The Comic on the Plane to Kansas City

A blog post written by Angela Han, a 2021-2023 Fellow

After graduating with my MPH, I was excited to join the Fellowship and to move to downtown Madison with my two beloved cats, Tyrion Lannister and Arya Stark. Moving into my own apartment was a unique experience in itself – I live in an old building, and both my kitchen and bathroom give horror-movie vibes. It’s actually quite fitting for me. 

In fact, I lived right on State Street next to a never-ending slew of restaurants with great food. I tried Poke Plus, empanadas, arepas, hibachi, Mediterranean Cafe, Ramen String, Estacion Inka, Taiwan Little Eats, Rising Sons Thai Restaurant, Taste of Sichuan, Chen’s Dumpling House, Parthenon Gyros, Short Stack Eatery, Raising Canes, Taco Bell, Shake Shack, all the food carts, and of course, my go-to place to eat – Chipotle, which is right across the street from where I live. I also enjoyed the many bubble tea shops surrounding me, including Kung Fu Tea, Sencha, and Le C’s, and I frequently ordered matcha and taro bubble tea with boba or lychee jellies. 

I would take walks to the Capital, which is often alive with the farmers market over the summer. I also enjoyed frequenting Lake Mendota and the terrace, filled with colorful chairs and bustling people. The view is breathtaking, as a red and orange sunset illuminates a glimmering deep blue lake. Sometimes the waters are quiet and peaceful, and sometimes they are turbulent and rough. They are always scenic and beautiful. I love slowly inching toward the ducks, as I greatly enjoy their company. One of my fondest memories is walking across the ice-covered lake. It was a long, cold Winter. In fact, it was so cold that the lake froze over, and many people walked across the lake, unencumbered by any worry of falling through. People even flew kites on the ice, and some of the air balloons were of my favorite animal – cats. 

I also explored the Chazen museum on campus, and the fourth floor is the most provocative, and therefore, obviously my favorite. But you’ll have to check it out for yourself to see what I mean, as some of it is too explicit to simply blog about. I also listened to wind ensembles at Hamel Music Center, and the music is powerful, moving, and melodious. But my favorite place to frequent downtown Madison is Comedy on State. I found new joy in stand up comedy. Each Wednesday night, I went to Comedy on State to watch the competition for “Madison’s Funniest Comic.” I went to each of the rounds, and I voted for who I thought should move on to the next round. This summer, both Amy Schumer and Taylor Tomlinson are coming to downtown Madison, and so I am excited for all the laughs yet to come. When I flew out to Kansas City, Missouri for the National Health Outreach Conference, I even bumped into one of the comics at the airport, and sat next to him on the plane! He let me read his notebook full of handwritten jokes, and I thought it was such a magical, neat item to carry around in your pocket to store all your inner genius. 

Speaking of the National Health Outreach Conference, I have not only had fun here in Madison, but I have also grown professionally. In May 2022, at the National Health Outreach Conference located in Kansas City, Missouri, I was able to present on the “COVID-19 Vaccination Facebook Ad Message Campaign in Rural Wisconsin,” which was a major project I worked on in Year 1 of my Fellowship. Within this project, we conducted a Facebook Digital Ad Campaign to inform our audience and guide decision making in getting vaccinated for COVID-19. Our target audience was NorthWest rural Wisconsin, and our goal was to increase COVID-19 vaccine uptake in rural Wisconsin by providing health information to guide Facebook users' decision making through paid, targeted ads.

From this project, I learned how to deliver messaging in plain language, strategically target information to specific target audiences, and keep up to date on the changing landscape of COVID-19 as an informed, reliable source of information. I learned how to intentionally develop messaging frames based on research. Additionally, I gained tangible skills, including how to run Facebook ads through Facebook Business Manager. It was also interesting for me to explore and work with all the data and metrics Facebook collects, and to then work with my colleagues to interpret this data. As Year 2 of the Fellowship rolls around, I am excited to work on a paper for publication surrounding this project. 

My trip to Kansas City was financed through the Fellowship’s professional development funds, which is a cool perk of the Fellowship! During the trip, I enjoyed eating Kansas City BBQ and meeting new people. I was even able to play some art mini golf with my coworkers, as seen in this picture! Unfortunately, I came in last place despite having tied up my hair as soon as the game began. Just because you are competitive about something does not mean you are skilled at it. 

The Return to In-Person

A blog post written by Erik Ohlrogge, a 2021-2023 Fellow

The last two years of the COVID-19 pandemic made me appreciate the convenience of working from home. They also made me value connecting with others in-person much more.

I think of myself as an I’m an introvert who masquerades as an extrovert. I’m perfectly content retreating behind a book or going for a long bike ride alone. It may be a biproduct of me being an only child—I don’t really know. It’s who I am, though.

The last two years of the COVID-19 pandemic shuttered in-person life for me like many others. Gatherings with friends became drinks over Zoom. Happy birthdays were sung over the phone. Group bike rides became solitary affairs. I went home to live with my parents and ride out the pandemic as we retreated to opposite ends of the house to not get on each other’s nerves. I was and am lucky. I had stable internet. I could work from home. I had space outside to bike. I could go back to a house that was large enough to retreat to opposite ends in. No one in my family died from COVID-19.

Prior to becoming a Wisconsin Population Health Service Fellow, I worked for Wisconsin’s COVID-19 response where my only in-person interaction at work was picking up my laptop when I started. While working at the DHS, I became familiar with the challenges of maintaining engagement over Zoom and trying to develop a shared team atmosphere. On one hand, I was part of a larger team working toward a common goal to minimize the impacts of the pandemic. On the other hand, I worked alone at home, and I never met a member of the team that I was a part of in-person. It was strange. I was part of a whole, but at the same time, I didn’t feel like it.

Surprisingly to me, I missed masquerading as an extrovert. I missed the chatting before a meeting, the networking, and the ease at learning about other people’s lives. I realized how hard it was for me to build genuine connections over video calls, and how I struggled to relate to people in a Zoom meeting in the same way that I can in-person. Maybe I am more of an extrovert than I realized.

Almost a year ago, I started the Wisconsin Population Health Service Fellowship at a time of optimism about the pandemic. People were being vaccinated. Cases were down. I started worked at my placement site in an office. Plans were made to have meetings and conferences in-person again. I got to meet my new colleagues and the other fellows in-person. The community building around in-person learning community meetings was something that I looked forward to going into the fellowship. The world seemed like it was taking its first steps back to “normalcy.”

Then came Delta and Omicron, and life slid into a strange limbo. Masks stayed on. In-person meetings were moved back to virtual. And eventually, my placement site moved back to working from home until the pandemic ebbed again.

