“When I saw how many hours the famers worked, and their inability to care for their children—when you come face to face with health disparities, the realization changes you.”—Helen Bellanca
The challenge. As a physician, Helen Bellanca was comfortable as a medical authority in Portland and Hood River, Ore. But she was not comfortable leading health care change.
After graduating from Northwestern University Medical School, and then completing her residency at Oregon Health and Science University in Portland in 1999, Bellanca was headed for a career in family medicine. But her path took an unexpected turn when she decided to practice in the farming community of Hood River, Ore.
She says she did "everything from delivering babies to orthopedics" to meet the medical needs of the migrant and seasonal farm workers in the community. And in the process she discovered a new direction: public health.
An unexpected turn from family medicine. "It was such an interesting environment, and I learned to appreciate firsthand how geography impacts health and access to health care," she noted. "We were working with migrant and seasonal farm workers and immigrants, and it brought this cultural piece to work. It was a look at poverty and health. And that played into my desire to go back to school and get a public health degree and create a different paradigm of health."
"Institutional racism and cultural derivatives deeply affect health," she continued. "That some communities are becoming more and more segregated from the real lives of people—the working poor—is really astounding. The same was true for me. I came from a middle-class background in Detroit, and it's not like I never saw poverty. But when I came to Hood River and saw how many hours the farm workers worked and their struggles to care for their children—when you come face to face with health disparities, the realization changes you."
From graduate student to rural health leader. From 2004 to 2006, Bellanca pursued her master's degree in public health from the School of Public Health and Community Medicine at the University of Washington in Seattle. That work allowed Bellanca to develop a deeper understanding of "what public health entails, and introduced me to the world of health policy, a key avenue to effect change," she said.
"Health policy really struck a chord with me. We can make decisions as a society about what our communities have access to, and if you can impact health policy, you can impact broader areas of the population."
Through the university's extended degree program, Bellanca primarily took online courses and made sporadic trips to Seattle for classes. She continued to live and work in Hood River on public health and health policy. Bellanca then won funding from the federal Office of Minority Health for Vida Entera y Sana (Whole and Healthy Life), a three-year program to address obesity among Hispanic farmworkers.
She served as co-director of the project, based at La Clinica del Cariño Family Health Care Center in Hood River. After receiving her MPH in 2006 and completing the project in 2007, Bellanca joined the Oregon Public Health Institute in Portland as a public health advocate on childhood obesity and other challenges.
"Certainly doctors have long played a role in writing about and standing up for issues that are relevant in public health. But in terms of getting engaged in hands-on advocacy work—not so much," she noted. The institute "saw me as someone who could bring evidence-based facts to the table, and recognized that engaging a doctor in what they were trying to do was a good move. They wanted me to take a leadership role."
Seizing an opportunity. However, as a public health advocate, Bellanca discovered that she did not have the same confidence as when working as a physician. "I felt comfortable in authority as a physician, but not comfortable leading change," she said. Talking to community organizations and others that affect policy—and trying to motivate people to make changes—seemed foreign. "I didn't know much about leadership. But I was really interested in the idea of leadership in health."
Bellanca read about Ladder to Leadership: Developing the Next Generation of Community Health Leaders, a leadership training opportunity created for the Robert Wood Johnson Foundation (RWJF) by the Center for Creative Leadership in Greensboro, N.C. With the approval of the Oregon Public Health Institute, she applied and was accepted.
Ladder to Leadership. From 2008 to 2012, Ladder to Leadership sought to develop a cadre of leaders to enhance the capacity of nonprofit health organizations that serve vulnerable populations, and to cope with an exodus of senior leaders as the baby boom generation retires. The program trained early-to-mid-career professionals to nurture organizational change and work across organizational barriers, develop more constituent-focused services, and adapt innovations from other fields.
The 16-month program included training sessions at the Center for Creative Leadership, one-on-one coaching and mentoring, and a team action project focusing on fellows' own communities. Over five years, Ladder to Leadership trained 219 health care professionals in eight cities and regions: Albuquerque, N.M.; Birmingham, Ala.; central New York state; Cleveland, Ohio; Kansas City, Mo.; Newark, N.J.; eastern North Carolina; and Portland, Ore.
From 2010 to 2011, Bellanca was one of 30 fellows in the Portland cohort, representing an area with nearly 9 percent unemployment and a 16 percent poverty rate at the time.
Tackling race, power, and privilege. Bellanca's work with her action learning team dominated her Ladder to Leadership experience. The team, composed of seven Portland fellows, interviewed health care leaders regarding the impact of race, power, and privilege on "health care delivery, health care perceptions, and the reality of who got what care.
"We investigated our own organizations, too, and our own experiences. We had a hard time talking about race, power, and privilege," Bellanca acknowledged. "It's difficult to have an honest conversation about your biases and opinions, and that's an important lesson. Asking ourselves, 'How do I need to change to be the kind of leader we need?' was very eye-opening.
"It was painful, and there was not a nice, neat ending to our project. But the seven of us and the majority of the Portland cohort got the message that we have to keep race, power, and privilege on the table." The message was not lost on the Center for Creative Leadership, where staff wove the topic into a revised curriculum used with subsequent Ladder to Leadership cohorts.
According to the center's leaders, "The Portland cohort definitely had a profound impact on us because they helped open our eyes to the systemic or structural nature of power and the many 'isms' present in societal systems (sexism, racism, heterosexism, able-ism, etc.) and the role leadership can play in changing these systems, given their direct connection to a community health system and many health disparities."
Transformations and milestones. Bellanca's Ladder to Leadership experience motivated her to change the way she approached health care disparities. "The default for me had always been, 'Here's the issue we are working on, here's the idea of a solution, let's get funding for it and oh, by the way, which communities of color should we get to sign on to this?' " she noted. "Ladder to Leadership made me see that there has to be a better way to bring everyone to the table.
"It's way more messy, and it takes longer, but it's important we step out of our comfort zones and not resort to tokenism. One of the main takeaways is that people in power who are Caucasian need to constantly ask themselves how their race affects their abilitly to get their work done."
When the program ended, she began searching for a job with a larger leadership role. In 2011, she became medical director of the Oregon Foundation for Reproductive Health, where she developed and led an initiative to better integrate reproductive health into primary care.
And in January 2012, Bellanca became program manager for maternal, child, and family health at Health Share of Oregon, a coordinated care organization (CCO) that provides care to 40 percent of the state's low-income residents enrolled in the Oregon Health Plan. "At this CCO, the entire scope of work is to transform health care," spurred by federal health care reform, she noted. Her new position "is exactly the type of job that Ladder to Leadership was preparing us for: to step into leadership roles around health care transformation."
RWJF perspective. RWJF has nurtured leaders in health and health care since its inception. "The Foundation's Human Capital Portfolio aims to ensure that we have a diverse and adequately trained health and health care workforce," said Program Officer Sallie Anne George, MPH. "The Foundation has a 40-year history of supporting the development of 'human capital.' However, we saw a gap concerning the leadership capacity of community nonprofits. We designed Ladder to Leadership to close that gap."
"We recognized that many nonprofit leaders are so focused on providing services to the most vulnerable that they are not looking to see where they fit into the larger system, and where it makes sense to collaborate," George noted. "We hoped that Ladder to Leadership fellows would gain confidence in their ability to lead regardless of their formal position, to think more strategically, and to collaborate effectively.
"There is evidence that we are strengthening collaboration in communities, and, we hope, leading them to be healthier places to live, learn, work, and play."
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