Transcription of Deborah A. Deatrick for the show Caring for Community, #81
Lisa: When life and work intersect, I believe there’s one way we can get with the greatest amount of energy behind our efforts in this world. Deb Deatrick is an example of how my life and my work intersect. Deb and I are good friends and also have worked together, worked together for more than a decade in fact at MaineHealth. Debra is the Senior Vice President of Community Health at MaineHealth and also a founding member of the Maine Public Health Association. How are you?
Deborah: I’m great. How are you?
Lisa: Very good. You are actually one of the people who got me into public health. I remember as a young resident in Family Medicine, I’m in Medical Center coming to talk to you. You have this thing called an MPH which at that time wasn’t really a degree that a lot of people were thinking about, at least not doctors, at that time. Why did you decide to go into public health?
Deborah: I think because I wanted to make a difference. Before I went into public health, I had a totally different career that just wasn’t as satisfying from perspective of important social issues. I was always very active on political issues in college, even in high school. Public health just interested me. I thought about medicine for a while but it seemed too focused. I wanted to work on a grander scale I think. I was very interested in the big issues, helping people get healthier.
Lisa: Arguably, you’re not from Maine?
Deborah: I’m not from Maine. I am from away, I’m actually from Michigan and grew up there as the daughter of a pediatrician, moved to Houston after graduate school. I was there for a couple of years and had an opportunity to move to Maine, a place that I had been exactly for one day before. I got a job offer to come here. The one day I had been here, I thought it was the most beautiful place in the world. I have never been in a place that was more beautiful than this than I thought. If I had the chance to live there someday, I would take it in a minute. I actually got a job offer and moved here in 1980, long time ago.
Lisa: Actually, that was three years after I moved here in ’77. It feels like it was just yesterday. Now, you’re raising your son.
Deborah: Yup. I have a 15-year-old son who is adopted. He is in high school now obviously. It’s a great place, obviously, to raise a family and just to live.
Lisa: What was your career path before you went into public health?
Deborah: Actually, I was in advertising. I was an art director. I have spent many years as a professional illustrator. I thought about going into medical illustration. Actually got into one of the two programs at that time at the University of Michigan and then decided that that just wasn’t for me. It wasn’t working on that grand scale. I envisioned my life sitting over a board illustrating hearts, and lungs, and sort of thing. It just didn’t have quite the appeal the public health had.
Lisa: It looks to me as though some of this work that you did in advertising and also with visual arts could have an impact on your ability to communicate effectively some of the public health messages that you have approached in the last few decades.
Deborah: That is hitting the nail on the head. That’s precisely why I went into public health because I think there are ways of communicating with people that are better than others. I think having a sense of how you message, how you approach people, even what kinds of images and approaches that you take are really, really important. A lot of the work that I have done over the years has really been to try to combine all of these elements both visual, sort of thematic elements, engaging messages, etc., to move health behavior often times at an individual level or at a community level.
Lisa: We’ve talked about public health before with some of our other guess but for people who are listening who may not be familiar with the idea of public health, can you describe it for us?
Deborah: The best that describe public health is a little story that I actually heard in graduate school. It goes like this, there once was a river, a very busy river with a lot of rocks and torrents etc. There are a lot of people in the river who are drowning, thrashing about, just were being carried down the river and couldn’t seem to save themselves. The ambulances came, the doctors came, the nurses came to the bottom of the river and they were incredibly busy trying to pull people out. A lot of people died. Some people were pulled out and resuscitated on the shore. The point of the story is that they were so busy pulling people out of the river, they never had time to go upstream to see who was putting them in in the first place.
In public health, it’s all about going upstream. It’s all about making sure that people don’t fall into that river. That they have medical care, they have primary care, they have ways of taking care of themselves and their families, they have clean air, clean water, good education, etc., immunizations, all the things that prevent people from getting into that river in the first place.
Lisa: My experience with public health is that it can be somewhat thankless at times because we have right now such a financially driven and probably always have to some extent, financially-driven healthcare system and people will say, when you know that if you can prevent a second heart attack, you’re going to save X dollars. Sometimes it can be difficult to quantify the upstream medicine. What are your thoughts on that?
Deborah: It can be. There’s no doubt about that. But we do know that prevention works. There have been lots and lots of studies that document if you stop smoking you’re going to live a longer life. If you eat a better diet, you’re going to be healthier and hopefully have less chronic disease etc. but what happens is that public health, I think one of the problems here, is that public health is largely invisible to most people. You go to your faucet in the morning, you turn on the tap, you get a glass of water and you just think that that water is going to be free from carcinogens, is going to be, you can drink it. It’s going to be safe. When you go to a supermarket, and you buy fruits and vegetables, or food, you think that that food is going to be safe and somebody has inspected it.
