This was not ‘on purpose.’ It just sort of happened, largely I think because when one explores disconnects due to ‘culture’ – differences in how various groups view health, or the body, or illness, or death, etc. – when all this is explored against the backdrop of biomedicine (ie the authorized, dominant healthcare system) those disconnects generally mean that some folks are not getting served as they might be. In other words, the equity focus comes with the territory. The label caught on after I already was involved in this kind of thing. But the ‘foot in the door,’ if you want to call it that, was my early fieldwork on ‘ethnomedicine’.
What led you to work with CommuniVax on equitable vaccine rollout?
I had worked with Emily Brunson previously (I’ve been doing vaccination stuff for a decade now) and so she thought of me as she was assembling the team. I had time because of the ‘shut down’ – meaning that although it’s an overload there was really nothing else to do (given my state’s ‘stay at home’ orders), and of course it’s a worthwhile project – simple as that 🙂
How do you think this project will impact the future of equitable health?
I do think it will be ‘impactful’ because there is an applied angle baked right into the work: we aren’t just ‘identifying problems’ but actually working toward solutions. For instance we are now launching a protocol to help CBOs that use a promotora or community health worker model secure funding for the long term. We are also interacting with government officials to get a more durable infrastructure built in areas that have been ignored previously – poor neighborhoods where people of color live, that is.
As a professor and member of many boards, how do you spread the ideas of health equity and do you believe that many of the people that you work with are aware of this problem?
Yes to the second part of the question: much of what anthropologists and others were preaching in terms of health equity in prior decades has by now become part of many people’s espoused worldview. ‘Regular people’ have heard of structural and institutional racism, for instance. Social justice is a concept taught in high school now: it’s not just for specialized upper division or graduate classes. The trick is to move folks beyond pure virtue posturing – to ensure that what we hear isn’t just lip service or a performative response but based on a nuanced understanding of what the stakes are, for whom, and why.
Are you focusing on specific communities in your attempt to increase community-based capacity building in support of vaccination or are you focusing on the general population?”
San Diego’s instantiation of the CommuniVax initiative is concentrated in our ‘South Region,’ where the majority of residents have a Hispanic/Latino background. We are focused particularly on barriers to access or to uptake that can be addressed in the near term but we also are doing some infrastructure-building. For instance part of our upcoming work is to support and train CBOs (community based organizations) in applying for funding. We are especially keen on helping the community health worker groups to garner funds because right now they seem to be on boom-bust cycles. The precarity experienced by these workers is shameful given how essential they are to the fight against Covid. There is another angle to this work, but one that I’ve not yet developed because we are in triage mode, and that’s to question the double standard held by researchers (and others, journalists included) when it comes to ‘vaccine hesitancy’. We are quick to associate lack of uptake with access issues when it comes to BIPOC communities, but when white communities don’t vaccinate we point fingers and call them conspiracy theorists. Fact is, many similar conspiratorial ideas are heard from BIPOC individuals. It’s time to better square or accommodate that in our conceptual models.
What advice would you give for students attempting to bring about change in their communities and increase their chances of equitable health?
Ah! Well, you can’t do it from your office. Get out there into the community. And I don’t mean stand near the grocery store entrance with a clipboard, no. Participate. Establish trust. Roll up your sleeves. Muck in and help. THEN do what you can – leverage your privilege, so to speak – your connections – to help people get THEIR priorities seen to. Help them identify for instance which public officials to hound. Help them collect data to make their case. Help them garner media attention, etc. Help to build skills within the community and work toward the day when your direct participation is no longer needed.
Interviewed by Dipti Venkatesh