Over the last few months, things have, again, begun to return to in-person. A couple weeks ago, the Fellowship Community had its first in-person learning community meeting in almost a year. It felt good to be in person with others. I had a feeling of connectedness that sitting in front of a computer screen during a Zoom meeting cannot fully replicate. The meeting also felt more memorable and not like an additional Zoom meeting in a week of Zoom meetings. Similarly, I attended the 2022 Wisconsin Public Health Association meeting, and just being at the conference with others was meaningful. It’s a special thing to be able to sit in the same room with others, and it’s amazing what getting a bunch of brains physically in the same room can accomplish. All this even despite uncertainty of having a meeting during a pandemic and navigating the awkwardness of understanding whether to shake hands or to bump elbows. What made it fun is understanding that we are all navigating this ongoing strangeness together.

Don’t get me wrong—there are many parts of the remote world that I love and which I think should be carried forward. However, I now have a more powerful appreciation for what is like to be in-person. The COVID-19 pandemic brought many changes to the world. I hope that some of these changes stick, and I hope that some of the changes help us recognize the importance of connectedness and community.

From Student to Discussion Leader- PopHealth 370

A blog post written by Mariana Pasturczak, a 2021-2023 Fellow

Throughout my undergraduate education, I had heard rumblings of a course that was eye-opening and engaging for those interested in public health. It was Dr. Remington’s population health class, PHS 370: Introduction to Public Health- Local to Global Perspectives. When my schedule finally permitted me to take this class in my last year (and last semester), I felt immediately at home. Dr. Remington was an engaging lecturer and brought in a slate of amazing guest lecturers and experts, and the discussion sessions were a space for me to think critically about public health and have conversations with my peers, unlike many of my other discussions where we just repeated lecture material. PHS 370 not only solidified my decision to pursue public health but made me want to stay involved in the course so I can be a part of engaging with the next generation of public health leaders.

This spring, leading a discussion in PHS 370 has been extremely fulfilling, especially after working from home and being isolated for the last couple of years. Having a space where I can meet with a small group of students and have honest, nuanced discussions about public health with people who care about it as much as I do is special. It has been so rewarding to see my students bond with each other and build a space where they trust each other and can share their honest perspectives in class. This environment has helped lead to difficult conversations among the students, and they truly listen and respond to each other, as opposed to just raising their hand and saying their piece. We still have a few weeks left in the semester and I know that with this group of students, the last few weeks are going to fly by. One of my goals for the Fellowship is to improve my oral communication skills, and this has been a lower pressure way for me to work on this. Leading this discussion has forced me to stop trying to plan every minute of our time and learn to come up with questions on the spot in response to what students are saying, and answer questions that may come my way. My students were patient with me as I worked to set a flow for our class in the first couple of weeks. As the semester progresses, I feel myself coming in more confident each week, and my oral communication skills improving.

This semester has come with its own unique challenges as well. During winter break, there was a lot of uncertainty around whether or not students will be returning to campus, and what that would look like. Once we knew we would be conducting discussions in person, there were a lot of nerves about being in the classroom with the Omicron surge still occurring, but we all upgraded our masks and began meeting in person. After spring break, the campus mask mandate expired, and we were faced with individual decisions on whether or not to continue masking. I had to make sure that the classroom remained a safe space and students felt comfortable coming to class, with or without a mask. Throughout the semester, it has been impossible to avoid the topic of COVID-19, and I have had to learn to balance my opinions with objective information, especially when students ask specific questions or my thoughts on events occurring. I have also had to become sensitive about letting the students discuss the pandemic, as we all have experienced a collective trauma and we are all in our own place when it comes to healing. Because my students have built a space where we trust each other, they have opened up and shared extremely personal stories and, in those moments, I remind them that they have to take care of themselves, even if that means taking a step away from class if the conversation becomes too difficult. I am so proud of my students, and I look forward to wrapping up the semester with this fabulous group of undergraduate students.

A Big Life Change

A blog post written by Julia Nagy, a 2021-2023 Fellow

I’ve never learned to not sweat the small stuff.  Sweating the small stuff is my main form of exercise. However, perhaps concerningly, I too frequently do not give the big stuff the sweat it deserves. Which is how last summer, for the second time in my adult life, I found myself moving across the country to live in a state I’d never so much as previously stepped foot in. After twelve years living in Boston, eight years in the health and healthcare workforce, and six years at the same non-profit, I’d just completed my MPH and was ready for a Big Life Change. That said, moving to Wisconsin absolutely was not on my radar.

Two main things I initially learned about the UW Population Health Service Fellowship convinced me to (very carefully) load my houseplants up into a UHaul and drive straight west on I-90 until I hit Lake Monona:

-       The core equity focus: I’ve seen and worked in many public health and health care settings that consider health equity to be a “nice to have” add-on to their work, but with the Fellowship equity is foundational. This, to me, was crucial.  I’ve learned that I do not want to do public health work that does not put equity at the center, and I see the Fellowship live that promise every day.

-       Learning communities: I completed my MPH part-time and, thanks to the pandemic, nearly half of it was virtual. Because of this I struggled to build strong, lasting collaborative connections with others in my cohort, and felt like I missed out on that important part of the grad school experience. The promise of a learning community appealed to the part of me that wanted to nerd out with others about public health, equity, social justice, and more. I’ve absolutely found that here with other Fellows, with Fellowship staff, and with colleagues and partners at my placement sites.

Since I arrived in Madison additional experiences have reinforced that I made the right decision to accept this opportunity:

-       Flexibility to explore: Within my placement site I had a ton of latitude to find projects that interested me and that I felt like I could learn into. I’ve been able to take on meaningful roles in projects that really align with my goals and interests within the two offices in which I’m placed. I also now know that if I was interested in a topic that I couldn’t address within my placement that Fellowship staff would be happy to help me find and connect with another department or team where I could work on that topic.

-       The trust the Fellowship confers: Coming from Boston, I didn’t have a lot of context for this Fellowship. I quickly learned that it is quite well-known in Wisconsin health systems and organizations, and PHI fellows have a reputation for being responsible, thoughtful employees and partners who do high quality work. As a result, there’s an intrinsic level of trust that Fellows receive that leads to being quickly given responsibility for meaningful work. This level of confidence might otherwise take years to build. Just six months into my Fellowship I began leading the process to develop the next State Health Improvement Plan, which is a major policy document that will anchor the Department of Health Services work to improve the lives of Wisconsinites for the next 5 years. I can’t imagine I would have been given this degree of independence and responsibility so soon without the weight of being a Fellow behind me.

All said, it turns out sweating this decision would have been an unnecessary use of energy anyways; I’m thankful that I took the leap. I am thriving, and so are my plants.

Professional Development and the Fellowship

A blog post written by Brie Godin, a 2020-2022 Fellow

I have always loved to learn. From eagerly attending summer school enrichment programs in elementary school to taking the maximum number of allowable credits in college, I have always had a desire for knowledge and exploration. Upon finishing graduate school, I was still searching for an opportunity to further explore my interests and options in the field of public health before settling on a permanent career, making the fellowship a perfect fit. Fellows have the unique opportunity to not only gain experience working at a placement site, but are also able to pursue further learning through professional development funds.

