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Dennis Hicks:
I work with the Toledo Lucas County Health Department.
Actually my office, the local Office on Minority Health, has
two bosses, I’m a county employee for the Health Department,
and I also work for the Ohio Commission on Minority Health
through a grant from that office in Columbus Oh. Without
both of those entities working together I would not be able
to do what I am doing.
EH:
Who are you when you go into work? And who are you on an
average day when you leave?
Hicks:
When I go to work, I am minority health coordinator, and all
that that entails. I try to be active in the community, I
pore over data, I look for grant opportunities, I work very
hard to end these health issues, I feel that responsibility
very deeply. It is something that is a preoccupation of
mine.
It is a very serious issue and I do take it seriously. I
would like to ultimately see a world where we don’t
subdivide people by majority/minority and create these
hierarchies where who is entitled and who is not in what
life has to offer.
Intellectually it is kind of a Cassandra-type experience.
Cassandra is the woman who was fated to know the future but
to have no one believe her. When I look around at the 43620
zip code in the Old West End Historic District, but it is
just one block away from crack houses, the big boom box cars
come by my house and that zip code it happens to be over 70
percent African American. And so I am right there in the
middle of all these issues on a daily basis and in my
personal life.
I look around at all of this and I see these patterns of
people living a life where they have been told, ever since
they can imagine, that they have no self-worth and they are
playing out that understanding of what their life is
supposed to be about. And I want to take the moment and say,
“No that is not the way it is. That’s a myth that we’ve
inherited.”
It is hard because you can’t blame it on any one individual
because all those individuals have been dead for hundreds of
years. It is part of a system that we have inherited that is
kind of a tribute to the power of that myth.
The level of the challenge that it is going to take to
eliminate that myth, I don’t see that happening in my life
time. But I so deeply want it to happen, because every day,
hour by hour, I see the human cost – intellectual,
productivity, the money,
Let’s make money the most important issue, the human cost is
most important, but the trillions of dollars we are spending
on perpetuating this myth. We need a community where
everyone feels equal and everyone feels part of the
solution, and everyone feels part of the whole not separate,
not less than. It is kind of heartbreaking to see it
happening and not being able to do anything about it and
knowing in my life-time it is not going to go away.
I am rather task oriented and the tasks in front of me are
rather huge and so I don’t generally have a lot of time to
get emotional about the issues. There is too much to do and
too little time. There are times when I am home and I am in
the community and I see the toll that this is all taking
especially knowing what I do about the data and the history.
Looking into a world of hierarchy, there is something that
we call social determinants of health that I work with a
lot. Things like education, access to pubic
Transport. Income for instance. For each dollar of wealth in
this country, an African-American family has three cents. I
think of it as a feed-back loop of disparity. Trying to get
insurance, the exposure to lead because of the because of
the buildings African Americans live in … these things
reinforce themselves over and over and over again
Like a spinning wheel. It is like that wheel spinning on
gravel kicking out health disparities. How could those
health disparities not affect someone’s health especially
when they are highly concentrated, in such a small portion
of the community?
Whatever I do, I am trying to interrupt that feed-back loop
of social determinants.
EH:
What are some of the key issues facing your department?
Hicks:
We have a mandate here in my office to end health disparity.
What I mean by health disparity is my office is committed to
addressing differences in the health status and outcome
between minority groups and whites in Lucas County. In
almost every case we are looking at an illness or a medical
condition or a case or a health outcome. For instance,
mortality rates among African Americans, Hispanics as well,
and in some cases Asians and also some cases Native
American. Native Americans have the worse outcomes from
health intervention and they also have more illness and more
disease. It is a population that is sicker and they live
shorter lives. So that’s the main issue that I am working
with, there are a lot of related issues but that is
primarily what I do.
EH:
What issues are you facing day-to-day. What is the most
complicated issue? What is the simplest issue?
Hicks:
Day to day my job changes dramatically. There are so many
facets to this job.
My plans usually don’t reflect what I’ve collectively done
at the end of the day. There are a number of requirements in
my job that I work with: data, collecting it and I work with
community groups to build coalitions and collaborations. The
goal there is to try to empower the community and to provide
them with catalysts for making change. I also deal with
policy issues. Those policy issues can be very wide ranging.
I find that very often the ultimate solution to health
outcomes is disseminating information. What’s going on with
the health status with minorities and those disparities is
policy related.
EH:
Could you tell me about a significant, current policy issue
and if that is especially significant one or if you know of
a policy coming up?
Hicks:
A current policy issue, one that I am dealing with is the
infant mortality rate. Actually it is related to our
national infant mortality rate.
The United States is not one of the world leaders in keeping
our babies alive through the first year. When we talk about
infant mortality we are talking about birth through the
first year. So we are dealing with that, first of all, and
in that respect the African-American infant mortality rate
in the United States is much worse than the white infant
mortality rate.
That translates as well to the state level. As a matter of
fact we just got some disturbing data that was updated only
last week that shows that in Ohio we are last in the nation
as far as black infant mortality. So it is not the South –
Alabama, Louisiana or Mississippi – that has the worst
infant mortality rate.
