Christy Erving: Engaging Local Communities to Address Racial Health Disparities

Christy Erving, a sociologist by training, does research on the social factors that produce and maintain disparities in health. In the Fall of 2016, she will join the University of North Carolina–Charlotte as an Assistant Professor in Sociology. Her knowledge exchange project at UW-Madison focused on how local communities are responding to recent findings about black/white disparities in health, education, and criminal justice in Madison, Wisconsin.

How did you feel about knowledge exchange projects when you entered the HSS program?

It’s very useful to think about how your work can be talked about beyond your subfield.

When I was applying for the Robert Wood Johnson Foundation fellowship, one thing I really liked was the emphasis on knowledge exchange, on making your research relevant for policy or for people beyond the ivory tower. Then, when I was selected for an interview at Wisconsin, I did some research on that particular site. I noticed that it was ingrained in the program, that it was something we were required to do. I really appreciated that because had it not been mandatory, I probably wouldn’t have done it. I do think it’s very useful to think about how your work can be talked about beyond your subfield. It forces you to learn how to use more general language, to use more layman’s terms, when you talk about your research, whether you’re interacting with the media or policymakers.

Did you have any worries before embarking on a knowledge exchange project?

I think typically sociologists who are solely academics don’t engage in the community as much, unless they do community-based participatory research, but that’s rare. I wasn’t worried about whether other people would view me as less of a scientist, but I was concerned that if the project became too big it might take away from the time I needed to focus on publishing or getting a new research project started. I spoke candidly with the directors of the program and said, “I want to do something meaningful, but I can’t do something where I’m at the state legislature 20 hours a week.” They said, “This is really about what you can gain from it and what you think would be useful for you at this point in your career. So we would probably advise against you doing anything that involves 20 hours a week of work just on the knowledge exchange.” After I spoke with them and they made clear it was very flexible and about what I thought would be useful at this point in my career, I felt good about it.

How did you prepare for it?

Knowledge exchange can be so many things, and it can look so many ways. I had imagined I needed to testify in some state legislature meeting that’s super important. But it doesn’t have to look that way.

We had some readings on knowledge exchange, and then Dave Kindig gave an hour-and-a-half seminar explaining what it is. It can be so many things, and it can look so many ways. That provided a sense of relief for me because I had imagined I needed to testify in some state legislature meeting that’s super important. But it doesn’t have to look that way. You can give a presentation at a local health community meeting. I thought, “Ok, I can actually do that.”

What kind of knowledge exchange project are you working on now?

My knowledge exchange project is very exploratory. It will be a continuation of what I started this year.

I was trained in the sociology of mental health and illness and quantitative methods, and I did some qualitative interviewing when I was a research assistant. But besides that, my training didn’t include interacting with media or figuring out how health disparities play out on the ground or at the community level. So I decided to focus on the city of Madison and Dane County and try to understand how communities and government respond to or are trying to address racial disparities there.

I got motivated to do the project because there was a report that came out in late 2013 (I came to Madison in Fall 2014) called the Race to Equity report. It talked about black/white disparities across the board in Madison and Dane County. It focused on the criminal justice system, education, health, a number of indicators, and there was always a disparity between blacks and whites, perhaps as we would expect. But because Madison is advertised nationally as this great place to live and the quality of life is really great there, I was stunned. Also it was surprising because there is such a small black population in Madison. It’s less than 8% of the population. That really struck me, so I wanted to further investigate why that was just being brought to the forefront and what communities were doing to respond.

It increased my confidence in speaking to people who weren’t necessarily in my specific subfield, even speaking to people who aren’t necessarily academics but who really care about health.

I started with that report, and I got in touch with Karen Timberlake [director of the Population Health Institute at UW-Madison], and she was able to connect me with the authors of the Race to Equity report.

What happened next?

After meeting with the authors of the report, it seemed like every time I met with someone they connected me with someone else. So I went on a series of interviews with different folks. It increased my confidence in speaking to people who weren’t necessarily in my specific subfield, even speaking to people who aren’t necessarily academics but who really care about health. That was challenging, but fun as well.

Steph, John, and Dave [the HSS site directors] also connected me with some people who worked with the State Department of Health Services (DHS), which is in Madison. It’s nice that Madison is the state capital—I can actually see what’s happening with state legislation 5 minutes from my house. So I talked with some people in DHS, and they were really helpful in terms of telling me about specific programs. They were also really honest about it being hard to address disparities and feeling like you’re actually making a change when sometimes the stats don’t move.

Who did you meet during the exchange?

