Conversations from Aspen Ideas: Health

JOEL BERVELL: We have a very special miniseries of short conversations for you recorded live at the Aspen Ideas Festival. I’m here, and to be honest, I kind of can’t believe it. This is a gathering of thought leaders and influencers in health care that really can’t or won’t happen anyplace else. I wanted to bring you along, in a sense, to share my excitement. But also, I wanted to introduce you to a few other professionals with careers devoted to human health.

Part of the excitement is, these are emerging doers. And what they are doing, and how they are doing it in their communities, is why they’re here. The person in charge of all of this is my first guest on this episode: Lola Adedokun, executive director of the Aspen Global Innovators Group at the Aspen Institute, where she leads a portfolio of programs that seek to expand opportunities and access to health and prosperity for people living at the world’s margins, including the Healthy Communities Fellowship.

Lola, thank you so much for joining me for this conversation. A kickoff to a kind of lightning round of conversations with three of this year’s Healthy Communities Fellows.

LOLA ADEDOKUN: It’s a pleasure to be here and talk to you today.

JOEL BERVELL: I’m so excited because you’ve quickly become one of my favorite people. So I really want to know, how does Aspen identify emerging leaders in community health for this opportunity and what kind of on-the-ground intel do you have?

LOLA ADEDOKUN: That’s a great question. We identify our leaders through an internal nomination process. So just like in our real lives, we know great people, and so we ask within our network who are great people that you know who are making change around the world. But moreover, when we start really thinking about who the right people are for this kind of fellowship, we really seek certain personality characteristics: senses of generosity, humility, authentic connection to community, a passion for the work that they do, a desire to have a deep impact and a legacy, a sense of just thoughtfulness and a willingness to learn from others. So these are, we call them the soft skills, but they’re not the soft skills. These are the human skills that enable them to be successful, that enable them to really benefit from working alongside a cohort of leaders like themselves, and also enable them to really think about their long-term vision and legacy.

JOEL BERVELL: The human skills. I love that you said it like that. So let’s talk about the three fellows that I get to chat with here in Aspen: Mary Oxendine, Shameca Brown, and Elizabeth Lutz, based in North Carolina, Oklahoma, and Texas. How did you find them?

LOLA ADEDOKUN: They were, honestly, truly nominated. We talked to philanthropists in the community that they were coming from, other leaders in our network who were like, “These are the kinds of folks that you want to know about.” But what’s interesting about our Healthy Communities Fellowship is we really take a holistic approach. We think about the full cohort. We are a public health–focused fellowship program, so that means we’re thinking about leaders who are tackling the complex issues that impact people’s lives. So our fellows focus on issues related to mental health, to access to health care, to food security, to ensuring that the folks in their communities have all the things they need to thrive. So when we think about the whole cohort, they’re touching on lots of different issues, but the leaders you have the privilege of talking to today, are really focusing on tackling the needs of immigrant communities, tackling the needs around mental health and mental health services, and really thinking about what the food needs are so that people can really live wholesome, full lives.

JOEL BERVELL: Absolutely. I love that community-based focus too, because that’s really where change begins, from that grassroots level of sparking change in your community that then ripples out to the rest of the world. What’s the support from Aspen? We’re here right now to all share ideas, but what is it that you hope happens back home when they go back to those communities? And how’s that being connected to the broader Aspen community as a whole?

LOLA ADEDOKUN: Great question. We love Aspen because it’s a place of convening and thought leadership, but with our Healthy Communities, we want to move beyond thought leadership, and talking to true action and impact. So during the fellowship program, our fellows have the opportunity to work with coaches and mentors, just to ensure that they have the support they need to do this very, very hard work. The second contribution that the fellowship makes is really building their communications, narrative, storytelling capacity, so that they can be, not only convincing for funders, but so that they can really communicate the added value of their leadership and advocate for the needs of the communities that they’re supporting. So they have 12 months to engage and they engage together as a cohort.

They also receive individualized coaching and support. And after that, we really commit to this model of once a fellow, always a fellow. So as they continue their work post the fellowship opportunity, we really work to connect them with other fellows within the Healthy Communities network, within the broader global Aspen Global Innovators community, and then the even more broad Aspen Institute network. So there’s also some intention about it. So we really follow the fellows as they’re doing their work. They call on us as they have different needs, and then we work very hard to ensure we can connect them with the right people at the right time, within our network or beyond our network, to ensure that they can thrive and grow.

