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Dennis Hicks:
Yes, all three. I can’t think of a more interesting job to
have. That’s one of the things that energizes me. I get to
learn and deepen my understanding of everyday it is also
depressing because this job is about illness, excess illness
and premature death. That’s what I try to address. That is
pretty much what my job is about, that frames my job.
So it is interesting and frustrating at the same time.
EH:
Where in Lucas County/which areas do you study, what do you
study, and why?
Hicks:
Formally what we do is study African Americans, Hispanics,
Native Americans,
Alaska Natives, Asians and Pacific Islanders. We are trying
to make inroads into the Native American community. It is
something that is important to me that we not neglect that
population. The Hispanic population, there is something
going on tomorrow called The Hispanic Health Summit. I take
every opportunity to collar, orate and deepen the roots with
the Hispanic community. African Americans are at the bottom
of the wheel or the health hierarchy. They have the most
illness and the most premature death. And so I spend a lot
of time working with that population.
EH:
How are the studies presented to you? How do you process the
information given to you? Where do the studies go from
there?
Hicks:
One of the most important tools I have is called The Lucas
County Assessment. That is created by a collaboration of
hospitals, health systems and managed care organizations,
led by the Hospital Council of Northwest Ohio. They’re the
ones who collect and compile the data and they will be
presenting the 2015 Lucas County Health Assessment this
fall. I am very excited to see what we find in the data.
They have been doing this every four years – meeting since
2003.
I have been dealing with 2011 data, and so the 2015 data are
very important for me. A lot of our data comes from the
National Institutes of Health, Centers for Disease Control,
The Census Bureau, The Ohio Department of Health … there are
lots of sources of data.
One of the challenges in my job is that the data is
scattered around a lot. And on my wish list of projects is
to come up with a document that I can use to share with
others to show where the data are, what kind of data we are
looking at and how to access it so that the next time we
need data we are not scrambling around trying to make a good
fit. I think those working in health disparities would be
well served by having some kind of centralized directory.
EH:
What kind of economic links are there to your studies?
Grants, etc.
Hicks:
I work on grants from the National Institutes of Health. I
set a goal this upcoming year of having two new grants. Most
of my money comes from a grant from The Ohio Commission on
Minority Health and they are also busy writing grants that
involve my office and other local offices on minority health
in Ohio.
EH:
What hope do you have for mothers at risk, and what major
risks are there for women? And for men?
Hicks:
For all adults the first two risks are heart disease and
cancer.
Sedentary life style, smoking, too much salt, fat, sugar all
of those things contribute.
It is recommended that we eat five servings of fruits and
vegetables a day, and control the intake of fat and sugar.
Also strokes, diabetes and chronic lower respiratory
disease, and accidents.
For Hispanic males accidents are at 10 percent of all deaths
in Lucas County.
Mortality is much lower among Hispanics. It is called the
Hispanic Paradox. The numbers would suggest that Hispanics
would be sicker and it is not entirely understood it is
called the First Generation Effect. First generation people
who come to the United States tend to be healthier than
later generations.
EH:
When did your office develop the position of Minority Health
coordinator?
Hicks:
That goes back. I believe the Health Department established
this office in 2003. Prior to that the office was part of
city government across the street at the Government Center
Building. For some reason, the office was moved from there
to the Health Department.
EH:
Why did you take the position and has it met your
expectations?
Hicks:
I took the position because I am generally a policy person.
My academic training and most of my career history has been
in health policy. This was an opportunity to delve into the
policy issues concerning minority health and hopefully make
a difference.
I look at this as a rare opportunity and I feel fortunate to
be here. It allows me to do all the things that I imagined
doing when I was in college and thinking to myself, OK, I’m
going to go out and change the world. Of course I am not
changing the world, but it is the kind of thing where I can
go home thinking this is worth me spending my day.
EH:
What have your realizations been as minority health
coordinator.
Hicks:
One of the most important things I have realized in this
job, is there is an actual physical mechanism in place for
race to become a health issue. We talked about that feedback
loop of all those social determinants that were self
reinforcing. Those create a situation of chronic stress for
those people who are living in that feedback loop.
Acute stress is a good thing if it helps you get through
those episodes where you want to have more alertness,
stronger immune responses … that kind of thing. Once, you’ve
gotten through that those stress hormones that you create
for that purpose go back down to a normal level.
When you go through a feedback level those stress hormones
go up and they stay up. A lifetime of living with chronic
stress causes your good cholesterol to go down and your bad
cholesterol to go up. It causes blood sugar to go up,
depression, heart disease and a number of physical effects
that are caused by chronic stress. So those health
disparities that we are dealing with are largely symptoms of
chronic stress caused by things that are outside the realm
of health care and what we traditionally think of as health.
So health disparities become a side effect of that
mechanism. So you can’t concentrate on health if you have to
concentrate on health disparities.
