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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
APHL.org
Summer 2018 LAB MATTERS
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