Lab Matters Summer 2018 | Page 15

partner profile I like to frame it this way: If we accept the proposition that all human beings are equal—not as individuals, but as an overall group—then you have to ask what accounts for the patterning of diseases and risk factors that we see. Is the problem the people? Or is the problem the context in which the people live, the resources and opportunities available to them? For example, to this day, I have never seen people sicker than the people I cared for in Harlem Hospital in the 1980s. My colleague, Colin McCord, studied mortality in Central Harlem. He found that a man in Central Harlem in the 1980s was less likely to survive to age 65 than a man in Bangladesh, the world’s poorest county. And this was before AIDS. There is a strong impulse to attribute these differences to individual factors. And I would argue that those individual factors are really shaped by the context; people can’t afford fruits and vegetables compared with a cheap, sugary bottle of soda. My focus has always been changing the context. Let’s start there. Let’s make it easier for people to make healthy choices. A recent APHL workforce survey showed that the public health laboratory (PHL) workforce lags behind state public health agencies and the US population in ethnic and racial diversity. What can we do to build a more diverse PHL workforce? My father was one of the very few of his generation to have a PhD in a basic science. It’s important to have those role models. That’s a fact. It’s something PublicHealthLabs @APHL we can work to address. In NYC, we worked with Hunter College—part of the city university system—to develop an affordable pipeline program for laboratory scientists. Recent graduates have to work a year before they are eligible to take the state licensing exam for clinical laboratory technologists, and we encourage them to do this training at the city PHL. Just last year, three graduates got through the program and got their licenses, and we won two of them over to the excitement of working in the city PHL long-term. Creating these pathways to a PHL career is important. And as we work to diversify our workforce, it becomes self-reinforcing: when you work someplace where people look like you, you become confident you will advance. We need the opportunities and the role models. How can PHL scientists help build a public health system that serves all US residents equally, including laboratory activities? I hope you can highlight how important our PHL is—the jewel in the crown of the health department. It really has enabled the department to do work at a level of excellence we otherwise wouldn’t be able to. It’s an asset not just for NYC, but for all the surrounding jurisdictions. for business and government in NYC. This was in February. We were surprised we didn’t see test requests coming from neighborhoods with large Caribbean populations. Because we looked at it with a neighborhood lens—which was something new for the PHL—we put in place a whole new test ordering system. I also went and talked to the Greater NY Hospital Association and shared the data. Then the map changed; by July we were seeing test requests coming from the places we felt they should, based on the people living there. NYC is a city of neighborhoods, and a very segregated city by race and ethnicity. It ranks in the top five most segregated cities in the county. So neighborhoods are a proxy for race, income and ethnicity. So look at data by neighborhoods. The NYC Health Department has a tradition of excellence and is recognized across the nation and world as one of the finest urban health departments. We’ve added to that the lens of equity. We’ll always have social determinants of health—your life is social; you are an organism in a society— but these longstanding variations by race and income we don’t have to live with. n Zika is a good example. All NYC Zika virus infections have been acquired through travel, mostly to the Dominican Republic, which reflects the travel patterns of our residents. Yet, during the 2016 Zika epidemic we found that many of those getting tested lived below 59th street in lower Manhattan—the central borough Summer 2018 LAB MATTERS 13