Throughout the fellowship program, fellows are provided with professional development funding that can be used in a variety of ways including conferences, continuing education, and educational materials, such as books related to public health. Often, fellows use these funds for events, such as out-of-state conferences they may not otherwise be able to attend. However, given the restrictions of the COVID-19 pandemic, most conferences in 2020 were offered virtually if at all.

For the first year of my fellowship, I chose to apply my professional development funds toward continuing education in an area where I hoped to development more familiarity, the non-profit sector. Mental health advocacy in particular is a passion of mine, and I currently volunteer for mental health non-profits outside of my fellowship placement. In my placement site at the Department of Health Services, I have had the chance to experience working in a governmental setting, but I am also considering pursuing a career in a non-profit organization post-fellowship.

To gain a better understanding of the non-profit sector as well as some of the potential opportunities for public health careers in this field, I enrolled in the Introductory Non-Profit Certificate program through the University of Wisconsin-Milwaukee, where I had previously completed my MPH. The certificate program is a package of courses on a variety of topics such as budgeting, grant writing, leadership, and non-profit boards. The courses are offered completely online, which is ideal for those working remotely, especially during the pandemic.

While many college courses run on a set schedule, the courses for this certificate program offered flexibility, something which I appreciated. Participants are given one year after enrollment to complete all course work and courses do not have to be completed within a given time-frame after starting. This allowed me to work through the courses at my own pace, often finishing a few course modules in between or after meetings at my placement site.

While online courses often involve a great deal of reading, this is not the best learning style for everyone. As someone who benefits from being interactive and engaging in the learning experience, I appreciated that the courses included a variety of elements including articles, video interviews with professionals in the non-profit field, and interactive review games, activities, and quizzes.

Through completing the Introductory Non-Profit Certificate program, I have gained a better understanding of how a non-profit organization operates as well as potential career opportunities in this field. I have also developed basic skills such as reading financial statements, which will be useful in applying for positions post-fellowship.   

For fellows or anyone looking to enhance their skillset or learn something new, I would absolutely recommend pursuing continuing education opportunities through the UW System. UW-Milwaukee offers courses on a wide variety of topics from foreign languages to early childhood education, with other campuses offering programs as well. I hope to be a lifelong learner and am grateful to have had this opportunity.

Uncertainty Throughout the Pandemic

A blog post written by Kong Xiong, a 2020-2022 Fellow

Amid a global pandemic, the fellowship has provided me with more than just a “job.” Before I accepted my role as a fellow, I was a 2nd-year graduate student in Milwaukee, WI with one semester left before graduation. I worked part-time but knew I would need a full-time position after graduating. Before I could even begin the job searching process, I still needed to graduate first. Completing a capstone was already time-consuming and stressful by itself. The eventual pandemic snowballed the stress of my capstone. Through it all, I managed to emerge on top and found myself at the Wisconsin Department of Health Services in their Maternal & Child Health (MCH) Unit.

Impostor syndrome has always caused me to doubt my abilities and knowledge and it was no different entering the fellowship orientation.

“Did I earn my spot as a fellow?”

“Am I capable of working here?”

“Can I match the intelligence of my peers?”

Anxiety settled in during the fellowship orientation. I was never one for big groups and small talk. As the fellowship orientation progressed, I began to settle in. The conversations were enlightening and the activities with the second-year fellows & faculty eased my nervousness.

I was uncertain on how to handle a “grown-up job” amid a pandemic, where in-person interaction is limited. Virtual on-boarding, remembering acronyms, and putting a name on faces was a challenge. I was reminded of uncertainty every day. Days soon turned into weeks and the uncertainty of navigating a virtual on-boarding was revealed to be simpler than I imagined. There many factors that eased my transition into the virtual workspace. The unit staff all met with me one-on-one to create some familiarity, while also allowing for introductory small talk. The kind of stuff that you usually would get during a small water break at an in-person setting at the office. During zoom meetings, my preceptor would regularly check in to see if I was aware of the acronyms that were used. Jumping into these meetings with little context created confusion early on but the MCH unit staff made sure that I would be up to speed with the current scope of work to the best of their ability.

During our orientation, we were tasked with signing up to plan monthly fellowship learning communities. I opted to sign up for the first month available and was joined by a second-year fellow and a preventive medicine resident. When it came time to facilitate our learning community, it was a joy to see (via Zoom) the high level of engagement during panel discussions and Q & A’s. As a fellow, we’re tasks with working with our state agencies to complete our work, along with balancing the responsibilities of being a fellow. As a first-year fellow, having a second-year fellow to help lead made the learning community planning enjoyable and less stressful.

After almost a year in the fellowship, my biggest takeaway from the learning communities, preceptor meetings, progress review, and coaching sessions is that all aspects of the fellowship amount to bringing the best out of fellows. The fellowship community not only provided me with a way to find my confidence but also reinforce my communication skills and public health knowledge within a short period. The fellowship has more than what I could have asked for and I look forward to seeing what the final year hold for me.

A Socially Distant Start

A blog post written by Emily Dejka, a 2020-2022 Fellow

“Do you know what “Eau Claire” means in French?” Of course, I didn’t. “It translates to ‘clear water’.”

This was the first question my grandpa asked when I told him of my fellowship placement offer. While I was appreciative of that Snapple cap fact, it didn’t answer any of the questions that I had about this opportunity. Mine were along these lines:

1.       How hard would it be to find an apartment?

2.       What would it be like to be queer in Eau Claire?

3.       Would my partner be able to find a job?

4.       Would I get along with my mentor?

5.       How quickly would I make friends?

6.       Is this the right job for me?

Did you notice that the pandemic wasn’t mentioned at all? I double checked my email to be sure, but I was offered the position on February 21, 2020. One week later, on February 28, 2020, I sent a scheduled email promptly at 8:00 AM accepting the offer. Two weeks later, my MPH program switched to virtual learning. Two weeks after that, I sent a moderately panicked email to the program asking if I should be looking for a new job.

Like so many others, my world had completely changed in what seemed like the blink of an eye. For the next six weeks, I would spend nearly 20 hours a day in my room, only leaving to make meals or get outside. Though this period was extremely challenging for me, especially mentally, I feel as though it would be irresponsible for me to not acknowledge the sheer amount of privilege I had during this time. For one, I was safe in my home. I only had one roommate, and while we weren’t terribly close, I trusted her, and we had the same mentality when it came to sharing resources (i.e., toilet paper). I was also able to continue working my two part-time jobs and pay my rent each month.

From mid-March until the end of June, my life took on some semblance of routine. I worked, went to class, and took walks. On an unremarkable Thursday, I graduated and was able to add those three letters after my name: MPH. I also finished all eight seasons of The Vampire Diaries and the first three seasons of its spin-off, The Originals. Before I knew it, the time came to make the next step and it was the busiest week I’d had in months. Between a Sunday and Friday, I moved out of my Michigan apartment, bought a new car, and moved into my new home in Eau Claire. It was the eighth time my parents had moved me into a new place in nine years.

