In 2008, in response to the devastating impact of Hurricane Ike, the CEHD made a commitment to have a strong focus on health equity in relation to local recovery issues, reaching across silos to address various determinants of health that affect health inequities, including health care, housing, education, air quality, nutrition and food security, and many other issues. While continuing that work, we have also extended our work to neighboring communities such as Port Arthur, especially to address local environmental health concerns. We take seriously and personally the continual need for public communication and education, as well as training of UTMB students to become the next generation’s leaders. Throughout our work, the common themes of addressing health disparities within an ethical/social justice framework has been constant. Indeed, we don’t believe you can effectively achieve the former without the latter.
The CEHD is proud to have assembled a dedicated team of professionals committed to research excellence as well as the well-being of the local community. We are also fortunate to have developed deep partnerships with key community organizations, local governmental entities, and other UTMB professionals committed to the same core values as the CEHD. As always, we appreciate the unswerving support that the UTMB community has given us, and look forward to the next steps of this journey.
Over the next several years, the Center will continue to focus on supporting Health in All Policies approaches; advancing equity in environmental health; promoting research-to-policy knowledge translation processes; and promoting better understanding among health professions students as well as the public of the relationship between health, health inequities, health systems, and social determinants of health.
Dr. Lexi Nolen, PhD, MPH
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To engage research, training and action related to health equity that effectively supports communities to become more healthy, sustainable, resilient, and just.
A world in which race, ethnicity, geography, income, education and other socially moderated factors do not predict health outcomes, where public systems and institutions are fair and inclusive, and where all people have access to the resources they need for good health and to make healthy choices.
The CEHD pursues health equity guided by the values of respect for science and research, social justice, integrity, respect for persons, diversity, and community solidarity.
About Health Disparities
The CEHD understands health in a broad context, related to the physical, social and economic environment, and also related to social justice and the stratification of power and privilege in society which often create health inequities.
Health inequities are unfair inequalities in health risk, outcomes, or impacts of poor health among groups stratified by income/wealth, race/ ethnicity, educational level, or other socially moderated factors. Their causes are multifactoral and complex, and reducing health inequities requires broad participation, understanding of the goals, and a sustained
commitment to the process. The CEHD uses several approaches to organizing its work, including
Addressing the health system, but also the causes of health inequities.
In order to reduce health inequities, barriers and challenges in the health system must be addressed, including improving access to health care services and quality of care, fair distributions of public health services, and reducing the economic consequences of ill health, such as bankruptcies due to the high cost of health care services and lost income due to illness.
However, we know that health care services and health systems alone are not the solution to creating health equity. In fact, social determinants of health - that is, the conditions in which people are born, grow, live, work and age - affect people’s health outcomes less through health care services than through other factors such as income, neighborhood and
living conditions, racism, and other factors (see figure).
Social determinants of health include issues such as food security and regulation and nutrition; employment conditions; educational attainment; housing; transportation; and all of the policies and decisions that shape the physical, social and economic environments in which people live.
Consequently, it is an absolute necessity to address both health systems and social determinants of health in order to effectively reduce health inequities and prevent their recurrence. At the same time, if we do not continually apply “an equity lens” to social determinants interventions by monitoring the impact of action on equity improvement, we run the risk of actually worsening health inequities.Therefore, the CEHD engages combined approaches to reducing health inequities.
Local models to be scaled-up and replicated
The CEHD also recognizes the imperative and responsibility to help rebuild our own community after Hurricane Ike, and to reach out to other communities in need around the world. Much of our work is currently focused on local research-to-action projects that have the potential to be scaled up. When possible, we develop tools to facilitate training and the scale-up process, including user-friendly online tools, guidelines and workbooks, training videos, and documentaries of processes we have engaged. Many of these tools are in development as our projects evolve, and will become available over the next year.
Action-based, community centered research
Finally, the CEHD recognizes that research is valuable and necessary to guide understanding and identify effective solutions, but that when research is not actively linked to a change process and with the community, it rarely creates significant or long-lasting change. Further, research that is not undertaken in partnership with potential users of the information has less potential for sustainable impact. Consequently, the CEHD staff orient our work towards action-based research, which is research undertaken in the context of testing interventions or working with partners for change, and we intentionally collaborate with partners who have a stake in the issues as well as those who are engaged in policy development and planning.
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Alexandra B. Nolen, PhD, MPH
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Alexandra (Lexi) B. Nolen, PhD, MPH, serves as the Director of the Center to Eliminate Health Disparities and Director ad interim of the Global Health Education Program at UTMB. Dr. Nolen served on the Secretariat of the World Health Organization Commission on Social Determinants of Health, was the Coordinator of the Global Equity Gauge Alliance, and was a technical officer for the Pan American Health Organization in the Division of Health and Human Development. She has experience coordinating community-based research and interventions as well as policy development on issues of health disparities and public health in a number of country contexts. Her work encompasses issues of health and health information systems development, strategies for advancing health equity, the impact of globalization and trade on health in Africa, and development of training materials on health equity and the social determinants of health. She is especially interested in translation of research for policy, and research-to-policy processes. In 2009, Dr. Nolen was elected to the Board of the International Society for Equity in Health.