JOEL BERVELL: How do you measure that impact that these individuals can have with the added support from Aspen?

LOLA ADEDOKUN: That is the core question. So we talk about measurement in different ways. So we will track the number of individuals they’re serving, for example, if that’s relevant to the work that they’re doing. But we really just continue to talk to them. Our open-door policy, we will continue to quarterly touch base, see how they’re doing, and we’ll track what kinds of engagements they’ve had, which ones we have introduced them to, and which ones they’ve made happen for themselves.

JOEL BERVELL: I love it. Well, thank you so much, Lola. It’s been a busy week here for you, and we love the collaboration that we’re having here in this studio. Thank you for bringing these fellows and stay tuned for a conversation with the rest of the fellows.

LOLA ADEDOKUN: Thank you. It’s been a privilege.

JOEL BERVELL: For the second part of this episode, I’m joined by Elizabeth Lutz, executive director of the Health Collaborative in San Antonio, Texas, where her work is dedicated to meeting the needs of hidden communities. That means people who have lost access to quality health care because of fear, threat, retaliation, or stigma.

As the daughter of immigrants, Elizabeth brings a personal understanding to her work of cross-sector coalition-building and collaborative partnerships to better inform the investment of public and private resources in the interest of equitable health care.

Elizabeth, thank you so much for joining me.

ELIZABETH LUTZ: Thank you for having me.

JOEL BERVELL: So issues of health equity in Texas often touch on lack of access. Precarious immigration status often makes people reluctant to seek out the care they need. You’ve been working on this issue in Bexar County, San Antonio for years. Can you give me a snapshot of how this looks today?

ELIZABETH LUTZ: So my work really comes from the community lens and really supporting families and helping them be comfortable with raising questions and getting more comfortable with accessing care, or maybe even just learning about the resources that they potentially have available to them.

It’s important to start with a premise of trust and then build on that, really leading people, not only to the safe spaces where they can have these conversations, ask questions, learn about the resources, but then also connect to those resources, and then through the connection of those resources, increase the voice of how those resources and those programs or those services are provided for them, where they’re provided to them, and how they are provided to them.

And so my work has really been based on really being more inclusive about how we make decisions around community health or public health or systems health, even education or workforce. It’s important for us to really understand that the reason why we have a community, the reason why we have resources, the reason why we have the infrastructures that we have, is because we are the people that build it.

And so I think through that same lens, we’re doing active work around engaging people around health care, around enrollment, around access, but always with the same sense of, “This is what an application looks like now, this is what the program looks like now. I’m going to have a conversation with you about the benefits of it, but I also want to have a conversation about what do you think we should be doing to improve it?” That’s really the basis of the work that we do.

JOEL BERVELL: I love that, and I love that you said making people feel comfortable asking questions. My parents are both immigrants from Ghana, West Africa, and I think that’s always been a tension for them, how do you ask the right questions or feel comfortable even asking questions when you have this inherent power dynamic that’s there?

ELIZABETH LUTZ: Yes.

JOEL BERVELL: What are the strategies that you’ve identified to make people feel safe asking for and receiving health care?

ELIZABETH LUTZ: I mean, the basic strategy is using knowledgeable and trusted people, the right cultures, the right faces, the right languages, the right settings. So we’re . . . The Health Collaborative is a 26-year-old organization, that’s been servicing community, Bexar County, for that long, but we don’t do the work. What we do is that we leverage those right people in communities to have those conversations and to hold the trust.

As an organization, we are funded, we’ve got resources, we’ve got grants. All of that money really has to go back into community. So I think the biggest strategy for us is ensuring that we step out of the way and that we allow communities to thrive as they have for many years. We have resilient, resilient communities that are doing so much with so little. I think that that also creates power in the voices because then what happens is people who have never been asked those questions before, it’s not that you don’t know what to ask, it’s maybe that you just haven’t been given the opportunity to voice what you know.

And we start from the emphasis of maybe right now we’re helping you try to get a resource like housing or transportation or maybe trying to get you on CHIP enrollment or Medicaid enrollment, but you slowly see that the person itself, when you’ve given them that opportunity to really share their own knowledge, their own experience, they become the champions for others.