Photo from the virtual 2021 Fellowship Orientation.

The following week, I attended the fellowship orientation. Trying to make a good impression, I angled my camera so people couldn’t see that the only furniture in my living room was a lawn chair and 6-foot folding table. I think the echo when I spoke gave me away though. Orientation was a happy blur of meeting people and learning more about the program. However, it also hit me how far I was from the rest of the community, which I hadn’t thought about previously. There wasn’t a second-year fellow in Eau Claire I could reach out to, and a couple of months in, the other rurally placed fellow accepted a new position. In a non-pandemic year, this wouldn’t be a problem since I would be travelling to Learning Community Meetings each month. Thankfully, I had a dear friend who was also starting her fellowship journey in Milwaukee.

For my first day at the Eau Claire City-County Health Department, I was nervous. Of course, that is natural when starting a new position, but I felt an added social pressure to make sure that in every interaction I came off as funny, charming, easy-going, dedicated, hard-working, intelligent, competent, interesting, and an active listener. While I’ve never been of the mindset that you need to form everlasting friendships with each one of your co-workers, I was so deeply aware that this place is where most of my in-person social interactions would occur, something that I had missed terribly in those months in my Michigan apartment. So, in that first week when I extended my hand to someone on first meeting her or forgot another person’s name and was introduced to them twice, I felt those as dings against me.

Does this come off as a touch melodramatic? Perhaps.

Writing this now, it’s been about seven months since that first day. I’d like to say all that social anxiety is gone, but that is not the case. There is much to celebrate though. The Eau Claire Health Department has an incredible team, who have been beyond supportive in the work I’m doing. My partner moved in a couple of months after I did, and the difference of having her there has been remarkable. I’ve also began cultivating a small list of people who will stop by my cubicle for a chat when they walk by. Everything is just taking more time. It’s hard to form relationships when most interactions are through a computer or in brief, physically distanced, masked conversations. From my graduate school experience, I know how quickly two years can go, and I want to be able to make the most of the opportunity I’ve been given.

I have been able to answer those questions from before, and for me, that’s a wonderful beginning.

1.       Hard, but you’ll eventually find a beautiful, albeit drafty, home that allows you to adopt a cat named Frida.

2.       Easier and harder than you thought.

3.       Yes! She’s had one happily since October.

4.       Another big yes!

5.       Faster than you thought.

6.       Absolutely.

First Hand Experience: Thoughts from a Fellow Involved in the COVID Response

A blog post written by Brie Godin, a 2020-2022 Fellow

While a fellowship is typically thought of as a training opportunity, fellows in the 2020-2022 cohort were in the unique position at beginning our placements during the greatest public health crisis of our lifetimes: the COVID-19 pandemic. For many fellows, myself included, this has meant taking an active role in the COVID response soon after entering our placement sites. While challenging, this has provided an opportunity to develop important career skills and contribute to the public health workforce in meaningful ways.

For my placement, I have been assigned to the Office of Preparedness and Emergency Healthcare (OPEHC), one of the nine bureaus and offices in the Division of Public Health (DPH) at the Wisconsin Department of Health Services. OPEHC has been deeply engaged in the COVID response since the pandemic began, with several staff serving on various workgroups and in leadership roles within DPH. OPEHC has also received grant funding to assist with pandemic response efforts.

Upon starting at OPEHC, I immediately became involved in a variety of projects related to the COVID response. These have included grant development, vaccination planning, and Wisconsin Emergency Assistance Volunteer Registry (WEAVR), a system working to provide staffing support to healthcare facilities throughout the state. These projects have provided an opportunity to develop skills, such as communication and leadership, while actively participating in response efforts.

My most recent - and perhaps most valuable role to date - has been serving as a member of the vaccination taskforce, a group consisting of various professionals throughout the Department of Health Services. I have participated in the education and communications workgroup and have also taken on a leadership role as a liaison for Wisconsin tribal governments.

A unique aspect of the fellowship program is the opportunity to take active leadership roles within placement sites. As tribal liaison for the vaccination taskforce, I have been directly tasked with answering or seeking out answers to critical questions from the eleven federally recognized tribal governments in Wisconsin related to all aspects of vaccination. I have also been involved in the allocation and ordering process, ensuring that vaccine is safely and ethically distributed to our tribal partners.

My role in the vaccination taskforce in particular has led to incredible opportunities. For instance, I was able to participate in one of the first vaccine distribution events, a truly groundbreaking experience. I have also been privileged to participate in a variety of meetings and events such as a meeting of the Great Lakes Inter-Tribal Council. These opportunities have allowed me to make connections with professionals outside of my worksite, potentially leading to future opportunities.

While becoming directly involved in the COVID response shortly after beginning the fellowship has certainly been a “trial by fire” of sorts, it has been incredibly rewarding to know that not only am I gaining valuable skills in public health, but that I am directly contributing to the public health workforce in a meaningful way. Working in OPEHC during the pandemic has also provided the chance to actively witness and be involved in emergency preparedness. The 2020-2022 cohort truly has an incredible opportunity, and I am very excited to witness the continued efforts of this group within the COVID response.

True Community Engagement

A blog post written by Maddie Johnson, 2018-2020 Fellow

One of my favorite parts of the fellowship program is the learning community meetings. As fellows, preventative medicine residents, preceptors, and faculty, we have the opportunity to convene once a month and learn about a different public health topic. Each year of the two year fellowship, a fellow is assigned to plan one of the learning community meetings. Last year, I organized a meeting called Housing Poverty, and the Law. This year, the focus of my planned learning community meeting was Arts, Social Justice, and Public Health.

Planning a learning community takes commitment, persistence, and organization. Facilitators have to find an affordable venue as well as engaging presenters. Plus, it is important to plan a day that is a mix of lecture, discussion, reflection and activity in order to keep the audience interested. Additionally, there are numerous administrative logistics to cover including RSVPs, catering, and post-meeting evaluation.

Arts, Social Justice, and Public Health took place on February 14th, 2020 in the Chazen Museum of Art auditorium, which is the University of Wisconsin-Madison campus art museum. I chose this location with my other meeting planners because it is fairly accessible for those living in Madison as it is on campus and a bus line. However, I had some concerns about not basing our meeting in a community setting. When planning a learning community meeting, it is important to consider all perspectives, which means engaging community groups. I think the University environment can potentially be less welcoming for community groups, so I did advocate for us to consider holding the meeting in another community setting. However, given that our meeting focused on art, being in an art museum made sense for learning purposes and we ultimately decided to have the meeting in the museum.

There are other barriers to engaging community groups when planning learning community meetings. In November, we had a learning community meeting on youth engagement. Given that the meetings occur during the work day this can be challenging for certain groups like youth to attend. Additionally, as a fellowship community, we are asking folks to present on a limited budget. Generally, we ask presenters to share with minimal compensation. There are some administrative barriers that prevent compensation. We consider local presenters whenever possible as monetary compensation for travel and mileage can be challenging.

