Todd Stanley [Program Coordinator]

Todd Stanley is the program coordinator for the Wisconsin Population Health Service Fellowship.




P.S. His name is Moose. We are best buds. He is so soft!

Todd graduated in May 2013 from the University of Wisconsin-Madison with a Bachelor of Arts in Psychology. He hopes to someday pursue a career in occupational therapy. However, working with the Fellows has inspired him to consider public health as well.  

In addition to the Fellowship, Todd is the program coordinator for the UW/MCW Healthy Wisconsin Leadership Institute (HWLI) team, working alongside Fellowship and HWLI program director Marion Ceraso.

With cold winter days ahead, Todd looks forward to spending time on the ski hills and cross-country ski trails in the area. He keeps himself busy playing volleyball on multiple recreational teams with friends and by serving as an adult leader and guitarist for Young Life College-Madison, a faith-based ministry for college-age students.

Casey Schumann, MS [Preceptor]

Casey has been an Epidemiologist within the Wisconsin Division of Public Health’s AIDS/HIV Program since 2008 and is currently Christina Hanna’s preceptor. Casey enjoys nothing more than working with large HIV-related datasets to characterize the trends in HIV diagnoses and health outcomes, and developing mechanisms to better use surveillance data for public health action.

Casey is no stranger to the Wisconsin Population Health Service Fellowship- she has served as the preceptor for two Fellows and is herself a former Fellow. She was part of only the third cohort of Fellows and graduated from the program in 2008. Casey looks forward to continuing her ties with the Fellowship.

Prior to her Fellowship, Casey completed her Masters of Science in Population Health Sciences at the University of Wisconsin-Madison and has worked in various capacities for Merck Pharmaceutical Company.

Jill Ness, MPH [Preceptor]

Jill Ness is the Deputy Director at Health First Wisconsin, and she is currently preceptor to Carly Hood.  Health First Wisconsin advances policy solutions to make our state a healthier place. Health is not something that begins in a doctor's office. It starts in our homes, schools, workplaces and in our playgrounds and parks. It's in the air we breathe and the water we drink. Viewing health in this way, offers a unique and effective opportunity to improve health before the onset of disease.

Jill earned her BA from Luther College in Decorah, IA, in Political Science, Sociology and Russian Studies and her MPH from University of Michigan School of Public Health, Department of Health Behavior and Health Education. Jill’s main interest has always been at the intersection of politics and health, and her career has centered on facilitating healthy, community-level changes through the democratic process.

 

Her first public health job was with Hennepin County (MN) Health Department where she worked as a tobacco control coordinator in the western suburbs of Minneapolis before moving to Madison to join the team at SmokeFree Wisconsin. Initially Jill worked with communities around the state as they pursued local smoke-free workplace ordinances and provided technical assistance on grassroots organizing and coalition building for statewide policy efforts, such as cigarette tax increases and preserving funding for the state’s tobacco control program.

In 2011, SmokeFree Wisconsin became Health First Wisconsin in order to incorporate other pressing public health issues into its agenda. With the organizational realignment, Jill’s role shifted to oversee a staff who offers policy and grassroots technical assistance in the areas of tobacco prevention, alcohol abuse prevention, healthy eating, and physical activity.

Jill lives in Madison with her husband, two sons, and two cats. She spends her free time wrestling with such important questions as: “Which part of the yard should we convert to a vegetable garden next?” and “When is our next trip somewhere cool, and which friends will be coming with us?” and, “What’s for dinner tonight, anyway?”

Marion Ceraso, MHS, MA [Program Director]

Marion Ceraso is the program director for the Wisconsin Population Health Service Fellowship and the Healthy Wisconsin Leadership Institute in the UW Population Health Institute.

Before joining the UWPHI in 2002, Marion’s professional experience included serving as the Assistant Director of the Johns Hopkins Institute for Global Tobacco Control and directing two statewide tobacco control programs in the State of Maryland. During this time, she was involved in teaching and international research projects related to capacity building in tobacco control. She’s also developed professional education programs in public health, translated cancer-related research information for the public at the US Environmental Protection Agency, and worked as a community organizer in Newark, New Jersey.

Marion was trained in Behavioral Sciences and Health Promotion at the Johns Hopkins School of Hygiene and Public Health, and completed a Masters degree in Journalism and Mass Communication at the University of Wisconsin-Madison. Her research and program interests focus on the impact of public policies on health, as well as the use of journalistic tools in the investigation and communication of public health issues.

In addition to working with Fellows, Marion and the UW/MCW Healthy Wisconsin Leadership Institute team (including former Fellowship coordinator Lesley Wolf and current Fellowship coordinator Todd Stanley) work with communities around the state who are mobilizing to address local priorities and improve population health.

Marion considers herself lucky to live in a community with great accessibility to open space and community gardens where her family, including dog Luna, can get their hands/paws into the earth.

Reflections on Native American Heritage Month from the Menominee Reservation

Lauren Lamers, MPH

Population Health Service Fellow

Menominee Tribal Clinic

Keshena, Wisconsin

Shawano-Menominee Counties Health Department

Shawano, Wisconsin

 

 

On October 31, President Obama declared November 2013 to be National Native American Heritage Month - a time to celebrate Native American culture and recognize the rich contributions Native Americans have made to the United States.  Prior to beginning the fellowship, I would likely have given this month little more than cursory notice. Since beginning my placement with the Menominee Indian Tribe of Wisconsin, however, Native American heritage has taken on a whole new meaning for me. 

