Strengthening Community Capacity for Structural Change to Advance Health Equity

Transcript

• 00:00Zoom, you like blurring, just
• 00:01make sure that's back on.
• 00:03And welcome to noon conference.
• 00:05We'll start hi. I'm Carrie
• 00:06Gross.
• 00:08Today,
• 00:09here's our CME code.
• 00:14Upcoming
• 00:15retreats
• 00:16with a special
• 00:19upcoming one. This is only
• 00:20a few weeks away now.
• 00:22It's the research and scholarship
• 00:23retreat.
• 00:24We sent out a few
• 00:25emails and,
• 00:27Outlook invites and such, but,
• 00:29we already have a very
• 00:30good,
• 00:31response as far as attendance.
• 00:32And we're looking for folks
• 00:34who wanted
• 00:35to get feedback on abstracts
• 00:37or
• 00:38research ideas, grant ideas,
• 00:41things that are in progress.
• 00:42So anyone who wants to,
• 00:44present
• 00:45verbally,
• 00:46and get feedback or share
• 00:47an abstract for a workshopping,
• 00:50please let us know,
• 00:51as far as the retreat.
• 00:55Okay.
• 00:57This is the,
• 00:59the FDAC,
• 01:01process.
• 01:02So, I guess I'll I'm
• 01:03supposed to walk you through
• 01:04this.
• 01:05The idea is, it
• 01:07just launched a couple of
• 01:08weeks ago.
• 01:09As you know, this is
• 01:10the opportunity for everyone to
• 01:12get feedback working with their,
• 01:14their mentors and also getting
• 01:15feedback eventually from senior faculty.
• 01:18So the first step, is
• 01:19to complete your FDAC form
• 01:22within we have plenty of
• 01:24time. So by February,
• 01:25please,
• 01:26fill out your form and
• 01:27submit it. Then you will
• 01:29meet
• 01:30you don't have plenty of
• 01:31time. You do not have
• 01:32plenty of time.
• 01:34You have plenty of time.
• 01:35Let me rephrase that. You
• 01:36have plenty of time today
• 01:38to complete your F DAC
• 01:39form,
• 01:41and then,
• 01:43meet with your mentor. So
• 01:44actually, it's something that always
• 01:45causes confusion.
• 01:46Confusion is,
• 01:49who you're meeting with and
• 01:50when. So you submit your
• 01:51f tag form. You meet
• 01:52with your mentor,
• 01:53who is someone who is
• 01:54a faculty member in the
• 01:56in the section.
• 01:58After that meeting,
• 01:59we have these spring
• 02:02senior faculty meetings,
• 02:04where we, go through and
• 02:06talk about each of the
• 02:07faculty and, people raise suggestions
• 02:09about who they should be
• 02:10meeting with or just other
• 02:12general career advice suggestions.
• 02:13After those meetings, then you
• 02:15will have
• 02:16a section
• 02:18leader
• 02:18designee, Patrick or some other
• 02:20vice chief or someone else
• 02:21within the section,
• 02:23that you'll be meeting with.
• 02:24So first, you meet with
• 02:25your mentor.
• 02:26That's, like, in,
• 02:28February, early March. Then later
• 02:31in the spring, you'll meet
• 02:32with another, leader within the
• 02:33section.
• 02:35And then FDAC is closed
• 02:36out. It's all good. But
• 02:38it's an important,
• 02:40process just to make sure
• 02:41everyone's getting getting some good
• 02:42feedback.
• 02:45Upcoming,
• 02:47grand rounds. So next week,
• 02:49Sachin Majumdar
• 02:50is presenting
• 02:52a medicine general medicine grand
• 02:53rounds, the evaluation and management
• 02:55of thyroid nodules.
• 02:56And then Joe Dhanra will
• 02:58be, here
• 02:59at noon, presenting,
• 03:01assessing internist competency and point
• 03:03of care ultrasound
• 03:05using the EPA framework.
• 03:09Disclosures, etcetera.
• 03:13More disclosures.
• 03:14Here you go. Now last
• 03:16but not least, excited to,
• 03:19introduce
• 03:20a close colleague, Carol Oladile.
• 03:22Carol comes to us originally
• 03:24from Florida where she, got
• 03:26her undergraduate
• 03:27degree at,
• 03:29Florida State and PhD at
• 03:31University of Southern
• 03:33Florida in epidemiology.
• 03:34And she's actually been here,
• 03:37since two thousand twelve and
• 03:39has really
• 03:40not only done instrumental work,
• 03:41as an investigator, but also
• 03:43has played a major leadership
• 03:44role, in ERIC and more
• 03:46specifically
• 03:47examining how social, and structural
• 03:49drivers of health
• 03:51influence chronic disease outcomes with
• 03:53a focus on food environments,
• 03:54hypertension,
• 03:56cardiovascular,
• 03:57and cancer health equity.
• 03:59She's a multiple principal investigator
• 04:02of the NIH Compass Hub
• 04:03here at Yale, which provides
• 04:05technical assistance,
• 04:07to community organizations
• 04:09implementing structural interventions to advance
• 04:11health equity.
• 04:13She's led and contributed to
• 04:14multiple,
• 04:15NIH and,
• 04:17private foundations such as
• 04:19funded projects
• 04:20addressing inequities and cardiovascular
• 04:23care and outcomes in the
• 04:24US and across the Caribbean.
• 04:28And here, she is going
• 04:29to present for us strengthening
• 04:31community capacity for structural change
• 04:34to advance health equity. So
• 04:36welcome.
• 04:43Thank you, Carrie, and thanks
• 04:44everyone for for being here.
• 04:50So for those of you
• 04:51who,
• 04:52don't know me, I'm Carol
• 04:53Aladale. I'm an assistant professor
• 04:55in the section
• 04:57and director of research at
• 04:58the Equity Research and Innovation
• 05:00Center.
• 05:01And this is the title
• 05:02of my, talk, strengthening community
• 05:05capacity for structural change to
• 05:06advance health equity.
• 05:08And I will
• 05:09focus today on the,
• 05:12project that Carrie mentioned, Compass.
• 05:17So,
• 05:18I'll start by sharing a
• 05:19bit about my journey and
• 05:21research contributions,
• 05:23how my personal
• 05:24and professional experiences have shaped
• 05:26the kind of work that
• 05:27I do and how I
• 05:28do that work. Then I'll
• 05:29talk about how I've built
• 05:31upon Yale strong foundation of
• 05:33community engaged research
• 05:35and how that's informed my
• 05:37approach to advancing health equity.
• 05:39From there, I'll highlight current
• 05:41work with the Yale Compass
• 05:42Hub, which focuses on strengthening
• 05:45community capacity for structural change.
• 05:47Finally, I'll close by looking
• 05:49ahead,
• 05:50at the next phase of
• 05:51my research.
• 05:59If I can go forward.
• 06:02Okay.
• 06:06So before I begin, I
• 06:08think it's important to talk
• 06:09about what drives the research
• 06:11that I do, like, you
• 06:12know, to answer my why,
• 06:14and explain how and which
• 06:16explains how I approach my
• 06:18work. So I'm influenced by
• 06:19who I am and my
• 06:20background.
• 06:21I spent the early years
• 06:22of my life growing up
• 06:23in Kingston, Jamaica where my
• 06:25family's from. We migrated to
• 06:27the South Florida area when
• 06:28I was ten.
