Are you concerned about the state of the U.S. public health system? Do you want to work with others to figure out a new way forward?

As the COVID-19 pandemic continues to affect the world, it has demonstrated the importance of a robust public health system, one that is ready to respond in times of crisis as well as supporting the foundations of a healthy society. The 2021 Salk Health Activist Fellowship will focus emerging activists on re-envisioning public health in America to address our current dismal state of health. While COVID-19 has exposed problems in our healthcare infrastructure, it is only one of a multitude of problems that need to be addressed. Now is the opportunity to look across disciplines to create a renewed vision of public health and create lasting change.

During the 9-week program, Fellows will learn from regional and national experts, past public health initiatives, and work in multidisciplinary teams to bring fresh solutions to the challenges facing public health in the U.S. Fellows will gain insights into the existing U.S. public health system, behavioral science principles, and how technology can be incorporated to foment change. Fellows will expand their ideas on health, exploring what health means to U.S. communities, as they work toward outside-the-box solutions that re-envision a new approach to public health. Utilizing the framework of design-thinking, they will synthesize their experiences to propose an innovative idea to a current public health challenge within either a local, statewide, or national context.

This Fellowship takes on a key challenge: the reality that professionals are not well prepared to deal with or talk about death, dying, and grieving families, especially during an era of COVID-19. The Fellowship allows participants to learn, confront, and discuss the legal, medical, social, cultural, familial, and spiritual aspects of death and dying within a multi-disciplinary group in a low-pressure environment. The sessions include opportunities to practice conversation skills, facilitated conversations, and virtual site visits.

Ever wonder why the issue that you are passionate about hasn’t grabbed the public’s attention or transformed health care? Do you want to learn how to construct a winning strategy to mobilize action and influence policy?

During the International Year of the Nurse and the Midwife, and as our nation heads toward a critical election, the 2020 Jonas Salk Health Activist Fellowship will focus emerging health activists on critical reproductive health issues that impact the work of nurses and midwives. COVID-19 has disrupted essential women’s health services with changing policies and practices across the nation. Now is the opportunity to advocate for a renewed platform for women’s health and create lasting change.

During the 9-week program (10 sessions), Fellows will interact with some of the region’s foremost leaders in policy, advocacy, and women’s health to learn how to develop compelling platforms, build coalitions, and advocate with elected officials. Fellows will develop new skills around public policy and storytelling in order to develop appealing and effective reform and build public will. During the finale of the Fellowship, Fellows will get the chance to engage with legislators and advocate for a strategy for bills impacting nursing, midwifery, and women's reproductive issues.

The home for the 2019 Salk Health Activist Fellowship.

We are going to use this platform to be able to communicate effectively, collaborate, and build each other up for this fellowship. Activism starts here. Let us learn and use each other's strengths to the best of our ability. 

Together, we can change the world. 

In an attempt to de-stigmatize drug use and promote access to care, an intiative to educate on the benefits of harm reduction methods, with an emphasis on access to syringe exchange programs, will be implemented. Using testimonials, infographics, and other promotional materials, myths and misconceptions of needle exchanges will be debunked. In addition, participants will be encourage to write their representatives to 1. decriminalize syringes, and 2. promote the legalization of needle exchanges statewide for Pennsylvania.

The aim of this project is to establish a maternal care collaborative similar to and modeled after the California Maternal Quality Care Collaborative (CMQCC). This collaborative will differ in that it will be run for and by hospitals that primarily service neighborhoods with a large black population (there is evidence that points to the quality of care at hospitals where a disproportionate number of black women deliver as a contributing factor as to why black mothers are dying at a rate that is higher than white moms). 

Key elements of the collaborative:

- All hospitals in the collaborative will work to submit data to the MMRIA (Maternal Mortality Review Information Application) a free data system that allows users to develop quality improvement plans based on the reports generated by MMRIA (CMQCC has their maternal data center. This collaborative will utilize an existing free one to cut costs at least in the beginning). 

- Create and share development of evidence-based quality improvement toolkits that address the leading causes of preventable complications and deaths 

- Physician education: provide patient first continuing medical education for providers that address the common issues black women face in their pregnancies; physician and hospital administration education on new protocols for rare situations

- Use of predictive analytics to develop a risk score for pregnancy related complications and maternal mortality that will be available for all providers to see in the patient's EHR. (Major difference between this collaborative and CMQCC). 

- Development or outsourcing of a doula program similar to the use of case/disease managers for women who were identified as high risk through the risk score analysis mentioned above 

- Development and distribution of a patient satisfaction survey. Dedicated Committee to review all surveys and address issues 

Stigma related to substance use  is considered a main barrier to the early identification, diagnosis and access to treatment. Decreasing stigma related to substance use among healthcare providers can help enhance early access to treatment and improve patients' health outcomes. 

Patients who lack the basic access to Food Transportation and Housing are at greatest risk for being isolated from the healthcare system. Efforts underway to improve and remove that barrier are needed to ensure long term patient improvement.

Transportation to medical appointments is a huge issue. People living in rural areas that do not have transportation to their medical appointments is an even bigger issue. By working with the health insurance companies, transportation companies and individuals from the community, I hope to combat and reduce this issue. Working on this issue will reduce not only health care costs but make individuals more healthy by being able to attend their medical appointments. With your help, we can work towards resolving this issue!

The home for the 2018 Salk Health Activist Fellowship.

We are going to use this platform to be able to communicate effectively, collaborate, and build each other up for this fellowship. Activism starts here. Let us learn and use each other's strengths to the best of our ability. 

Together, we can change the world. 