As the president acknowledged, along with celebrating the culture and traditions we might typically associate with Native American heritage, “we must not ignore the painful history Native Americans have endured - a history of violence, marginalization, broken promises, and upended justice.”[1]  Unquestionably, coming to understand some of the more painful events in the history of the Menominee Tribe has been one of the most personally challenging learning experiences of my fellowship so far.

In the early 1800s, the Menominee Tribe resided on a land base of approximately 10 million acres in what is now Wisconsin, Michigan, and Illinois.  Through a series of treaties in the nineteenth century, the tribe’s lands were reduced to the 235,000 acres of its present-day reservation.  Menominee children were separated from their parents and sent to boarding schools where they were forbidden to speak their language or practice traditional elements of their culture.  In the 1950s the Menominee Termination Act removed federal recognition of the Menominee as a sovereign American Indian tribe.  In addition to losing their tribal status, the Menominee suffered severe economic hardships and lost portions of their land and many of the healthcare and educational services the government provides to federally recognized tribes.  Although the Menominee fought for and eventually won back federal recognition in 1973, the effects of termination were devastating.

Perhaps the most disconcerting part about this history, however, is that the Menominee, like American Indian and other historically marginalized communities around the country, are still struggling with the impact of the injustices they experienced.  This phenomenon is known as historical trauma, which has been defined as the “cumulative emotional and psychological wounding across generations, including the lifespan, which emanates from massive group trauma.”[2]  In other words, experiences like forced relocation, assimilation, and termination so profoundly disrupted the lives of American Indian people and caused such emotional and psychological damage that their effects still plague American Indian communities. 

This historical trauma manifests itself in clear and tangible ways among the Menominee Tribe today.  Menominee County is the poorest county in Wisconsin and one of the poorest in the United States.  Rates of obesity, diabetes, teen pregnancy, and substance abuse are high, and according to the County Health Rankings, the county ranks last for health outcomes in Wisconsin.

Yet when I think about American Indian heritage and my experiences on the Menominee Reservation so far, one theme resonates more powerfully for me than past injustices or historical trauma:  resilience.  The Menominee Nation has shown incredible determination, innovation, and passion for improving lives in their community.  They have fought to preserve their language and culture, and several programs currently work to pass traditional teachings and practices to Menominee youth.  They have carefully protected their natural resources and have been nationally recognized for their sustainable forestry management.  They have also made great strides toward improving the health of their community.  Just a few of their recent efforts to improve community health include:

·         Convening a community engagement workgroup that brings stakeholders together from numerous sectors of the Tribe and county to address youth obesity, teen pregnancy, and school readiness

·         Providing school-based preventive dental services to Head Start, elementary, and middle school children

·         Planting a community orchard

·         Expanding opportunities for physical activity in the community and implementing healthier nutrition guidelines in schools

·         Holding Bridges out of Poverty trainings to help health and social service professionals better understand how to work with clients struggling with intergenerational poverty

·         Identifying innovative ways to address adverse childhood experiences and implement trauma-informed care in local health, education, and social service agencies

 

While the social, economic, and health challenges in Menominee are great, the dedication and passion of local leaders and community members to address these challenges is truly awe-inspiring. I am humbled and privileged to have the opportunity to work in this community. 

So this November as the nation recognizes Native American heritage, I would challenge us all not only to learn more about traditional American Indian culture or the historical injustices American Indians have faced, but to truly celebrate the legacy of strength and resilience that enables tribes like the Menominee to continue striving to improve lives in their communities.    

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[1] The White House. Office of the Press Secretary.  Presidential Proclamation – National Native American Heritage Month, 2013.  Available online at http://www.whitehouse.gov/the-press-office/2013/10/31/presidential-proclamation-national-native-american-heritage-month-2013

 

[2] Brave Heart, M.Y.H., Chase, J., Elkins, J., Altschul, D.B.  2011.  Historical trauma among indigenous peoples of the Americas:  Concepts, research, and clinical considerations.  Journal of Psychoactive Drugs 43 (4): 282-90.

2nd Year Fellow Interview: Carly Hood

Carly Hood, MPA, MPH

Population Health Service Fellow

Wisconsin Center for Health Equity

Health First Wisconsin

Wisconsin Division of Public Health

Madison, Wisconsin

When did you begin your Fellowship?

I started the Fellowship in August 2012. While I participated in orientation activities in early July, I was finishing credits for my global health certificate during the month so I didn’t actually start at my placement sites until August.

Where is your Fellowship placement?

My placement sites were originally at Health First Wisconsin and the Wisconsin Division of Public Health in the Coordinated Chronic Disease section. Since my interest area has evolved and much of my work is equity focused, I have maintained my Health First Wisconsin placement, but transitioned to doing more work with the Wisconsin Minority Health Program and the Wisconsin Center for Health Equity. It’s nice that the program is adaptable; my preceptors and sites have changed to suit my interests and ensure I’m getting the most I can out of the Fellowship.

What were you up to prior to your Fellowship?

Prior to the Fellowship I had been gallivanting internationally for several years; I was teaching English, volunteering, working on photography, and shaking my sense of wanderlust (never leaves btw…). Post international work, I moved to Wisconsin to pursue my Master of Public Affairs at the Robert M. Lafollette School of Public Affairs and kept finding health justice was the policy area I was most interested in. Just before starting the Fellowship I completed both my Master of Public Affairs and Master of Public Health degrees. My coursework was heavily policy analysis and global health.

What inspired you to take the Fellowship route rather than a different type of job/school/etc.?