• 06:30And from there, I I
• 06:31grew up there, most of
• 06:32my life. With an ICU
• 06:34nurse for a mom, I
• 06:36was drawn early on to
• 06:37health care and health experiences
• 06:40and to understanding the experiences
• 06:42of the people around me.
• 06:44So these experiences really shaped
• 06:47my why.
• 06:48I'm motivated to a commitment
• 06:50to drop to close,
• 06:52gaps in how health care
• 06:53and public health systems
• 06:55serve and benefit populations that
• 06:57share my background.
• 06:58My why also comes from
• 07:00firsthand observations
• 07:02of a disconnect between how
• 07:04care was provided to black
• 07:05and immigrant
• 07:06communities,
• 07:08versus their lived experiences.
• 07:10And I'm also driven to
• 07:11ensure that the models and
• 07:12solutions
• 07:13that we develop are relevant,
• 07:16that they truly reflect
• 07:17the the needs of populations
• 07:19that experience health disparities
• 07:22or populations that are underserved,
• 07:24marginalized, and disenfranchised.
• 07:30This slide's a lot. It's
• 07:32my journey, which Carrie,
• 07:34touched on.
• 07:35But the important thing is
• 07:37that each step of my
• 07:38journey, even the unexpected steps,
• 07:40which I think most of
• 07:41us have,
• 07:42they build the skills they've
• 07:43built the skills and perspective
• 07:45that I bring to my
• 07:46work today. After graduating from
• 07:48high school in South Florida,
• 07:50I attended FSU, where I
• 07:51majored in health education,
• 07:53followed by a master's degree
• 07:55and, doctorate in
• 07:58epidemiology from the University of
• 07:59South Florida.
• 08:00My subsequent move to New
• 08:02Haven was certainly an unexpected
• 08:04one and one that I
• 08:05expected would last two years.
• 08:07It's fifteen years later.
• 08:10Nearly married, my husband, was
• 08:11suddenly interested in business school.
• 08:14Here I am.
• 08:16I completed my dissertation work,
• 08:18while here in New Haven
• 08:19while working at the Center
• 08:20for Outcomes Research and Evaluation
• 08:22or CORE.
• 08:23I met Marcela Nunez Smith
• 08:25in spring of twenty twelve,
• 08:26and just a few months
• 08:27later, had the opportunity to
• 08:29join the faculty in GIM
• 08:31as a associate research scientist,
• 08:33and project director for an
• 08:35NCI funded project.
• 08:38I later on became co
• 08:39investigator on several projects,
• 08:41at ERIC.
• 08:42In twenty nineteen, I received
• 08:44a K01 award,
• 08:46followed by a YIGH Global
• 08:50health faculty research award in
• 08:51twenty two and a UO
• 08:53one in twenty twenty four,
• 08:54which I'll I'll focus on
• 08:55later on in the presentation.
• 09:02My early work was a
• 09:03mix of investigating social determinants
• 09:05of health,
• 09:07nutrition, and cardiovascular
• 09:09research, and health care disparities.
• 09:11I've been fortunate over the
• 09:12years to have really fantastic
• 09:15mentors,
• 09:16including doctor Elizabeth Barnett, now
• 09:19at NHLBI.
• 09:20But she's the person who
• 09:21introduced me to epidemiology
• 09:23and health disparities research, and
• 09:25I really credit a lot
• 09:26of my interests and my
• 09:28where I am today, to
• 09:30her along with the mentors
• 09:31that that followed her.
• 09:36As project director of the
• 09:38NCI funded project that brought
• 09:40me to the GIM faculty,
• 09:42I led the, daily operations
• 09:44of the project, oversaw study
• 09:46implementation,
• 09:47the analysis,
• 09:48dissemination efforts. The goal of
• 09:50that project was to develop
• 09:52a standardized approach for measurement
• 09:54of health care discrimination.
• 10:00Other scholarly contributions are focused
• 10:02on health care system inequities
• 10:04and health disparities.
• 10:06I, along with my colleague
• 10:07Karen Wan, led a group
• 10:09of fifty investigators during the
• 10:10height of the COVID pandemic,
• 10:12to investigate disparities in COVID-nineteen
• 10:15infection and outcomes,
• 10:17within our own healthcare system.
• 10:19And we have a number
• 10:20of, we're fortunate to have
• 10:21a number of publications,
• 10:23from that.
• 10:24My other work has sort
• 10:26of broadly focused on,
• 10:27disparities in quality of care.
• 10:32I have a rapidly
• 10:34growing body of work on
• 10:35ultra processed food consumption and
• 10:37cardiovascular
• 10:38outcomes,
• 10:40and its role in racial
• 10:42disparities in cardiovascular disease. My
• 10:44work has been this work
• 10:45has been recognized by the
• 10:46American Heart Association
• 10:48through an award for excellence
• 10:50in research addressing cardiovascular
• 10:52health equity.
• 10:58My global research is mainly
• 10:59focused in the Eastern Caribbean,
• 11:01leveraging
• 11:02the infrastructure of the ECHORNE
• 11:04cohort. That's the Eastern Caribbean
• 11:06Health Outcomes Research Network cohort
• 11:10to conduct research on food
• 11:11systems, food insecurity, and cardiovascular
• 11:14health.
• 11:19I've also had the opportunity
• 11:20to collaborate with several incredible
• 11:23investigators across the institution, some
• 11:25of whom are are are,
• 11:27pictured here, whose expertise has
• 11:29really helped broaden the scope,
• 11:31and impact of my research.
• 11:40I've also been fortunate to
• 11:42build collaborations internationally,
• 11:44in Jamaica,
• 11:45Brazil, and the Netherlands.
• 11:47Had an invited talk in,
• 11:49a few years ago,
• 11:50at the University of Sao
• 11:52Paulo School of Public Health
• 11:53in Brazil. The faculty there
• 11:55are the developers of the
• 11:56NOVA classification system, which is
• 11:58widely used now to,
• 12:01classify foods to examine ultra
• 12:03processed food consumption, which has
• 12:05really taken off, that body
• 12:07of work over the last
• 12:08few years. Lots of attention
• 12:09on ultra processed foods.
• 12:12And so it was,
• 12:13great. I got a chance
• 12:14to meet with the
• 12:16the,
• 12:18senior investigator of that group,
• 12:20and really, learn from them,
• 12:22give a talk and learn
• 12:23from them during that time.
• 12:25I was awarded a Vlog
• 12:26Fellowship,
• 12:27at Wageningen University in the
• 12:29Netherlands in twenty twenty four.
• 12:31This is a research fellowship
• 12:32to strengthen
• 12:33international collaborations.
• 12:35I embedded with the nutrition
• 12:36and cardiometabolic
• 12:38research team there.
• 12:40And the photo
• 12:42on my, what is this,
• 12:43left,
• 12:45is a picture of me
• 12:46and other investigators,
• 12:48at Wakningen.
• 12:49I organized a workshop,
• 12:52as a sort of,
• 12:55to cap off my time
• 12:56there,
• 12:57which is wonderful.
• 13:00My collaboration with,
• 13:02the team at the Caribbean
• 13:03Institute for Health Research,
• 13:06on my right, your left,
• 13:08has been,
• 13:09wonderful and really
• 13:12a a goal of mine
• 13:13over the years. And I've
• 13:13talked to some of you
• 13:15in this in this room
• 13:16about,
• 13:17my desire to,
• 13:19and commitment to,
• 13:21bringing my expertise back to
• 13:23Jamaica where I'm from. We've
• 13:25been working together for about
• 13:26three years now,
• 13:27on a project that was
• 13:29funded through a YIGH faculty
• 13:31research award
• 13:32to examine the prevalence of
• 13:33food insecurity and its contribution
• 13:35to blood pressure control
• 13:37in two chronic disease clinics
• 13:39at the University of the
• 13:40West Indies.