Right Care is a human right. It places the health and wellbeing of patients first. Right Care is affordable and effective. It is compassionate, honest, and safe. Right Care brings healing and comfort to patients, and satisfaction to clinicians. Achieving Right Care will require radically transforming how care is delivered and financed.

The Right Care Alliance (RCA) is a grassroots coalition of clinicians, patients, and community members organizing to make health care institutions accountable to communities and put patients, not profits, at the heart of health care.

We affect change by

• Conducting local campaigns on right care issues such as primary care access and high drug prices
• Collaborating with others to identify areas of improvement within clinical specialties
• Speaking up about the systemic problems in our health care system through op-eds, videos, and other media
• Listening to experiences of community members and sharing stories
• Mobilizing for direct action on a national level through events like the March for Science

According to the Healthy People 2020 Midcourse Review (2016), only 21.3% of American adults meet the minimum physical activity (PA) guideline recommendations of 150 minutes of moderate intensity aerobic physical activity per week.  The vision of this action group is to become an advocate for prevention and wellness in health care.  This would involve a cultural shift from a reactive intervention based system to a proactive prevention based system.  This shift would prioritize maintaining an individual's independence and quality of life across the lifespan through minimizing sedentary activities and optimizing physical activity.  

The World Health Organization defines The Social Determinates of Health (SDH) as the circumstances in which people are born, grow up, live, work, and age, along with the systems put in place to deal with illness. These are in turn shaped by a wider set of forces that include the local environment, economics, education, social and community context, and access to healthcare.

According to the Centers for Disease Control and Prevention, we know that poverty limits access to healthy foods and safe neighborhoods and that more education is a predictor of better health. We also know that differences in health are striking in communities with poor SDOH such as unstable housing, low income, unsafe neighborhoods, or substandard education. By applying what we know about SDOH, we can not only improve individual and population health but also advance health equity.

Addressing these factors are vital to improve the overall health of the population. The SDH are ultimately influenced by the money, power, and resources at the local, state, and international level which has a large influence in health inequities.

Educating health professionals about the social determinants of health generates awareness among those professionals about the potential root causes of ill health and the importance of addressing them in and with communities, contributing to more effective strategies for improving health and health care for underserved individuals, communities, and populations.

Adverse Childhood Experiences (ACEs), stressful or traumatic events that a child experiences while growing up, are proven risk factors for future developmental, behavioral, and emotional distubances. For example, ACEs can impact an indiviual's lifespan, sustance abuse, high-risk sexual behavior, pregancy outcomes, and depression levels. Considering the drastic impact ACEs can have on a child's future, we believe it is imperative to increase protective factors against them and investigate how to mitigate their effects. These effort are driven by the goal of impairing the  tragectory of negative outcomes ACEs induce in order to promote a safer future for children disadvantaged at a young age. 

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Young adults are among the most affected by low rates of health literacy. Increased health literacy can lead to fewer chronic health condtions, better lifestyle choices, and a more complete understanding of one's medical rights. My vision is one where people understand their health insurance and how to navigate it. And based on this understanding of their health insurance, they maintain a healthier lifestyle. It's a vision of a world where people understand their doctor or nurse when speaking to them and do not leave the hospital or office completely confused.  

Persons experiencing homelessness often have poor access to healthcare and experience significant barriers to basic health management. While this occurs in a wide range of disease processes, this is most obvious is management of basic diseases such as wounds. Small abrasions and injuries are exacerbated by difficult living situations and lack of access to supplies. Patients experiencing homelessness who present to the hospital with significant wounds and/or infections are often discharged with minimal instructions or supplies to ensure maintenance of wound care. 

By providing these patients with a basic backpack with wound care supplies as well as instructions for resources, wound care amongst this population could be significantly improved. Patients would not only have dry supplies to maintain healing but would also have a list of free clinics to visit for further healthcare. By allowing for proper wound healing outside of the hospital, patients would have less frequent admissions for severe infections which would ultimately benefit not only the patients but healthcare systems at large.

I believe that an interdisciplinary, multilevel intervention is essential for the transformation of health care from a system that is reactive and medically focused to one that is proactive and holistically based. Each of us fellows will have experience working at different levels of the health care systems, including the interpersonal, organizational, communal, and public policy. Multilevel change can be achieved by working together and building upon the strengths and expertise that my colleagues and I bring to the table.   

Although many aspects of the social work and public health fields inspire me, I am especially passionate about helping the uninsured and underinsured understand how to utilize their health insurance and how to be consumer advocates for health care reform. According to the Pennsylvania Department of Health, Allegheny County has an uninsured rate of 9.9%. Individuals who are uninsured experience worse health outcomes than insured adults do. Studies repeatedly demonstrate that uninsured individuals are less likely to receive care for chronic diseases and health conditions (Kaiser Family Foundation, 2016). Moreover, many individuals are not aware of how to access available health care or what benefits they are due once they have health insurance.  

As an individual who has social capital, I often find the health care system complex and arduous to comprehend. Therefore, I care deeply about empowering those who need health care and who lack the knowledge that will allow them to successfully maneuver through the intricacies of the health care system. While I recognize that existing organizations already address this population and their needs, I hope that the interdisciplinary approach endorsed by the Salk Fellowship will build upon and expand the current work being done. In addition, current policies are looking to undermine and spread misinformation about the United States’ health care system (“The Same Agency That Runs Obamacare Is Using Taxpayer Money to Undermine It,” New York Times, 2017). Therefore, it is imperative that health care activists work together to thwart policies that undermine and confuse health care consumers.

Your voice matters and understanding how the health care system works can help you become a better advocate.