The Fellowship seemed a great way to TRY ON different aspects of public health. It’s such a broad field and it’s so easy to get pigeonholed in specific roles and jobs. Rather than jumping into a particular job, the fellowship has allowed me to dabble in a wide variety of projects, requiring use of different skills and specialties. To me, this meant I’d be better equipped in the long run to choose a job that aligns most closely with my desired professional objectives and the skills I enjoy using. It’s allowed me to both determine what I LIKE to do day in and day out, and what I DO NOT like to do. I should also note, this flexibility means the Fellowship requires a lot of self-direction. Since there’s no pre-determined “job deliverable” or particular skill set required, you sometimes have to look harder for those projects you want to work on or create them yourself! But I enjoy that.

What are your main areas of interest within public health?

Having the economics and policy background that I do, I definitely come at public health with that lens. My main area of focus is how social policies—those related to income/poverty, employment, education and housing—ultimately impact health outcomes. Having studied economics in undergraduate school at Lewis and Clark College, I view things at the systems-level and often take a very global perspective (details aren’t my forte. See? I’m learning about how my brain works in the Fellowship!). I’m fascinated by how we set up our societies, programs, institutions, etc. to support or inhibit health and well-being—which I believe is a human right. There are a lot of countries around the world that have established recognized pillars or foundations for their citizens (access to education, housing, healthcare, and financial support in times of need) which leave their populations healthier, living longer, and requiring less money to be spent on “band aid” solutions down the road.

What are some things you are working on right now in your fellowship?

The biggest projects I’m currently working on include:

1) Implementing and evaluating a professional development training for my public health colleagues to encourage a focus on the social determinants of health;

2) Researching the link between social policy and health outcomes and presenting this information at orientations, trainings and conferences; and

3) Trying to turn efforts towards writing/publishing for my last 7 months as a Fellow!  

What is one public health achievement you think will happen in the next 25 years? What is one you would like to see in the next 25 years?

I think people will start to connect poverty to health a bit more and I HOPE this means we start considering bigger poverty reduction/child support policies at the national and state levels (we could take a page out of the books of some other countries in this respect).

I would LIKE to see traditional health professionals (doctors, nurses, hospitals, clinics) adopt practices/advocate for broad policy change that would have a more far reaching impact on patient health outcomes than individual, clinical care alone. I think this, too, is attainable. The more people can understand that health is not just in the hospital or clinic, the quicker the solutions will come.

Do you have any fun insider tips about life in Madison?
Get a CSA! Community Supported Agriculture is HUGE here and it’s amazing! For 2 summers now, I’ve picked up a box of veggies from a local farm every other week and spent about $50 a month on yogurt, tofu, and beans in the store. It saves money, it’s delicious, and it supports Wisconsin farmers. Do it!

2nd Year Fellow Interview: Erica LeCounte

Erica LeCounte, MPH

Population Health Service Fellow 

City of Milwaukee Health Department

Center for Urban Population Health

Milwaukee, Wisconsin

When did you begin your fellowship?

July 1, 2012

Where is your fellowship placement? 

I’m placed with the City of Milwaukee Health Department and the Center for Urban Population Health.

What projects are you currently working on?

I’m currently working on four main projects: 

1) I’ve been developing an evaluation plan for the DAD Project, a new home visiting program for fathers with young children or men in a father role.  I’ve been researching and designing surveys and evaluation tools to measure outcomes, and I will also be facilitating focus groups with mothers and fathers to get feedback about the program.

2) I am also working on a home visiting evaluation to see how well the Empowering Families of Milwaukee, Nurse Family Partnership, and Prenatal Care Coordination programs are doing in helping mothers have healthy pregnancies and healthy children.  So far I have been working on an IRB application and will soon begin analyzing program data.

3) I am working to develop a prematurity surveillance system and analyzing data to get a better understanding of premature births in Milwaukee.

4) Finally, I am working on a life expectancy project, which involves calculating and mapping life expectancies for all zip codes in Milwaukee County.

Why did you decide to pursue a career in public health?

I took a course in undergrad in maternal and child health.  The course introduced me to public health, and I realized that there are other ways of improving health than becoming a physician.  I also learned a lot about developing programs and evaluation plans, which really introduced me to the field of public health and made me want to pursue a career in this area.

What made you decide to join the fellowship program as opposed to other career or educational options?

I chose the fellowship because I had spent my entire life in school and I wanted more work experience, which I knew I would need for the jobs I am interested in pursuing.  I also thought the fellowship would be a great opportunity to grow and develop in ways that I wouldn’t be able to if I had stayed in school for another degree or accepted a job right out of grad school.

What has been your favorite part of the fellowship so far?

The ability to explore different career options.  My background is in epidemiology, so in my first year I focused mostly on projects involving data.  In my second year I have been able to focus more on planning, implementing, and evaluating programs.  It has helped give me a broader range of experience and a better idea of what I want to do career-wise.

What is one of the most important things you have learned over the course of your fellowship so far?

Definitely to take advantage of every opportunity I’m given and utilize the people around me.  It’s great to be able to take advantage of my preceptors, especially when I have questions about any ideas I have or about different career paths.

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

This is a hard question for me – there are so many places I want to go!  I guess I’d say Hawaii because it would be great to take a nice long vacation on the water.

Time to Rewrite Our National Narrative

Carly Hood, MPA, MPH

Population Health Service Fellow

Wisconsin Center for Health Equity

Health First Wisconsin

Wisconsin Division of Public Health

Madison, Wisconsin

Looking globally, the United States (US) doesn’t fair incredibly well on a number of indicators. Research shows we rank last for female life expectancy and second to last for males compared to most other Western industrialized countries. Furthermore, comparing the US to 17 countries of similar development and Gross Domestic Product (GDP) rankings, the US has more years of life lost due to a number of causes: communicable and nutritional conditions, drug related causes, prenatal conditions, injuries, cardiovascular disease and other non-communicable diseases.