• 13:45And that work was highlighted
• 13:47by American Heart Association this
• 13:49year,
• 13:50with a Paul Dudley White
• 13:52International Scholar Award. So one
• 13:54of our abstracts,
• 13:55received that award. It's a
• 13:56photo of,
• 13:58what well, a former trainee,
• 14:00now research associate,
• 14:02Vivian and the rest of
• 14:03our team at
• 14:04EPI this year.
• 14:11I've been fortunate to have
• 14:12leadership opportunities related to my
• 14:14areas of scholarship.
• 14:16I'm the lead for the
• 14:17regards nutrition working group.
• 14:19That's a group that brings
• 14:21investigators,
• 14:22together around a shared, shared
• 14:24goal to advance science,
• 14:26to inform policy and practice
• 14:27change.
• 14:28More recently, I serve as
• 14:30chair of the,
• 14:31ECORN Data and Scientific Review
• 14:33Committee.
• 14:34I serve as director of
• 14:36research,
• 14:37at ERIC where I contribute
• 14:38to our strategic
• 14:40vision and advancing
• 14:41our health equity research agenda.
• 14:43I was also honored to
• 14:45serve as an advisor for
• 14:46the Commonwealth Fund bias in
• 14:48health care advisory panel. All
• 14:50of these experiences have really,
• 14:53been learning experiences and shaped,
• 14:56my perspectives and and the
• 14:57next step steps of my
• 14:59research and how I do
• 15:00my research.
• 15:07So a common thread that
• 15:09kept emerging,
• 15:10through all of this work.
• 15:11So all of the patient
• 15:13experience work,
• 15:15you know, investigating disparities in
• 15:17the Caribbean, thinking about,
• 15:19clinical care, social determinants of
• 15:21health,
• 15:22thinking about solutions.
• 15:24So when I was trained
• 15:26as an epidemiologist,
• 15:27I
• 15:28there was no focus
• 15:30on solutions. It was you
• 15:31generate the evidence. It's somebody
• 15:33else's job to sort of
• 15:35take that evidence, implement it.
• 15:37And while that wasn't so,
• 15:39so long ago, I mean,
• 15:41that
• 15:42was sort of the culture.
• 15:43However, the longer that I
• 15:46am in this
• 15:47line of research, you know,
• 15:49you have to have a
• 15:51hand in sort of translating
• 15:52the evidence. So,
• 15:54a couple things came up
• 15:55as I started to reflect,
• 15:58about how to achieve meaningful
• 15:59change through my research.
• 16:01And looking across all the
• 16:03projects, the common thread was
• 16:05a need to center
• 16:06community expertise
• 16:08to coproduce research
• 16:10and also to cocreate solutions.
• 16:13So without it, you know,
• 16:14we're not really centering the
• 16:15needs of those who are
• 16:17impacted,
• 16:18by disparities.
• 16:21So I want to develop
• 16:22interventions that consider contextual realities,
• 16:26given my work, both,
• 16:28domestic and and and global,
• 16:30increase successful translation of interventions
• 16:32in communities that experience disparities,
• 16:34and elevate community leadership and
• 16:37expertise.
• 16:44So thankfully, there are others
• 16:45who have been doing this
• 16:46work for that center doing
• 16:48work that centers communities for
• 16:50a very long time, including
• 16:51many in this room.
• 16:53I had shoulders to stand
• 16:55on in in elevating community
• 16:56expertise and leadership,
• 16:58in my work. And I'll
• 16:59the next few slides will
• 17:00sort of touch on the
• 17:02long history of community engaged
• 17:04research,
• 17:05here at Yale,
• 17:07which started with the,
• 17:09Robert Wood Johnson Clinical Scholars
• 17:11Program, two thousand and five,
• 17:13focused on CBPR,
• 17:15research.
• 17:16That body that program established
• 17:18an advisory body for community
• 17:20based participatory research,
• 17:22which has gone on to
• 17:24advise and guide numerous projects
• 17:26over
• 17:27a twenty year period.
• 17:30There have been lots of
• 17:30advances in the field at
• 17:31the in in the meanwhile,
• 17:33with regards to models, principles,
• 17:35and community engaged initiatives.
• 17:38The office of health equity
• 17:39research was established with,
• 17:41support from the YSM,
• 17:43dean's office
• 17:45in twenty in twenty twenty,
• 17:48the community health equity accelerator,
• 17:51an initiative of,
• 17:53the office of health equity
• 17:54research was launched in twenty
• 17:56twenty two. I'll talk a
• 17:57little bit more about,
• 17:59the Community Health Equity Accelerator,
• 18:01CHIA,
• 18:02in a few minutes. And
• 18:03today, there are more efforts
• 18:04to establish
• 18:05bold new initiatives to support
• 18:07community
• 18:08led work, which
• 18:10I'll get into.
• 18:14Early examples of community engaged
• 18:16research,
• 18:17really focused on equitable partnerships,
• 18:20shared decision making,
• 18:21evaluation,
• 18:22and sustainability,
• 18:24which were were were great.
• 18:32The
• 18:33the steering committee on community
• 18:34partnered research, which I mentioned,
• 18:38that originally was the advisory
• 18:39body for the Robert Wood
• 18:40Johnson clinical scholars program.
• 18:43It was reorganized as an
• 18:44overarching community academic advisory body
• 18:47in twenty fifteen.
• 18:49And all of our work
• 18:50at at ERIC,
• 18:52you know,
• 18:54is governed by this
• 18:56by by the steering committee.
• 18:57They sort of serve as,
• 18:59like, a board of directors.
• 19:01It's a group of twenty
• 19:01five members that represent many
• 19:03New Haven community based organizations,
• 19:05city government,
• 19:07neighborhood leaders, neighborhood management teams,
• 19:10and New Haven colleges and
• 19:11universities.
• 19:13And they co develop research
• 19:15initiatives,
• 19:16and provide oversight for Yale
• 19:18trainee research projects as well.
• 19:24Other community engaged,
• 19:26initiatives,
• 19:27the community research fellows program.
• 19:29This is a program that
• 19:30trains,
• 19:31community members,
• 19:34in research, and they get
• 19:35to embed with,
• 19:36research teams to bring lived
• 19:38experiences and their perspectives to
• 19:40to research,
• 19:43the cultural ambassador program, which
• 19:45many of us are,
• 19:46probably familiar with.
• 19:51The community health equity accelerator,
• 19:54is one example,
• 19:56of,
• 19:58how we've we've grown in
• 20:00this area of work here
• 20:01at here at Yale.
• 20:02Again, it's funded by, YSM,
• 20:05through funds from the dean's
• 20:06office.
• 20:08CHIA is a model for
• 20:10health equity research that unites
• 20:11community leaders across multiple sectors
• 20:15to tackle health equity issues.
• 20:16It's led by a guiding
• 20:18coalition, and that coalition includes
• 20:20community
• 20:21leaders, that oversee all aspects
• 20:24of Chia. So they are
• 20:25the primary
• 20:26decision makers here. So,
• 20:29you know, I mentioned,
• 20:30sort of earlier models where,
• 20:32there's sort of co development,
• 20:34co design.
