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Practicing Health Equity · Healthier Together: Larimer County's Public Health Podcast

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Welcome to Healthier Together, Larimer County's
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public health podcast, where we come together
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for healthier lives, connected communities, and
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real conversations. From your local public health
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team, I'm your host, Tom. And I'm Joanna. Health
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equity is critical to our mission here at the
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health department, as we work to provide everyone
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in Larimer County the opportunity for a healthy
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life. Identifying and addressing inequities is
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crucial. Today, we're joined by Devante Tobe,
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our Health Equity Initiatives Coordinator, here
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to take a closer look at health equity and how
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it shows up in the work of the health department.
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Devante, thank you so much for joining us. Yeah,
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thanks for having me. I appreciate it. To start,
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can you explain what health equity is? Yeah,
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sure. So one way I like to think about health
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equity is making sure everyone has a fair and
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just chance of a healthy life. Two things we
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really have to keep in mind as we're doing that,
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making sure we understand that what one individual
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may need at one point in time doesn't necessarily
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mean that that's what every... individual in
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that community might need so just making sure
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we give our resources and our services and making
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sure we all have an understanding that yeah this
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is what this individual might need at this point
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in time and somebody else who might have a similar
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story or similar circumstances might need something
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differently later on down the road and next um
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just being able to recognize the different barriers
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that keep people from being able to have those
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resources that are super important for people
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to have a healthy life I think those are two
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key components of making sure we as public health
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practitioners are able to provide the services
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and make sure that everyone has that chance of
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having a healthy life that we're talking about.
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How does health equity show up in public health
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in particular versus, say, like health care,
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for example? Yeah, for sure. So I think for public
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health, health equity shows up in the ways that
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we offer our services. So making sure that our
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forms are plain language or are accessible, making
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sure that we offer. Plenty of times for people
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to come in and have chats with us. Just honestly,
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the way that we talk to individuals, I think
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that's kind of how we think about health equity
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and public health. I really feel like the relationship
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building aspect that we offer as a public health
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department is something that I think is exemplary.
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The quality of the services we're providing,
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how much we're able to provide those services
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are obviously super important. I also think that.
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The way that we go about providing these services
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is just as critical. So just making sure we're
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able to understand where our community members
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and clients are coming from whenever they're
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entering our office or whenever we're entering
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a space with our community. I think that that
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really signifies how we approach health equity
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and public health. How do health inequalities
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show up here in Larimer County? That's a great
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question and a big question. I think for us to
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really... look at where health inequalities show
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up in Lamar County specifically, we have to look
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at our most marginalized individuals. And so
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when I say most marginalized individuals, I'm
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talking about individuals who are living in areas
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who may not have the necessary resources or services
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for them to be able to, you know, be able to
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get the best out of their health. And so I'm
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talking about like our LGBTQIA plus community,
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our rural community, our low income community,
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People of color, people with disabilities, those
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types of communities are where we have to look
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at how health inequalities show up in our community.
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And typically we can see that in individuals
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in those type of communities talk about how their
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mental health is negatively impacted from living
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in their communities just because the political
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and social climates that we're living in, that's
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a lot of stressors going on. you know, obviously
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it's hard to make a living and be able to provide
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for their families. And then it ends up impacting
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these communities in a lot of different ways.
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And we see that in how they interact with us,
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right? So sometimes they may not have that same
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trust for us to be able to have like a quality
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relationship, a collaborative relationship, just
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because of a result of a lot of different historical
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things that have happened, whether that's from,
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you know, policies, procedures, just a cultural
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aspect of how people are perceived. Yeah, I think
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those are, some of the ways that we can see it.
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So looking at our most marginalized communities
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and understanding what their story is and how
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it ends up impacting their day -to -day. Social
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determinants of health is a term that we throw
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around a lot in public health. Can you kind of
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explain what that is for us and how it relates
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to health equity? Yeah, for sure. So I think
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of social determinants of health as... you know,
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the non -medical conditions. So non -medical
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conditions are like where we live, work, play,
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and age. So all of those aspects and how it ends
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up ultimately impacting our wellness. So one
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example I like to think about, Allen Commerce
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City, which is like a different region, there's
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a lot of industrial facilities out there. There's
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a lot of neighborhoods out there as well where
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these industrial facilities are. And so sometimes
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you can also see in research showing that a lot
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of these communities out there in Commerce City,
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they're having higher rates of asthma and cardiovascular
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disease as a result of the communities in which
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they're living. And so, again, social determinants
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of health are like where you live, work, play
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and age and ultimately has an impact on your
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health. So, Devonta, I'm curious, can you tell
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us just a little bit more about what your role
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in the department is and what is a day in the
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life like? Great question. I feel like day in
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the life is always changing, is always like different.