Those are the kinds of things, frankly, that public health does. We do things that keep people safe, that protect people, etc., but it is largely invisible. The extent of which people want to pay for those kinds of things I think is diminished.
Lisa: In such a sense right now, we seem to be a sort of an employer insurance payment situation. If you have an employee who may or may not be with you for a very long time, it’s possible you don’t want to pay for things that are going to happen once they stopped working for you. How do you approach that issue?
Deborah: I think for all of us, we need to work together and agree upon the things that really do keep people healthy. Employers for the most part, I think, now agree that things like helping their employees stop smoking or to exercise on a regular basis is actually a good thing for society in addition to their own employees. Many more employers are investing in these kinds of things. If you work for one company and you go to work for another company, those kinds of things are still going to be available to the vast majority of the population. It’s also one of the reasons that we need to invest in public policies that can help everyone.
Things like smoking bans. Things like efforts to keep the air clean or the water clean etc. Everyone needs to invest in those. They float everyone’s boat so to speak and keep everyone healthy. It’s one of the reasons that in public health, we work at a policy level, we work in an individual level, and we work at a community level. All those things really have to be knitted together.
Lisa: What are some of the initiatives that you’ve been involved in through MaineHealth or through some of the work that you’ve done and other public health spheres in Maine?
Deborah: The two big ones and the two big predictors of whether or not we’re going to be sick or have chronic disease etc. are tobacco and obesity. Those are the two areas that I think everyone agrees. We do have problems here in Maine with both of these issues. We’ve done a lot of work on both of them but we have a long way to go. If we can stop people from smoking in the first place, we know they’re going to live healthier lives. Certainly for someone who does smoke, helping them to quit and giving them the tools and the resources they need to do that is incredibly important.
On the obesity side, I think we’ve learned that it’s not just about obesity and overweight. It’s really about healthy eating and active living. Eating a healthy diet and getting enough exercise. Again, there is a lot of resource on both of these issues. There’s no question that they both have a lot to do with our overall health. One of the other things that I often talk about frankly in addition to these issues that are everybody knows are related to health are issues that may not be quite so apparent but have a lot to do with how healthy we are. Those are things like poverty and education. Those are the two strongest predictors of how healthy we are going to be.
Whether we have a job, whether we have sufficient income, and also to a certain, to a large extent, how much education we have, people who finished high school are much likely to be healthier than people who have only finished sixth grade. People who live below the poverty line are much likely, more likely, to be unhealthy than people who have, who live, who have a living wage. All of these things are important predictors of health. In public health, we have a very, very broad view of what it takes to be healthy. It’s not just about doctors and hospitals although that’s really important to have a place to go when we’re sick. It’s also about our behavior whether we smoke or whether we eat junk food or fresh fruits and vegetables and also continuing education and supporting that and also supporting programs that can help those people out of poverty.
Lisa: When you and I met not so long ago, you are telling me an interesting and startling statistic about the number of children that now are throwing within the Maine Care system and how that’s risen over the last few years. Talk to me about that.
Deborah: It is a real statistic. It’s a very troubling statistic. We are, we, being MaineHealth are doing a lot in the area of early childhood health education etc. as our many other organization around the state. These are children or kids between the ages of birth and five. Last year, 2012 in Maine, almost three-quarters of children in that age range between birth and five were enrolled in the Maine Care Program which is a very, in my view, startling statistic as you just mentioned. Basically, it says that these are kids who are living in low-income households who may not have access to healthy food, who may not have access to clean air, who may have not access to all of the things that are needed to create healthy kids and kids who are ready to go to kindergarten etc.
It’s one of the reasons that there is now a lot of focus here in Maine on that particular age group in providing child care, high-quality child care to kids, in providing oral health education, and providing health education, making sure the kids get a healthy diet, have clean water to drink etc.
Lisa: In Maine, we have an issue with access to dental care. From The First Tooth is a program that MaineHealth has gotten behind to address that issue from early on. Why does it matter that we have good dental care from our earliest years?
Deborah: The simple answer for that question is that baby teeth are taking the place of permanent teeth. It’s really important for parents and even small children to learn how to take care of their baby teeth because they’re place holders for those permanent teeth. Decay, abscesses, other problems, can really affect oral health in later years not only as kids but as adults. It’s really important to prevent, again, going upstream, that concept, baby teeth from the time a child has his or her first tooth. This is another initiative where a very forward-thinking foundation came to us and said we know this is a huge problem in the state of Maine and we’d like to do something about it.