The learning objectives of the February learning community meeting focused on exploring art through different mediums such as visual arts, music and theater. We also discussed how art can shape the perceptions of certain communities and how art can help communities heal from trauma. As one of the facilitators and organizers of the day, it was a whirlwind. I constantly was thinking one step ahead as the speakers presented to ensure the day flowed smoothly and that all details were accounted for (Is the speaker using the microphone? Is the speaker’s PowerPoint up and running? Do we have time for one more question or do we need to move on to the next presenter?).

Because of my role as the meeting organizer, I felt like I had less time to sit back and digest the information from the day. Since as fellows and residents we switch each month who plans the day, other months I get to sit back, relax, and reflect. It has now been about two weeks since the February learning community meeting and I have had some time to think. My main takeaway is a question: what does true community engagement look like in public health work?

I have wrestled with this question since the beginning of my public health career and found that the February learning community provided examples of true community engagement, yet none of the presenters likely identify as public health practitioners. However, the presenters are addressing public health issues (such as housing, built environment, and youth engagement). They also recognize that the process of engaging a community is sometimes more important than the outcome of the project.

Image source: https://madison.com/ct/news/local/photos-hawthorne-tunnel-mural-dedication/collection_cf25e77e-f21c-535f-9317-4e88350e19f9.html#3

One of the presenters, Emida Roller, the executive director of Dane Arts Mural Arts, Inc. (DAMA), discussed how DAMA incorporates community engagement into their work. DAMA works alongside communities to beautify neighborhoods through mural paintings. Community members are engaged in every step of the mural production from identifying the location to the mural images as well as the actual painting and creation of the mural. One example she mentioned was near Hawthorne Elementary School in Madison. The mural was painted inside the walls of a tunnel under East Washington Avenue. Previously, the tunnel was not used by the students because they thought it was dirty. Alternatively, students crossed a busy intersection at east Washington Avenue to get to school. By beautifying the tunnel, the hope is that the tunnel will be the students’ new pathway to school.

This example of community engagement reminded me of another learning community in October 2018. Lead by Human Impact Partners, a non-profit and advocacy organization, we learned about racism. I specifically remembered an exercise where we considered how much we incorporate community engagement in our work. Known as the Spectrum of Community Participation, I see DAMA’s work on the co-power level, but I think public health work especially when guided by health departments tends to be at the consult level.

Image Source: Health Impact Partners Spectrum of Community Participation, October 2018 PowerPoint

As I reach the final months of my fellowship, I am considering more deeply how my future career can involve community engagement. I think each level of government from the local to the federal level should ultimately support the voices of communities. Regardless of my next position after the fellowship, I want to strive toward the collaborate and co-power levels in my public health work where the community has decision-making authority. Community members are the experts in their own stories.

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Below are some additional images from the Learning Community meeting!

National Public Health Conferences Review

A blog post written by Kara Mathewson, 2018-2020 Fellow

One of the many great aspects of the Fellowship is the focus on professional development. Conferences are one common opportunity for fellows to expand skills, knowledge, and networks. For me, 2019 was a year full of conferences. For this post, I’ve decided to do a ‘Google-style’ review for a few popular conferences that I attended – including CityMatCH, APHA, and AEA’s Annual Evaluation conferences.

Why these conferences? It can be hard to choose what conferences to go to because there are so many good ones. One of the reasons I chose to go to CityMatCH was because I work in the Maternal and Child Health Unit at DHS, and this conference brings together folks working in this area specifically. This meant that I had a few coworkers attending and several who could speak to their previous experiences attending as well. Additionally, my preceptor (shout out Fiona) had an abstract accepted for presentation, but since she was not able to attend, she asked if I could present in her place. For APHA, I decided to attend because it’s the ultimate public health gathering. It’s good for exploring and learning about a wide range of public health topics, especially things you’re interested in but don’t get to work on day to day. And lastly, I chose to go to the Evaluation Conference because I have a lot of interest in evaluation, and as a fellow, I’m engaged in evaluation planning and implementation for several programs at my placement site. I was looking to gain more general tools for my toolbox and get some specific insights related to the evaluations I’m working on.

So before I dive into the review, I want to share a few tips:

• I recommend downloading the conference app (if there is one) ahead of time. This gives you an opportunity to figure out where you need to go and browse the sessions ahead of time to make it easier to decide which sessions to attend once you’re there.

• I personally prefer to go to skill-builder type sessions over sessions that solely align with topics of interest. I always seem to get more out of these, but I will usually go to a few sessions that align with the topics I’m currently working on as well.

• It’s okay to take some breaks! Something that took me several conferences to learn is that it’s okay to skip a session here and there to take care of your needs. Conference days are really long and don’t always offer breaks longer than 15 minutes between sessions. I’ve found that skipping a session every once in a while to grab lunch or exercise helps me get more out of the sessions I do attend.

• Space out your conferences out a bit. Conferences can be a little exhausting, especially if they involve traveling a ways and I’ve found it can be a lot to do two in one month. It can also be stressful to be out of the office that much because it’s really hard to get any other work done when you’re there. So plan ahead and set that out of office reply!

CityMatCH 2019

Cost: $$$$

My presentation at CityMatCH.

Summary: In terms of overall content, I would give this conference three stars, but having several co-workers there and having time to debrief and talk about sessions with them brought it to four stars. The plenary/keynote presentations were phenomenal and for me, were the highlight of the conference. The breakout sessions were just okay, but I was really excited to see so many sessions on adolescent health and youth voice. For anyone who works in Maternal and Child Health, these are your people! It felt very at home to be with other MCH colleagues who are working on similar objectives. Also, as a total side note, the food provided at the conference was fantastic and the registration fee covered breakfasts and lunches during the conference.

Favorite keynote presentation was from Kitcki Caroll, titled “America’s Original Sin: The Untold Truth of Tribal Nation-United States Relations and its Relevance to Today’s American Division”.

APHA 2019

Cost $$$$$

Summary: Despite the high cost (registration is pricey and meals are not provided), APHA was a fun conference. This year, APHA was held in Philadelphia and I’m glad I got to spend much of the first day exploring Philly with a coworker. The rest of the conference was filled with very busy days that included breakout sessions, exhibitors, posters, and networking. The style of this conference is more academic than others I’ve been to, so some things weren’t as applicable to public health practice. Nonetheless, I learned some new things and had an opportunity to connect with public health professionals from all over the world. I did think the closing panel, Health and Justice Denied, was incredible.

My favorite sessions were a presentation about improving a Domestic Violence Protective Order process, a presentation that shared validated measures for shared risk and protective factors, and a panel about vaccine information, misinformation, and disinformation.