As far as the future goes the health department wants to
concentrate more on working upstream. The upstream is kind
of a metaphor, if you picture a stream that at the end of it
has a waterfall. A lot of what we have done is work on
health-care intervention. A lot of what we do is to try to
catch people before they go over the waterfall. The further
upstream we go the more we talk about policy.
With the metaphor we talk about how to prevent people from
falling into the stream in the first place. So, I think in
the future upstream initiatives are going to be more and
more the conversation.
And for intervention and downstream we have done a really
good job there. We have put a lot of safety nets in place as
far as the health care system goes. For instance, dealing
with birth outcome and maternal and child issues. We’ve got
those pieces in place and they’re doing a good job. But, at
the same time we are still very high as far as to infant
mortality. It is because we have not done a good job of
preventing those mothers and babies from falling into the
stream in the first place into those social determinants
that help.
To allow those to serve as a barrier to the bad outcomes
that might have occurred downstream. We are going to be more
active in that area in the future.
EH:
If you could reach out to a young African-American woman,
what would you say?
Hicks:
Well I would start younger than 20. First of all unintended
pregnancies are a problem.
The birth rate is going down. Unintended pregnancy is going
up for teenagers. I would
have to say here is how I see part of the problem. In the
African-American and Hispanic
communities people are living with abandoned buildings,
broken streets and side-walks
litter all over the place, and very little commercial
activity going of a legal kind.
I feel there is a general sense that they don’t matter, that
they don’t count. Because everybody knows what’s happening
out in the suburbs. They see that disparity, they see what’s
available for other people that’s not available to them.
They have that belief that: “I don’t count, I don’t have any
self worth.”
What I would say to a young woman 15 or 16: “You do have
self-worth, you do not have to give up on your future and
just throw your fate to the wind, and do whatever works for
you at the moment. You can make plans, you can choose not to
get pregnant, because with pregnancy at that age at that
income level I guarantee that you are going to live a life
of poverty.
“You can become a college graduate, you can make a
contribution to your community, you can make an example for
those coming up behind you. I would say hold on to your
self- worth believe in your future, make plans for it and
don’t let those plans be interrupted by someone who comes
along and tells you you’re special. Just know it yourself,
you don’t need someone else to tell you that.”
EH:
Describe how poverty affects the populations you are
studying and poverty affects that population’s health. How
is poverty described in your research?
Hicks:
Poverty is important. As I described before it is a major
risk factor for all kinds of illness, and other unhealthy
behaviors. One of the things I want to interject here, those
unhealthy behaviors, one statistic is that poverty and
depression go hand in hand. The data tells me that high
levels of poverty and depression go hand in hand. There is a
direct correlation between high levels of poverty and
depression. What people do when they have depression is they
self-medicate. With alcohol, with drugs and with food,
and/or with risky behaviors. There is a new study out that
if you have a cigarette within five minutes of getting out
of bed you’re clinically depressed.
Some studies show that half of the people that study among a
group of smokers, either had either a diagnosis of
depression, or had the risk factors associated with
depression.
So, I would say that poverty, depression and unhealthy
behaviors all go together. I would say that when researchers
included screening and treatment for depression their rate
was much better. So I think one of the things we have to do
is more screening for depression,
Anxiety and stress. And we need to teach resiliency, and
make sure that when do those screenings uncover depression
and other mental illnesses then we provide the treatment.
With the Medicaid expansion we are going to find more people
will access the health care system.
In terms of Medicaid we are talking about a lower-income
population, where that risk of depression is created. We
have to position ourselves be ready wait for people to show
up with diagnosable depression and make sure they do receive
the services and treatment they need.
EH:
That was my last question, Dennis, are there any comments
you would like to add?
Hicks:
I would just like to say that even though this is a
one-person office, it has a kind of invisible support system
behind it. The Health Department and the Commission on
Minority Health who are funding my office are two examples.
I am running the risk in naming names here of leaving
someone out, but The University of Toledo, particularly
their School of Public Health; ProMedica and Mercy Health
Partners; Buckeye; United Health Care … there are a number
of social organizations out there who are supporting the
Office of Minority Health who are close partners and who are
supporting my office and so we work together.
Whenever there is a grant opportunity, there is an
initiative that we want to take on there are groups of
people, not just me. I am kind of, I don’t know if you
remember the old Mickey Rooney movie, and if there was a
problem in the neighborhood, and he would think of a way to
fix it, with a little bit of money, and he would say, “ok
kids let’s put on a show,” and they would sort of gerry-rig
a stage and they would do little numbers and stuff like
that. And at the end of the show they would have a few bucks
to go and take and fix the problem they saw in the
neighborhood.
I kind of see myself as the Mickey Rooney of minority
health, I am always going around to these other
collaborators and say “let’s put on a show, let’s do this,
let’s address the stigma of mental illness in the black
community.”
“Let’s find a way to help people enrolled more effectively
in Medicaid. Let’s put together a grant to do one thing or
another.”
So that is a big part of my job to get people to throw in
with me to get these problems solved.
Interview with Dennis
Hicks, Minority Health Coordinator Toledo Lucas County
Health Department, Part 1 |
