Dinner Parties and Health Inequity

“Personal relationships are the fertile soil from which all advancement, all success, all achievement in real life grows.” – Ben Stein

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CADCA’s 2017 Mid-Year Training Institute – Las Vegas

In my former role of Director for CADCA’s Geographic Health Equity Alliance (GHEA), part of my responsibilities included shaping our constituents’ feedback, subject-matter-specific questions and other forms of technical assistance requests into breakout and training sessions. Featured during CADCA’s two major training events — the National Leadership Forum (Forum) and Mid-Year Training Institute (MYTI) — the sessions are developed in partnership with consultants, subject matter experts, coalition leaders, my team and me. We interpret emerging public health data trends and ways to reconcile them with what we currently know. We reiterate best practices with examples of successful or promising interventions. We reassess emerging strategies for measures of efficacy, efficiency and scalability. During the most recent 2018 Forum, we convened a panel to discuss building non-traditional partnerships that address health inequity and lack of health literacy.

Health Equity Panelists

The three-person panel comprised an academician from North Carolina, librarian from Oklahoma City and training consultant who leads an eastern Tennessee based coalition. In this post, I will share my takeaways from the academician, Dr. Nadine Barrett, who serves as Director of the Office of Health Equity and Disparities at the Duke Cancer Institute. Lessons I learned from insights shared by the librarian and consultant will be highlighted in separate posts.

Who is sitting at the table?

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Barrett — with years of experience executing public health interventions addressing health inequity — led the panel discussion by sharing an analogy about guests attending a dinner. Who is sitting at the table, Barrett questions. In other words, when planning and executing public health interventions, consider how representative of the priority population are those calling the shots. I define the priority population as a group of individuals intended to benefit from a tailored intervention purposed with address a public health issue. Throughout her talk, Barrett likened inclusivity in planning, executing and evaluating public health interventions to planning and hosting a dinner party. Below are questions Barrett posed during her talk, which I slightly edited for this post:

  1. Are dinner guests seated at the table as a mere formality or because they are genuinely wanted there?
  2. At which point were dinner guests invited to the table, last minute or weeks in advance?
  3. Have seating arrangements, styles of dinnerware or flatware been decided prior to extending an invitation?
  4. Has the table already been set, the color scheme or theme determined — does it clash with guests customs and beliefs?
  5. Has the menu already been decided before considering dinner guests preferences or allergies?

Sure, in planning a dinner party it is ultimately the responsibility of the host to answer Barrett’s questions — a process that may not directly involve dinner guests’ overt input. However, the dinner party host does not make those decisions in a vacuum or without any contextual knowledge. Knowing how to plan and execute the dinner is based on the preferences of the guests. To further articulate Barrett’s point, consider: Do the guests prefer red or white wine? What are their favorite cuisines? Does anyone have any food allergies? If so, to which allergens? Where should two guests with a history of verbal squabbles be seated? Will the guests want to pray before eating?

Knowing the answers to these questions requires the dinner party host to engage most if not all of the guests (i.e. members of the priority population) in a repetitive, genuine and deliberately interactive manner. (S)He organically acquires this information over time, in a way his or her current dinner guests would feel comfortable and safe sharing. Circling back to Barrett’s analogy and what I consider one of her overarching points — public health interventions geared toward improving the lot of priority populations must involve their input and participation. Doing intervention to communities and not with them is a one way of generating suboptimal outcomes.

Doing the Ground Work

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Orchestrators of public health interventions have a responsibility to invest time in getting to know the communities they strive to serve. In ensuring we public health professionals, nonprofit affiliates, and medical professionals do not give the impression of taking over otherwise doing intervention to our compatriots, consider the following:

Which (in)tangible resources are available in the community and how do they support the intervention?
Which of the community sectors (e.g. local nonprofits, law enforcement, churches) wield the most influence or have the most successful history in solving public health problems?
Who harbors the most robust local data about the public health issue at hand (e.g. local hospital)?

Put Yourself in Others’ Shoes

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Federal and state-led data mining and analyses alone will not provide a clear cut picture of local conditions driving adverse public health outcomes — especially without members of the priority population qualitatively putting said numbers into their proper context. Moreover, members of the priority population should play managerial and evaluative roles in the roll out and completion of public health interventions. Such involvement can increase the odds of community buy-in; contextualize results epidemiologists in federal and state health offices may miss; or give the intervention a boost in credibility by opinion leaders and familiar community sectors among other things.

Admittedly, grant applications, contractual agreements with private donors, or governmental mandates may come with a small turnaround time. In situations of unforgiving time constraints, members of the priority population may be difficult to reach. When these situations arise, and they frequently do, the stress that follows can be mitigated if ongoing relationships with the priority population are constantly running in the background — which I presume to be Barrett’s foundational point.

Community centric relationships manifest differently depending on public health issues and how the most active community sectors show-up in addressing them. Ask yourself, do you enjoy being rushed? Appreciate being asked to drop everything to tend to someone else’s emergency? Relish feeling undervalued because you are only engaged when the requestor needs something from you?

Obviously no is the answer. Neither do members of the priority population.