AEA 2019

Cost: $$

Summary The Annual Evaluation Conference is a great gathering of evaluators from many fields and sectors.  I’ve attended three AEA conferences in the past three years – the Summer Institute and two Annual Evaluation Conferences. Both have a lot to offer for professional development in evaluation. For more skill building, I highly recommend the Summer Institute because it is a workshop heavy conference. The annual conference offers a wide variety of sessions that include roundtable discussion, skill-builders, panels, expert lectures, multi-paper sessions, and more. This varies quite a bit from other conferences that I have attended and it really helps to switch things up during long conference days. If you’re looking to attend this conference to build skills, I recommend focusing on choosing sessions based on the type of session and not based on the topic area alone.

Additionally, there is an added bonus that the conference registration is relatively low cost compared to other multi-day conferences, especially for AEA members. And with this year’s conference being in Minneapolis, it really helped lower the cost as well, since I was able to drive.

My favorite sessions were Evaluating Advocacy and Policy Change in Local and Community-Based Settings and a session that included a discussion around ethics in evaluation, following a case study.

I want to give a huge thanks to my placement site, the Division of Public Health – Family Health Section, and the Fellowship for providing me with these development opportunities.

Thanks for reading!

–Kara

From Minneapolis to Milwaukee: Progress, Reflection, and New Beginnings

A blog post written by Maddie Johnson, 2018-2020 Fellow

Near the end of my graduate education, I knew I wasn’t ready for it to be over. Two years seemed gone in an instant and though I felt like public health was the right field for me, I wasn’t prepared to focus on a specific career path. I still wanted space to learn and grow while also working towards positive change in the community I lived in. This sentiment is what drew me to the Wisconsin Population Health Service Fellowship. Working a full-time job while also creating time to learn and reflect seemed countercultural in a society that emphasizes constant doing rather than being. When I found out I was offered a position in Milwaukee working as a population health fellow, I was conflicted because many of my peers were moving straight into the working world. I had never even visited the city of Milwaukee – was I ready for such a move?

At the time of the fellowship offer, I was living in Minneapolis, Minnesota and finishing my last semester at the University of Minnesota in their master’s in public health program with a focus in public health administration and policy. The morning after I was accepted into the fellowship, I trudged along University Avenue to my graduate research assistantship at the UMN Rural Health Research Center. After arriving, I relayed the news to my supervisor, Dr. Carrie Henning-Smith,  conveying my feelings of excitement but also reservation. To my surprise, my supervisor informed me she completed the same fellowship ten years ago with site placements in Milwaukee.

Now that I am entering month 11 of my two-year fellowship, I look back on this coincidence, reflecting on my experience at the University of Minnesota and how my education led me to this program. I revisited my connection with Dr. Henning-Smith recently and asked her about her fellowship experience and career since then. During her fellowship, Dr. Henning-Smith was placed at the Milwaukee County Department on Aging where she worked on various projects including developing a county-wide wellness council. She was able to have a secondary placement at a small nonprofit, which worked on social services and wellness programming for older adults living in public housing. One of her favorite parts of the fellowship was having the freedom to explore different opportunities and areas in public health while also affirming her interests.

After completing the fellowship, Dr. Henning-Smith went to the University of Minnesota to complete her PhD with the goal of conducting research to address systemic problems. She states that the fellowship helped her work on her skills in listening and community engagement in a meaningful way. I find a lot of parallels when looking at Dr. Henning-Smith’s journey and my own journey. I currently have duel site placements at the City of Milwaukee Health Department in the Office of Policy, Strategy and Analysis as well as the Center for Urban Population Health. I am finding that success in the real world looks different from my academic studies, especially when incorporating the philosophy that change starts with the community.

While working at the UMN Rural Health Research Center with Dr. Henning-Smith, we created the Mental Health in Rural Communities toolkit (funded by the Health Resources and Services Administration (HRSA) through the U.S. Department of Health and Human Services (HHS)), which refined my interests in mental health and in stakeholder engagement, both interests I have been able to explore throughout my fellowship. I connected with Dr. Henning-Smith recently to see what she wanted to highlight from this toolkit. I hope that this blog post can serve as a reflection of both of our fellowship experiences, but also shed light on a wonderful resource which will be helpful to rural communities across the country. Dr. Henning-Smith states that there is an urgent need to think about addressing mental health in rural communities. This toolkit provides a means to do so as we interviewed mental health programs across states to gather information on promising practices in the field.

When I talk to most people about how they came to work in public health, I find that our journeys may differ drastically, but we have one commonality: the path was indirect and at times far from obvious. Another commonality I have found is that public health folks have an innate desire to seek truth, justice, and a better society. I have met these individuals both in my time at the University of Minnesota and throughout my fellowship program. The fellowship has given me and others before me the opportunity to reflect, learn, and explore with the overarching goal of providing community service and creating positive system change. For these opportunities and future opportunities, I am grateful to my university professors, mentors, and fellowship staff. My path feels less uncertain and I know year two of the fellowship will provide me with more clarity, inspiration, and guidance.

Movements and Public Health: Making Change at Different Levels

A blog post written by Rachel Kulikoff, 2018-2020 Fellow

On October 5, 2018, Jason Van Dyke, a Chicago cop, was found guilty of the second-degree murder of unarmed black teenager Laquan McDonald. I ducked out of my cubical to take a walk and listened as the jury foreperson read the 16 guilty verdicts for the 16 counts of aggravated battery (one for each shot). It was a powerful, visceral moment.

Chicagoans were rallying in the streets, and most of my Twitter feed was celebrating. Finally, finally, finally a police officer was being held accountable for shooting a black kid; finally, there was some measure of justice. Even as the relief and celebration continued, some folks, especially those active in the abolition movement, were beginning to grapple with what justice looks like in a broken system. Some were frustrated at the focus on the punishment individual rather than structural inequities and the criminalization of black bodies, while at the same time supportive of Laquan’s family achieving a measure of peace. Many were openly skeptical that the system was capable of providing justice, especially with the deployment of hugely increased police presence in the city for “public safety” ahead of the verdict (whose safety?).

I have been humbled by the experience, thought, and action that Chicago activists shared around Laquan’s murder. The important questions that they ask are ones that I also think about often in the context of my work in the fellowship program. What does progress look like in a system that benefits some and harms others? How do you stay patient and hopeful and committed to justice when you’re working in those very institutions and systems? How can incremental changes bracketed by long periods of talking and meetings and bureaucracy be enough when, for example, in Wisconsin black babies are dying three times as often as white babies?

When I think about what progress looks like in a government setting, my brain often goes to a panel I went to during the Facing Race Conference, attended using fellowship professional development funds. It was about how to find an open window to advance racial justice in government, and the presenters were sharing their own success story. They were from a county in which half the population were non-English speaking, with some Spanish speakers and many others speaking indigenous Mexican languages. The phone trees in the county office were all solely in English, and after months (or maybe years) of work, they were able to add an option at the very beginning to hear the tree in Spanish. While I understand progress is incremental, and slow, and complicated, and changing institutions is hard, I was pretty discouraged by the celebration of this improvement, which seemed like such a bare minimum. 

