issue Winter 2023

Intersectional Health Equity

By Judy Masterson
Amanda Simanek, PhD, MPH
Photo by Michael R. Schmidt

Social epidemiologist Amanda Simanek, PhD, MPH, arrived at RFU on Aug. 22, 2022, to lead the recently established Michael Reese Research and Education Foundation Center for Health Equity Research (CHER). Her vision includes facilitating health equity-focused research collaborations that respond to community needs and implementation of interventions aimed at improving health equity in Lake County, Illinois.

Helix: You left a tenured position to take the founding directorship of CHER. Why the leap?

AS: I joined the faculty at UW-Milwaukee in 2013 to help build a School of Public Health. We designed from scratch a master of public health and a PhD in epidemiology. The inception of the school was grounded in training up a workforce that could contribute to improving public health and health equity in the Milwaukee community. That’s work that is really appealing to me. I read about RFU and CHER, and I was intrigued by the interprofessional approach to education that, to some extent, we had also emphasized in UWM MPH programs. I also saw a need at RFU that my skill set might help meet. So, I’m up for the challenge. Challenges are interesting. They’re stressful, but they can be fun and it can be an opportunity for creativity.

How’s it going five months in?

We’re still at the early stages of doing this work. You have to be comfortable with it being an iterative process. We have largely been focused on identifying community needs and priorities around health equity and this will help us to identify how the center might best meet those needs. My long-term vision is that in three to five years, maybe even before that, we will offer a well-oiled process, where a community group thinks, “We have this project, let’s go to RFU for the help we need.” Or, “We have this data but don’t have a way to analyze it, let’s contact CHER because they have a statistician we can consult with.”

“We’ve seen a reckoning, in particular over the past two to three years, around recognizing racism as not just discriminatory acts by some individuals against others, but systems and structures that have over hundreds of years perpetuated inequitable access to resources and how that translates to poor health.”

How did you begin?

I’ve talked about doing both a community inventory and an RFU inventory as my first steps in getting a lay of the land. A lot of people and RFU community partners are already doing health equity-related work and advocacy in their own communities. I want to get to know what’s happening in Lake County. It takes time to really get to understand the historical influences of an area, the way that neighborhoods have been shaped. I want to partner with the people at RFU and in the community who already know that history. The RFU inventory is about learning what students and junior investigators want and need in their training. Are they looking for research opportunities? What training are they getting in research methods — in working with communities?

How do you envision student involvement?

At UWM, we were very much health equity and social justice focused in our training of students. They completed field experience training with organizations in the Milwaukee community. We were unique among programs, designing it so that our students would be trained to use the tools of epidemiology to help community groups advance their social justice and health equity work. We would help marry the skill sets our students are gaining with the projects community partners wanted to do. I’m looking forward to identifying those spaces in which RFU faculty, students and community partners can collaborate on research projects that advance the health equity efforts already being carried out in Lake County.

Your research has looked at how socioeconomic disadvantage relates to health and disease across generations. What have you come to understand?

I’ve conducted studies that have looked at the relationship between prenatal disadvantage — the social environment in which your mother is pregnant with you and gives birth to you — and how that may impact the health of the next generation. Through this work, I’ve identified several ways in which a child born into a low socioeconomic environment — who has no choice about that — is already, potentially, at higher biologic risk of certain diseases, which is unjust. We also know that health behaviors and other things that we pin on lifestyle choices of adults are actually highly determined by social environments that people often have little control over. From a social justice perspective, it makes it imperative to utilize any information gained about the biologic consequences of such environments to advocate for interventions that target unjust structures and systems.

RFU’s Community Care Coach at the intersection of 10th Street and McAlister Avenue in Waukegan, Illinois.

What are some big-picture takeaways on the shift in public health and epidemiology from an emphasis on health disparities to health equity?

The word “disparate” itself really means difference, and it is devoid of the other context, which is that inequities are driven by unjust and preventable causes, and that’s unacceptable. The shift in language acknowledges the component of unjustness — that these are not organic differences. Inequities in health have emerged because of structures and systems that have perpetuated or increased those inequities. That’s no accident. It happens because structures and systems benefit some people to the detriment of others. We’ve seen a reckoning, in particular over the past two to three years, around recognizing racism as not just discriminatory acts by some individuals against others, but systems and structures that have over hundreds of years perpetuated inequitable access to resources and how that translates to poor health. It’s no longer acceptable to just document or even map out where inequities are happening. We need to understand the historical context in those neighborhoods — who lives there, what kind of jobs are available, what environmental toxicants are present and the myriad factors that have contributed to the health conditions of people living in a given ZIP code or census tract. Again, not just to catalog those historical facts, but to ask, “How do we undo, how do we rectify and change those structures or remedy the consequences of them?”

What’s your go-to example of an unjust structure?

Discriminatory housing and lending practices. Take the house that I own in Milwaukee, which is over 100 years old. Many people don’t realize that at points over the past century, it was common practice to include clauses in the deeds on homes that said you can buy this house, but you can never sell it to an African American or Jewish person. So there always has to first be a recognition — but then also a reckoning. We need to go further, to say, “Okay, knowing about this unjust historical practice, what ways can we undo some of the damage done by these systems around lending that have gone on over the past century?” But it is through that documentation and uncovering that we acknowledge that these unjust systems exist. It’s through research that we identify the social and biologic consequences of such systems. It’s through interventions and policies targeting these systems that we can work to address the resulting inequities in health. That’s all part of the work to create health equity.

Judy Masterson is a staff writer with RFU’s Division of Marketing and Brand Management.