Public Health Practice is Social Justice Work
Lillian M. Shirley, RN, MPH, MPA, Multnomah County Health Department, Oregon
Shirley's research helps communities identify and improve on the health impact of public health concerns such as smoke-free housing, through policy change and education. "...We are all in this together and the health of our own families and communities cannot be separated from the health of the community at large."
The first public health job that Lillian Shirley, RN, MPH, MPA, had was in Boston neighborhoods where she worked with communities that were disproportionately affected by communicable disease. She quickly realized that she was learning more from her clients in their kitchens than she had in her academic lecture halls. In addition, these teachable moments framed her scientific and professional knowledge in ways that continue to inform her decisions. Shirley explains, "They made crystal clear the truth that we are all in this together and the health of our own families and communities cannot be separated from the health of the community at large."
Today, Shirley is director of the Multnomah County Health Department in Portland, Oregon where she is excited by the increasing understanding that public health practice is social justice work. Using the science and tools of public health; epidemiology, surveillance, and community engagement, the Multnomah County Health Department has refocused its work on eliminating the root causes and consequences of racial, ethnic, and economic disparities in health. "Initially it seemed too daring to think that a county health department could have an impact on setting a community agenda," says Shirley. "But positioning equity as the lens we use to determine our decisions has led us to increasingly use this policy as a vehicle for improving the public's health."
Shirley put this principle to work when the health department began working closely with low-income rental housing owners on the issue of creating smoke-free properties. Initially, they assumed that tenants in low-income brackets smoked and therefore would not want smoke-free environments. Through the use of community based participatory research and the solid science in tobacco research, they determined that tenants and potential tenants, including existing smokers, would choose to live in smoke-free housing. This led to a new coalition of property managers, housing advocates, and community development corporations to create smoke-free, low-income rental housing as an increasingly available option for renters in their county.
Shirley believes that increasing U.S. investment in public health research also can advance social justice. "Some of the major gaps that need to be further researched are the connections in communities that allow certain populations to experience health and illness in very different ways," she says. For example, Oregon has the highest rates of asthma in the nation. South Dakota has the lowest rate. "Why is that?" Shirley asks. "We suspect things like high particulate matter but what really is going on? And what is the confluence of factors that a community must address to change these outcomes before they can start?" She knows that public health research can find the answers.