Asomugha: Time For A “Change Of Thinking” On Health

Chisara Asomugha, the city’s community services administrator, recently sat down for an interview with D. Shahid Abdul-Karim of the Muslim Journal and the Muhammad Islamic Center on Dixwell Avenue. The following article was originally written for the Journal.

During the days of debate over President Barack Obama’s health care reform initiatives, one underlying question continued to surface: Is health care a human right? Is it only determined by what money can buy?

Should poor children be put on a more level playing field, where at least they can see the doctor and receive medical attention and even afford to go further than their parents in attaining optimal health? Certainly, good health plays an important role in learning, performing, and getting ahead in life.

One of the most significant people in the New Haven area when it comes to health and well-being is Dr. Chisara N. Asomugha, community services administrator for New Haven, who oversees the health department along with other social-service agencies in city government. In a casual setting, she gives enlightenment and shape to critical questions affecting people today.

In conversation Dr. Chisara (whose family hails from Nigeria) causes the listener to think on health care with more deliberation and reverence for what such care really means.

MJ: Dr. Chisara, in regards to health, what are some of the critical health concerns that effect New Haven and its residents?

DR. CHISARA: Well, I think it would depend on the way you would define health and the concerns. We can look at it from a disease process and say the things that are definitely impacting the citizens in New Haven would be asthma, obesity and chronic diseases associated with obesity such as diabetes and stroke.  Many of the health problems we are seeing today stem from obesity.

But then there’s another way of looking at health—through a much broader lens.  One that requires you to look at societal factors that impact health.  What some may call “the societal determinants of health.”  These would include things like transportation and education, economic security, the built environment (like sidewalks) and public safety.  They all impact health.

So, then when you ask the question about health concerns, its not just the disease processes that people are experiencing or the individual responsibility one has in ensuring their health.  Rather, it is about the environment and policies that either support or hinder health.  Are there safe streets to bike in, parks to play in, convenience stores that sell healthy foods? 

MJ: Since your new role as deputy mayor for community services for the City of New Haven, what have you learned the most since you’ve taken this position? And what has been the most challenging for you?

DR. CHISARA:  Actually, it’s one in the same. It’s that things take time. I am used to being in an environment where you see patients rather quickly. You have to see them in a 15-minute period. Be able to see the problem, look at the person, talk to them, find out what the issues are, diagnose the problem and treat them within a span of 15 minutes.  Sometimes 30 if the patient has complex health issues. 

In government or in policy work, it’s more like you see the problem, get the players at the table who might be able to address the problem, and that takes a little bit longer.  Both in process and in achieving outcomes.  Especially, if you are working to modify a system or create a system that has not been in place before.  It can be a month, or two months, 10 years, 20 years…. So in a sense, what I’ve learned the most is that things take time. What’s been the biggest challenge is that things take time. Because you know what you want to see happen and it takes time for that to happen.
MJ: What’s your view on the recent health care reform that President Obama and the U.S. Congress passed?

DR. CHISARA: On the health care reform bill? So on the health care reform bill, I will say this: The bulk of the legislation is about health care financing, essentially insurance coverage. You could say a good portion of the bill really addresses some of those issues that many people have had to deal with regarding pre-existing conditions, coverage for older kids… having an insurance company tell you, “I’m sorry, we’re not going to put you on our insurance roll.  But here’s your state option!”—which costs three times as much money for less coverage.

So in that sense, the health care reform bill addresses a lot of those issues.

But here’s the real issue.  What health care reform Is really about is changing our mindset about health and how we discuss it. For instance, like I was saying before you talked about health in terms of the clinical setting or the medical setting, somebody might think of stethoscope, listening to your heart, making sure your body is healthy and that your body parts are working.  But not everyone’s really looking at how environment and policy can actually impacting your health. 

Not everyone’s asking who are the key players, the folks who haven’t traditionally been at the table to discuss health—like the business community, education systems, transportation, those things that I mentioned earlier. There wasn’t much talk about that before from the federal government.  Now, however, if you read through the bill you’ll find a section that discusses the Interagency Council on Health and then another council that was focusing on public health and prevention that brings many of these key players to the table.

That’s where you begin to see a glimmer of true health reform, which is a change of thinking that redefines how we talk about health and who talks about health. It’s not just insurance companies, not just the doctors and hospitals and nurses, but really the environment and how agriculture, the labor, commerce, all of these people together can work with those who are in health care to actually, really reform it.

That’s my impression. I don’t know if folks will agree but hey….

MJ: So how do you propose to, in your new role, help rid youth of violence, incarceration, homelessness, which has risen in New Haven? And the second part of that question is: Does racism or politics play a major role in that?

DR. CHISARA: In terms of the first question, that’s a tall order to address: Youth violence, reentry, recidivism, incarceration and homelessness, and one that can’t be done alone. I think the best way to do that is to take a preventive stance. So when it comes to youth violence, we did a research study actually, while I was at Yale, talking to at-risk kids about why is there gun violence in the community.