• 20:36In this,
• 20:37paradigm, they are they are
• 20:38leading,
• 20:39and the academic folks are
• 20:41sort of supporting,
• 20:43and providing technical assistance in
• 20:45the back seat.
• 20:46So they, you know, they're
• 20:48charged with, you know, identifying
• 20:51the health equity topic that
• 20:52will be addressed,
• 20:54the review process, the development
• 20:56of a request the request
• 20:57for, applications,
• 20:59final selection of those teams,
• 21:01and also budget decisions.
• 21:08This slide shows,
• 21:11our our funded,
• 21:12cycle structure. So, you know,
• 21:14selected interventions, they're implemented over
• 21:17an eighteen month period.
• 21:19And at the end, investigators
• 21:21will determine which aspects
• 21:23of the project they will
• 21:24scale or,
• 21:26or or d descale.
• 21:29To date, she has had
• 21:30two cycles.
• 21:31One focused on pediatric asthma
• 21:33and the other focused on
• 21:34colorectal cancer screening led by
• 21:36our very own Alana Richmond
• 21:38in our section. Congratulations.
• 21:46So leadership in community gaze
• 21:48research and health equity research
• 21:49really,
• 21:51poised us well for a
• 21:52national initiative to shift the
• 21:54current health equity research paradigm
• 21:56to one where we have
• 21:57communities leading.
• 22:04And the example I'll present
• 22:06today is, the,
• 22:08Yale Compass Hub.
• 22:10This is Compass stands for
• 22:11Community Partnerships to Advance Science
• 22:13for Society.
• 22:16So before I dive deeper,
• 22:18into Compass, I wanna orient
• 22:19you to the to our
• 22:20journey with this project because
• 22:22it's really been a journey.
• 22:25So,
• 22:26Compass,
• 22:27Compass awarded,
• 22:29twenty five, grants,
• 22:32in twenty twenty three to
• 22:34twenty five community based organizations
• 22:36that call CHESIs,
• 22:39community
• 22:41health equity structural intervention teams
• 22:43to implement
• 22:44structural interventions.
• 22:46In twenty twenty four, they
• 22:47awarded,
• 22:49health equity hubs,
• 22:51to support provide support for
• 22:53those twenty five community based
• 22:55organizations. And I forgot to
• 22:56mention, in twenty twenty three,
• 22:58they also funded a coordinating
• 22:59center.
• 23:01We were, thankfully, one of
• 23:03the five hubs selected,
• 23:05along with our colleagues at
• 23:07Michigan,
• 23:08NYU, University of Maryland, and
• 23:10University of Mississippi Medical Center.
• 23:14We got a we received
• 23:15a letter of termination,
• 23:17in April of this year,
• 23:20and we were reinstated in
• 23:22July of this year, and
• 23:23our project continues today. So
• 23:26I will tell you a
• 23:27little bit about what the
• 23:28project
• 23:29looked like sort of before,
• 23:32termination and what it looks
• 23:33like today.
• 23:38So in twenty twenty three,
• 23:40you know, this is the,
• 23:41announcement for the health equity
• 23:43research hubs. We responded to
• 23:44the RFA for health equity
• 23:46research hubs.
• 23:48We were successful,
• 23:50in getting the award, which
• 23:51started in September twenty twenty
• 23:53four. We are one of
• 23:54five institutions, as I mentioned,
• 23:56along with Michigan, NYU, Mississippi,
• 23:58and Maryland.
• 24:05So this is an initiative
• 24:06that was funded from the
• 24:07by the NIH office of
• 24:09the director. It was a
• 24:10bold new initiative
• 24:11to shift health equity research,
• 24:13to shift the health equity
• 24:14research paradigm to have communities
• 24:17lead structural change. There was
• 24:19a focus on health equity.
• 24:23Communities
• 24:23leading the implementation of these
• 24:25interventions.
• 24:26There's a focus on leveraging
• 24:27multisectoral partnerships
• 24:29and intervening on social determinants
• 24:31of health.
• 24:32And it came with a
• 24:33pretty big price tag, but
• 24:36structural intervention work is hard
• 24:38and expensive.
• 24:43There was a three phased
• 24:44approach to the original,
• 24:46project.
• 24:48So the first two years
• 24:50were focused on planning.
• 24:52So, you know, getting IRB
• 24:55approvals,
• 24:57instruments,
• 24:59things like instrument selection,
• 25:01you know, developing,
• 25:03data collection infrastructures, things like
• 25:05that.
• 25:06Years
• 25:07three through eight,
• 25:09were focused on implementing the
• 25:11actual intervention,
• 25:13and then nine and ten
• 25:14were focused on dissemination
• 25:16of findings.
• 25:21And I mentioned earlier that
• 25:23many of these,
• 25:25CHESIs, as they were previously
• 25:27called, were focused on,
• 25:29addressing,
• 25:30social determinants of health,
• 25:32many of them mainly nutrition
• 25:34and food,
• 25:35interventions,
• 25:36health care access, and economic
• 25:38development.
• 25:42So in this model, each
• 25:44of the five hubs
• 25:46are assigned
• 25:47or community based organizations that
• 25:50they provide support to.
• 25:53And so the Yale hub
• 25:54was a fine was originally
• 25:56assigned five. We now have
• 25:57six with the restructuring.
• 26:00Most of them are tribal
• 26:02communities
• 26:03in Alaska, Maine,
• 26:04New Mexico, California, and Hawaii.
• 26:07And we have one that's,
• 26:10not a tribal community in
• 26:11Los Angeles, California.
• 26:14So our
• 26:16San Francisco,
• 26:17so they they work. Jesse's,
• 26:19they're now called CRPs, community
• 26:21research projects.
• 26:23You've probably all experienced the,
• 26:26name the word word changes
• 26:28that
• 26:29had to happen.
• 26:31So CHESIs and CRPs are
• 26:33are the same thing.
• 26:34It's been really wonderful. Yes?
• 26:39That's
• 26:42yeah.
• 26:43Yeah. When we got our
• 26:45initial assignment, we were like,
• 26:46woah.
• 26:48They're all over the place.
• 26:49We've had to, like, figure
• 26:50out meetings across time zones,
• 26:52things like that.
• 26:54They were we were told
• 26:56that they were,
• 26:57the match was made based
• 26:58on hub expertise.
• 27:00So many of our assigned,
• 27:03CRPs
• 27:04were implementing,
• 27:06food environment, food security,
• 27:10you know, housing, economic development
• 27:12type,
• 27:13interventions.
• 27:15So that's that's how they
• 27:17made the match. But, yes,
• 27:18initially, we were like, they're
• 27:19all over the place. How
• 27:20are we gonna,
• 27:22but it's worked beautifully.
• 27:23It's been a real pleasure
• 27:25to
• 27:26meet and learn from
• 27:28all of these teams. So
• 27:30the other thing I had
• 27:31I didn't mention is that
• 27:32each of these
• 27:33CRPs has an academic partner.
• 27:36So we're sort of the,
• 27:39I like to think of
• 27:40us as sort of a
• 27:41a deep bench of expertise
• 27:43beyond,
• 27:44the community based organizations and
• 27:46their academic partner,
• 27:48that can provide,
• 27:49support,
• 27:50with them implementing these structural
• 27:52interventions.
• 27:53Our team in Los Angeles
• 27:55is really focused on addressing
• 27:57economic instability,
• 27:59and its impact on mental
• 28:00the mental health of folks
• 28:02in their community.
• 28:03And they are implementing
• 28:05a workforce program to develop
• 28:07promontories
• 28:08who,
• 28:09can provide
• 28:11services to people
• 28:13in
• 28:14culturally relevant ways.