Closer to home, we can compare how Milwaukee, Wisconsin specifically lies in relation to the rest of the state and the US in general on a number of indicators. The Milwaukee Health Report shows that the city has a much higher rate of infant mortality compared to both Wisconsin and the US. When divided by social and economic status (SES), you can see that those in the lower SES group have higher rates than both middle and high SES categories. And the report shows similar trends for smoking rates, sexually transmitted diseases, dental visits, cancer screening practices, teen birth rates, violent assault, social support, lead poisoning, access to healthy foods, uninsured adults and obesity rates. Milwaukee fairs worse in all of these areas compared to both Wisconsin and the US.

Despite these wide differences, as a country the US spends more on health care than any other country in the world: nearly $8000 per person on average!! It is clear many countries achieve higher life expectancy rates with much lower spending.

One reason for this—and very politically charged currently—may be that the United States lacks universal health insurance coverage. Our health system has a weaker foundation in primary care and greater barriers to affordable care. This lack of access to primary and prevention services means US patients are more likely than those in other countries to require emergency department visits or readmissions after hospital discharge…which ultimately increases costs. But health is determined by more than health care. And I would argue this is a small piece of the larger puzzle we need to be considering.

Literature continues to show that 40% of health outcomes are driven by social and economic factors and 10% by our physical environment. That means that nearly half of health outcomes are a result of what we call the social determinants of health. This includes things like poverty/income, education, and where we live. Going even further upstream, health and wellbeing are considered within the context of racism/discrimination, sexism, classism, and power (this is an entirely amazing body of literature I would suggest you start reading more about here).

 Honing in a bit more on the social determinants of health, we know that employment gives working individuals an opportunity provide their families with nutritious food, educational opportunities, and healthy living situations. There is a clear relationship between employment and health—life expectancy for male workers has risen 6 years for those in the high income brackets, but only 1.3 years for those in the bottom income brackets. Employment translates directly to income, and we know the wealthier you are the healthier you are likely to be. Not only are high income individuals more likely to have insurance and medical care, but also have better access to nutritious food, opportunities to be physically active, ability to live in safe homes and neighborhoods, and feel less stress associated with obtaining these things.

This is interesting in and of itself, but when we take a step back, these problems don’t stop with the individual. They are perpetual and impact families generation to generation. Models increasingly show if you grow up in a low income house you are less likely to have access to education—amongst other things—which in turn decreases your opportunity for higher paying employment, ultimately starting the cycle over. An emerging body of research suggests that inequality of income makes family background play a stronger role in determining the outcomes of young people than their own “hard” work (what does this say about the bootstrap story we tell ourselves??) Inter-generational earnings mobility is low in countries with high income inequality—Italy, the United Kingdom, and the US—and is much higher in the Nordic countries, where income is distributed more evenly. The media is finally picking up on this, and more studies continue to link poor health outcomes in the long run to stressors associated with poverty at a young age. I believe it’s the cyclical nature of this issue that has increased the inequality gaps in our country over the last forty decades. Once you’re stuck in a lower education or lower income bracket, it becomes that much more difficult for you to get out.

So we know that things like education and income seriously impact health outcomes. But as a nation we are highest in poverty rates and third to last in educational rates compared to similarly developed countries. Social policies, or a lack thereof, show what a country prioritizes and how they fund those priorities. The US ranks second to last in social benefits—support with sickness, unemployment, retirement, housing, education and family circumstance—and some of the countries with the best health outcomes rank the highest in terms of social transfers. Health policy experts have noted how easy it is to “connect the dots from inadequate social spending to excess poverty and income inequality to more chronic illness and higher health care spending.”

In recent months, the medical associations of both Canada and Australia have called for a focus on the social determinants and poverty as focus for both medical professionals and policy work, clearly recognizing health should be considered beyond the clinic and hospital (watch an amazing 3 minute clip of Canada’s political perception on health). Here in the US we are still myopically funding medical services rather than the upstream drivers of health which would have the greatest impact on outcomes and equity.

How we choose to live reflects both the citizen and consumer in all of us; we are each at once a citizen who supports our individual and community well-being, and a consumer who seeks cheap prices and large returns on our investments. For decades we’ve let our inner consumer speak louder than our inner citizen, and this has resulted in increased deregulation and financialization, threatened wages and working conditions, falling taxes (and ergo less support for a plethora of public services), and increasing environmental degradation. And while we’ve listened to the consumer voice and voted this way for the benefit of ourselves and our families, whether knowing it or not, these decisions have had the greatest impact on the health and wellbeing of the poor, people of color, and marginalized groups around the world. Inequality is a choice however, as noted recently by Nobel economist Joseph Stiglitz. To him, we are entering a world divided not just between the haves and have-nots, but also between those countries that do nothing about it, and those that do. I couldn’t agree more.

It’s clear the dominant narrative we’ve told ourselves as a society is one supportive of individual behavior, personal choice, freedom and strong work ethic. Unfortunately, the data show this doesn’t seem to be producing a particularly equal, healthy and productive population. And while creating a more equitable society has benefits for economic growth and cost savings, that shouldn’t be the only rationale we use in an attempt to create solid social policy. It’s ok for the rationale to be about the moral obligation we have to create opportunity for all to lead healthy lives; it should be about nurturing the relationships and connections we foster in our families and communities; living on a planet we are proud to leave to our children; finding support in every environment in which we exist—our homes, schools, and places of work; and it should be about sewing the safety nets that catch any of us who might occasionally fall. In the United States, we can and should be rewriting the narrative so that our dominant societal view is one which reflects these ambitions, not just coping with the “individualist” story we’ve read to ourselves for so long.