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I would say my role is very internal facing,
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helping our department continue to prioritize
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health equity on a day to day basis. Typically,
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like on a day to day, I'm trying to have a lot
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of different conversations. There's a lot of
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relationship building, I think I would describe
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my job as. You know, getting to know different
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teams, understanding what their work is like
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and trying to figure out different ways we can
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continue to incorporate different tools, resources
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in a way that allows us to continue to embed
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health equity as a main priority for us, while
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also understanding there's still a workload that
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is being managed by our teams in the department.
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So, again, that goes back into that relationship
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building aspect of making sure people feel comfortable
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and safe with me. and understanding what my role
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is and how I'm not here necessarily to say, oh,
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like you're not doing health equity right or
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anything like that. It's more so just trying
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to understand how things are working in their
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part of the world and then trying to offer different
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tools and resources to help make sure we continue
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to prioritize health equity like we want. Is
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there any common recommendations that you make
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to teams when you're working with them that,
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you know, themes that just keep coming up? Yeah,
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for sure. I think conversations is the biggest
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thing. Honestly, like just being able to talk
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about all of our own lived experiences and identities
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that shape how we end up working or going out
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in the community. I think that that's been something
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that has been super helpful for me. and working
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with teams because I think that's when we were
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able to break down some walls because health
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equity, it can be overwhelming and it could be
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like pretty activating and activating as in like
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it can bring up a lot of different emotions because
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there's a lot of different things that end up
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impacting everybody, right? And both positively
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and negatively. And so just being able to lower
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some of those walls and have some of those conversations
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in regards to health equity and like really talking
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about our own lived experiences. has really allowed
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us to, you know, have conversations naturally.
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And then, like, from there, I think tools and
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resources kind of come from that based off of
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those conversations. How do you start those conversations?
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I'm very curious to see how you get people to
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have those kind of uncomfortable at -time conversations.
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We have this thing called Breaking Barriers,
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Building Bridges. And so it's like a monthly
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space that people can come to in the department
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that allows us to have these type of conversations
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that we're talking about. And the last session
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we had was around language. We started off with
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an icebreaker, kind of get people warm. I think
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it's nice to get people warm and things that
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there aren't necessarily right or wrong answers
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to. With health equity, it can feel like there's
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supposed to be a right or wrong answer. And so
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that kind of eases us into the conversation of
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health equity. And then we kind of get into some
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more of that structural stuff, some of that more
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of that theoretical or framework type stuff.
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And we got into more of like the euphemism treadmill.
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And so euphemism treadmill is like essentially
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just this idea that language is constantly changing.
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It's always supposed to be changing. And that's
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the role of language. It's never supposed to
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stay stagnant. It's never supposed to stay in
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one place. I think. The role of that was to give
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us all permission to understand sometimes words
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that we've been using or words that we have used
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or words that we are currently using end up having
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to change just because of culture, the environment
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in which we're in, policies, oppression, all
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of these type of things impact what ends up being
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the right word, quote unquote, for us to be using
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at any point in time. I think that conversation,
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that's like kind of giving us permission, okay.
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Like this is part of the process. Health equity
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and health equity, like language is supposed
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to change. So sometimes words that we use to
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identify certain groups of people, those words
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change. Words are supposed to do that. And our
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role, again, as public health practitioners is
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to not necessarily feel like we have to have
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the right word all the time, but rather just
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be responsive. And in those moments where, you
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know, somebody might call you out and be like,
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hey, like, actually, I didn't like that word
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and being OK with it and understanding that's
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just the process. That's a good segue to my next
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question, which is you've been with the department
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since 2023. So almost three years here that you're
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coming up on. Have you seen any changes within
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the department with how you've approached health
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equity work or how the department has changed
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that has influenced your work? Absolutely. I
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always say when I came in, honestly, it was like
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I don't have a public health background. So I
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came from like an educational background. All
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of this was super new. I think. That first year
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was foundational learning for all of us, like
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having this foundational understanding of, oh,
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this is what we mean by health equity. This is
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what we mean by practicing it or making it actionable.