• 28:16They're learning. They're being trained
• 28:17in,
• 28:19native cultural healing practices,
• 28:22as well as,
• 28:23helping to
• 28:26navigate people,
• 28:28through
• 28:30a closed system,
• 28:32of services,
• 28:33health care services and services
• 28:34to address social needs.
• 28:36In LA, their interventions focused
• 28:38on, improving the built environment,
• 28:40addressing blight.
• 28:43In Alaska,
• 28:46this is this is one
• 28:47of the CRPs that I
• 28:48was really, really, really fascinated
• 28:50with. They are addressing,
• 28:53food security and food sovereignty
• 28:55and are working with communities
• 28:56in in very remote parts
• 28:58of Alaska
• 28:59where it's hard to get
• 29:01it's just logistically hard.
• 29:03And it's logistically hard to
• 29:04get
• 29:05fresh fruits and vegetables, things
• 29:07like that, things that don't
• 29:08that that don't have long
• 29:09shelf life to them. For
• 29:11example, we met with the
• 29:12team, and they were like,
• 29:13oh, in the,
• 29:15in the winter, we have
• 29:15to take a bush plane
• 29:17there. And in the summer,
• 29:19we can take a barge,
• 29:20I think,
• 29:22out to these areas. But,
• 29:23anyway,
• 29:24you know, it was really
• 29:25fantastic to to sort of
• 29:26work along with,
• 29:28the CBO and the academic
• 29:29partner in thinking about,
• 29:32you know, how to,
• 29:33implement their their interventions.
• 29:35In Maine, they're also focused
• 29:37on food security and food
• 29:38sovereignty
• 29:39and are implementing a food,
• 29:42sort of food pantry truck,
• 29:44intervention and also addressing the
• 29:46lack of data,
• 29:48in their in their community
• 29:50to be able to monitor,
• 29:51like, how many people have
• 29:52food insecurity, what's you know,
• 29:54and and prevalence of just,
• 29:56many conditions that are related.
• 29:58Our Hawaii team is newly
• 30:00assigned to us,
• 30:01after reinstatement,
• 30:03and they are focused on
• 30:04improving health and well-being among
• 30:05youth through the development of
• 30:07culturally relevant,
• 30:09approach research approaches and,
• 30:12and care approaches.
• 30:14The final one in New
• 30:15Mexico, they're focused on
• 30:18implementing interventions to address harmful
• 30:21environmental exposures in the home
• 30:22and and asthma disparities.
• 30:30So while we were, like,
• 30:31getting to know these teams
• 30:33and a big part of
• 30:34it was,
• 30:36you know, building relationship.
• 30:38So remember they already had
• 30:39an academic partner, and then
• 30:41NIH said, okay. Now you're
• 30:43gonna have, like, another partner
• 30:45to, you know, support your
• 30:46work. So,
• 30:48you know, the first few
• 30:49months, was spent sort of
• 30:51getting to know them, their
• 30:52communities, doing,
• 30:54you know, research on their
• 30:56communities, what are the sort
• 30:57of local,
• 31:01local,
• 31:02like, newspapers, things like that.
• 31:03Just trying to get a
• 31:04feel of, like, what their
• 31:05communities
• 31:06are, were like.
• 31:08But on April seventh, we,
• 31:10were terminated.
• 31:12And with great support from
• 31:13the office of general counsel,
• 31:15we appealed the termination,
• 31:17which was rejected.
• 31:23However,
• 31:24through the action of one
• 31:26of our fantastic team members
• 31:27who had an active,
• 31:29APHA membership and joined the
• 31:30EPHA lawsuit, our grant was
• 31:33reinstated
• 31:34with the ruling,
• 31:35that terminations were illegal.
• 31:37So
• 31:38if you're support APHA.
• 31:41Did you clarify? Yes.
• 31:43Were all terminations deemed illegal?
• 31:46Well, this was the ruling
• 31:47on the APHA lawsuit. So
• 31:49everyone who had signed on
• 31:50to that lawsuit
• 31:52Yes.
• 31:53Yes.
• 31:55Yeah.
• 31:57So we're grateful for our
• 31:59team member who signed on.
• 32:05And can I spell it
• 32:06a bit? Yeah.
• 32:07Going through office council here
• 32:09at Yale, did they suggest
• 32:11that you should pursue it
• 32:12after it was rejected?
• 32:14No.
• 32:15They did not.
• 32:17However, after the ruling,
• 32:21they thought that it was
• 32:23likely
• 32:24we would
• 32:25get the grant back. I
• 32:27wasn't so sure personally, but
• 32:29we did.
• 32:32I I just wonder if
• 32:33they did any soul searching
• 32:34themselves after.
• 32:40Right? Yeah.
• 32:42Yep.
• 32:43Carol. The other hubs did
• 32:45not come back because they
• 32:46weren't part of the APH.
• 32:48Right. They're five Thank you.
• 32:50To two.
• 32:51Yep.
• 32:52So yes. Thanks, Emily.
• 32:55Yeah.
• 32:57Yeah. So
• 32:58it it really so
• 33:00yeah.
• 33:02So in total now so
• 33:04remember, originally, there were twenty
• 33:05five
• 33:06CRPs funded.
• 33:08After it was all said
• 33:09and done in in July,
• 33:11two hubs came back. Those
• 33:13two hubs were on the
• 33:14APHA lawsuit,
• 33:16and
• 33:18seven more seven CRPs were
• 33:20reinstated.
• 33:21The six CRPs that
• 33:23were they were terminated in
• 33:25less than twenty four hours.
• 33:26So, really, they didn't, you
• 33:27know,
• 33:28they didn't really stop working.
• 33:30They were all tribal,
• 33:32CBOs,
• 33:33tribal communities.
• 33:35So they
• 33:36they were still working
• 33:38alone
• 33:39while
• 33:40everybody else was terminated,
• 33:43with no support in this
• 33:44program that, you know, that
• 33:46so So the tribal
• 33:48grants continue Yes.
• 33:51Where on the APHA lawsuit
• 33:52got reactivated,
• 33:54and then the rest are
• 33:55no longer. Yes.
• 33:57So we now
• 33:59It's been a challenge. I
• 34:00mean I
• 34:04some have there there were
• 34:05some other lawsuits that
• 34:09folks had signed on to.
• 34:12Nothing has come out of
• 34:13them yet, but we are
• 34:15now we're thirteen CRPs, two
• 34:17hubs. So the Yale hub
• 34:19and University of Maryland.
• 34:22And the coordinating center? And
• 34:24the coordinating center. Thank you.
• 34:25Yes. And the coordinating center.
• 34:27So coordinating center,
• 34:29thirteen CRPs,
• 34:30two hubs,
• 34:31where we had five hubs
• 34:33before, one coordinating center, and
• 34:35twenty five
• 34:36CRPs,
• 34:39which takes me to oops.
• 34:43So changes. Lots of changes
• 34:45after reinstatement.
• 34:47So before this was a
• 34:49program. Right? Very
• 34:51well thought out. There are
• 34:53many years planning
• 34:54for this program. It's very
• 34:56bold. Again, big price tag,
• 34:58but, like, big benefit too,
• 35:00or potential for benefit.
• 35:02The program had different course
• 35:05to support training
• 35:06in many different areas, research
• 35:08and capacity building,
• 35:10data management, and data collection.
• 35:13There was a scholars program
• 35:14included that would train both,
• 35:17scholars in CBOs
• 35:18and scholars in academic settings.
