Tag Archive | Public health

Oh, Some of the Things I Have Done

Sep9

A few years ago, while serving as a resource person for a national food security organization, I responded to an inquiry. It was from a woman doing related work for a small non-profit. Though I was then staying and working out of state, she was from a community very close to my home–so there was a welcomed familiarity in connecting with her.

When I returned home, I made the lovely thirty-five minute drive down beautiful back roads to meet with her. Sitting together in her office–a large warehouse space–she described her programs related to food access, nutrition education, and Produce Prescription Programs. Having done the same work myself, I was impressed with her sophisticated and creative approach, and the success of her efforts. She had been in this job for four years and had accomplished a lot in a rural area with limited resources. And, though her face was largely hidden behind a Covid mask, I realized that she had obtained this professional maturity by, at best, her mid-thirties.

We stayed in touch, and a few months later she informed me she was moving on to pursue an unrelated opportunity, and I wished her well. Having become linked on LinkedIn, I noticed that she identified herself as a Public Health Innovator. This intrigued me. While I did not doubt her right to ascribe that title to herself, I wondered what being such an innovator would entail, and might I, with a few decades on her, have any claim as such. And so, I began an inventory of my own path.

Let me acknowledge that by all measures, and certainly by today’s standards, my efforts were itsy-bitsy, teeny-weeny, tiny. I have been a very small fish, in a very small pond, with little personal agency to swim out into larger waters. I had no funds, grants, or extra supports. Maybe just some supervisors who let me do some things–or didn’t stop me. I just wanted to help those I was serving. My reach was small, and the sustainability of my projects limited, but I did possess some type of fins and gills, impelled to create something to fill a need that had lacked attention or address in its time.

What turned into my career began in the early 1980s, a period when the government, still in the wake of the ‘War on Poverty’, was crafting its national nutrition programs to bluntly address abject hunger, the effects of a few decades of corporate interests controlling the American diet were seriously taking their toll but had not yet reached full crisis level, and the folks in the natural foods movement were making the connection between diet quality and personal and societal health–but they were quite marginalized.

Margarine was still cool, soda drinks were just starting to supersize, the term ‘wellness’ was not yet coined, and no one knew were were a mere decade away from an obesity and chronic disease red-alert. Likewise, mimeograph machines were just surrendering to Xerox, typewriters to word processors, and print materials knew not of the worldwide web.

Arriving at this cusp of nutritional awakening, I began to work my way through a number of different community and clinical settings, propelled by geographic moves related to early adulthood and marriage. At each stop, I was witness to emerging issues, and being in unchartered waters I had a modicum of freedom to make things up–or should I say, find some innovative solutions.

I first stepped out of the box in 1980, when as a WIC Nutritionist in the federal program that was then only about five years old, I arranged to walk a group of moms down the street from the WIC clinic site to a little whole-grain bakery for a tour–certainly this was not within normal operating procedures. This was before there was any widespread, soon-to-be earth shattering news about the ills of Wonder Bread. But I had gotten the memo, and I guess thought this was an opportunity for an interesting, educational outing. Though my intention seemed rather innocent or naive, I guess something deeper was rising within me that would inform my future endeavors.

And so I swam forth through the next four decades, trying some innovative things largely within various work settings but beyond the requisite duties of my role. Here are just some of them:

The Nineteen Eighties

Presented a paper I had written entitled, The Role of Nutritional Services in Prenatal Care, to the medical team in the Department of Obstetrics & Gynecology at a large, prestigious university medical center. (Yes, young me!). This forwarded the integration of nutritional assessment and counseling into prenatal care within that practice and enabled me to later provide specialized nutrition support to pregnant women in other settings. (1984)

Presented workshops on nutritional approaches to women’s health concerns in various workshop settings. Many of these concerns had not been properly understood until the mid-1900s and were only gaining wider recognition and support around the 1970s due to the visionaries and feminists of that period. (1985-1987)

The Nineteen Nineties

Developed a cooking class for pregnant teenagers while working for another WIC Program and observing the demise of home-prepared meals in a peak period of teen pregnancies. I enjoined the collaboration of a local Cornell Cooperative Extension agency and a community food pantry. Participants received a free bag of groceries at each class. (1994)

Implemented the following at a Community Health Center to provide greater options for well being to a low-resourced community: (1997-2001)

Physician-Nurse Team-led walking program and nutrition classes for staff and patients

Center-based Yoga Class Series taught by certified Yoga Teachers–there was a waiting list for the class

Coupon Program and Cooking Demonstrations with the local food-coop

The Two Thousand Aughts

Invited one of the nation’s first mobile produce vans intended to bring quality, discount-priced produce to underserved neighborhoods to make a weekly stop at a Community Health Center to reinforce the notion of ‘food as medicine’. This popular stop served a wide-range of clients, staff, and medical providers and raised awareness about food insecurity. (2008)