Some of these kids have been very involved in that sort of climate and others on the periphery. What you found was that family was important, feeling of community was important, or connectedness to your community, whether it’s the civic community or your schools, your families, or just simply your physical neighborhood.

Kids were feeling isolated, feeling disenfranchised or feeling like their only option “out of” their circumstance was engaging in deviant behavior.  Like there were no other options in their mind. So how would you address that?

Well you tackle the education issue; you tackle that issue of connectedness, develop better mentor relationships and have better role models. People who feel that they can stand in the gap for some of these kids are actually doing it. That’s one way of handling it.

With reentry, how we’re doing it in the city is we’ve developed a reentry initiative. You will see coming through my office at least 10 people everyday looking for our prison or reentry coordinator to say, “You know what? I just came out of prison, and I want to do something with my life that’s positive. I don’t want to be out there on the streets engaging in the kind of behavior that put me into prison in the first place.”  What we’ve done in the city is to say how can we coordinate all the resources that we know that exist and help them re-navigate the system and actually enter into society positively. Now there are a lot more partners who can help with this; it’s not just the city that has to deal with that.

I mean the state, community partners, stakeholders, have to embrace those who want to make a positive change, people using the resources of the reentry program to better themselves as a part of the community not a deviation from it.

Then the second part of your question? [Does racism and/or politics play a major role in those objectives?] Racism, in so much as an individual experiences it, can play a role in many societal problems.  And as with other negative influences can impact the ability to achieve the objectives you set forth.  Those definitely exist. You cannot live in this society and not acknowledge or be sensitive to those facts.

You ask whether politics can play a role into whether there is youth violence or not. Let me define what I mean by politics. Politics is all about relationships. So, the relationships that you have with individuals, whether you’re in a government environment or non-government environment, there’s a degree of politics.

So who you develop relationships with can definitely influence the outcome of any particular issue on the table. Whether it is youth violence or it is having a new bank open up in your city, it’s all about relationships. It’s the same thing when you’re talking about racism or sexism; its relationships.

How one perceives themselves being viewed by the other and how that other is viewing them. Those definitely play a role in outcomes. And what you try to do is mitigate some of that.

MJ: We were talking about the incarceration, youth violence, etc…, homelessness. What are some of the departments that you oversee?

DR. CHISARA:  So, there are three departments I oversee – the Youth Department, Elderly Services Department and the Health Department.  Essentially think of us as the “health and human services” arm of the administration.  We also oversee SAGA Support, which is like welfare. So those people who qualify for welfare in the state of Connecticut, that live in the city of New Haven and are single adults, resources are out there to navigate the system and put themselves back on track economically.

We also address homelessness and support the work of the Early Childhood Council, The Teen Pregnancy Prevention Council –all started by the mayor—and the Street Outreach Worker Program which addresses youth violence and is more like a violence interrupter program overseen by our Youth Department. 

[From the Government Community Services website, these services also are provided: Elderly services, Children and Families Services, the New Haven Child Development, and other Youth Services, along with the Office of Substance Abuse and Prevention and Services to the Homeless.]

MJ: How are you all funded, being that the city doesn’t have that much money for these types of programs?

DR. CHISARA: Many of our funds come from grants, whether it’s a foundation or private entity. State aid is also a huge resource for the city. Then there are federal grants as well.

For instance, in the health department, the majority of our funding is through grants from the State, Federal government and Foundations.

MJ: You talked about the broader social disparities and leading to the education cepartment. In your department, how would you all work toward closing those gaps with wealth and education in particular?

DR. CHISARA: That’s a fantastic question! And actually something we are embarking on right now. I think what is unique for the city of New Haven is that you have a physician who understands the social determinants sitting at the table and beginning to engage not only city departments but community members and say how are we going to frame what we do in the context of health?  Even more important is that you have government officials who are also saying how can we look at what we do from a health standpoint and access whether we are promoting or prohibiting healthy outcomes.

So it’s no longer that you know transportation can build a street, but is that street safe? Does it have bike lanes? This is what the city has already been doing but it’s now like you’re starting to see it come together. People are starting to think, “Hum, that does impact health.”

The fact that we have trucks going up and down I-95 in the City of New Haven, that impacts health. What are we going to do about it? So in one sense, we should capitalize on this uniqueness.

The second things is we’re going through a process where we’re looking at the goals and programs that we do and we’re saying, “Does it line up with the outcome we want to see in the city of New Haven?”

So if we’re saying that we want every kid in the city to be able to graduate from high school, go on to college and be productive citizens in the world, then what are we doing in each of our departments to make sure that happens?

We’re lining up our activities with the outcomes that we want to see. Not just to do for the sake of doing but to be purposefully deliberate. We’ve been sitting down and aggressively looking at what is it that we have been doing, what is it that we need to do, so that we can see the change that we’re looking for.