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I think that was the first step for us. And then
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gradually we continue to think about what we
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want that environment to look like as we're practicing
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it. We've gone from this place of, OK, now I
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think we're all. and a similar understanding
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of what we mean by health equity and what it
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looks like for us. Now, how do we go about making
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sure as we're practicing this and continuing
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to do the work of health equity that we're making
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an environment where everyone feels comfortable,
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safe, and like we're all on the same page around
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how we want to do it? Having the same sort of
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understanding around health equity can be complicated.
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So being one of the health equity champions in
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the department, that's a big endeavor. How do
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you go about furthering health equity? I mean,
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as one person in a larger organization, I can
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imagine that would be like a daunting experience
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because we've got 100, 100 and some odd employees.
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Honestly, that was one of my learning moments
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was learning that I don't have to do it alone.
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I think that was the biggest thing for me and
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where I felt like I had my biggest growth. Although
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I am the health equity initiatives coordinator,
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everyone here in the department is doing the
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work. in one way or another. How do we continue
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to share that ownership of the work and not feel
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like someone has to own it? I think relationship
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building has been the biggest thing for me this
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year as far as like how I want to continue to
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grow in health equity and building these relationships
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has been super important for approaching it because
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it just, it makes the work that much more sustainable.
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It can be overwhelming to try to approach health
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equity. from like a standalone point of view.
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And so that's why it's super important to try
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to find different ways of sharing the work with
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individuals and whether it's just through conversations
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or if it's actually working on a project together
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or, you know, a number of different things. I
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think we're always moving in the right direction
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if we have another question leading us to something
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because it's just like questions are important.
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And then. You know, me posing a question around
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like, OK, so what are you doing? Like, what makes
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you feel like health equity is actionable? And
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so, yeah, that's kind of how the roadmap came
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about. And really the roadmap, what it does is
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it breaks down health equity into nine different
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focus areas. And focus areas are like the conditions
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for us to be able to practice health equity sustainably.
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Obviously, we find health equity important, but
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it's a broad topic. So if we don't know how exactly
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we're doing the work, it could feel like we're
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not doing the work at all. So having these nine
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focus areas is like super important to just making
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sure we can see exactly how we're doing the work
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and where we're doing the work and recognize
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how we're doing the work. It allows us to refine
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the work in a lot of different ways and, you
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know, just approach it in a way that feels like,
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oh, yeah, we are actually doing the work. Because
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I think that's another key component for health
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equity is knowing that you are doing the work
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and being able to celebrate those wins. Again,
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like it's a daunting experience. You know, obviously
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we've been trying to fight for health equity
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for a long time. And, you know, sometimes it's
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hard to feel like we're actually moving the needle
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in any sort of direction. The goal is to continue
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to help us embed health equity into our everyday
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approach. Because when we are able to do that
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and we're able to see how it's impacting the
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work we're doing in our communities, then it
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just, I don't know, it just, it provides a different
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energy. So it sounds like it's more the journey
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than the destination where it's the questions
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leading to other questions. But you did mention
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that it's kind of important to celebrate those
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wins. Can you highlight some of those wins that
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you've noticed in the last almost three years
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here? I think some of the wins we've had so far
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are a lot of teams just being able to connect
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back to the work that they're doing, how it connects
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back to health equity, I think, has been some
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of the bigger wins. I also think that, you know,
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as a result of like a lot of different conversations
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we have around health equity the idea of cross
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collaboration has came up a lot and so I think
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from there we've had more opportunities we've
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been more intentional about being more collaborative
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across the department which I think is a win
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in itself is because now teams who may not have
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had the opportunity to connect are now connecting
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and are learning from each other and are creating
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those relationships and stuff like that and so
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Yeah, I think those are some of the wins currently
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that I feel very happy with. I did want to ask
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about TIP or trauma -informed practices. That's
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something that we've also been working towards
14:25
here in the department. And recently, our TIP
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team has joined our health equity team. Can you
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talk about how those things work together? I'm
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glad you asked because I'm really happy about
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it. Because like, honestly, having practices
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that sort of... you know, try to keep us from
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re -traumatizing folks and stuff like that is
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ultimately what trauma -informed practices is
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about. And then, of course, health equity is
14:48
about making sure we give everyone what they
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say they need so everyone has that just chance
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of being healthy. And so, like, as you said,
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we kind of combined our TIP team and our health
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equity team to one. We thought it was important
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for us to combine these two things because really
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having one without the other kind of limits the
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work in a way because... Obviously, health equity
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is a result is kind of coming from a place of
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a lot of historical harm that has been done to
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a lot of groups of people. And so that that has
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left like generational trauma on a lot of communities.
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As a result of that, we have a lot of relationships
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that we're trying to repair and stuff like that.
