365 Days Later...

We have all heard the phrase “time flies,” but man does it! Lately, we have found ourselves asking “where did the year go?” As first--almost second year--fellows, this question has forced us to pause and reflect on the ups, downs, and everything in-between. Over the span of this seemingly fast-paced year, we have gained insight intothe interdisciplinary and multi-sectoral world of public health, become more intimately acquainted with the communities we serve, and grown as public health professionals. Therefore, as the first year fellows get ready to jump into year two, we wanted to share some insight with the upcoming cohort and give others a snapshot of how the fellowship encourages growth and stimulates learning in the first year. 

What tips do you have for incoming fellows?

  • My tip for first years would be to be vocal about what sounds exciting (or not) to you! If you learn about an initiative at your placement that sounds really interesting, ask about what you might be able to contribute. More likely than not, they will be grateful for your enthusiasm and contributions.

  • I found it helpful to make a short list of what I want out of the fellowship. This meant prioritizing Core Activities of Learning (CALs) and thinking about areas I’d like to improve on. I have this list in the back of my mind and think about it often when taking on new projects. Knowing what you want is the first step to thinking about how to get where you need to be at the end of the fellowship. It sounds very Stephen Covey, but “beginning with the end in mind” has been helpful for me.

  • I learned that the fellowship community--particularly the staff-- are on your side. They want you to fully explore the world of public health and find your fit. Make a wish list that includes everything you would like to do over the 2 years, no matter how extreme the items may seem. The fellowship staff, faculty, and other fellows are great at helping you figure out how to get the experience/skills that you want and need.

  • Try to temper expectations about how quickly you will feel integrated into the work. Learning the organization and projects takes time, but you'll get there! Eventually you will feel ownership over your work, and in the meantime-- fake it til you make it! Show up, offer your time and effort, and show interest. Soon enough, everyone will be asking for your ideas and input.

What opportunities should fellows take advantage of during the first year?

  • Think outside of the box and take advantage of UW classes, trainings, or seminars that interest you. I mean when else will you have a full time job that encourages learning and experimentation as much as the fellowship! You have time and funds, so use them.

  • If possible, be a discussion section leader for a public health course! Leading a discussion section this spring was one of my favorite experiences in the fellowship thus far. Not only will you gain experience in facilitating discussions and teaching others but I guarantee you will also learn a lot from your students. Plus, it is just fun! Dr. Remington typically offers a course in the spring. I would suggest talking to him about other opportunities.

Is there anything else you would like to tell first years OR that you would have liked to know before you started?

  • Conduct informational interviews with people who are doing work that interests you. Learn how they got to where they are now, what they do on a daily basis, what motivates them to continue the work, etc. This is a great way to explore public health careers and to give you ideas for work you can do during your fellowship to prepare you (and your resume) for future employment!

  • Be flexible and adaptable – more likely than not, your outlined project plan from when your site applied will morph over the course of the fellowship and in some cases, may even look entirely different by the time you’re done.

  • Get involved with projects outside of your site such as fellow driven projects. It’s a great chance to interact with other fellows, give birth to an innovative idea, or even dive into an area of work not associated with your site projects.

Curious to learn more? One of our fellows could not have said it any better -  

“Have coffee with a former Fellow! Our fellowship community is very welcoming and wants you to succeed. Meeting with former Fellows was helpful and encouraging.” 

The invitation is always open - We hope to connect with you! 

Stevie and Janine

Zoonotic Disease, Up Close and Personal

Sometimes our work in public health and our personal health collide.  This month, I tied up my soon-to-be published report of a tickborne illness called babesiosis, and I visited our future home in wooded and beautiful Ithaca, NY for an up close and personal encounter with tickborne disease risk.  

We often joke that my eldest daughter Quinn “turns feral” when she encounters nature.  I love watching her transformation from a quiet, somewhat anxious child into a forest sprite, running through the woods without a care in the world.  Unfortunately, as a parent, I have to consider the risks of this outdoor activity, especially in an area endemic for Lyme, Babesiosis, Powassan Virus, and Anaplasmosis.  On our last day of our upstate NY trip, we took a trip to our future house and its wooded land and pasture. Out of our family of four, only Quinn ended up with a dozen nymph deer ticks on her head and body, presumably because she got closer to nature than the rest of us.  After a lengthy head and body check at the airport before our Sunday evening flight, we felt confidant we’d pulled all the ticks off.  On Thursday, we got a call from her principal at school who reported Quinn had the engorged tick on her ear. We took advantage of a free University of Rhode Island lab service, and, using an emailed picture, they identified it as an adult female deer tick and estimated it had been feeding for 3.5 days.


Specimen discovered on Quinn's ear, under the microscope

Lyme is transmitted by the spirochete Borellia burgdorferi. Its vector is the black legged deer tick, which becomes infected by mammalian hosts such as deer and white-footed mice.  Initially discovered in the 1960’s in Lyme, CT, it is endemic to the upper Midwest and Northeastern US but cases have considerably increased in recent years, both in number and in geographic range (see below).  The causes of this marked uptick (pun intended) are likely multifactorial and include the warming climate and patterns of deforestation, with homes being built closer to wooded tick habitats (more exposure) and breaking up forests (fewer predators to keep down animal reservoirs of Lyme, such as the white-footed mice).