Provided to my clients (on a very small scale) low-cost, non-perishable nutritious food samples boxed in cardboard Chinese Food containers. They included sardines, beans, oatmeal, teas, spices–along with cooking instructions. These were essentially a precursor to healthy meal boxes available today. (Back then I wished I had a way to get funding to expand that idea.) (2010)

Expanded eating disorder services and resources at a college. Also, helped initiate changes to support more sustainable practices and local food sourcing for the college’s Dining Services. (2007)

The Twenty Teens

Developed and administered the clinical component of one of the nation’s earliest Produce Prescription Programs. Conducted a Program Evaluation and the Program’s results were published in a Public Health Journal. (2011-2013)

Designed a Diabetes Education Program that had included a diabetes-friendly meal that was prepared together by some of my patients in the Program who were experienced cooks–mainly elderly black ladies who had each fed countless mouths and who could serve an army or at least a filled church. The program also included a dance segment led by a local Latin Dance teacher. (One of the program attendees became a member of the teacher’s traveling dance troupe.) (2012)

Solicited local businesses to donate breastfeeding supplies to a Community Health Center for nursing mothers in honor of National Breastfeeding Month. (2013)

In the mid-Twenty Teens my work took me out of direct care environments and into more Program Management roles. By this point, innovation was largely being measured by technology-based advances where I was less well-equipped–though I still pushed my grassroots efforts where I could. My inspirations and innovations grew out of having sat with thousands of eaters from around the globe and from all walks of life, a plethora of pregnant moms, a couple of hundred college students eating their way from adolescence to adulthood, and a few dozen elementary-aged school children who knew more about food and life than you might think. I looked for every available resource to support them all as best I could, created partnerships when possible, and came up with new solutions when necessary.

Surreptitiously I removed infant formula promotional materials from the ‘free’ gift bags and magazines targeted to pregnant women and quietly encouraged vending machine vendors to replace the most nefarious offerings with others less harmful to the human organism. I produced lots of nutrition education materials and wrote many newsletter articles. And then, I embarked on documenting in 125+ blog posts ‘the intimate art of eating in response to the personal and cultural milieu’. From my work chairs to my pitter-patterings about, I bore witness to much of the difficulties we are now experiencing in even more extreme ways–demanding a more robust and urgent response. My writings presaged much of what we are confronting and I invite you to to search my site for my insights on any number of nutritional matters including breastfeeding, eating disorders, toxic food systems, child health, obesity, racism, health inequities, nutrition insecurity and food marketing. Gosh, things got a lot more complicated than just whole wheat bread.

Looking back, I acknowledge that I did a lot for a small fish. I used to say that one thing I would not do was to dress up like a fruit or vegetable, but I will don the Public Health Innovator Hat, at least for a moment. I still have a list of things that I would love to see be done, so as I ease out of this work, I’d be glad to share my ideas. Also, feel free to build upon my efforts if you can appreciate their value. Finally, fellow innovators, keep up the good work. If I catch sight of your schemes, I will be glad to celebrate them.

Thank you for listening, sharing, following, and supporting my writing. Please subscribe in the sidebar to receive notice of new posts. Comments and greetings always welcome.

Be well. Take care. Stay safe. Let’s heal.

In health, Elyn

P.S. OK. Here is one of my ideas. Let’s implement a program for vulnerable senior citizens similar to the Women, Infant and Children (WIC) Program. Maybe just an add-on program called WICS.

And, here are some other important insights and innovative ideas shared by Food Bank News regarding collaborative efforts working with underserved populations with globally-based examples.

My Plate Haiku

Craving for pickles

And German Chocolate Cake

My friend is pregnant. by Gretchen

private health

Apr29

My dilemma was really excited. We hadn’t been to a conference in a while. Usually, I try to keep my nutritional dilemma quiet and out of sight. But, last week as I was heading to a meeting of the New York State Public Health Association I figured nothing would be too controversial, so I relaxed my grip on it a bit as we headed out. It was an unusually warm morning and as I rolled down the car windows, my dilemma, riding shotgun, stuck its head out into the fresh air, giddily taking in all the sights and smells like a golden retriever.

golden retriever

We arrived at the hotel, easily found a parking space and the right room, and settled in. I applauded the availability of Tazo Tea and forgave the choice of bad white bagels. I knew there was some consciousness on the part of the Association to be mindful of the food so I appreciated that there was an alternative to the usual sugar-laden breakfast pastries.

