom apparel for aerialists and other movers. When I’m not upside down or in my studio, I’m finding ways to eat my CSA veggies, enjoying a sunset at my secret sunset spot, or cruising around town on my super awesome pink bike. Never a dull moment!

The Wisconsin Population Health Service Fellowship is an initiative of the UW Population Health Institute’s Mobilizing Action Toward Community Health (MATCH) Group. The Fellowship program is funded by the Wisconsin Partnership Program at the UW School of Medicine and Public Health.