15:30
And so trauma informed practices helps us see
15:32
how important that is and like where. The harm
15:36
has taken place, essentially. And then health
15:39
equity kind of helps us think about how we can
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continue to, you know, repair that relationship
15:45
by making sure we're thinking about the needs
15:47
that those individuals from those communities
15:49
or just that individual in general might need.
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So, yeah, we thought it was a good idea for us
15:55
to bridge those two together because the work
15:58
goes hand in hand in a lot of different ways.
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I think it'll just make the work that much more
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impactful by making sure we understand that when
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an individual is in the room, trauma is in the
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room as well. And so like when that is happening,
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how can we make sure we're not re -traumatizing
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that individual and making sure their needs are
16:14
being met when in the same space. Equity work
16:17
can often feel pulled between opposing ideas
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or forces. I think one that comes up for me personally
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a lot is the need for individual responsibility
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versus holding larger systems accountable? Or
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as you've alluded to in this conversation, the
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need for change and growth versus the need for
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safety. How in your work do you hold all that
16:41
tension? It's honestly still a learning process
16:43
for me. I think that the first main step, I feel
16:47
like that was super important for me and my work
16:49
and understanding like how conflicting some ideas
16:52
can be was just being able to call it out. Just
16:56
being able to be like, yeah, like a lot of times
17:00
we're feeling like we're having to choose between
17:03
having a safe environment or being in an environment
17:06
where we can grow. A lot of times we don't want
17:09
to be told that we're saying the wrong thing.
17:11
You know, that never feels good. And, you know,
17:13
at the same time, we don't want to continue to
17:16
be saying the wrong thing either. And so sometimes
17:18
we're put in these positions of like, oh, do
17:21
I have to choose safety over growth or like my
17:24
role as an individual? isn't that big since,
17:27
you know, a lot of the major problems that we're
17:29
facing are a result of systemic things. And so,
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you know, a lot of the times you can get in that
17:35
headspace when trying to do a lot of the health
17:37
equity work. And when that happens and where
17:40
you're in that sort of pressure of feeling like
17:43
you're seeing these constant, like two ideas
17:45
conflicting, you end up feeling like you have
17:47
to choose one or the other. So I think for me,
17:51
it's been really trying to think about what does
17:53
it look like to do both? Like have both in the
17:56
room together and understand like that's just
17:59
we don't have to choose one or the other. I think
18:03
just being able to acknowledge that they're both
18:06
in the room and also understand like when we're
18:09
acknowledging them, they're both important to
18:12
the work in one way or another. How does all
18:14
of this change or guide the work that the health
18:17
department does? How does it show up in sort
18:19
of the day to day? pool inspections and clinics
18:23
appointments and all the work that the health
18:25
department does. It's not really the work that
18:28
we're doing, it's how are we doing the work.
18:30
It's really important for us to be thinking about.
18:33
And so I think those are what these tools and
18:36
resources are for, is just to help us think about
18:39
how we're doing the work and think about how
18:41
we are showing up in this space and thinking
18:43
about how our lived experiences are helping us.
18:47
determine how we're talking to a specific client
18:49
at a specific time, you know what I mean? And
18:52
just kind of, you know, being realistic and reflective
18:56
and aware of, like, our position in the systems
18:59
in which we're trying to, you know, play a role
19:01
in is, I think, the role of all these tools and
19:05
resources. It's really easy for conversations
19:08
about health equity to grow and grow and grow,
19:11
to start with something small and grow into...
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I'm going to reshape my neighborhood and I'm
19:17
going to change food systems and whatever the
19:20
case may be. How do you determine the scope of
19:24
your work and keep it grounded in what the health
19:27
department is responsible for? Well, yeah, that's
19:30
a wonderful question. I always say for me personally,
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what I try to do is really focus on the people
19:37
in the department, trying to figure out what
19:39
does this individual need for me, focusing on
19:41
that relationship building aspect. Being a resource
19:44
to individuals and teams is how I feel like I
19:47
help myself kind of stay grounded and within
19:50
a scope that makes sense for me and I'm not stretching
19:53
myself too thin. What would you say are some
19:55
other challenging parts of your work? Kind of
19:58
going back to the conflicting, like the conflicting
20:00
sort of ideologies that come up within health
20:03
equity. That's really a big one. I always say
20:06
just trying to balance the idea of like people
20:11
have. their work that they're already doing in
20:15
the department. And then also what tools and
20:17
resources am I offering? And like, how do I make
20:20
it connect back to the work that they're doing
20:23
in a way that doesn't add more to their plate?