The title of the conference was “Transforming Communities through Public Health Practice”.  The keynote speaker was  Michelle Davis, Deputy Regional Health Administrator for the  US Department of Health and Human Services.

As I sat through the morning, I checked the program to remind myself of the focus of the day and why I had chosen to apply my limited continuing education benefits here. Though I mainly do my nutrition and health thing privately within the confines of my small offices, working with one member of the public at a time, I also try to promote health messages to a larger audience as well. I practice what I term stealth health–introducing information or programs that enhance well-being in both supportive and unsuspecting ways. Here was an opportunity to listen and learn from others who are out there doing community transformation. This is what motivated my choice–to be with my peeps–like-minded people doing great things in this arena.

As an attendee I learned of the new goals of the Healthy People 2020 initiative; I heard about some worthy activities happening on the local scene; and, I sat in on an interesting session that reviewed a relatively well-funded menu labeling education campaign that encouraged consumers to choose fast food meals containing 600 calories or less. The initial results were apparently somewhat disappointing though the evaluation data was limited. The research ironically showed that those who did not receive the message curtailed calories more than those who did.

I thought I had my dilemma well-leashed, but in retrospect, I realize it was already starting to whimper and whine. However, it was not until I attended the first session of the afternoon, “Development and Implementation of  Formal Policies and/or Local Legislation to Increase the Availability of Non-Sugar Sweetened Beverages in Public Buildings: Reports from the Field” that its bark became disruptively loud. The session was facilitated by two women who had overseen a project of the NY State Association of County Health officials wherein monies and other resources were allocated to a handful of county health departments to assist their county governments in achieving this goal.

They effectively reviewed how the different counties applied their efforts–which really were intended to decrease the availability of sugar-sweetened beverages (SSBs). They described media campaigns, seltzer water promotion activities, revenue concerns, working with government officials from the top down and with procurement managers from the bottom up. They discussed vending contracts and how these are virtually impossible to change until the contract runs out. They explained the challenges, push back and resistance that each county encountered and the small changes that were made. This was an absolutely positive action, but it required that they had to play nice politics with these good public dollars.

I suppose I know this is how the process works but the cumulative view of the public health community working so hard for such small gains–even in the public sector–turned my dilemma rabid. It circled wildly, foamed at the mouth and even raised its hand and expressed its opinion. To calm it back down, I had to go get it a fruit kabob at the next break.

Who do we still have to convince at this stage of the game that vending machine revenues will not outpace health care spending? Who do I need to invite into my office to hear the daily stories of health compromised by tepid health care policies and timid action? How many cases of people addicted to Mountain Dew, Pepsi, and other such SSBs must I detail as evidence to show how they suffer from rotted teeth that cannot be repaired; ravaged digestive systems bandaged with a plethora of damaging antacid medications; excessive weight that has literally brought them to their knees; anxiety propelled by excessive caffeine; and, destroyed glucose control that relegates them to a life with diabetes? Is it not tragic how many are children and young adults are already affected?

I always say that if I was the ruler of the food planet, I would remove sodas immediately. There is a heavy toll on health from such irresponsibly marketed products available for consumption with the clink of just a few coins in most public places–not only here but around the globe. And, though soda addiction knows no boundaries, as usual, the economically poor, are disproportionately affected. Recently, a client of mine told me that the school bus company that he works for removed soda vending from the employee break room. Cannot our own government agencies venture such a commitment? Bearing such witness, I am perforce required to display the amount of sugar in various SSB bottles wherever I may be. Right now in the lobby of the health center, I have such a display with associated handouts. People truly gasp when they see the load of sugary stuff that otherwise stays dissolved in the highly acidic medium.

This week, just a few days after the episode at the hotel, a fifteen-year-old boy who has lived a large part of his life in a home for troubled youth was brought to see me–ostensibly for his high weight problems. He was accompanied by a case manager–and another boy who came along. We had a pretty good chat and among other things, we talked about his soda drinking. I told him I really felt sodas were toxic substances that deserved some type of poison label. He asked me if I had a Sharpie. I said, of course, dug it out for him–and he drew me a page full of well-executed skulls and crossbones. I thanked him profusely for his contribution to my crusade. Who knows, perhaps through this experience of participation, he will become a stealth health advocate. When we were done, I gave him and his little buddy two water bottles that I had actually picked up at the conference.

Afterward, I realized my dilemma had been watching the whole encounter from under my desk. It pawed at me and looked me squarely in the eye. It bemoaned that private health is truly a deeply public health matter and vice-versa, and with its tail between its legs, it quietly crawled away.

Let me know what you think about this issue. Thanks.

In health, Elyn

My Plate

My Plate Haiku

Lagoon watercress

Peppers my tongue

With spring joy.

by Roxanne