A nonprofit publication of the Kentucky Center for Public Service Journalism

Constance Alexander: When addressing health equity issues, having the difficult conversations is often key


Family conversations can be awkward, even downright difficult, according to Vivian Lasley-Bibbs, Director of the Office of Health Equity for Kentucky’s Department for Public Health. Despite the discomfort, honest discussions are crucial, she remarked at the kick-off of a lively interactive session on health equity last week in Louisville, at the offices of Foundation for a Healthy Kentucky.

The purposes of this unique “family” gathering were to assess the factors contributing to health equity (and inequity) in Kentucky; examine the Foundation’s mission in regard to unmet needs, and begin to chart a path to the future using a process of meetings and workshops that will present a final report and action plan in November.

To establish common ground for meaningful communication, Ms. Lasley-Bibbs assured the group, “This is a safe space. You can ask questions with no judgment.”

In an environment that welcomed candor, she encouraged participants to share their lived experiences, so even uncomfortable exchanges — akin to “Grandma, no more fruitcake” — were welcome.

“Sometimes listening is all you need to do,” Ms. Lasley-Bibbs continued. “What’s important is that you leave here enlightened.”

For the next four hours, about sixty Foundation leadership, staff and board members, Advisory Board members, and health care leaders and advocates from throughout Kentucky explored the meaning of health equity. They itemized causes of health disparities, the differences between equality and equity in terms of health, and underlying issues that affect the health of individuals and communities.

A close look at the Foundation’s mission — “To address the unmet needs of Kentuckians by developing and influencing policy, improving access to care, reducing health risks and disparities, and promoting health equity” – zeroed in on the significance of every word.

Follow-up discussion explored the challenges associated with transforming words into meaningful policies. To do that, “We need to have people who have lived the reality,” remarked Fran Feltner, Director of University of Kentucky’s Center of Excellence in Rural Health.

Dr. Feltner is well acquainted with reality. She started her career as a Licensed Practical Nurse but went back to school when she realized that Registered Nurses earned better pay. Struggling successfully with school and working two jobs was possible because of encouragement from her family.

“So many kids don’t have the ‘You can do it’ behind them,” she said. Because she did, she understood its role in helping her overcome barriers.

“I went on and got my Ph. D. just to show my kids they could do it,” she quipped.

Foundation board member, Carlos Martin, Assistant Dean of Community and Cultural Engagement at UK’s College of Medicine, talked about his own experiences related to equity. “What do you think is the most-asked question I get?” he said.

The answer: “Where are you from?”

A native of southwest Texas, Mr. Martin has been in Kentucky forty years, but his name alone raises questions, based on faulty assumptions. He pointed out that Kentucky‘s population is changing, along with the rest of the country. Multi-cultural communities are not confined to the cities; rural areas are becoming more diverse too.

To engage the audience in small group discussions, Carlos Martin introduced a case study about a little boy named Bobby, a resident of West Oakland, California, who had asthma.

“What are the factors that contribute to Bobby’s health?” Carlos asked.

Discussion was animated and responses varied as each group of four reached agreement on the most important factors affecting Bobby’s health. Most groups identified socio-economic issues, including possible health hazards in the boy’s physical environment. Some discussion also considered the role of local political leadership in ensuring health equity.

With all the pressures on budget and crumbling infrastructure in rural counties, community health is not on the priority list of most County Judge Executives, one participant remarked.

Over the next eight-to-ten months, the insights and ideas generated from the day’s activities will forge ahead and provide input into strategies that address unmet health needs of all Kentuckians.

“We need to be more intentional and talk about these issues more,” declared Ben Chandler, the Foundation’s Executive Director.

Board president Dr. Brent Wright, a family physician from Glasgow, challenged the assembled group to stay involved as the process evolves, so the Foundation can become “the health conscience of Kentucky.”

Dr. Wright stressed comprehensive feedback as a key factor in making an impact. “Embrace this opportunity to drive this state forward,” he concluded.

Information about the Foundation for a Healthy Kentucky is available at https://www.healthy-ky.org/. Offices are located in Louisville, 1640 Lyndon Farm Court, Suite 100. Phone is 502-326-2583.

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Constance Alexander is a columnist, award-winning poet and playwright, and President of INTEXCommunications in Murray. She can be reached at calexander9@murraystate.edu. Or visit www.constancealexander.com.


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