And that same voice can be carried into platforms about policymaking, voting, right? Resources that are coming, elections even at the local level about city council or homeowners’ associations or what’s happening right here in my neighborhood. Why don’t I have lights? Why don’t I have a park? Why don’t I have . . .

JOEL BERVELL: Yes. I’m getting chills right now. That’s such a beautiful answer because I think all too often we think our role is to jump into community and give the answers when maybe we’re not letting the community ask the questions or give the answers that, like you said, they already know.

ELIZABETH LUTZ: Yeah. When we think about doing our needs assessment now, at least in our community, there’s always a scope of, “Do a key informant interview. Oh, let’s go talk to the judge. Let’s go talk to the mayor. Let’s . . .” Lay leaders are amazing resources, because they are the voices for 10, 15, 20, 30, 60 families that are depending on them for that knowledge power.

JOEL BERVELL: Ah, I love it. Thank you so much for that. And I know one of your initiatives focuses also on health care literacy. To you, what does it mean to build health literacy in a community?

ELIZABETH LUTZ: Again, I think it starts with conversations. It starts with trust. And we held a conference every year and we would start with the ABCs of health literacy. We found that there was this very split dynamic between health care professional and community. Every one of us has had that person in our lives that’s been affected negatively by a health challenge.

I remember when my mother got cancer and I hear the story often, they hear the word cancer, that’s all they’re going to hear. They’re not going to hear anything else. Mental health, you are bipolar. They get labeled, and health literacy for them is about, “How do I take that?” Right?

JOEL BERVELL: Yeah.

ELIZABETH LUTZ: So health literacy is not just about receiving information, it’s also about understanding information and then having those action steps to move you forward. It starts with just who is there to help me. And the unfortunate part of it is that there are many people, especially our refugee immigrant and migrant communities, that don’t have that level of support.

And even in our health care system, sometimes they’re forbidden from being able to bring in cultural aspects, right? There’s space for us to continue to learn about cultural medicine, right? And so health literacy really encompasses understanding all of that, but having that conversation, that openness to say, “What do we do next?”

JOEL BERVELL: Absolutely. What are the tools that can help people find insurance coverage for themselves, their families, especially in cases where English is not the primary language. And as we know, the insurance marketplace is a pretty significant challenge to navigate. I mean, even for people that are native English speakers, so let alone someone that doesn’t speak English as their primary language, what kind of resources are there?

ELIZABETH LUTZ: Great question. So we happen to be one of the Texas Navigator Fund agencies, and we deploy community health workers in 18 counties. And these community health workers are bilingual. The application process is not easy. It is time intensive. There are many nuances. So in order for us to get people enrolled, again, I go back to this, it has to be those right people. It has to. You have to know who your community is.

We’ve seen a tremendous amount of growth, a change with our enrollment from year one to year three. The numbers have just exploded because we are removing ourselves, right? We’re saying we don’t want people to come to our office. We need to be in the center of where communities are. We need to deploy those resources and community.

I think another aspect of this is also understanding that we can enroll as many people as we want to. We have to keep people enrolled. And we have to make sure that people know how to use that insurance. So our navigator team and our community health worker team is doing so many roles, but you know what? It’s necessary. It’s necessary.

JOEL BERVELL: Absolutely. Elizabeth, thank you so much for being with me and sharing your insights and expertise. You’ve devoted nearly two decades to continuously implementing creative strategies to enhance health care for your communities in San Antonio. It’s been a real privilege to be able to join you in conversation and learn more about it.

ELIZABETH LUTZ: Thank you. Thank you for the opportunity. We really appreciate it.

JOEL BERVELL: Absolutely. Thank you.

Thank you so much for checking out this first pair of conversations from the Aspen Ideas Festival. We’ll be back next week with my interviews of two more of this year’s Aspen Global Innovators Healthy Communities Fellows.

This episode of The Dose was produced by Jody Becker, Mickey Capper, and Naomi Leibowitz. Special thanks to Barry Scholl for editing, Jen Wilson and Rose Wong for art and design, and Paul Frame for web support. Also thanks to the Aspen Ideas Festival for their support. Our theme music is “Arizona Moon” by Blue Dot Sessions. If you want to check us out online, visit thedose.show. There you’ll be able to learn more about today’s episode and explore other resources. That’s it for The Dose. I’m Joel Bervell, and thank you for listening.