Culture of Health Blog

This post is the second in a blog series that explores how preemption has served as a double-edged sword in either supporting or undermining efforts to advance health equity. We explore how some states have limited public health authority and what must be done to rebuild a public health infrastructure that centers equity.

Centering the community in making its own decisions, confronting a long legacy of trauma and violence, and honoring genuine emotion are among the pathways to mental health that many residents of Palm Beach County are embracing.

Maria Gomez has had her finger on the pulse of our healthcare system and the people it serves throughout her storied, 30+ year career running a community health center that serves a low-income, immigrant community in greater Washington, D.C. Maria entered the United States at age 13, started Mary’s Center after becoming a nurse, and helped grow it into a powerhouse serving 60,000 people each year. Mary’s Center helped pioneer an integrated model of healthcare, education and social services to put people on a path to good health, stability and economic independence. In 2012, President Obama presented Maria with the Presidential Citizens Medal. She retired in late 2021. Here, in the second part of a two-part interview, she reflects on the challenges facing our healthcare system, how nurses can continue leading efforts to meet them, and what we can learn from the pandemic.

What are the greatest challenges facing our healthcare system?

Today, it’s all about the numbers—the number of patients you see and the number of minutes it takes. Because that’s how you get paid. To transform lives, we need to change how we address patient needs. Providers can’t do it all in 15 minutes. Some are so overwhelmed by the numerous demands on them that they’ve grown numb to what their patients are feeling. Too many smart, incredibly passionate people who devote themselves to healthcare have become disheartened, burned out, and are even leaving the workforce. This is the most discouraged I’ve seen providers in my career.

Thirty-five local non-profits will be awarded up to $40K to work with local data to dismantle structural racism via a new funding opportunity.

Editor's note: This funding opportunity is now closed. 

We are proud to live in one of the most racially and ethnically diverse states in the nation. Our home state of New Jersey is also a national leader in areas such as expanding health care coverage, enacting paid family leave, and maintaining low smoking rates.                                                       

Unfortunately, however, these bright spots are offset by glaring disparities with roots in our nation's long history of racism that persists to this day. For example, a Black woman in New Jersey is seven times more likely to die from pregnancy-related causes than a White woman and Black babies are more than three times more likely than White babies to die before their first birthday.

The COVID-19 pandemic exposed and worsened these inequities, especially along racial/ethnic lines.  

In addition to the role played by social determinants of health, a major contributor to these disparities is a state public health system strained for decades by lack of funding and insufficient coordination across health and related sectors. Experts agree the system lacks the capacity to simultaneously achieve its core missions while equitably responding to and managing public health emergencies such as the COVID-19 pandemic.

RWJF’s Maryam Khojasteh sat down with Janet Topolsky, who served as the executive director of the Community Strategies Group at the Aspen Institute, to discuss rural economic development, the challenges and opportunities facing rural America, and what the future holds for improving rural economies. Topolsky, who stepped down after a 40-year career working on developing opportunities and capacity in rural America, oversaw the development of the Thrive Rural framework, an effort begun by the Aspen Institute Community Strategies Group (Aspen CSG) in partnership with the University of Wisconsin Population Health Institute with support from the Robert Wood Johnson Foundation. The Thrive Rural framework aims to organize learning, strengthen understanding, and catalyze and align action around what it will take for communities and Native nations across the rural United States to be healthy places where everyone belongs, lives with dignity, and thrives.

What happens when young men and boys of color aren’t able to be themselves in any setting? 

In San Diego, refugees from East Africa commonly experience discrimination, racism, and Islamophobia. Young men and boys, in particular, describe how they have to act one way in school, another way with friends outside of school, and another at home. It is important for the community to find ways to improve social connections, increase opportunities, and build resilience, since their social isolation can lead to unhealthy behaviors that put their health and futures at risk.

Social isolation—the lack of significant social connections interpersonally and within a community—is a “deeply consequential” public health crisis, according to U.S. Surgeon General Vivek Murthy. He noted how “During my years caring for patients, the most common pathology I saw was not heart disease or diabetes; it was loneliness.”

Indeed, the health risks of social isolation have been compared to those of smoking and obesity, and it is linked to depression, impaired immunity, increased suicidal tendencies, and increased risk of death. 

For generations, Indigenous Peoples have known that our health is intertwined with the health of our earth. Their worldview recognizes that being healthy means ensuring the natural resources that give us life are well cared for.

In contrast, Western mindsets tend to view the natural world as an inventory of useful commodities—separate from, and existing only in service to, humanity. Overusing, polluting, and extracting without considering the long-term impacts has created conditions that fuel health inequities in our country: contaminated drinking water, food scarcity, air pollution, and extreme heat are contributing to poor health and driving up disease, particularly in low-income neighborhoods and communities of color.

Transforming our relationship with nature is key to building a sustainable, equitable, and healthy future for all. Through the forcible removal, violence, oppression, and other injustices Indigenous Peoples have experienced, they have remained powerful stewards for many of our natural resources. Their values, practices, and policies can show us the way to heal and reclaim the health of our earth and humanity.

Bring horses and Native youth together, and connections are built that can change lives. 

Deep ties to the land and close connections with animals have long helped to define Native American culture and make their way of life possible. In Fort Peck, Montana, Charlie Four Bear reclaimed that legacy by helping young people develop enduring relationships with horses. Four Bear (Dakota and Lakota) was an elder on the Fort Peck Indian reservation and a former police officer.

 “First they took away our land,” he said, describing the destruction that occurred as White settlers pushed West. “And then they took away our buffalo. And then they took our horses away.” The theft of so much Native culture, and the inequitable distribution of resources and opportunity that continues to this day, have damaged lives and undermined communities. The scars are apparent in the substance use and loss of hope revealed in one horrifying statistic: in a single year, 28 of 223 students at the local high school attempted suicide.  

Our nation’s health is intertwined with the health of our rivers. And our rivers are unwell.

Drinking water, food, sanitation, clothing, transportation: almost everything we do involves an interaction with water. Yet many people in America take water for granted, not realizing that pollution, overuse, and climate change are putting a chokehold on the country’s natural water reserves—posing a direct threat to health, equity, and our way of life.

While many may think that new technology and innovation can resolve our water crisis, I believe that the solution lies with Indigenous practices that have fostered a holistic approach to living in relationship with the natural environment for millennia. Let me explain.

Our Relationship with Nature

Indigenous peoples share a common worldview of our relationship with the natural world. One that is guided by Indigenous values and principles of respect, cooperation and responsibility. These principles govern our individual and collective beliefs, behaviors and relationships—as given to us from our ancestors. While our customs may differ, our lived connection with our environment is universal. In sharp contrast, Western mindsets tend to view nature as a commodity, maintaining a relationship that is centered on resource-taking.