Blog

Photo by Ian Schneider.

It’s 3:00 on a hot summer afternoon in downtown Boston. The sidewalks are full of sightseers, working people on their coffee breaks, and people rushing to meetings or appointments. Almost everyone is carrying a cold drink to battle the heat. A man hands a woman a bottle of water, and they stop to chat. He’s part of a group of Boston University School of Public Health (BUSPH) staff, faculty, and students passing out water to—and having conversations with—thirsty members of the community, including a significant population of people experiencing homelessness. The neighborhood includes BUSPH and the Boston Healthcare for the Homeless Program.

This scene repeats itself every Monday, Wednesday, and Friday all summer long. This simple practice of giving out water and having brief conversations doesn’t just remind the BUSPH team that their “on-track” lives could be just a life circumstance away from being seriously derailed. It also reminds them why they entered the field of public health in the first place: to promote the health of the general public and to improve the lives of people at risk for—or experiencing—conditions that undermine health, including homelessness.

“Handing out water is a small gesture to help those in need, but is important to remind our BU community that the underserved members of society are, first and foremost, people—with human needs, experiences and feelings. It reinforces the need for public health professionals to work hard to make larger, more systemic changes to level the playing field in food, housing, clean water, addiction treatment, and other services for all members of society,” says Assistant Dean for Public Health Practice Region I – New England Public Health Training Center (NEPHTC) Principal Investigator Anne Fidler.

Dr. Fidler’s years of experience advocating for workers’ health and safety shaped her views on public health, as has her understanding of how public health and housing issues intersect. “If you really want to change public health with a focus on health equity,” says Dr. Fidler, “a good place to focus activism is on the residents of public housing. Nearly 10% of Boston’s population lives in public housing, and the higher rates of risk factors and disease among public housing residents are well documented.” BUSPH hosts a collaboration to focus on the long-term goal of reducing health disparities between Boston’s public housing residents and other Bostonians.

To the BUSPH team, public health and health equity are intertwined, says Associate Dean of Public Health Practice, Harold Cox. Dr. Cox’s early activist work with the AIDS Action Committee and on intellectual disability were instrumental in developing his equity focus. “Hopefully, we’re always talking about social justice when discussing public health,” says Dr. Cox.

This way of thinking is not new at BUSPH. A mindset for social justice and activism has permeated the school throughout its history and increased in the past decade, in recognition that public health and social justice are inextricably linked.

That activist mindset grew into a sharper focus in 2015, when Dr. Sandro Galea became Dean of BUSPH. Dr. Galea had worked for years to help people in low-income countries, and had researched the effects of poverty and poor education on health. As BUSPH’s leader, Dr. Galea found an opportunity to highlight how public health can advance social justice.

Under his leadership, BUSPH transformed its practice office into The Activist Lab, home of the NEPHTC, a public health training program.

“As a public health university, we have an obligation not just to understand the root causes of health equity issues, but also to harness our position to create dialogue and form partnerships that will change the system for vulnerable populations,” says Dr. Galea. “Many people in the homeless population who live near BUSPH suffer from substance abuse disorders, combined with a fragile support system. An Activist Lab within a research institution is well positioned to know what is known about such complex issues, to choose among the issues, and to build coalitions to address them.”

Public health schools and programs generally emphasize the importance of addressing health inequities, and BUSPH’s Activist Lab takes this further by reexamining the role of university-based public health and workforce development programs through the lens of activism. In the Lab, the team translates practice and research into real-world change. This includes reconceiving the concept of “practice.” Traditionally, practice refers to the activities of the public health workforce—assessing problems and designing, implementing, and evaluating programs and policies to address them. Implicit in this is the desire to change the status quo, to improve the health of the public. The Activist Lab encourages this desire by shining a light on public health inequities in an effort to motivate members of the school community, as well as society at large, to take action. (See BUSPH’s contributions to the #Enough campaign, for example.)

The Lab’s mission is to “educate, innovate, and advocate” on health equity issues. It provides opportunities for students to learn the skills of advocacy: framing the issue, building and sustaining partnerships and coalitions, implementing strategic plans, and communicating effectively. “It’s not enough to want to do good; we have to give students and practitioners the skills they need in order to advocate for change,” says Dr. Fidler.

Training is a critical part of these efforts. “There is a new perspective emerging in the workforce training field,” says Karla Todd, Program Manager for NEPHTC. “There is recognition that the good work done by public servants, with their often scarce resources and thin staffs, is essential to keeping our communities safe and to ensuring health equity. Providing broad access to excellent training is the number one contribution a training organization can make to social justice.”

Drs. Cox and Fidler agree that substantial change cannot be made without forging partnerships, among groups both within and beyond the public health sector. They emphasize that the most important partnerships must be with those whose lives public health advocates are trying to improve, and that understanding issues from the perspective of those most affected—and getting their input at each stage—is critical to making lasting change. “Nothing gets done in a cubicle. We need to work collaboratively with people who care and should care,” says Dr. Fidler.

The results are tangible. As a result of one such collaborative partnership, over 800 members of a public housing community found a safe and inviting space in Boston’s South End to recreate, exercise, and participate in nutrition and cooking classes. BUSPH worked with Boston Centers for Youth and Families (BCYF), the BU Sargent College of Health and Rehabilitation Sciences, and the BU School of Social Work to provide programming that would increase access and use of the BU FitWell fitness center and other resources at the Blackstone Community Center, which serves residents of the diverse South End and Lower Roxbury neighborhoods. Community residents participated in focus groups and informational interviews, in which they described barriers to their participation in the FitWell Center’s programs and provided possible solutions to accommodate the realities of their lives. These conversations were critical to the program’s success.

The Lab recognizes that the role of academia goes beyond providing excellent instruction and conducting rigorous research about public health problems. Universities must also work to make lasting and meaningful change by educating, innovating, and advocating about concerns that affect marginalized populations.

Authors:

Courtney Perdios, Writer/Editor at Region I – New England Public Health Training Center

Deborah Gardner, MPH, MFA, Project Manager, Northwest Center for Public Health Practice, Region X – Northwest Public Health Training Center