Health Equity and Social Justice Theme of YSPH Alumni Day 2021

Yale School of Public Health alumni got a close-up view of the school’s impressive health equity and social justice work during this year’s Alumni Day celebration on Oct. 15.

Faculty, students, staff and alumni discussed their various roles in addressing social and health justice during several virtual panel discussions over the course of the day. Alumni were also introduced to the school’s new U.S. Health Justice Concentration.

“Social justice and health equity have been central to what we do at the school of public health for quite some time,” said Trace Kershaw, Susan Dwight Bliss Professor of Public Health and chair of the Department of Social and Behavioral Sciences (SBS).

Kershaw said the department began shifting its focus from individual health behavior to larger social determinants of health about 10 years ago. With that change, the department brought in a cadre of experts focused on addressing racism, discrimination, stigma, housing and poverty. The school was one of the first public health schools to make social justice a core part of its curriculum, he said.

A complete recording of the Alumni Day social justice panel discussion can be viewed on the school’s YouTube channel.

One of the leaders of the school’s health equity and social justice efforts is Associate Professor Danya Keene, who teaches a core curriculum course, Social Justice and Health Equity, and is founding director of the U.S. Health Justice Concentration. Keene’s research examines housing and housing policy as determinants of population health equity. She is currently focused on the health implications of the nation’s severe affordable rental crisis.

“There is no state in the U.S. where a full-time minimum-wage job is enough to affordably rent a one-bedroom apartment, and that lack of housing really has significant health implications,” said Keene. One study being led by Keene is examining the relationship between affordable housing access and Type 2 diabetes management and control. The 5-year study is comparing the health of people who receive subsidized housing support with those that don’t.

A recent addition to the SBS team is tenure track Assistant Professor Ijeoma Opara, founder and director of the Substance Abuse & Sexual Health Lab. Opara focuses on youth substance abuse and HIV prevention, specifically in urban communities.

She is currently leading a 5-year study that is examining potential associations between substance abuse prevalence rates and mental health prevalence rates among youth in Paterson, New Jersey. Opara intends to use the study’s findings to develop a substance abuse and mental health prevention and intervention program that is community-, racial- and gender-specific. She has also launched the Dreamer Girls Project, which seeks to develop an HIV/substance use intervention for Black girls.

“This project is going to be designed by Black girls for Black girls,” Opara said. One aspect of the study looks at how gendered racism impacts Black girls’ perception of themselves, their behavior and their health.

One of Opara’s long-term goals is to change the “deficit narrative” that she said is often placed on Black and Hispanic youth.

“I want them to view themselves as being successful,’ she said. “I want researchers to be able to view Black and Hispanic youth through that lens and be able to look at them and their families and communities as communities that can thrive and that are thriving, and their outcomes are mainly due to systemic racism, structural racism and segregation.”

The Yale School of Public Health is also engaged in social justice and health equity locally in New Haven. One of the leaders of that effort is Kathleen Duffany, Ph.D. ’15, an associate research scientist and director of research and evaluation for the Community Alliance for Research and Engagement, or CARE, which is a joint collaboration between YSPH and Southern Connecticut State University. Duffany’s work addresses structural barriers to health equity, and it includes extensive interactions with New Haven area schools and community organizations to improve local health and educational outcomes.

“My main focus right now, and it has been for a few years, is food security here in New Haven and also social determinants of health,” she said.

Food security has been identified as a primary concern by New Haven community leaders and through local community assessments, Duffany said. CARE is collaborating with and supporting local efforts to address barriers to food security and to make the city’s food pantry system more accessible. Yale teams are also working with community leaders and advocates to implement healthier food choices at local pantries and link people visiting pantries to job opportunities and clinical care. CARE is also working closely with New Haven’s Breastfeeding Task Force in providing breastfeeding support at the individual level through peer counseling and other initiatives.

Also on the panel was Assistant Professor of Public Health Katie Wang, PhD ’14, whose research focuses on the role of stigma as a psychosocial determinant of mental and behavioral health disparities among diverse marginalized populations.

Wang is currently investigating mental illness stigma as a risk factor for substance use in adults with depression. She launched the study after noticing a gap in existing research.

“People with mental health disorders are significantly more likely to develop alcohol and drug use problems,” said Wang. “But while there has been a lot of research looking at the biological and psychosocial factors driving that (behavior), stigma has not been discussed.” She said it’s important to study the impact of stigma because it can potentially hinder people’s willingness and ability to seek help.