Not surprisingly, these same trends can been seen with other tickborne diseases such as babesiosis, which is the topic of the report that I have been working on.. However, knowing that 20-50% of upstate NY ticks have been found to carry borellia burgdorferi, and that children can develop disabling and chronic symptoms from severe infection, I was most concerned about Lyme.

Lyme disease may develop when people are bit by an infected blacklegged tick that attaches for at least 36 hours. Within 3 to 30 days, individuals may develop early stage infection of a classic erythema migrans rash (bulls-eye in appearance), fatigue, fever, and muscle and joint pain. Some infected individuals do not display early symptoms. If not treated with antibiotics or if an individual does not display early symptoms, people progress to the early disseminated phase of infection, marked by symptoms that may include neurological effects (severe headaches, facial nerve palsy, poor cognition, inflammation of the brain and spinal cord, and/or nerve pain), cardiac effects (inflammation of the lining of the heart), and joint problems (arthritis with severe swelling of large joints). Treatment with antibiotics is usually effective for these severe complications, although there is a lot of controversy about this among the medical community.  The medical literature describes patients that go on to suffer persistent symptoms of late Lyme diseases that have not been shown to be treatable with antibiotics.  

What is a worried parent to do?  Like any good public health practitioner, I first checked the CDC website, which directed me to the 2006 Infectious Disease Society of America 2006 Guidelines. They state prophylactic treatment is warranted when the following criteria are met: 

1.      The tick is indeed a deer tick. Check.

2.      The tick was attached for at least 36 hours. Check.

3.      At least 20% of the ticks in the area are known to carry Lyme.  According to the University of Massachusetts Medical Zoology department surveillance data, exactly 20% of the ticks they have tested from the Ithaca zip code tested positive for Lyme. Check

4.      Treatment can be administered within 72 hours.  Close enough, check.

Next, I looked into having the tick tested. Our new friends at the University of Rhode Island recommended University of Massuchetts Medical Zoology lab for testing the tick. UMass has great marketing for an academic lab, using a branded name “TickReport” with the motto Because of a piece of data is peace of mind. I was a sold customer.  In addition, they boast highly sensitive and specific testing for properly collected ticks, and the test includes internal quality control checks.  We paid $50 and sent our little arthropod off in a ziplock bag on Friday and got the report back on Wednesday, complete with a picture of our tick under the microscope and the full panel of possible diseases:


Hooray! Negative for Lyme among other things.  The CDC cautions that one should not equate the negative tick with negative infection because the individual could have had other unrecognized bites.  Also, a positive test does not mean the spirochete was necessary transmitted from tick to human.  I still enjoyed contributing to the lab’s nationwide surveillance efforts.  Our tick joined their sample of 140 ticks from our future zip code, of which 20% were positive for Lyme.   

When I first encountered the harrowingly large tick population surrounding our new house, I felt overwhelmed and disheartened by the fact that enjoyment outdoors could come at a price.  But Prevention is Power, right?  Unfortunately, the prevention of Lyme Disease at a population level involves interventions beyond my control (reduced deforestation, halting globing warming).  However, I can employ the best methods for individual prevention (clothing and hats treated with permethrin, DEET, tick checks including looking in ears) and educate my patients. These ticks don’t know who they are dealing with.

Beth Stein

PSA: Violence Against Women is Still Happening

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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.  BetweenRussia decriminalizing domestic violence and Trump’s new budgetthreatening to completely eliminateall 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.  in 3 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 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 nearly 45% of all American women (almost in 2)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 the Rape 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 onethis 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.

Leslie Tou, MPH

Population Health Service Fellow, 2nd Year

Wisconsin Department of Health Services

UW-Madison Lifecourse Initiative for Healthy Families

Madison, Wi

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

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.

Nick Zupan, MPH
Population Health Service Fellow - 2nd Year
Wisconsin Division of Public Health Western Region Office
Eau Claire City-County Health Department  
Eau Claire, WI

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.

$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.

Evicted: Poverty and Profit in the American City
by Matthew Desmond

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!

Half the Sky: Turning Oppression into Opportunity for Women Worldwide

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.

Just Mercy: A Story of Justice and Redemption

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.

The Signal and the Noise: Why So Many Predictions Fail--but Some Don't

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.

The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures

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.”

The Wisdom of Whores: Bureaucrats, Brothels and the Business of AIDS

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.

Thinking, Fast and Slow

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.”

Toms River: A Story of Science and Salvation

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?

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. herehere, 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:

Understanding Implicit Bias

Can you Overcome inbuilt bias

Unpacking the Invisible Knapsack by Peggy McIntosh

Miles to Go Before We Sleep: Racial Inequities in Health by David Williams

Toward a Cultural Consciousness of Self in Relationship: From “Us and Them” to “We” by William Ventres and Cynthia Haq

White Fragility: Why It’s So Hard to Talk to White People About Racism

Maria Mora-Pinzon, MD, MS

Preventive Medicine Resident

School of Medicine and Public Health

University of Wisconsin - Madison
Twitter: @mariacmorap

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

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!

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