Doug Mormann, MS [Preceptor]

Doug Mormann is the director of the La Crosse County Health Department (LCHD) that provides public health services to a population of about 114,000 people. The LCHD has about 70 employees and a budget of $5,000,000. He has served in this capacity for 29 years. Earlier in his career, he was the Portage County Health Officer, worked for the University of Wisconsin Madison in their Department of Preventive Medicine, and for the State of Wisconsin's Department of Health Policy and Planning. He received an undergraduate degree in Biology from St. Mary's University in Winona, Minnesota and a Master of Science Degree in Environmental Health from the University of Minnesota in 1972. Among his many roles, Doug is currently the preceptor for Lindsay Menard, a 2nd year fellow, in the Wisconsin Population Health Service Fellowship Program.

Nationally, Doug has served on advisory committees for the National Association of County and City Health Officials (NACCHO) the American Public Health Association (APHA), and the Public Health Leadership Institute. He has had the opportunity to serve in various state level leadership positions including President on the Boards of the Wisconsin Public Health Association (WPHA) and the Wisconsin Association of Local Health Departments and Boards (WALHDAB). He currently serves on the University of Wisconsin's School of Medicine and Public Health Wisconsin Partnership Grant Program Oversight and Advisory Committee. Throughout La Crosse County Doug has either served or is currently serving on advisory committees or boards for numerous organizations including Great Rivers United Way, the Scenic Bluffs Community Health Center, St. Clare Health Care Mission, Scenic Bluffs Chapter of the American Red Cross, the La Crosse Medical Health Science Consortium, and the University of Wisconsin-La Crosse's Community Health Education Program.

Doug feels fortunate that he receives great satisfaction from the work involved in helping people live healthy and productive lives. It is hard for Doug to pick a favorite public health topic (all topics are fun to him!); although, assuring access to dental care including fluoridated water supplies and restorative care for low income people has been a long term effort of his, along with tobacco control and obesity prevention efforts.

Doug and his wife, Sue, have three married daughters along with two grandchildren that live in Canada, Washington, and California.


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Fellow Monthly Meetings

Once a month, Fellows and Fellowship staff gather to learn about a public health topic. The meetings are meant to create awareness, inspire deep thought, and promote action. Each month's meeting is planned by a different Fellow. With topics like social justice, incarceration and re-entry, and urban farming, these meetings are an important component of the Fellow experience. Read on for highlights of these meetings.

2nd Year Fellow Interview: Christina Hanna

Christina R. Hanna, MPH

Population Health Service Fellow

AIDS/HIV Program, Division of Public Health

Madison, Wisconsin

When did you being your Fellowship?

July 1, 2012

Where is your Fellowship?

My Fellowship placement is located at the Wisconsin Department of Health Services, Division of Public Health, Bureau of Communicable Diseases and Emergency Response, AIDS/HIV Program

What were you up to prior to your Fellowship?

I had a three year gap between undergraduate and graduate school. I spent two years teaching English in South Korea after graduating from the University of Wisconsin-Madison. After my time in South Korea, I moved to Michigan where I had a number of things going on including an internship for the Michigan HIV/AIDS Drug Assistance Program at the Michigan Department of Community Health. Then I completed my MPH at the University of Michigan School of Public Health before beginning the Fellowship.

What inspired you to take the Fellowship route rather than a different type of job/school/etc.?

I applied to the Fellowship because it provided me with an opportunity to explore my options and experience different approaches to public health which I felt would help me figure out what I wanted to pursue and accomplish. The fellowship has provided me with this opportunity, as well as the flexibility to explore my interests and gain additional skills as a young public health professional.

What are your main areas of interest within public health?

Sexual and reproductive health; women’s health, social justice, health equity, family and community health issues related to birth and incarceration issues, and community health and resiliency.

What is one thing (or many!) that you are working on right now in your fellowship?

A: I’m in a transitional phase right now, just wrapping up some big projects and starting new projects. I am finishing up a qualitative evaluation on the Linkage to Care Program (pilot program that provides assistance with linkage and retention to medical care for HIV positive individuals) in which I conducted client interviews on their experiences with the program. Results from the evaluation may impact future program implementation and best practices for HIV service providers.

I’m just starting a project with the Department of Public Instruction (DPI) on their In School Pregnancy/Parenting Interventions, Resources, and Education (InSPIRE) grant in which I’m currently developing needs assessment tools for use by the school districts and DPI.

I’m also working on a couple of projects with the Wisconsin Alliance for Women’s Health. I’m assisting them with the planning of the 2014 Wisconsin Women’s Health Policy Summit by developing materials for the event as well as assisting with logistical planning issues when needed. I’m also working with the WAWH to disseminate the results of the evaluation of the Wisconsin Adolescent Health Care Communication Program as a promising practice.

Do you read a public health journal/blog/website regularly? If so, what?

I receive Department of Health and Human Service newsletters from the Office of Minority Health and the Office of Adolescent Health.  I also follow the blog of an MPH classmate and friend who writes about living with Type 1 Diabetes (http://www.typeonederful.com/).

What is one public health achievement you would like to see in the next 25 years?

I would like to see a shift in how mental health is addressed and to decrease the stigma of having a mental health issue and seeking treatment for one.  Stigma prevents many people from acknowledging they are having trouble dealing with life challenges or a known mental health issue. Mental health issues not only affect the daily functioning of the individual, but having a mental health concern makes it more difficult to manage other health issues. I believe that poor mental health is strongly connected to challenges people face in terms of other health issues like obesity, addiction, and the well-being that comes from social and emotional connections with other people. By addressing mental health in a holistic manner, we could see an improvement, not only in individual and community health, but also in social and economic wealth.  