• 35:22It was really
• 35:24just, you know, well thought
• 35:25out, and there were lots
• 35:26of components to really
• 35:28support community based organizations in
• 35:30a way
• 35:33to ensure that they'd be
• 35:34successful at the end of
• 35:35the ten year period.
• 35:37All of that went away.
• 35:39So grantees
• 35:40were reinstated as individual grants.
• 35:43So, you know,
• 35:44we are an individual
• 35:46just an individual grant. We're
• 35:47not part of the program
• 35:48as disbanded.
• 35:50Instead of ten years of
• 35:51support for the for the
• 35:52CRPs, there's now there'll be
• 35:54a total of five.
• 35:55They had two. They just
• 35:56started we all just started
• 35:57year three.
• 35:59Again, twenty five CHESIs, one
• 36:00coordinating center, five hubs. Now
• 36:02there are thirteen,
• 36:04CRPs,
• 36:04one coordinating center, two hubs.
• 36:07Before, the intention was for
• 36:09them to pilot and then
• 36:10fully implement their interventions.
• 36:13Now with the three years
• 36:14they have left,
• 36:15the guidance from NIH has
• 36:17been, you know, we're gonna
• 36:18pilot interventions only,
• 36:20you know,
• 36:21have a focus on sort
• 36:22of the next steps, like,
• 36:24what can you produce during
• 36:25this pilot period,
• 36:27to, you know, position you
• 36:29to go for
• 36:31RON or or some other
• 36:32award.
• 36:35Again, the program wide,
• 36:36you know, training
• 36:38is is gone.
• 36:40However, CRPs can still get
• 36:41training from their assigned hubs.
• 36:43For example, we we've done
• 36:45a photovoice training for one
• 36:46of our CRPs,
• 36:50you know,
• 36:51decision making,
• 36:52between
• 36:53community based partners and academic
• 36:55partners. So we've provided we
• 36:57provide support sort of individually,
• 36:59but the coordinating center originally
• 37:01had the role of sort
• 37:02of providing
• 37:03compass wide training.
• 37:05And now that is you
• 37:06know, it's just each hub
• 37:08would provide,
• 37:09training
• 37:09whatever training each CRP needed.
• 37:12And I I mentioned before
• 37:13the elimination of the scholars
• 37:14program.
• 37:18So with all with all
• 37:19that, that's what that that
• 37:21is the project that,
• 37:23has been sort of the
• 37:24the focus for for me
• 37:26over the last,
• 37:27number of months.
• 37:29The next few slides, I'll
• 37:30talk about my the next
• 37:32phase of my research.
• 37:37So areas for growth and
• 37:39expansion and areas that I'm
• 37:41thinking
• 37:42carefully about and and and
• 37:44and planning and thinking about
• 37:47how to achieve these things.
• 37:48So,
• 37:49one is to you know,
• 37:51I'm thinking about how we
• 37:52can have a sustainable infrastructure
• 37:54to support community led research.
• 37:57With the
• 37:59Compass program no longer in
• 38:00existence,
• 38:02you know, at the end
• 38:03of the day and and
• 38:04then I'm I'm thinking bigger
• 38:05than sort of Compass. Right?
• 38:06I'm thinking even for about
• 38:08CHIA, which is, like, our,
• 38:09like, led you know, a
• 38:11signature initiative
• 38:12of the Office of Health
• 38:13Review Research. But what is
• 38:15the like, what's the next
• 38:16step for for them? They're
• 38:18not,
• 38:20you know, they're not trained
• 38:22researchers, right, like, formally trained
• 38:24researchers.
• 38:25However, can they lead implementation
• 38:27of
• 38:28interventions to respond to their
• 38:30community? Absolutely.
• 38:32And can they be partners
• 38:33in research and learn about
• 38:34research? Yes. But we have
• 38:36to be able to build
• 38:38capacity.
• 38:40So figuring out what that
• 38:41infrastructure
• 38:42is to support that. So,
• 38:43you know, funding sources in
• 38:46particular is what I'm thinking
• 38:47about.
• 38:48You know, and this was
• 38:50a big shift for NIH.
• 38:52And I don't know about
• 38:53you, but I haven't really
• 38:54seen lots of,
• 38:57you know,
• 38:58opportunities like Compass or like
• 39:00Chia where communities are truly
• 39:02leading, not that you're going
• 39:04in together. Like, the grants
• 39:05were awarded to the community
• 39:07based organization.
• 39:09You know, they they have
• 39:10academic partners, but it is
• 39:11to them.
• 39:12So thinking about, like, what
• 39:14how do we get to
• 39:16that type of infrastructure where
• 39:17we can support that if
• 39:19we want sustainable,
• 39:20effective, and relevant and sustainable
• 39:23change?
• 39:24The second is, thinking about
• 39:26adapting, how we adapt and
• 39:27scale
• 39:28structural interventions.
• 39:31If I haven't learned anything
• 39:32from Compass,
• 39:33it's really hard
• 39:35to implement structural interventions. Just
• 39:37thinking about all the different,
• 39:41like, interest holders.
• 39:43It's, you know, all the
• 39:44people that have to and
• 39:45it's, like, multisectoral,
• 39:46who needs to be at
• 39:47the table, how do you
• 39:48actually execute this. This isn't
• 39:50something that's been done
• 39:52for, like, decades or anything.
• 39:54So, you know, everything is
• 39:55still very new. But thinking
• 39:56about, how we adapt and
• 39:58scale structural interventions that are,
• 40:01proven to be successful,
• 40:03and approaches
• 40:04that are,
• 40:06proven to be successful in
• 40:08implementing those interventions.
• 40:09The other is research training
• 40:11opportunities
• 40:12for community leaders.
• 40:14How can we build capacity
• 40:15within CBOs,
• 40:18to if they want to
• 40:19co lead research or or
• 40:20lead research.
• 40:22And one example so the
• 40:23the Office of Health Equity
• 40:25Research,
• 40:26did a pilot of what's
• 40:27being called the academy.
• 40:29So I think it was
• 40:30like a six or eight
• 40:31week training,
• 40:33period for
• 40:34community based organizations to learn
• 40:36all about research.
• 40:46So projects in the pipeline,
• 40:50though you're in
• 40:51unprecedented times,
• 40:53I I'm
• 40:54I remain committed to,
• 40:57my area of research and
• 40:58to writing grants and,
• 41:00advancing science.
• 41:02One,
• 41:04one of the projects,
• 41:06under review,
• 41:07hopefully, one day,
• 41:08when the is
• 41:10focused on ultra processed food
• 41:12consumption, cardiometabolic
• 41:13disease,
• 41:14in the Caribbean territories.
• 41:16So that builds upon my
• 41:18work that I've done within
• 41:19the mostly,
• 41:21in the US with the
• 41:22regards cohort,
• 41:24investigating ultra processed food and
• 41:26cardiovascular outcomes.
• 41:29We have a PCORI grant
• 41:30under review to develop a
• 41:32Yale engagement readiness,
• 41:34assessment. So that's a tool
• 41:37that
• 41:38patient focused organizations can use
• 41:40to gauge their readiness
• 41:42for engagement in research.
• 41:44Many times, community
• 41:47or patient organ organizations are
• 41:49approached to
• 41:50to participate and, you know,
• 41:52there are many different, you
• 41:53know, reasons or motivations for
• 41:55them to participate or not
• 41:56participate.
