Public health requires collective courage [PODCAST]

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“To create a healthier, more just, and more equitable world, we must confront the truth, and that requires an act of collective courage. Perhaps there needs to be a whole new consciousness that abandons ideas of reforms and instead labors a social transformation toward liberation. There cannot be effective solutions that expand globally in the public health sphere if there isn’t an effort to shift the way we think about the kind of power that is needed to create a world worth living in.”

Ira Memaj is a public health educator.

She shares her story and discusses her KevinMD article, “The local and global concerns of COVID-19.”

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Transcript

Kevin Pho: Welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. On the show, we have Ira Memaj. She’s a public health educator, and she co-wrote the KevinMD article “The local and global concerns of COVID-19.” Ira, welcome to the show.

Ira Memaj: Thank you for having me. I appreciate it.

Kevin Pho: We’ll get into your article in a little bit. First off, just briefly share your story and journey to where you are today.

Ira Memaj: Yeah, absolutely. My public health journey actually started in Detroit, Michigan, because that’s where I grew up and went to school. Originally, I wanted to do medicine. But after getting many research opportunities, which I was very fortunate to have, and seeing the social conditions in Detroit, mainly while working with community-based organizations, it was the community engagement that really sparked my interest in public health. I wanted to analyze how social constructs, policies, laws, and history have really shaped the conditions that people live in, and ultimately how that impacts the health of populations.

That’s when I decided to pursue public health. I got my master’s in public health, and then I decided to get my PhD in public health as well, and that’s where I am right now. I’m currently based in New York.

Kevin Pho: All right. So give us an example. Tell us a story of something that you’ve done in the past from a public health standpoint that really impacted the community, that moved the needle in the community that you worked in.

Ira Memaj: Yeah. I think one of the major events, so to say, or experiences that shaped the trajectory of my career was sometime during my undergraduate years. I was talking with one of my mentors, Dr. Latoya Falk, and we were talking about incarceration rates in Detroit and the prison conditions. We decided to start collecting books and donating them to correctional facilities. So we started this little project, but as the months went by, we started getting letters from incarcerated folks and from the librarians in the correctional facilities that we were working with, asking us to expand the project even more. So we started to furnish their libraries with GED books, and we also hosted community panels to talk about mass incarceration in general and what the community was doing.

I think that was the experience that taught me a lot about the history, how things came to be, so to say, and again, the laws and policies that impact people and their well-being, and what we can do to come up with some solutions that can improve the well-being of those individuals. Obviously, it’s more of a transformational change, and I understand that these are incremental changes that we make. However, even those little victories should be recognized and celebrated.

I think one of the main things that I’ve learned in the field of public health is the power of the collective community. Sometimes, when we look at history and really examine what is going on, the root problems, we tend to feel despair, and I don’t blame people for feeling that way. However, sometimes despair hinders our actions. So I think it’s important to keep in mind the power of the collective community, to work with community-based organizations, and to center the community that is really feeling the burden of certain conditions and diseases.

Kevin Pho: All right. We’re going to talk more about the power of the collective in your KevinMD article that you co-wrote. It’s titled “The local and global concerns of COVID-19.” Now, for those of you who get a chance to read your article, just walk my audience through it and share the story of why you decided to write it.

Ira Memaj: Yeah. This article was written by one of my mentors, Dr. Robert Fullilove, and me, and together we worked a lot during COVID-19, as a lot of public health officials did as well. One thing that we wanted to talk about was that, at the time, there was the rise of vaccinations. The vaccines became available, and a lot of people were feeling hopeful. Sometimes we get lost because we apply whatever is going on to the standard, so to say, and that comes from ideologies that are so embedded in our society in America. We think that because vaccines are available to everyone, everyone has access to them, when in reality that’s not really the case.

We wanted to look into what was happening in the U.S. and also in some of the countries globally, so to say. Obviously, we couldn’t mention all the countries, but we spoke a little bit about India and then the dire conditions that were happening, and are still happening, in Yemen, just to show the frailties of public health infrastructure and how important it is to invest in public health infrastructure, so that for future pandemics, because they are bound to happen, especially with climate change, we can be better prepared and more people are not impacted at such a large scale.

Kevin Pho: From a public health lens, how was the collective response to COVID in the United States?

Ira Memaj: I do think that, obviously, we could have done so much better, because our response was not as timely, and it was very much downplayed. Again, because of these individualistic ideologies, determinism, economism, and the American creed, as Drs. Geronimus and Thompson have stated in the past, we as public health officials tend to neglect a lot of equity in our responses. That ignores very important populations that historically have been marginalized. And when we do come up with these life-saving technologies, like treatments and vaccines, those communities that have been exploited and have had this history of abuse are very mistrustful of the medical community, rightly so.

Kevin Pho: Give us an example of some of those populations that were marginalized during the COVID response.