Conferences - Another Opportunity to Learn

Christina R. Hanna, MPH

 

Population Health Service Fellow

 

AIDS/HIV Program, Division of Public Health

 

Madison, Wisconsin

 

One of the many benefits of being a UW Population Health Service Fellow is the ability and support that we receive to attend various conferences throughout our two years as a Fellow.

In the first 16 months of the Fellowship, I have had the opportunity to attend seven conferences, each one teaching me something new about public health and about myself. As an early career public health professional, I have approached conference attendance with three main goals:

·       To network with other professionals, locally and nationally

·       To learn more about public health and find the topics, people, programs, public health models and tools that are most interesting to me

·       To learn more about others’ work and how I can make my mark on the public health landscape, i.e., trying to figure out what I want to do when I grow up

Other Fellows shared that they attend conferences to:

·       Receive training and learn from seasoned public health professionals who are doing work that we would like to do one day  

·       Learn about public health from different perspectives including local, state, national, business, non-profit, and academic

·       Learn new skills and tools to use in our work

·       Meet other professionals who share our same interests and passions

·       Get out of the office and immerse ourselves back into a learning environment

·       Network and meet people who are doing really interesting work and discover opportunities for future projects and collaboration.

·       Practice “elevator speeches” about the work we are doing

·       Have the opportunity to showcase the great work we are doing

Fellows also receive support to submit abstracts to conferences for poster and oral presentations. A number of Fellows have had abstracts approved and have presented oral and poster presentations at local and national conferences. Later this week, November 2-6, 2^nd year Fellow Carly Hood will be attending the American Public Health Association’s (APHA) AnnualConference in Boston and giving an oral presentation on her work titled: “Increasing capacity to promote health equity: Using evaluation toinform a professional development curriculum”.  

Fellows have attended a wide variety of conferences that help us learn more about public health, as well as other interests. Some of these conferences have included:

·       Wisconsin Public Health Association (WPHA)Annual Conference

 

·       American Public Health Association (APHA) Annual Meeting and Exposition

·       National Association of County and City Health Officials (NACCHO) Annual Conference

·       Wisconsin Prevention Conference

·       Wisconsin Health Education Network (WHEN) Annual Meeting

·       Minnesota Evaluation Studies Institute (MESI)Annual Conference

·       2012 Ryan White Grantee Meeting

 

·       Placemaking Conference

·       Community Engagement in Research (CEnR) Conference

·       YWCA Racial Justice Summit

Gary Hollander, PhD [Preceptor]

Gary Hollander, preceptor for Mallory Edgar, is the founding President and CEO of Diverse and Resilient, Wisconsin’s largest LGBT organization. Gary supports a staff of 20 as they provide important disease prevention and health promotion services throughout the state. Agency services focus on known health disparities in sexual health, substance use, mental health and suicide, and community and partner violence. Gary has received numerous awards including the state’s public health award and the public health educator award. Diverse and Resilient is Wisconsin’s only directly funded CDC HIV prevention program, providing over 900 HIV tests each year and reaching more than 700 young African American gay and bisexual men in their prevention programs.

Gary is a licensed psychologist with extensive experience in individual and group psychotherapy, diagnostics, community psychology, health psychology, and organizational change. In 2013, after 30 years with his partner, Paul Mandracchia, they were married at their Milwaukee home, as he puts it: “Legally in a state that has an illegal constitutional amendment.” They are avid gardeners and keen admirers of Jack Russell Terriers, including their own, Dexter.

Born in Milwaukee, Gary has spent his life here with periodic forays to the Carolinas and New Mexico. He also teaches a course each semester at UWM and keeps a small consulting practice, mostly in Chicago.

On Your Calendar: Health Literacy Month

Mallory Edgar, MPH

Population Health Service Fellow

City of Milwaukee Health Department
Diverse & Resilient

Milwaukee, Wisconsin

Image by Health Literacy Consulting via Health Literacy Month

In case you haven’t heard, October is Health Literacy Month! Started in 1999, this awareness month exists to bring attention to the topic of health literacy and what it means in people’s lives. Many folks in the public health field, myself included, are very interested in health literacy and spend a great deal of time thinking about how it impacts an individual’s health and well-being. For those outside the health professions (and, unfortunately, even many who are in this field), this topic may be something entirely new to think about. Not sure you understand this “health literacy” business? Read on!

Minus the “health” part, “literacy” refers to a person’s basic ability to read and write. This, in and of itself, is an issue of great concern in the U.S. According to the U.S. Department of Education and the National Institute of Literacy (2013), 14% of U.S. adults are unable to read and 21% read below a fifth grade level. Literacy is a skill that is vital for a person to function easily and effectively in so many settings, from work to school to – you guessed it – health systems. When we’re thinking about that last setting, however, our concern becomes about more than just basic reading and writing. Health literacy is more complicated. According to the National Network of Libraries of Medicine (2013),

“Health literacy […] requires a complex group of reading, listening, analytical, and decision-making skills, and the ability to apply these skills to health situations. For example, it includes the ability to understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctor's directions and consent forms, and the ability to negotiate complex health care systems.”

Adequate health literacy also includes health numeracy, which involves understanding numbers, quantitative words (e.g., “small” or “increase”), and quantitative images (e.g., charts and graphs) related to health topics. It “encompasses the numerical knowledge needed to understand and act upon directions and recommendations given by health care providers” and includes a multitude of skills “such as arithmetic and use of percentage as well as higher-level concepts like estimation, problem-solving, error in measurement, probability, and risk concepts” (Apter et al., 2009, p. 386).