• 41:57But many times, they haven't
• 41:59really assessed their readiness or
• 42:01know, like, what to expect
• 42:02until they're sort of deep
• 42:03in it. And they're like,
• 42:04well, I didn't know. You
• 42:05know? But, like, you know,
• 42:06can they make sort of
• 42:07a more informed and intentional
• 42:09decision about their participation,
• 42:12in research. So that's the
• 42:14focus of that. I'd like
• 42:16to
• 42:17I'm working on expanding the
• 42:18work,
• 42:19that we are doing in
• 42:20Jamaica,
• 42:21through a r o one
• 42:22proposal,
• 42:23to NINDS,
• 42:25to improve secondary stroke prevention
• 42:27through multimorbidity care and social
• 42:29needs interventions,
• 42:31using implementation
• 42:32science. So, I'm currently working
• 42:34with, the team there,
• 42:37to develop,
• 42:39a proposal.
• 42:42And then,
• 42:44further on the horizon,
• 42:46you know, investigating social, clinical
• 42:48and healthcare system factors
• 42:50that contribute to blood pressure
• 42:52control in the region. And
• 42:53that's
• 42:54an extension of my k
• 42:56o one work,
• 42:57where I found, you know,
• 42:59really high rates of uncontrolled
• 43:01blood pressure and this link
• 43:02between food insecurity
• 43:04and blood pressure control. So
• 43:07yes.
• 43:07And, Janine, can now is
• 43:09this social needs screening
• 43:11part of clinical care? Like,
• 43:13how are you No. It's
• 43:14not. And that's well, the
• 43:15team has actually talked about
• 43:17that, social needs screening and
• 43:19also
• 43:22depression screening. So we found
• 43:23in our our,
• 43:24pilot results that a lot
• 43:26of people,
• 43:30you know, their score
• 43:31on the PHQ
• 43:33nine, but they, you know,
• 43:36scored high.
• 43:38And so they're they're considering.
• 43:40And I think this was
• 43:41a conversation they were having
• 43:42before, but screening
• 43:43for depression
• 43:44in the clinics as well,
• 43:45that's not done. But, yes,
• 43:46they are thinking about both
• 43:48both of those things
• 43:51and screening, yeah, especially food
• 43:52insecurity.
• 43:58So I'll I'll close,
• 44:00by just reiterating that my
• 44:02research is driven, by a
• 44:03commitment to improving health and,
• 44:06among racial,
• 44:07ethnic, and immigrant communities.
• 44:08I'll continue engaging
• 44:10those most affected by health
• 44:11disparities
• 44:12as partners and leaders, in
• 44:14research.
• 44:16I want to deepen investment
• 44:17in community capacity to drive
• 44:19systems change, both here in
• 44:21the US and in the
• 44:22Caribbean.
• 44:23And I definitely wanna expand
• 44:24my focus to incorporate intervention
• 44:27based research
• 44:28to translate some of the
• 44:29findings that,
• 44:31come from my work to
• 44:32solutions.
• 44:34So thank you for your
• 44:35attention.
• 44:39And I'm happy to take
• 44:40any questions that you have
• 44:41about any of the work
• 44:42I shared. Alana.
• 44:45This is amazing. Thanks for
• 44:47I was curious about the
• 44:48one,
• 44:50program that you're a part
• 44:51of. Can you talk a
• 44:52little bit more about the,
• 44:54like, what the work of
• 44:55the Chezzys or what they're
• 44:56now called? Like, what they
• 44:59I guess I'm thinking about
• 45:00sometimes there's a tension between
• 45:02providing services that a community
• 45:03needs versus studying it and
• 45:05making generalizable knowledge. And, like,
• 45:06where along that spectrum do
• 45:07those
• 45:08organizations
• 45:09fall in terms of their
• 45:10objectives and the,
• 45:12evaluation?
• 45:15Yeah. So they are
• 45:17the interventions
• 45:18that they've selected
• 45:20are really informed by their
• 45:21community. So I didn't mention
• 45:23this, but each of the
• 45:24CRPs has
• 45:25a what are what's called
• 45:27a AHARA health equity research
• 45:29advisory board. And so, you
• 45:31know, in the first year
• 45:32when we were when we
• 45:34were, we received our award,
• 45:36some of them were still
• 45:36thinking about trying to come
• 45:38to a decision, right, on,
• 45:39like, what's what do we
• 45:41focus on?
• 45:42And mainly because there's so
• 45:44many
• 45:46priority areas, so many needs,
• 45:48that it was hard in
• 45:49many cases to decide, okay.
• 45:51We're gonna focus on this,
• 45:52focus on that. So that
• 45:52was a a process to
• 45:54and you said something about
• 45:55evaluation? What
• 45:57what is the expectation for
• 45:58evaluation? Like
• 46:00yeah.
• 46:02Yeah. So the evaluation was
• 46:03part of I mean, part
• 46:05of the,
• 46:06original
• 46:09program. So that was the
• 46:11job of the coordinating center
• 46:12with support from the Health
• 46:14Equity Hub. So they were
• 46:16collecting common data elements,
• 46:19you know, and collecting other
• 46:21metrics to be able to
• 46:22do the evaluation.
• 46:24Now, as it stands and
• 46:26I think,
• 46:28there's some clarity, but I
• 46:30think we could use a
• 46:31little bit more clarity about
• 46:32the evaluation.
• 46:33But right now, each hub
• 46:35is guiding
• 46:36each of their CRPs
• 46:38and setting them up to
• 46:39figure out, like, okay,
• 46:41you need to collect this
• 46:42data, and this is how
• 46:43you're gonna store it. And
• 46:43this is how we're gonna
• 46:44use it for the analysis
• 46:45to demonstrate that,
• 46:47you know, your pie you
• 46:48know, your pilot works or,
• 46:50like, it's feasible. It's acceptable.
• 46:52So that's the work of
• 46:53the,
• 46:54the expertise on the hub.
• 46:55And each
• 46:56each hub was,
• 46:58each hub had a research
• 47:01no. What is it called?
• 47:02Data
• 47:03monitoring.
• 47:04I'm drawing a blank. Anyway
• 47:07no.
• 47:10Anyway, so we have the
• 47:11expertise in house. Right? Like,
• 47:13as still part of our
• 47:14team. Thankfully,
• 47:15you know, we did not
• 47:16lose any of our hub
• 47:18members. Many of our,
• 47:20colleagues at other institutions,
• 47:22you know, they lost team
• 47:24members.
• 47:25We're grateful that our team
• 47:26is still intact, and we
• 47:27still have the methodological and
• 47:29biostatistical
• 47:30expertise,
• 47:32implemented implementation science,
• 47:35among our team members. So
• 47:36we are sort of guiding
• 47:37them in in doing that,
• 47:39evaluation.
• 47:40Thank you. Yeah. But it
• 47:41was originally
• 47:43that was originally, like, the
• 47:44coordinating center.
• 47:46Yeah. Yes.
• 47:47I'd like to ask somewhat
• 47:49provocative, please.
• 47:51Okay.
• 47:53Physicians don't own health care
• 47:55or health.
• 47:57And we have a certain
• 47:58kind of training.
• 47:59Right? And others have other
• 48:01kinds of training. Mhmm. When
• 48:03we talk about structural interventions,
• 48:06we may not be the
• 48:06most appropriate people
• 48:08for making some of those
• 48:09interventions. So I'm just curious
• 48:11how you
• 48:13negotiate
• 48:14with the communities. You know,
• 48:15they may say,
• 48:16jeez. It would be really
• 48:17great if you could fix
• 48:18this building.