John D. Prochaska, DrPH, MPH
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John Prochaska, DrPH, MPH, is a Program Manager, and is Assistant Professor in UTMB's Dept of Preventive Medicine and Community Health(PMCH). He received his Doctorate in Public Health from the Texas A&M Health Science Center School of Rural Public Health with an emphasis in Social and Behavioral Health and holds a graduate certificate in health systems and design from Texas A&M University's College of Architecture, with course work tailored towards building healthy communities. His current interests focus on Geographic Information Systems in health impact assessments, community-driven research, and applying systems thinking to public health problems.
Sayali Tarlekar, MPH
Research Associate II
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Sayali Tarlekar, MPH received her Master's in Public Health from the Texas A&M Health Science Center School of Rural Public Health with an emphasis in Social and Behavioral Health. Sayali previously served as the Associate Editor-in-Chief for Context - the Journal of Health Students Taking Action Together, the nation's first student-run, online, peer-reviewed journal that highlights exceptional work of health students. She also represented United States as the National Focal Point for the Global Youth Coalition on HIV/AIDS (GYCA).
Christen Miller, MPAff
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Christen Miller, MPAff received her Master's in Public Affairs from the LBJ School of Public Affairs at the University of Texas at Austin with a certification in the graduate portfolio program in Nonprofit Studies. Christen previously completed policy internships at Texans Care for Children and at the Office of the Governor of the US Virgin Islands Children and Families Council. Her research interests focus on child and family wellbeing, community-driven poverty alleviation, mentoring, and international volunteerism.
Rob Buschmann, MPP, RN
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Rob Buschmann received his Masters in Public Policy from Duke University. He received a Presidential Management Fellowship, and worked for the Congressional Research Service and the Social Security Administration, specializing in federal risk /regulatory issues and survey research. Rob worked for Mathematica Policy Research on case study research and program evaluation in a wide variety of social policy areas, including disability policy, education, and welfare. Rob also received his BSN from Georgetown University and is a registered nurse.
CEHD Senior Fellows
Sharon (Petronella) Croisant, MS, PhD, is Associate Professor in the Department of Preventive Medicine and Community Health. She holds a PhD in epidemiology and an MS in health promotion and education. She currently directs the UTMB National Institutes of Environmental Health Sciences Center in Environmental Toxicology’s Community-based Research Facility as well as its Community Outreach and Engagement Core. She is also a Center Investigator within the Institute for Translational Sciences, for which she serves as co-director of the Community Engagement and Research Key Resource. A major focus of her career has been translational or integrative research, i.e., building interfaces between and among environmental and clinical research, education, and community health. She has expertise in Community-Based Participatory Research, including applications in Environmental Justice communities. She serves on a national Scientific Advisory Panel for the Environmental Protection Agency.
Karl Eschbach, Ph.D. is a Professor in the Department of Internal Medicine, with secondary appointments in the Population Health Sciences and Rehabilitation Sciences programs in the Department of Preventive Medicine and Community Health. Dr. Eschbach received his Ph.D. in sociology from Harvard University, and completed an NICHD post-doctoral traineeship in demography at the University of Wisconsin-Madison. Dr. Eschbach’s research specialty is the demography of health disparities in racial and ethnic populations in the United States. His research at UTMB studies in particular the geographic and socioeconomic roots of disparities in disease incidence, health care access, and mortality, with a special focus on the Mexican American population. He is a co-investigator and director of the Knowledge Translation Core of the consortium center for comparative Effectiveness Research on Cancer in Texas (CERCIT), funded by the Cancer Prevention Research Institute of Texas.
John Sullivan, M.A. directs the Public Forum & Toxics Assistance Division of the UTMB NIEHS COEC. He is Adjunct Faculty in the Department of Preventive Medicine & Community Health and an Associate at the Institute for Medical Humanities. He uses Augusto Boal’s image and Forum Theater techniques to teach toxicological concepts and to create public dialogues on risk assessment and the health and social effects of toxic exposures. Mr. Sullivan is the recipient of numerous writing awards and honors including the "Jack Kerouac Literary Prize," "The Writers Voice: New Voices of the West Prize," several fellowships, and “featured playwright” at Denver's Summer Play Festival. The CEHD's work on environmental health is collaboration with the UTMB NIEHS Center's Community Outreach and Education Core. Click here for more information and to see a video of a work session used at a conference hosted by the Environmental Protection Agency.
Rebecca Hester, M.A., Ph.D. Assistant Professor at the Institute for Medical Humanities, received her doctorate in Politics with an emphasis on Latin American and Latino Studies from the University of California Santa Cruz. Her research interests include immigration, health disparities, cultural competency, and biosecurity. Dr. Hester is engaged in several community research projects focused on racial and ethnic health disparities. She is an advisor to international and U.S.-based indigenous organizations, the Frente Indígena de Organizaciones Binacionales and Centro Binacional para el Desarrollo Indígena, respectively.
Jason Glenn, Ph.D. is an Assistant Professor at the Institute for the Medical Humanities at UTMB. He received his Ph.D. in the History of Science at Harvard University in 2005, and has a B.A. from Stanford University in African and Afro-American Studies and Euro-American History. His main area of specialty is the history of U.S. drug policy and drug research, particularly as related to trends of incarceration. Other areas of specialty include the history of theories of race, the intersection of science and law, the history of human subject research, health disparities, and topics related to genetics, race & health. Dr. Glenn is the co-founder and executive director of Sobriety High, Inc., a non-profit community organization providing residential and out-patient services for minority men returning to Galveston from prison who have a history of substance abuse.
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