Wang, who is blind, is also examining the experiences of people with disabilities during COVID-19 and how the pandemic – particularly in terms of disability-related stigma and social isolation – has affected their mental health.

As a stigma researcher, Wang said social justice is central to her work improving the lives of marginalized populations. She is particularly interested in incorporating intersectionality into her research. She mentioned studies that focus on racism and studies that focus on sexism as examples of research that could be merged.

“There’s not a lot of attention looking at how different marginalized identities intersect, which is unfortunate because our identities do not exist in a vacuum,” said Wang. “We exist at the intersection of multiple identifies, and we are oftentimes marginalized in different ways depending on how our identities combine.”

Many of the issues discussed by the panel are amplified in the school’s new U.S. Health Justice Concentration, which launched last spring after several years of collaborative effort on the part of school administrators, faculty and students.

In 2017, in response to a national travel ban on Muslims, white supremacy rallies, lack of federal action on climate change and acts of police violence against people of color in the U.S., students approached the administration seeking more opportunities for social and health justice study and training, said Dashni Sathasivam, M.P.H. ’19, one of the students involved in the discussions at the time.

“I, along with many of my fellow classmates, entered YSPH hungry for social justice and looking to learn in the classroom and beyond,” Sathasivam said. Those discussions led to the creation of a mandatory social justice and health equity course for all students and, eventually, the U.S. Health Justice Concentration.

“The aim of the concentration is to give students an opportunity to dig into these issues of equity and justice and the way that power and structure constrain health,” Keene said.

The concentration includes a class in advocacy and activism led by Assistant Professor Adjunct Tekisha Everette, a long-time social justice advocate and director of the Hartford-based nonprofit Health Equity Solutions. Students are also required to do a practicum in social justice, including opportunities to work with local community organizations.

Yale School of Public Health alumni and students working on social justice and health equity shared their experiences during Alumni Day 2021. The following are highlights from that discussion.

Marina Marmolejo, M.P.H. ’19, founder of the nonprofit DreamKit app that connects housing-insecure New Haven youth with housing, mentorship and employment opportunities.

On Public Health and Entrepreneurship:

“If you have an idea and want to propel it forward, people will absolutely join you in your journey as you lean into your power.”

“Public health directly connects with business principles, I promise you. So as you are taking your courses, just know you have the skill set to be able to write a business model. It is basically the same thing as a logic model for research, just with different terminology… If I can do it, you can do it.”

“Reflect constantly and tweak your public health brand. For me, I’m currently working on technology efficiencies for housing-insecure populations. It took me awhile to get there, but now I can communicate more strongly… map out your intentions as often as you can.”

“If you have mentors in your field … ask them what media they consume … be in a mindset of absorbing knowledge at all times because it absolutely pays off.”

“Lastly, center people over everything. Center people over your research, over your work. That’s how I got to the place where I am today. People will remember how you made them feel, not what you said.”

Krysten Thomas, M.P.H. ’18, student attorney with the Health Justice Alliance Clinic at Georgetown University Law Center litigating disability rights and a juris doctor candidate.

On public health training and service:

“There is always something that we can do to make the world a better place, and in times of uncertainty, we have an imperative to find out what that is and to act.”

“Everyone [in public health] has an impressive set of public health skills and public health expertise that can meet this very moment, so what are you going to do?… There are so many options. You simply have to be open and remain aware of the power that you have to create a world of good.”

Alicia Whittington, M.P.H. ’06, assistant director of engagement and health equity research for the Football Players Health Study at Harvard University.

On the importance of community engagement:

“The framework that drives all that we do is community-based participatory research and we have a huge emphasis on health equity.”

“Part of our work is to communicate findings to (the community)… What does the community think about them? What can be driving (these findings)? The conversations are ongoing and we're working on other papers, so stay tuned.”

Jessica Ainooson, M.P.H. ’22, member of the Neighborhood Health Project, and Beatriz Duran-Becerra, M.P.H. ’22, executive director of the HAVEN Free Clinic.

On working with community leaders:

“Consistency and flexibility are essential in working with community partners, and it’s really important to the overall building of trust that continues into the future.”

“It is possible to have nearly every part of a project be community-informed, but it takes consistency, flexibility, a lot of work and time.”