Image by U.S. FDA via Wikimedia Commons

Examples of how health literacy and numeracy affect a person’s health and well-being can be found everywhere in our daily lives. Nutrition facts on food products are a great illustration of how both literacy and numeracy can impact an individual’s ability to make healthy choices about what they eat. This means we have to think of ways to educate people about how to interpret nutrition facts, or come up with creative ways to explain or simplify this information.

Take a minute to think about how many times you interact with health-related information on a given day. Do you always understand all of it and/or the action steps you’re supposed to take based on that information? If you’re reading this blog, the odds are good that your answer is generally “yes.” Unfortunately, this isn’t the case for many people, including individuals of lower socioeconomic status, and those with low education levels and/or decreased cognitive ability. (Sound familiar? See shor’s post about health disparities and health equity.)

In short, poor health literacy negatively impacts a person’s ability to fully and effectively manage and advocate for their own health and the health of individuals in their care. The bottom line is this: Health information – no matter how accurate, comprehensive, or up-to-date – is useless if those who need it cannot understand and act upon it. Public health and medical professionals must be sure to remember this when designing and delivering health communications.

Find out more about health literacy and related resources here.

Monthly Meeting Reflections: Transgender 101

e.shor, MPH

Population Health Service Fellow

HIV/AIDS Department, Division of Public Health

Madison, Wisconsin




I promised I would update you on the transgender 101 portion of our last monthly meeting! I don't break promises.

For our skill building section of the meeting we learned about gender identity & transgender identities. There are a lot of reasons we did this:

• It is important
• People in your life and in your workplace may identify as transgender
• Gender is a part of life that impacts EVERYONE
• Everyone has a gender identity
• It is respectful to use the correct name and pronouns for people
• I respectfully demanded that we do it :)

There are many ways to define transgender and it can be very personal to some to define it for themsleves. That being said, transgender often refers to a person whose gender identity is different from the sex they were assigned at birth. Let's unravel some of this a little more...

 

I bet you are wondering...what does this mean for me?

 

 

Well...more likely than not you probably know some who identifies as transgender, and even if you do not, it is still important to be respectful of everyone you meet by not making assumptions you know anything about their gender identity based on their gender expression or biological sex.

 

Practically this means, asking HOW someone prefers to be called. For example, my name is e.shor and I prefer to be called by that name or shor, and I also prefer that you use my name or gender neutral pronouns like they/them/their. Here is how to talk about me: Did you see that awesome new haircut e.shor has. I wonder if they went to the salon on Willy St. or if they got their haircut by a friend?

 

Now, the hardest part about this for many people is reframing how you conceptualize gender altogether. We are often socialized in our homes, schools, places of worship to see gender as binary (male or female) and inextricably linked to sex. Think about all the things that you have been taught about gender in your life...

 

So you are probably wondering now...well why is this on a public health blog?

 

There are many reasons. One of which is that transgender health is a public health issue and a health equity issue.

 

More on that another time...

Monthly Meeting Reflections: Health Equity & Transgender 101

 

e.shor, MPH

UW Population Health Service Fellow

HIV/AIDS Program, Department of Public Health

Madison, Wisconsin





On September 3rd the fellows, preceptors, and staff had our first monthly meeting for this "year" ...we kinda roll on our own timeframe. Our topic for this monthly meeting was health equity and for our skill building we discussed transgender 101. We had quite an epic day full of learning, games, and applying a health equity lens to our work.

Maybe you are thinking... oh my, what is health equity? I've heard this somewhere...but I can't put my finger on it.

There is no simple answer to this question...nor is there a simple solution. I am going to try my best here to explain health equity and link you to some resources.

Health equity does not exist in a vaccuum...it is intimately linked to health disparities and health inequities. It is important to have an understanding of all of these things and social determinants of health (SDOH) to truly understand health equity. So let's start with social determinants of health...they are:

"The complex, integrated, and overlapping social structures and economic systems that are responsible for most health inequities. These social structures and economic systems include the social environment, physical environment, health services, and structural and societal factors. Social determinants of health are shaped by the distribution of money, power, and resources throughout local communities, nations, and the world" (World Health Organization 2008)

Here is a picture to help understand SDOH (there are lots of cool pictures of SDOH if you google it):

Illustration from Anthony B. Iton. "The Ethics of the Medical Model in Addressing the Root Causes of Health Disparities in Local Public Health Practice."

 So we know there are all these SDOHs out there impacting health...what happens next? These big structural systems make it easier for some people to have good health outcomes and they make it harder for others to have good health outcomes. This is health inequity. CDC (Centers for Disease Control) describes health inequities as:

A difference or disparity in health outcomes that is systematic, avoidable, and unjust

Then what is a health disparity? How is it different from health inequity? Good question smart reader...a health disparity is:

Variations or differences in health status among groups of people. This may refer to any difference in health, with no implication that these differences are unjust (American Medical Students Association)

A key workd that has cropped up a few times for us is unjust. This makes health a social justice issue. Social Justice refers to an equitable distribution of social, economic, and political resources AND when there is an unequal distribution of resources and opportunities is manifested through inequitable access and exposure to social determinants of health. Full circle.

Finally, that means health equity is:

When all people have the opportunity to "attain their full health potential and no one is disadvantaged from achieving this potential because of their social position or other socially determined circumstance" (CDC 2012, Braveman 2003)

This is just a brief overview of some things related to this ginormous area of public health. It is also an incredible shift in the way we approach public health and the world. Health equity is a frame of mind (and a science!) that is supposed to help us put context to the forces in the world that unjustly impact people's health. It is something that you have to believe in...and, ultimately, what we all have to work towards in our public health work.

And now onto Transgender 101...oh wait, maybe that is for next time :)

 

Welcome to a new class of UW Population Health Service Fellows!