Meanwhile as part of my position, I’ve had the opportunity to interview community members. I’ve heard feedback that the impression of my workplace is that we’re all talk and no action, and that we have a lot of institutional power, so why aren’t we using it. And it can be hard to be in the position of representing the organization when I kind of agree: why can’t my workplace throw its weight behind opposing mass incarceration and supporting the demilitarization of police? Why aren’t we bolder about using our voice, our power, our money for policies like a living wage or paid family leave? Why are we always talking about health and racial equity and floundering on how to put it into practice?

And I know things aren’t that simple; that there are some valid reasons (fear of state preemption, rules against lobbying, inexperience with venturing so far beyond direct service) for caution, and that my workplace and other institutions are thinking about and taking steps toward racial justice and systems change. And yet these questions remain, and I know that I’ll continue to contend with them for as long as I live and work in systems that feel so broken, that advantage some and dehumanize others.

I have no answers to these questions and will probably continue not to. But what I’m trying to find-- what the fellowship program is helping me find-- are ways to proceed in current reality. Community partnerships and building up individual (if not institutional) trust with community members is a good starting place, but I know that I sometimes need to latch on to something more concrete and immediate. Two examples of concrete ways to work within systems came up at a recent Human Rights Festival that I went to in Chicago. One was a harm reduction program that aimed to get Naloxone and training to use it into the hands of people with substance use disorder, as they most often are in the position to save the lives of peers. Another is the CityKey program in Chicago, a municipal id that can act as in a limited way as government identification, with less stringent requirements than state and federal id. Specifically geared to be useful to marginalized populations, undocumented folks have access to CityKey, and you can self-identify your gender. I don’t know what it might look like for an entry level employee like a fellow to push these types of concrete programs, but they offer insight on what working slowly but productively within a system might look like.

Jason Van Dyke was in the news again in January, when his sentencing took place. Instead of the aggravated battery charges, which carry a longer sentence in Illinois, he was sentenced to 6 ¾ years on the charge of second-degree murder, and he could get out in as little as half of that time. One thing that immediately struck me is that the special prosecutor in the case said afterwards that the system worked, and that justice was served; some community activists might say that the system did work in the sense that it continued to devalue black lives. Again, I have no answers, but at the end of the day, I’m learning to believe that incremental improvement inside systems and radical change from the outside of systems can coexist, if not without tension.

Given that my placement site sits squarely within the system, I am hopeful. I am excited to be entering into the education and advocacy world in maternal and child health. I’m lucky to be at a placement site and with a preceptor who is open to both having conversations and innovating. And I’m grateful to be in a fellowship community in which space is intentionally created to be welcoming of questions and critiques, where we can both grapple with the systems we work in while being gently nudged out of frustrated burn-out.

Coming Full Circle: Population Health Sciences 370

A blog post written by Kara Mathewson, 2018-2020 Fellow

I still remember walking up the hill to Birge Hall with one of my good college friends (and now fellow public health professional at Auburn University) and arriving at the basement entrance where we were met each day by a fierce, stuffed badger in a glass display case. We were headed to our first class of the day – Pop Health 370: Introduction to Public Health, Local to Global Perspectives.

As a sophomore in college, this was one of the first public health courses I would take. I recall being intrigued about using the public health approach in a discussion around bike helmets. Looking back, I also recall not fully understanding the practical applications of the social-ecological model. (Don’t worry, I do now.) Dr. Remington’s lecture sparked my interest in public health, and I started thinking about the larger population-level ties to the microbes I was studying in my other classes (as a microbiology major). I realized I was much more interested in the population level of infectious disease and prevention rather than studying the physiology of these microscopic organisms.

Fast forward five years and two academic degrees later (I went to get my MPH, as I didn’t want to spend one more minute doing wet lab bench work and I was so ready to dive deeper into public health) and now I’m a pop health fellow! I could go on and on about what an amazing year it has been as a fellow, but I’d like to zoom into one aspect of my fellowship experience: being a discussion leader for the UW Pop Health 370 course.

This spring semester I had the opportunity to lead a weekly discussion for the very class where my public health interest began. Despite my initial nerves about leading a discussion of 15 students only a few years my junior, I had a great experience leading them through discussions on a wide variety of public health topics.

So let me jump right into the positives of leading section 317:

1. Had really great students

• I was a bit nervous that I might have a class of students who were shy to participate or were not excited about the topics; however, I was lucky to have a class that was eager to discuss the topics each week. The students were fun to interact with and brought their own opinions and experiences to share and reflect on.

2. Realized my own level of knowledge

• I can now confirm that teaching really does help you to understand and retain knowledge better than just studying it. From leading this discussion, not only have I been able to really assess my knowledge level around public health fundamentals, but I also deepened my understanding of them and feel like I can more easily apply these concepts in my everyday work.

3. Strengthened my facilitation skills

• The first tip they give you about facilitating is to embrace the awkward silence. This is something I’m glad I knew going into the discussion group, as there were plenty of times this occurred, and eventually students chimed in. I also learned a number of facilitation skills from leading this discussion including strategies to create a space where all views are valued. I found it extremely helpful to hear from other discussion leaders about their methods and best practices for meaningful discussion.

4. Jumped into things I loved from grad school

• Outbreaks and case studies and vaccines, oh my! Another highlight for me in leading this discussion was revisiting some of my public health passions that I don’t work on every day. One of my favorite discussion activities was an outbreak investigation case study, of which I did many in grad school. It was fun to share my excitement about these public health topics with students and see what topics excited them as well. 

5. Applied critical thinking skills

• These skills have come from all the learning I’ve done in the first 11 months of the fellowship through learning community meetings, the Community Teams Program through the Healthy Wisconsin Leadership Institute, and my placement site at DHS. I noticed in preparing for discussion each week, I was able to delve further into readings and videos in ways I hadn’t before. I found myself thinking more critically about articles which sparked questions for me to ask students around things such as upstream determinants of health and equity considerations.

In reflecting on my Pop Health 370 discussion section, I must also add that even the best experiences have their own challenges.

1. Many public health topics lead to hard conversations. We talked about gun violence, the diabetes epidemic occurring in Native American communities, and social determinants like poverty and racism. While these are all crucial discussions to improve public health they can be difficult to debate without also discussing, in-depth, strategies to solve these problems, including the work people are currently doing to combat these issues.

2. On that note, I think there is a need for bringing more solutions and current examples of good work to these conversations. It’s certainly difficult to get through everything you want to in a 75-minute discussion, but I feel that it would have improved the discussion to also read and explore solutions and current strategies. We did spend some classes exploring the evidence-based programs and policies that could improve issues, but I would have loved to have students take a deeper dive into these and get exposure to the many organizations, agencies, and individuals doing great work.

3. Lastly, it was difficult for me to not receive any feedback from students throughout the semester. Trying to read students’ faces did not give me much indication about how I was doing as a facilitator and I’m anxious to hear what my students thought about our discussion so I can explore ways to be a better discussion facilitator/leader.

Overall, I had a wonderful time leading this discussion and I’m so grateful that my fellowship experience brought me back to the place my interest in public health began.