• 48:19Right, or something along those
• 48:21lines that perhaps is beyond
• 48:22the scope of what
• 48:24physicians can really help do.
• 48:26So I'm just curious how
• 48:28you negotiate that.
• 48:30Yeah.
• 48:30You know, I think
• 48:32I think that's part of
• 48:35this whole sort of shift
• 48:37because,
• 48:38typically, it's like us, the
• 48:40researcher,
• 48:41the
• 48:41you know,
• 48:43either you know, or physician
• 48:45sort of
• 48:46guiding that research, identifying those
• 48:48priorities, those needs. These are
• 48:50community based organizations that are
• 48:52saying,
• 48:53this is the issue. You
• 48:54know, many of them health
• 48:55related related to health out
• 48:57poor health outcomes,
• 48:59but
• 49:00they are sort of
• 49:02What would they take issues
• 49:03that you don't
• 49:04You have to address.
• 49:07Well, who doesn't have the
• 49:08capacity to oh, that they
• 49:09don't have the capacity to
• 49:10address?
• 49:12Team. Whatever
• 49:13team has the capacity to
• 49:14address. I mean, there are
• 49:15lots of structural issues that
• 49:16are probably well beyond any
• 49:18teams.
• 49:19Yeah. Yeah.
• 49:20But I think that's so
• 49:22this was a a
• 49:23a really, I think, a
• 49:24first of its kind. Right?
• 49:25That's why it was multisectoral.
• 49:27So you may not have
• 49:28that expertise, but somebody else
• 49:29does. And you bring those
• 49:30people to the table, and
• 49:32they're supported with lots of
• 49:33funding over a long time
• 49:35period, ten years,
• 49:37to implement these interventions. So
• 49:39they are essentially the decision
• 49:41makers.
• 49:42So if they say, you
• 49:43know, in New Mexico, they
• 49:45were like, there's radon exposure,
• 49:47and we think people are
• 49:48getting sick. And, like, you
• 49:50know, that's what they wanted
• 49:51to that's what they wanted
• 49:52to use the money to
• 49:54address. And,
• 49:55you know, they're working with
• 49:57physicians.
• 49:58Their academic partners are physicians,
• 50:01but they are really the
• 50:02decision makers. And so it's
• 50:03up to the community, actually,
• 50:05really, to make those decisions
• 50:06and execute whatever intervention that
• 50:09they
• 50:09deem a priority,
• 50:11for the health of their
• 50:12community.
• 50:14I don't know if that
• 50:14answers your question, but it's
• 50:17I think that's why this
• 50:18came about. That that's why
• 50:19this type of,
• 50:20paradigm exists.
• 50:23So they can address
• 50:25yeah. Yeah. Yeah. Yeah.
• 50:28Yeah.
• 50:29You know, one would think
• 50:30that the most efficient solution
• 50:32is one do have some
• 50:34back and forth. Right? Because
• 50:35there's probably
• 50:37in their list of priority
• 50:39stuff that you guys are
• 50:40just better
• 50:41better equipped to really
• 50:43address
• 50:45than other things.
• 50:46Right? Like, us specifically at,
• 50:48like, the Yale hub or,
• 50:49like, team. Okay. Mhmm.
• 50:52Okay.
• 50:53And so I I find
• 50:55it possible that, you know,
• 50:56okay. If they
• 50:58say, we're worried about radon,
• 51:00and you have absolutely
• 51:01no
• 51:02good angle to come in
• 51:04on radon, then you would
• 51:05say, okay. Fine. Let's do
• 51:06radon.
• 51:07I mean, that just doesn't
• 51:07make sense to me. Oh,
• 51:08so we would if if
• 51:10they propose something that we're
• 51:11like, we don't know anything
• 51:13about, I don't know, radon,
• 51:15then the hub is responsible
• 51:16for, like, bringing that expertise
• 51:18to the hub. So we
• 51:19bring that expertise to say,
• 51:20you wanna study radon? And
• 51:22if there's nobody here that
• 51:23can help with radon and
• 51:24asthma, we are going to
• 51:26so the original,
• 51:28and, you know, it's
• 51:30we're grateful that we are,
• 51:32like, at an institution where
• 51:33we have, like, so much
• 51:34expertise and deep expertise across
• 51:36so many different areas. But
• 51:38we would bring that expertise
• 51:40to them.
• 51:41You know, the photo voice,
• 51:43training
• 51:44that one of our teams
• 51:45requested,
• 51:47one of our team members
• 51:48knows something about photovoice, but
• 51:49we brought that expert
• 51:51to to them. They did
• 51:52a, you know, a whole
• 51:53webinar or a workshop
• 51:55with the team to teach
• 51:56them, and they've had follow-up,
• 51:58meetings with with that said
• 52:00expert.
• 52:01So we we would bring
• 52:02it there. Now is there
• 52:03negotiation sometimes if, you know,
• 52:05we recommend a particular approach,
• 52:08or, you know, to to
• 52:10doing something and they're like,
• 52:11no. That's not gonna work
• 52:12for us?
• 52:13They're absolutely
• 52:15they can absolutely go ahead
• 52:16and,
• 52:17you know, proceed however they
• 52:18they want because they are
• 52:20the
• 52:21they are the decision makers
• 52:22and the leaders, you know,
• 52:24they are leading the work.
• 52:25So it's
• 52:26it's a it's a totally
• 52:28it's just a different way
• 52:30of operating, a different way
• 52:31of doing work.
• 52:32And I think even for
• 52:34us as the hub, you
• 52:35know, we're all researchers and
• 52:36used to sort of doing
• 52:37the re doing the work
• 52:38ourselves, right, and making those
• 52:40decisions.
• 52:41But we're really
• 52:43in a space where we're
• 52:45providing,
• 52:46scientific
• 52:48guidance, support, technical support, training,
• 52:50capacity building so that they
• 52:52can execute whatever
• 52:54it is that they,
• 52:56have identified to select to
• 52:58address.
• 53:01Yes.
• 53:02Thank you for your wonderful
• 53:03talk. I just mostly have
• 53:05a comment thinking about as
• 53:07a primary care provider,
• 53:10at least in Connecticut and
• 53:12New Haven,
• 53:13I have patients who are
• 53:14working not one job, not
• 53:15two jobs, but two point
• 53:17five or three jobs. Yeah.
• 53:20Ability to find community really
• 53:22is limited to the workplace.
• 53:24So, you know, they're they're
• 53:28not well, partly because they're
• 53:30working so many jobs to
• 53:31create a sustainable wage.
• 53:33And if they work here
• 53:34within the hospital system,
• 53:37and so it's a it's
• 53:38a piece of if you
• 53:40like, you know,
• 53:42time besides family happens,
• 53:44you how does that occur?
• 53:45It it is a it
• 53:46is a commitment in terms
• 53:47of
• 53:49how employment
• 53:50currently
• 53:51in our capitalist system influences
• 53:54who potentially
• 53:55can participate in programs
• 53:58labeled as community.
• 54:00I am shocked at how
• 54:01much like Amazon,
• 54:03not to
• 54:04really
• 54:06people
• 54:07and defines
• 54:09what their health trajectories are
• 54:10gonna be.
• 54:12Yeah. Yeah. Thank you.
• 54:14Yeah. Thank you.
• 54:17I think we're out of
• 54:18time, but,
• 54:21Yeah. Sorry.
• 54:23Yeah. Thank you, everyone. Thanks
• 54:24for your questions.