Marion Ceraso, MHS, MA

UW Population Health Service Fellowship

Program Director




Welcome 10th class of Wisconsin Population Health Service Fellows!

Our new class - 2013-2015 - has already launched an impressive portfolio of public health action, and we're just a few months in.   They're  working on advancing health equity, reducing childhood obesity, strengthening Wisconsin's food systems, preventing domestic violence, improving LGBT health, building sustainable  data collection systems, and disseminating health-related innovations.

Second year Fellows are continuing their important work, including  making strong contributions to the local public health accreditation process, building capacity for health equity in Wisconsin, and improving access and competency of care for individuals with HIV/AIDS.

 
Thanks to first year Fellow, shor, for kick starting the blog this year.  And check back here early and often for updates on what Fellows are up to, and other exciting public health happenings in Wisconsin and beyond.
 
Here's to a great year ahead!

Marion


 

This is Public Health: Acronyms and Organizational Charts by Anneke Mohr

 

Acronyms.  Anyone who has worked in public health knows that it can often turn into a game of alphabet soup.  Working at the state government level adds another layer of complexity.  After a year and a half in the fellowship, I’m trying to finally understand who’s who at the

DHS has three Offices and six Divisions.  The Division fellows work in is the Division of Public Health (Acronym #2: DPH).  Other Divisions include:

• Division of Health Care Access and Accountability
• Division of Mental Health and Substance Abuse
• Division of Quality Assurance
• Division of Long Term Care
• Division of Enterprise Services

Each Office or Bureau in DPH has several Units, Programs, or Sections:

OHI

• Public Health Information Network (PHIN)
• Epidemiology Coordination
• eHealth Initiative
• Population Health
• Vital Records
• Health Care Information

OPPA

• Regional Offices
• Primary Care Office
• Policy (including HW2020 and Minority Health)

BCDER

• Communicable Diseases/Epidemiology
• HIV/AIDS
• Sexually Transmitted Diseases
• Immunization
• Emergency Health Care and Preparedness

BCHP

• Nutrition and Physical Activity
• Family Health
• Chronic Disease Prevention and Cancer Control
• Tobacco Prevention and Control

BEOH

• Health Hazard Evaluation
• Food Safety and Recreational License
• Asbestos and Lead

BOO

• Budget Section
• Communications
• Administration

Current fellows working at/with DHS include:

Year 2

• Kristen Audet (BCDER, Emergency Health Care and Preparedness)
• Akbar Husain (OPPA, Western Regional Office)
• Emma Hynes (BCHP, Family Health)
• Anneke Mohr (BCDER, HIV/AIDS)

Year 1

• Sarah Geiger (BEOH, Health Hazard Evaluation)
• Christina Hanna (BCDER, HIV/AIDS)
• Carly Hood (BCHP, Chronic Disease Prevention)

Hopefully this makes things a little clearer.  The next time you hear OPPA, don’t just think about Gangnum Style.  Think about public health!

Fellow Alumni Doing Great Things

Paula Tran Inzeo and Katherine Vaughn Jehring to Represent Wisconsin at the National Leadership Academy for the Public’s Health

Congratulations to Paula Tran Inzeo and Katherine Vaughn Jehring, 2010-2012 Wisconsin Population Health Service Fellows, who will represent Wisconsin at this year’s National Leadership Academy for the Public’s Health, along with David Liners, Executive Director of WISDOM , and Jennifer Weitzel Blahnik, Public Health Nurse with the Health Equity Team at Public Health Madison-Dane County. The team plans to build a powerful, permanent statewide network for achieving health equity:  the Wisconsin Health Equity Alliance (WHEA).  The WHEA, a network of public health practitioners, academics and community organizers will serve as a hub for training, strategy development, state meetings and planned action for policy and systems change to eliminate health inequity.

The National Leadership Academy for the Public’s Health (NLAPH) is a program of the Public Health Institute's Center for Health Leadership and Practice.  NLAPH is an applied leadership training program that enables multi-sector jurisdictional teams from across the US to address public health problems within their communities through team-identified community health improvement projects.

Welcome!

 

 2012-2014 Fellows are Underway!

On July 2, five new Fellows took their posts, and after a two-day orientation in Madison jumped right into their work, providing service and working to improve health in their placement communities and across the state. Thanks to Rashonda Jones - Fellow blogmaster - for taking the baton from former Fellow Kat Grande, so that current and past Fellows, Preceptors, faculty, staff and other partners can share a window onto the important work in public health going on in Wisconsin and beyond, and to maintain their links to this network of colleagues and friends.

Here’s just a quick glimpse of what the new (2012-2014) Fellows are up to:

Sarah Geiger, placed with the Bureau of Environmental and Occupational Health at the Division of Public Health and with the Milwaukee Health Department is analyzing a range of environmental data including data on great lakes fish, well water and childhood lead exposures in Milwaukee.

Christina Hanna, placed with the HIV/AIDS program at the Division of Public Health is working on a program to use social networks to increase testing for HIV and improve referral to treatment for those testing positive.

Carlyn Hood, placed with the Chronic Disease Prevention and Cancer Control program and Health First Wisconsin, is assessing chronic disease programmatic focus on health disparities, helping to coordinate efforts on the state chronic disease burden report, and is researching food system policy and its impact on obesity.

Erica LeCounte, placed with the Family and Community Health division at the Milwaukee Health Department and the Center for Urban Population Health is conducting data analysis and program evaluation related to improving birth outcomes in Milwaukee. 

Lindsay Menard, placed with the La Crosse County Health Department is conducting an infectious disease outbreak investigation in La Crosse County.