I spoke with a gentleman who was a doctor, a pediatrician by training. He was the Chief Medical Officer at the DHS, but he also has a Masters in Public Health, so he told me, “I understand that the social determinants of health are real, but I have to try to convince other people of that because in the medical community it’s all about healthcare access and treatment.” But he understands that social determinants of health matter. I think it’s really nice that someone like him would have such an influence in the DHS at the state level. The social determinants of health may not have even been on the table had he not been in that leadership role.

I was quite intimidated at first to meet with him because he was a medical doctor, and I feel like there’s this hierarchy, whether you say it or not. It’s kind of subconscious: “I’m a PhD, but he’s a medical doctor, so I don’t know how he’s going to feel about what I’m bringing to the table.” He was warm and open and receptive to the things that I had to say.

I also talked to someone who was a community coordinator for the County Health Rankings program in Wisconsin. This person works with communities to help them utilize those rankings to get resources that will help address some of the health issues. And then I talked to a woman who runs a black women’s wellness group and an annual conference in Madison. And I spoke with someone who works at the Goodman Community Center on the east side of Madison. She talked about how they’re addressing health issues.

Was it hard to get meetings with all these people?

Everyone that I approached was pretty welcoming. I think because the directors of the program knew some of the people or I got a connection from a previous interview, once I mentioned that person and said, “This is what I’m doing, this is a little bit about me,” I appeared to be legitimate. It was interesting how it was so much easier to access these people than I expected. I expected a lot of rejection, and maybe in a different context I would have experienced that. But there was none of the pretense about if my intentions were pure. Everyone just took what I said at face value. And my intentions are pure! Surprisingly, I haven’t had any issues accessing people, even people at the DHS.

What comes next?

This year I was talking to people all over the place. My plan next year is to really focus on one organization or entity and figure out how they think about health disparities, how they’re addressing it, and how it may be similar or different than what I’m doing. Maybe I’ll actually have something to contribute, even though I feel a little reluctant about that.

I was attracted to the black women’s wellness organization because it focuses on a population that I’m a part of and that I also study. But I don’t know if I’ll actually work with that organization because it seems like they do something once a year, a big conference, and that’s sort of the main focus. I will attend that conference this fall because it happens every September, but I don’t know if I could do something outside of just going.

I need to figure out where my skills would best be put to use. One thing that I haven’t done yet that I feel like I really want to do is be in the community or interact with the people whose health we’re trying to improve. I still haven’t gotten that close to what disparities look like on the ground. I still feel like I’m a few steps away from being with the population or doing something that would directly impact them.

What has been the most challenging part of the knowledge exchange so far?

When you describe the results of a study, you may talk about a specific statistic and effect sizes, but really people want to know what the bottom line is. What did you do, and what did you find, and what are the implications for the community or for whatever population that you’re studying?

Putting yourself out there. In general, I have a difficult time approaching people who I feel are unapproachable. And that is heightened when you are moving beyond the ivory tower. It’s one thing to approach that distinguished researcher in your field at one of your academic conferences. That’s already scary enough! It’s even scarier to say, “Oh, I’m going to go talk to this person who does health policy work outside of the university and this person who is organizing in the community.” That’s intimidating. At least it is for me. Even if I don’t end up doing everything I want to do with the knowledge exchange, it has made me more confident about speaking to people outside of the ivory tower.

What has been the best part of your experience so far?

Finding a way to talk about my work that isn’t so jargony. When you describe the results of a study, you may talk about a specific statistic and effect sizes, but really people want to know what the bottom line is. What did you do, and what did you find, and what are the implications for the community or for whatever population that you’re studying? I think it’s forced me to do that and do it better than I did before.

Do you think that knowledge exchange will continue to be a part of your work after you leave UW-Madison?

I’ll be starting a tenure track position in sociology at UNC–Charlotte. When I start that position, maybe not the first year, I definitely want to get involved in the local discussion about health and disparities and racial inequality. I will be more apt to do that now that I have more confidence in my abilities to speak with people in the community and talk to people who are developing the laws and policies that affect people in that particular context. It’s made me more confident that I can do this in Charlotte when I move there.

What kind of scholars do you think can benefit from engaging in knowledge exchange projects?

I think it could be beneficial for everyone. People may have different levels of engagement with it. There are some people who are interested in doing knowledge exchange where they’re out in the community or out in the policy world, and then there are people who try to incorporate it occasionally or may go and give a presentation every now and then.

Another concern is that as junior faculty, or future junior faculty, we do have to be aware of how we’re being evaluated in terms of tenure requirements. If there’s more of an emphasis on research and teaching than service or knowledge exchange, then you may have to balance your time accordingly. I think it would be beneficial for everyone, but I wouldn’t say everyone has to engage with it at the same level.