Monica Valdes Lupi | Boston Public Health Commission

Neutralizing disparities in public health

Championing Equity in Boston

Leveling the playing field has always been a priority for Boston Public Health Commission (BPHC) Executive Director Monica Valdes Lupi and her colleague, BPHC Office of Health Equity Director Margaret Reid.

Margaret Reid (left) and Monica Valdes Lupi – Boston Public Health Commission (Photo by Ken Richardson)

Valdes Lupi is a first-generation immigrant; her parents moved from the Philippines to the United States when she was 3 years old. Growing up, her family was among just a few families of color living in a small town. Racism was a factor as her family met challenges accessing services and community resources, she recalls.

Reid comes to social justice from another angle. She spent much of her 20s and 30s working as a community labor organizer, mostly with low-wage women of color. Advocating for people who were living from paycheck to paycheck, she learned firsthand how important government services were to their survival.

“It’s an issue that can’t change for people without advocacy of some kind,” Reid says.

Developing Leaders

Advocacy is what a recent BPHC health initiative is all about. Earlier this decade, after an assessment revealed disparities in how health resources were being communicated and administered among different populations, Valdes Lupi, Reid and other BPHC leaders set out to rethink their approach and establish the department as the city’s health equity hub. They identified the need to change organizational practices to align better with racial justice values, engage other city departments in the cause and create new community advocates and organizers to ensure that health equity is key in all decisions, policies and programs.

The commission turned to The Kresge Foundation in 2017, receiving about $125,000 in grant funding through Kresge’s Emerging Leaders in Public Health (ELPH) later that year. ELPH is a leadership development initiative funded through the foundation’s Health Program that equips public health officers with knowledge and skills to lead in today’s changing health care environment. Through ELPH, Valdes Lupi and Reid spent 18 months working on projects designed to enhance organizational and leadership competencies in business, planning and public health systems development. Armed with additional skills and tools, Valdes Lupi and Reid set out to inspire trickle-down leadership by emphasizing narratives.

“In the past, we haven’t done a great job in describing the innovative work we’ve done and the resources we have,” Valdes Lupi says. “Being part of the ELPH cohort has helped me be more aware of how to tell stories about what we do, and how we do it in more effective ways.”

Advancing Health Equity

“Being part of the ELPH cohort has helped me be more aware of how to tell stories about what we do and how we do it in more effective ways.” —Monica Valdes Lupi, Boston Public Health Commission

With the rest of their colleagues at BPHC, Valdes Lupi and Reid created an interagency task force to promote health equity citywide.

To ensure that community voices were being heard, they created advisory boards that equally represented mothers receiving services and physicians administering them. They also redesigned the format for community dialogues they hold to present data differently. Instead of giving hard and fast numbers, they used the numbers to tell stories designed to keep constituents engaged.

In addition, at their prompting and at the behest of the BPHC, city transportation department crews shifted from prioritizing street repairs by the number of complaints to a more chronological approach.

“Data indicated that when (the city) got complaints, most of them came from wealthier, whiter neighborhoods,” Reid explains. “Now crews are responding on a need basis (regardless of who complains), which levels the playing field quite a bit.”

Engineering Change

The Boston Public Health Commission, under the direction of Margaret Reid and Valdes Lupi (pictured left top and bottom and on opposite page), is changing organizational practices to better align with racial justice values, involve other city departments and create new public health advocates at the community level. (All photos by Ken Richardson except for the third, which is iStock)

Valdes Lupi and Reid engineered other major changes.

Take procurement. Each year, the commission doles out approximately 1,000 contracts for services. In the past, there had been no mandate to prioritize awarding contracts to minority- or women-owned companies. Now BPHC is being joined by other agencies in pushing to source from a more diverse roster of companies.

Valdes Lupi and Reid also redesigned new public-facing messaging. BPHC’s “Moving Equity Forward Together” social media campaign featured print and online ads and banners, as well as a video series designed to demonstrate — rather than define — racial justice and health equity in public health practice.

“These are stories of amazing work that’s going on with job training for our homeless clients, with recovery programs (and) how recovery services need to look a little different for women (than they do) for men, with how we’re reaching other lingual communities,” Reid says.

And because Valdes Lupi and Reid participated in an ELPH cohort with public health organizations from around the country, including neighboring states such as New Hampshire and Rhode Island, they will continue to sharpen their approach as they turn to colleagues to share best practices and resources.

“The world of public health is always changing,” Valdes Lupi says. “When we’re having challenges, we can connect with like-minded people who may be trying things in different places — and learn.”

With the support of other Emerging Leaders in Public Health, county and local health departments can think beyond their traditional roles and transform public health in their community.

Kresge's take

Supporting Fearless and Bold Initiatives

Monica Valdes Lupi

An Interview with Monica Valdes Lupi

How can funders like Kresge support your leadership development?

Kresge plays an important role in leadership development and for me in particular because I've been able to have the time and space that I need to develop from being a leader that's focused on just the day-to-day transactions of our work here in public health to being more of a transformational leader. And that's where Kresge has been invaluable.

What advice do you have for up-and-coming leaders in your sector?

I think new staff, especially out of grad school expect, that on day one they're going to be working on developing policies and exciting new initiatives and programs, and what I've learned is these things take time. You must be resilient and a bit stubborn to be successful in governmental public health.

Can you share a time your leadership was tested and how you responded?

I met with Mayor Walsh about an initiative that had been led out of the public health commission that he wanted to completely transform, given feedback from the community. The Mayor basically asked me to blow up the program, take the funding and redistribute it. I had to think through how to do that, because there were definitely going to be losers.

So, I took that directive that the mayor tasked me with, went back to our community residents and also to our current grantees, brought them together, and what happened over the last three years was a complete turnaround of this program.

It's called our Neighborhood Trauma Team Network, and it's now one of the most successful programs that we've been able to implement with Mayor Walsh's leadership. We've redesigned the ways in which community-based partners work with our community health centers in the city to respond to the impact of community violence and provide long-term behavioral health supports that our residents need.

Kresge's Take

Supporting Fearless and Bold Initiatives

Unity. The notion of municipal departments working together is akin to the Holy Grail — every governing body aspires to it. It’s also what inspired leaders at The Kresge Foundation upon learning about the plans of the Boston Public Health Commission (BPHC) to embrace equity.

Boston leaders seek a more equitable health landscape. (iStock photo)

The commission sought to equalize disparities in public health by becoming Boston’s go-to source for health equity strategy. According to David Fukuzawa, managing director of Kresge’s Health Program, this is precisely the kind of tactical leadership that Kresge’s Emerging Leaders in Public Health (ELPH) initiative is designed to celebrate.

“No one entity or sector can address a public health problem, so the idea that public health can become a strategic force in bringing together multiple components of government is a really big deal,” he says. “The idea is to see public health play a more expansive role, and to have public health departments working with a host of other departments to, in a sense, take on the role of chief health strategist for an entire city or area.”

Phyllis Meadows, a Kresge senior fellow who has overseen ELPH from the outset, says public health equity issues are ubiquitous, so an effort to unify agencies to make programs more equitable seems fearless and bold.

Access to quality health services affects quality of life. (iStock photo)

Interdepartmental collaboration, renewed messaging about equity and raising awareness of fair treatment and racial justice in relation to housing are examples of true leadership, she says.

“This wasn’t lip service; they really wanted to build meaning around equity within their department and with other departments and focus on how the issue is seen by others across the city,” she says. “Putting this on people’s radar screens is not as easy as it sounds, and the work they accomplished (moved the agenda) in a big way.”