20:25
So it's like always trying to balance this idea
20:27
of like, don't want to add more to individuals'
20:29
plates. What would you say, though, that you
20:31
enjoy most about your job? Oh, I always say,
20:34
like, just having conversations with people,
20:37
honestly, like, which is surprising to me because...
20:41
My first year, I was definitely not the type
20:43
to feel comfortable having conversations around,
20:47
like, lived experiences and identities. I'll
20:49
own that. But, like, over the last year or so,
20:52
last year and a half, I found myself in conversations
20:55
with people who I wouldn't have expected myself
20:59
having that type of conversation with. And, like,
21:02
you know, just seeing their, like, lens of what
21:09
health equity looks like. Seeing how people are
21:11
thinking about it now, like, oh, I've seen this
21:13
now. Like, I'm thinking about it in my work now
21:15
here. Like, where is it here? Like, even just
21:17
asking a question about where is health equity
21:20
in my work has been, like, kind of cool, you
21:23
know, just feeling like I've been a part of that
21:24
process for some folks. It feels very rewarding.
21:28
So, honestly, just being able to talk to people
21:30
and, you know, just ask questions around people's
21:33
lived experiences and sharing my lived experience
21:36
with them. That has been super rewarding. What
21:39
does the future hold for health equity here in
21:42
the health department? Yeah, that's a great question.
21:45
I feel like for us now, we have this cool shared
21:48
understanding about what we mean by health equity
21:50
and stuff like that. And now we want to continue
21:53
to build on that infrastructure a little bit
21:55
around just making sure the practices and the
21:58
different ways we go about doing the work of
22:00
health equity. like kind of stay consistent in
22:03
a way that like makes sense for us. For me, honestly,
22:05
what would be great is like when somebody, if
22:09
anybody in a department is walking down the street
22:12
and somebody's like, oh, you work for the public
22:13
health department, how do you like practice health
22:16
equity? Folks can feel pretty confident in being
22:18
able to outline exactly how we do that. So just
22:21
kind of making the practices more consistent.
22:24
What are you most excited about or looking forward
22:27
to in the next year of your work? Just kind of
22:30
taking what we've done this year and applying
22:32
it next year and trying to figure out how to
22:34
make it even more embedded into the way we do
22:37
stuff here. Are there ways that listeners can
22:39
advocate for or act on health equity? Yeah, I
22:43
think really just being able to have conversations
22:46
with like some of your closest folks around different
22:51
aspects of your identity or their identity or
22:54
their lived experience. It's super beneficial.
22:57
Like, I mean, for me personally, like my, my
23:00
journey with health equity really started with
23:02
my partner and like how, you know, some of the
23:06
stuff I was doing or like some of the music I
23:09
was listening to or the ways that I was showing
23:11
up in certain instances was like not good. Like
23:17
not, it was kind of like re -perpetuating a lot
23:20
of different things that I wouldn't want to be
23:23
happening. And so, you know, It really starts
23:26
with a conversation, honestly, about some stuff.
23:29
And I think that's really important. I think
23:33
about, like, I have a lot of cool conversations
23:35
with my brother. I think that that's where we've
23:37
been able to grow the most is thinking about
23:40
our lived experiences and how they differ and
23:42
where he's at and how he thinks about stuff.
23:45
And so, yeah, I think being able to have those
23:47
type of conversations with people and leaving
23:50
those conversations in a way that everyone can
23:54
feel, good about where that conversation ended
23:57
off is, I think, a great way to sort of make
24:02
it clear that health equity isn't some sort of
24:04
idea that, you know, only these groups of people
24:08
are supposed to be getting the resources and
24:10
no one else. Like, that's not what health equity
24:12
is about. It's really about making sure everyone
24:14
gets what they say they need. And, you know,
24:17
sometimes what people need is a good conversation
24:19
with somebody. What somebody needs is... you
24:21
know, feeling like supported and appreciated
24:23
for, you know, who they are. And I think, yeah,
24:27
it really starts with a conversation. So being
24:29
able to talk to somebody about your lived experience
24:31
will go a long way. Awesome. Devante, thank you
24:34
so much for joining us. Yeah, thanks for having
24:36
me. It was really cool. Do you have a question
24:42
about public health in Larimer County or a topic
24:45
you'd like us to discuss? Let us know. Email
24:48
us at HealthierTogether at Larimer .org. Thanks
24:52
for listening, Larimer County. Until next week,
24:54
stay well, stay connected, and remember, we really
24:56
are healthier together.