So the worst place for a black baby to be born is right here
in Ohio. In Ohio, Lucas County is among the top 10 highest
infant mortality rates of any community in this state. So we
are dealing with the United States which does not have a
great record and then we have Ohio which as far as black
infant mortality is among the worst. And then we have Lucas
County which is the worst in the state.
It is something that can’t be addressed simply by the
health care system. The health care system in Lucas County
is actually doing a pretty good job. Because, among the
state’s worst communities in the state of Ohio, Toledo/Lucas
County is actually the best of the worst. We’ve got some
good maternal and child health intervention going on here.
We’ve got a program called Pathways that targets women of
childbearing age. So that we can wrap services around them
and it has been very successful in preventing negative birth
outcomes.
So it is not the health care system as a problem, it is more
of a set of policy issues, in Lucas County and in the state,
that affect the infant mortality rate.
EH:
What significant information you are gaining about
blacks/Hispanics?
Hicks:
Let me talk about Hispanics first because that is kind of a
complex issue. In the United States we have a large, growing
Hispanic population who are first generation in the country.
Interestingly enough, the first generation Hispanic infant
mortality rate is similar to the white rate. As the
generations of Hispanics continue to live here in the United
States their infant mortality rate increases and becomes
more like the African-American rate.
So we have a first generation effect that’s improving the
Hispanic infant mortality rate. And also one other factor is
that Hispanics smoke very little when they are pregnant.
Whites smoke about 22 percent during their pregnancy so.
Hispanics smoke at a rate of two percent.
Smoking is a risk factor for infant mortality. So we have
that and the first generation effect that are driving down
the Hispanic infant mortality rate. While at the same time
the smoking rate is driving up the white mortality rate. The
result is that those two rates appear to look similar for
different reasons. Where we have a disparity is the
African-American infant mortality rate.
We are involved in a state-wide response to Ohio’s terrible
infant mortality rate right now.
It is called the Ohio Equity Institute. Each community that
is involved in the OEI has its own team – maternal and
childhood health experts of community leaders and community
activists who are concerned about this issue. They have
gotten together first of all to collect data and understand
what’s going on in here Lucas County locally.
We spent a year doing that and what the data has told us are
two things: first of all, we have a problem here with
safe-sleep issues. There is a history of parents putting
their babies to bed on their stomachs. If you ask any
grandmother in Lucas County she’ll say, “Yeah that’s the way
to do it.”
We have new information that says that’s not the way to do
it, that that’s a risk factor for SIDS. So we have got a job
to do to get that new information out, to reduce the chance
of SIDS among our infants. It is not just positioning; it is
the stuff that people like to put in the crib. The stuffed
animals and the baby bumpers and the plush blankets and the
stuff that people like to put in with the baby all of those
things put the baby at risk for smothering.
The best way to put a baby to bed is on their back in their
crib with nothing in it. The baby can just wear a onesie and
that’s it, because anything else in the crib increases the
chance of SIDS.
Also related to safe sleep is co-sleeping with parents.
Parents sometimes fall asleep with the baby in bed with
them, so they don’t look at the positioning and the baby can
fall asleep on its stomach, they can roll over on the baby,
the baby can roll over between the wall and the bed. Those
are the kind of things that are avoidable. So that’s what
the data has told us.
So we can improve the infant mortality rate here in Lucas
County by teaching safe-sleep practices. That’s one thing.
Another thing is to address pre-conception health.
Women in Lucas County – and nationwide – are not in the best
of shape. So what we found here in Lucas County are issues
like diabetes and hyper-tension, smoking as I mentioned
before, and obesity. Those are the things that create a risk
for the baby.
A healthy mom is the best way to have a healthy baby. And so
this is an issue that we are going to have to pay much more
attention to and to improve the health of women of
child-bearing age. The time to get healthy is not after
you’re pregnant it is before you’re pregnant.
And there is one other thing that we are looking at related
to national data, and that has to do with race, because
we’ve got some confounding issues here. Very often when I
talk to people about infant mortality they talk and quickly
leap to one answer that they think is going to solve the
problem: ‘Education is the thing that will fix it. If we
encourage people to get a job to improve their lives or
improve their socio-economic status than that’s going to
solve the problem.’
But what we find is that when we control for genetics, when
we control for education-socio economic status, we find that
we still have racial and economic-health disparities. So for
instance, an African-American woman with a college degree
has a higher infant mortality rate than a white woman who
hasn’t graduated from high school. That is the kind of
things we are looking at. We can’t eliminate race as an
independent factor in the birth outcome.
When we look at genetics we find there is no such thing as
an infant mortality or low birth weight gene it doesn’t
exist. When we talk about Hispanic or first generation
Africans their babies have a birth rate that is very similar
to white babies. But their children when they have their
babies their birth rate is very similar to African
Americans.
So there is something about being in America that causes
these birth outcomes that is independent that is independent
of education or socio-economic status. So that is another
thing that we are looking at.
Ed. Note: This was part one of our interview with Dennis
Hicks. The second and concluding part will be published in
next week’s issue. Hicks will further discuss the impact of
race and poverty on minority communities.
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