Section 317 – outdoor policy discussion! The students went through the nominal group process to select a policy they thought would have the biggest impact on public health and eliminating disparities.

Reflecting on September

Blog post by Masami Glines, 2018-2020 fellow

Now that it is early November already I feel so behind to post this blog on this topic, but I would like to reflect on September Northern Wisconsin Trip to visit Menominee and Oneida tribes, and also the Ho-Chunk tribe in the Kickapoo Valley area.

It was eye-opening for me to see the historical damage done to the tribes over many decades.  They are still in the process of recovering and trying to find inner peace in their hearts.  As a Japanese who didn’t grow up in the US and didn’t learn US history in school, it was almost shocking.  I didn’t know that Native American children were sent to boarding schools, being separated from their parents at young age, being forced to learn English and forget their own language.

Language is such an important part of cultural heritage.  The longer I have not been using my own language regularly, the more I feel this way.  There is so much subtlety you can manipulate at ease with your mother tongue, and good feeling coming from being able to do that.  How terrible it must have been for parents of those children.   Their children missed the opportunity to learn this subtlety while they were forced to learn the language that was not theirs.  How bad the children must have felt when they grew up and realized that they didn’t know what the elders were talking about.   Not to mention other cultural traditions, way of thinking, ceremonies and values that might have been lost due to these interruptions. 

At least what we humans can do is to learn from the past.  We should be smart enough not to repeat the same mistake.   We have to keep working on directing the society to be equitable, liberating, and just, not to be divided and hurt from oppressing/marginalized relationships.  And this work is part of Public Health. 

Learning Community Reflections: Tribal Health

“If you have come here to help me, you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together.” – Lilla Watson, Aboriginal activists group, Queensland, 1970s

In September, our learning community ventured up to northeastern Wisconsin for an engaging two-day monthly meeting where we learned about the culture and health of the Menominee and Oneida tribes.   

An important theme was the powerful role that the US history of colonization and systematic oppression of native communities has played in causing the current health concerns of these communities today. Just as salient was the resilience and innovation of the Menominee and Oneida peoples and how they incorporate their culture for improved health and wellness. Jerry Waukau and Diane Hietpas of the Menominee Tribal Clinic explained how compulsory boarding schools, in which Indian children were forced by law to attend government and church run schools for assimilation, caused loss of language, culture, disrupted family ties and community structure, and often resulted in child neglect and abuse (aka ACEs) which is at the root of some of the cyclical family trauma in community. The work that the clinic and its partners are doing around culturally appropriate and person-centered trauma-informed care is making a huge difference in the community, has drastically improved their high school graduation rate, and led to their Culture of Health Prize recognition by the Robert Wood Johnson Foundation. At the Menominee Cultural Museum, Dave Grignon informed us of the success of ongoing family culture camps in improving substance abuse issues in the community. He also told us about the unjust Termination (I.e. loss of sovereignty) of the Menominee Tribe in 1961 and the major losses of land control, jobs, access to health care, and wealth that resulted, taking a major toll on their quality-of-life. I find it an atrocious abuse of power how the Federal government has stopped recognizing the sovereignty of tribes or forced them off of their land whenever the existence of the tribe was inconvenient for government or corporate profits.

Fellowship Learning Community learning about food sovereignty, heirloom seeds and community rebuilding from Menikanaehkem.

Personally, I was most inspired by our visit with the grass roots, culture-centered group, Menikanaehkem. I was moved by their guiding philosophy when planning community events, which is, “Is this event going to bring hope, belonging, meaning, and purpose to this community?” As a way to resist the deficit-minded, consumerism culture of our time, this group is refocusing on their traditional cultural practices, values, and spirituality that guided their way of life for thousands of years. Guy Reiter of Menikanaehkem embodied that traditional spirituality with his peaceful presence and conviction to do what is best for the community. He verbalized this mindset when he said things like, “the creator loved us so much that he gave us our language and culture,” “we’re adding to the beautiful story of our people,” and “what matters more than everything is that we connect with each other right here in this moment.” It was easy for me to see how reconnecting to a mindset of gratitude, beauty, and connection with the land and their ancestors can build personal and social resilience and improve the health of their community.

Our discussion with Menikanaehkem has got me pondering. In many ways, Menikanaehkem is the opposite model of governmental public health: grassroots vs. hierarchical institution, culture vs. science, personal connection vs. systems and processes. How should authority, decision-making power, and resources be distributed among these models? How can our rigid institutions be more responsive to the needs of the people in the way that grassroots movements are? What can governmental and academic agencies learn from grassroots groups, whom are closest to the largest inequities, about how to improve the social and physical environment of the communities we live in and serve? How can those of us who work in governmental public health support or collaborate with grassroots groups like Menikanaehkem in a way that honors their history, expertise, culture, and way of life?

Mr. Dave Grignon at the Menominee Cultural Museum as the Fellowship Program is hosted by the Menominee Indian Tribe of Wisconsin.

I don’t anticipate having all of the answers anytime soon, but we were able to discuss that last question a bit more than the others. During our visit with Menikanaehkem, one memorable piece of advice was that “if you don’t understand us, recognize our strengths, and know your own, then you can’t help us.” Melissa Metoxen from the Native American Center for Health Professions (NACHP) and the Oneida Reservation gave similar advice. She said that the key to working with tribes is to enter into relationship with members from the tribes. That means building trust over time by putting the tribes’ interests first, meeting face-to-face, and working hand-in-hand.

~ Cory Steinmetz

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

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.  1 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 1 in 3 women have experienced “rape, physical violence, and/or stalking by an intimate partner in their lifetime” with 1 in 4 experiencing severe intimate partner violence.  And nearly 45% of all American women (almost 1 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 one, this one, or this one or even this one). But I truly believe this is an issue worth elevating at every opportunity.  We need everyone to understand that so many women suffer in the United States but our current government wants to completely eliminate a huge source of federal funding. 

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

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

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

3.            Center NSVR. Statistics About Sexual Violence2015.

4.            Thomas E. Rape Is Grossly Underreported in the U.S., Study Finds. In: The Huffington Post. 2013. http://www.huffingtonpost.com/2013/11/21/rape-study-report-america-us_n_4310765.html. Accessed February 23 2017.

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

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

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

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

8.            Prevention CfDCa. Intimate Partner Violence: Consequences. Atlanta, GA. 2015.https://www.cdc.gov/violenceprevention/intimatepartnerviolence/consequences.html. Accessed February 23 2017.

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

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

11.          Justice TUSDo. Grant Programs. United States DOJ. 2017.https://www.justice.gov/ovw/grant-programs. Accessed Feburary 23 2017.

[*] As defined by the UN: gender-based violence is “physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or private life”[†] But really, you should probably look into volunteering because they are going to need all the help they can get if their programs are defunded.

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. here, here, and here). What we know is that bias can affect behavior, so it is important to recognize them and make sure we don’t act based on those biases.

I am biased. What should I do now?

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

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

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

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