Ira Memaj: Yeah, I’ll talk a little bit about my work. From the end of 2020 to 2021, I went back to Detroit, to the Detroit Association of Black Organizations, headed by Reverend Horace Sheffield. We worked with community-based organizations on any hesitancies and concerns that people had, people in the Detroit neighborhoods that have been historically marginalized, which were poor Black and brown neighborhoods. We partnered with Bus Diagnosis to make sure that people had access to vaccines. But while they had access to these vaccines, we also had professionals there, health professionals and trusted leaders in the community, to ensure people understood what the vaccine was about, to address their concerns, and to explain why it was important to get vaccinated.

Other topics that I have covered, along with my mentor, Dr. Fullilove, have been our response to incarcerated populations. Usually, almost all the time, in any kind of response that we have to public health emergencies, we tend to ignore incarcerated populations, and that’s not right, because the state of being incarcerated in and of itself already presents a lot of health issues: the overcrowding and the poor ventilation. But prison populations have also been very vulnerable to abuse in medicine, where they have been used as participants in studies without their permission.

So when we have something like, “Here’s the vaccine, and here, you take it because you have to,” without really being culturally competent, or without taking accountability for where public health, medicine, and even public leaders have gone wrong, that presents a lot of issues. Here you have this life-saving technology that can save someone’s life and prevent transmission, but yet there is this mistrust. How do you navigate that? I think that’s where we failed: in communicating, in taking accountability, and in really shaping policies that abandon our individualistic ideologies.

Kevin Pho: Now, can you contrast the collective action to COVID in the United States? You said that you did compare it with other countries, so talk about that contrast between the collective action in the United States versus that of other countries.

Ira Memaj: Yeah. I think the best example that comes to mind, especially globally, is Rwanda. After the genocide in the 1990s, Rwanda was left to repair a lot of its infrastructure, and it focused a lot on its public health infrastructure. One of its main focuses was community engagement and centering community workers, really using them to build trust with their communities and make sure that the communities had access to treatments, screenings, health care access, talking with their doctors, and whatnot.

During COVID-19, they actually set up this really interesting way of testing people and providing treatment, where they worked with doctors, health care workers, and community workers. They communicated with each other in order to have those health providers go and visit people in their homes, because sometimes not everybody has the means to go to the hospital and whatnot. So it was very community-centered, a collective approach, so to say, in how they tested people and provided treatment.

Here, it was more, “Wear masks and keep your social distancing,” and whatnot, without considering that not everybody has those choices. In the United States, because there is this American creed ideology and individualism, so to say, we expect people to do what we say without understanding that this is really a regime of choices, and without really giving people the opportunity, or understanding that some folks do not even have the luxury of making the choices that we’re forcing them to make. For example, many low-income people, immigrants, and Black and brown communities are essential frontline workers who could not really escape, so to say, and do social distancing and whatnot. Or even in the prisons that we talked about, how do you do social distancing when you’re so overcrowded and so confined?

It wasn’t until perhaps the vaccinations that we started to really utilize our partnerships with community-based organizations and faith-based organizations to ensure that people had access to the vaccine and to address vaccine hesitancy. But then again, that didn’t happen in every state either, because of this individualistic ideology. Every state has its own rules and policies, which also creates a lot of disparities, whether it’s in data or eventually in outcomes.

Kevin Pho: So you’ve alluded several times to this uniquely American individualistic quality. Going forward, what are some of your solutions in terms of squaring that history of individualism with the collective action that public health normally needs? How do you square those two sides?

Ira Memaj: Yeah, and that’s a challenge, right? Because you have public health, which is all about preventing disease and putting people first, which is really all about this collective look, this ecological look, right, where everybody is responsible for everyone’s well-being. And then you have these ideologies that are so embedded in our country, like individualism and the American creed, where it’s all about meritocracy, right? If you work hard and you follow the rules, you’ll succeed, so to say, and if you don’t, then it’s your fault.

When that kind of ideology is applied to health, we start to victim-blame. We say people are sick because it’s their fault, and not because of social structures that have really shaped the types of laws and policies, for example, redlining, gerrymandering, food apartheid settings, and whatnot. Those have really contributed to people having these preexisting conditions that make them a lot more vulnerable to, for example, COVID-19, or perhaps even future public health emergencies that will emerge.

Kevin Pho: We’re talking to Ira Memaj. She’s a public health educator. We’re talking about her KevinMD article that she co-wrote, titled “The local and global concerns of COVID-19.” Ira, what are some of your take-home messages that you want to leave with the KevinMD audience?

Ira Memaj: I know this probably sounds a little boots, but I’m a firm believer in the power of the collective effort. I think the one thing that we need to do is really gather up our courage, our collective courage, to go against the grain and truly look into reimagining the world, a different kind of world that is more just, more equitable, and a lot healthier, and start with that.

Also, keep in mind that the journey for the transformative change that we are seeking, right, systemic change, will take a while. It’s a slow journey. But I do think that these incremental changes we are making, even though they may seem small and sometimes we still think that it’s not enough, should be celebrated and used as stepping stones for that kind of legacy to continue, right, to do good and to create that world that we do imagine.

Kevin Pho: Ira, thank you so much for sharing your time and insight, and thanks again for being on the show.

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