MJ:  So, what drew you to New Haven? We know you did a fellowship a couple of years ago. Was it the actual city? Or was it Yale that drew you to New Haven?

DR. CHISARA: Yale drew me to New Haven, yes. I had applied for a fellowship and it was in Los Angeles, Philadelphia, New Haven, which is Yale, and then Michigan. Michigan was just too cold for me.

But Yale’s program and the fact that it was on the East Coast and close to D.C, which is a city I like and I have a lot of family and friends there, I said, “OK, let me come into New Haven then.” So it worked out. The reason I stayed? Because it worked out. A door opened, so I said, “Let me try this.” And I did.

MJ: Do you feel optimistic about the role you’re taking?

DR. CHISARA: In what sense?

MJ: The overall sense. Those things in which you’re responsible for?

DR. CHISARA: Oh, yeah. Absolutely. Although, I don’t know if I would call it optimistic. I’d call it excited and expectant…but I recognize the challenges.  I’m glad though that I tend to look at challenges as opportunities! And New Haven is going to get a lot done! 

With the economy as it is right now, this is an opportunity to reflect and look at what are we doing. And how do we want to set ourselves up, so that five years from now, our kids are okay! 10 years from now, our grand kids are okay.

You know, that kind of thing. What kind of environment do we want to live in? And sometimes crisis allows you to do that. Maybe that is optimism.

MJ: Another thing we want to look at is housing in New Haven. There have been some concerns about housing and the particular housing discrimination. Can you define what housing discrimination is? And how will your department(s) get rid of that as well?

DR. CHISARA:  My department actually doesn’t deal with “housing” per se so I’d be remiss to define housing discrimination outside of what the experts might say. The New Haven Housing Authority deals with housing in a sense like Section 8 vouchers, affordable housing and that kind of thing.

What my department does is provide contracts for homeless shelters so that they can provide space for those who are homeless and receive case management services where possible. But in terms of housing and actual stock, that’s not in our purview. Although, I do think it’s important to keep it on the radar.

MJ: There’s been some controversy about the New Haven Elm City Resident Card (???) Can you give us some good information about that?

DR. CHISARA: The Elm City Resident Card was created a couple of years ago to make sure that we could promote an environment of engagement and community interaction. And so coming into this several months ago, I looked at the card as an opportunity for people in the city who call themselves a New Haven resident to feel connected to the city.  Which, like I said before, is very important when thinking about health.

I think the research has definitely shown, especially in the young adolescent population and the young adult population, that if you don’t feel connected to your city, the outcomes for you are not as good than for those who do feel connected to your city. So I see the Elm City Resident Card and all of us on staff see it as a vehicle for promoting community engagement, community connectedness.

I’m a New Haven Resident, I’m proud to be a New Haven resident. Having the Elm City Resident Card, you know, you get your discounts at retail stores whether they’re health related or clothing retail or food places. And you also get discounts on city services like going to Lighthouse Park or with recycling.

So there’s not only civic benefit, because now you can engage the city a little bit more. But there’s economic incentive, because you’re getting discounts at places that you frequent. Over the next year or two, what we want to do is expand the card so that you can actually get some true health benefits on it.

So health incentives, think about it like if you go to the gym, you know 20 times maybe, you can get something for free. Like a free pair of shoes or something like that. Something that encourages healthy behavior. Also think about how this card could be used economically, so somebody could have a debit function on the card and be able to access resources that way.

I was saying with the young people, that when the young people have this they can access resources, like an after school programs.  For them it becomes, “I’ve got my Elm City Resident Card, I’m a New Haven resident, and I’m going to access this resource because it’s here!”

There are people who care! I feel welcomed! That kind of thing. So it facilitates that engagement piece that I think for a while people were missing.

MJ: So what was the controversy about?

DR. CHISARA: I think the controversy, and this is just going from reading the papers, seemed to be that folks had touted it as an immigration card for illegal aliens or pathway to citizen ship, which is not true.

Interestingly enough, to get the Elm City Resident Card, you need not only your proof of residence but you need a social security number and additional ID to get it. So you have to have documents to obtain it.  The purpose of the card is to promote engagement of ALL New Haven residents and to promote community connectedness.

MJ: Can you give our readers some background history about yourself?

DR. CHISARA: I grew up in Southern California, Los Angeles County. My family came here in the 1970s from Nigeria, and I’m the oldest of four. My parents instilled within us the importance of faith, family and education.  With those things, and of course love, you can do anything.  I’ve lived in many places across the country—including North Carolina where I received my medical degree (at Duke) and Master’s degree (UNC), Pittsburgh where I did my residency training and of course now New Haven.  During that time I joined the ministry and became an ordained minister of Bet HaShem YHWH in New Jersey.  So a lot of what I do has been informed by my experiences and the people and places that I have come to know along the way.  It’s been a lot of fun!

MJ: Thank you, Dr. Chisara, for your time and especially for sharing your knowledge and understanding

This interview was posted in Vol. 35, No. 47 issue of the Muslim Journal

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