Several years ago, a program was developed that is now called, From The First Tooth which is really about taking your child again to that well-child visit at your doctor’s office. The doctor, or the nurse, or another person on the team will look at the child’s teeth very quickly and no pain, no instruments being used, and then apply something called a fluoride varnish to the child’s teeth which really does a very thin protective coating of fluoride. It’s colorless, it’s odorless, it doesn’t hurt the child, but it puts a protective shield around that child’s teeth whether it’s one tooth or more baby teeth.
That fluoride application will actually protect the child’s tooth for many months. The ideal is to have two of those fluoride applications every year during a well-child visit or other visit to the child’s physician. Again, we also recommend a child see a dentist hopefully by age one if that’s possible but as you just mentioned, Dr. Lisa, in some areas of the state, we don’t have dentists who are able to see, first of all, we may not have dentists at all in certain areas of the state. Secondly, not all dentists will see children at the age of one or even two. This is a compromise. We’re trying to provide some protection for these child’s teeth, for these children so that when they do get to their first dental visit, they don’t have decay and they don’t have dental problems.
Lisa: You’ve also worked with an organization that is associated with Maine but does work outside of Maine called Konbit Sante. What’s that all about and why?
Lisa: Great question, Konbit Sante …
Deborah: I’m sorry, Sante.
Lisa: … is an amazing organization headed by an amazing person, Dr. Nate Nickerson. The focus of Konbit Sante is to help rebuild and strengthen the healthcare system in Northern Haiti, in particular, in a community called Cap Haitien. Many people from Maine and actually other parts of the country, physicians, nurses, not only healthcare workers but other to volunteer their time to go to Cap as it’s referred to and actually teach some of the physicians, the nurses, the people who work in the public health system there.
The public health system in Haiti is run by the government and there is a public hospital in Cap Haitien where many of the folks from here go to work for a period of time. I’ve had the honor of going to Cap on a couple of occasions. It’s quite an amazing place. The people who are working in the healthcare system there are incredibly committed, working under the most challenging conditions that you could ever imagine. It’s quite an organization and I would certainly commend all of your listeners that there’s a website www.konbitsante.org to hear and see more about it. It’s a fantastic investment. Again, in global health in one of the most impoverished nations in the world.
Lisa: Why did people from Maine decide that they cared about people from Haiti?
Deborah: I think there’s some affinity. Maine is a very poor rural state. We have limited access to resources. Until the last several years, we haven’t had a public health school here. We do now have two public health programs in Maine. I think there was a recognition that, by the way, there were some individuals here going back many years, Dr. Mike Taylor being one of those who got connected to Cap and some of the folks there. That has been built upon over the years. Now, there ‘s a very strong relationship. Many physicians here travel to Cap maybe a couple of times of year engaged in projects etc. It has simply built up, there’s a relationship between the city of Portland and Cap Haitien. I think a recognition to that, we need to lift ourselves out of poverty that no one is going to do that for us.
Lisa: How can people find out about the work that MaineHealth is doing in the area of community health?
Deborah: Probably, the best thing is to go to our website, www.mainehealth.org. There is information and link to the Raising Readers Program, the From The First Tooth Program and our work in tobacco which again, focuses on helping people to quit smoking for the most part and obesity. Actually each of these initiatives have their own websites. I don’t know if you want me to go through all of those but one of the programs that we’ve talked about a little bit before on obesity prevention that really going upstream is called Let’s Go, that also has its own website at www.letsgo.org. The now famous 5-2-1-0 mantra and you’ll find lots more information there.
Lisa: For our listeners who are with us in a regular basis, our interview with Dr. Michael Dedekian actually is all about Let’s Go. You can go back to the Podcast on iTunes and listen to that show if you haven’t had the chance. I really want to thank you for, first of all for being my friend, for inspiring me to go into public health and for being a mentor when I worked at MaineHealth for all those years but also for the work that you’ve done for the state of Maine over the last there I say, decades.
Deborah: Decades, with an S. That would be appropriate.
Lisa: Most recently as the Senior Vice President of Community Health at MaineHealth. Thank you for joining us today.
Deborah: Thank you Dr. Lisa, and I will say that you too have been an inspiration just in terms of your career over the years becoming a much more highly-skilled communicator about health and medical issues. Kudos to you.