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environmental justice

LISTEN: Carlos Rodriguez-Diaz on infectious diseases and social justice

“We need to work on the pipeline of the future of public health in such a way that we are as diverse as the communities that we are meant to work with.”

Dr. Carlos Rodriguez-Diaz joins the Agents of Change in Environmental Justice podcast to talk about how we can learn from COVID-19 to make our infectious disease responses more effective and equitable.


Senior Agents of Change fellows Gavin Rienne, an epidemiology and biostatistics Ph.D. candidate at the University of Kentucky College of Public Health, and Lorraine Velez-Torres, a microbiology Ph.D. candidate at the University of Puerto Rico, also talk to Rodriguez-Diaz about why representation in academic research matters, the advantages of being a multicultural and bilingual researcher, capturing the diversity within Puerto Rico, and the power of identifying community strengths and public health interventions.

The Agents of Change in Environmental Justice podcast is a biweekly podcast featuring the stories and big ideas from past and present fellows, as well as others in the field. You can see all of the past episodes here.

Listen below to our discussion with Rodriguez-Diaz, and subscribe to the podcast at iTunes, Spotify, or Stitcher.

Transcript

Lorraine N. Vélez-Torres

So we are here with Dr. Carlos Rodriguez Diaz. He's an Associate Professor and Vice Chair at the George Washington University Milken Institute School of Public Health. He holds a master's in public health education from the University of Puerto Rico School of Public Health, a PhD degree in public health and community health promotion and education from Walden University College of Health Sciences, and a postdoctoral training in HIV and global health from the University of Puerto Rico School of Public Health. Dr. Rodriguez Diaz’s work has focused on infectious diseases, particularly HIV care and prevention, as well as sexual health promotion and health equity through actions on the social determinants of health. Dr. Rodriguez Diaz, thank you for being here with us. It's great to see you.

Carlos Rodriguez

Thank you. It is, it is my pleasure to be here with you today.

Lorraine N. Vélez-Torres

Thank you. So we wanted to start the conversation by getting to know more of your inspiration or motivation that had led you to be the community health scientist that you are today. Your work has focused on various topics about health equity and social determinants of health. And we wanted to know what made you research public health and from this perspective?

Carlos Rodriguez

Yeah, so well, as you shared in the introduction, I've had the privilege of having access to higher education, and to hone in my competencies and knowledge in areas that are dear to my heart personally and professionally. You know, my inspiration was primary care. Although I have to say that I had no idea I would not be able to work, I was not able to articulate that when I was in my teens and trying to figure it out what to do next, going to college. And, but my inspiration was a primary health care provider in my hometown of Aguas Buenas, Puerto Rico, a relatively small rural town in in the center of the island. And I knew the primary health care provider and she was very active in the community. She was a healthcare provider of almost everybody that I knew. And to me, that was a model of something that I wanted to do. So I thought, well, I will be a physician and I will do similar work. Through my experience in college, I went to college for chemistry. And I was doing a lot of wet lab work, learning a lot and very passionate about what, what I was doing. But I found a mentor who, in my senior year, advised me to I explore the health field in which I was planning to commit as a medical student. And so I did. And I went to the University of Michigan School of Public Health. And that was my introduction to public health. I went to a program on health policy and management, and got to work with a Latino serving organization in southeast Detroit. And everything changed for me after I met a community of Latinos in Detroit, Latinos that were working with their own community. And a significant portion of the work that this organization was doing was providing HIV services to the Latino community. So for me, I was, I was 20 years old. And it was also a very enlightening opportunity to see myself reflected in the community, as at that time, and still today, most of the HIV cases are reported among gay and bisexual men. And as a queer man, I, I could see myself in the populations that we were serving. And at the same time, I had the opportunity to reflect on how, what are the privileges and the opportunities that I had, that I was in my 20s, knowing very little about HIV, I was not living with HIV, and I was in this position that was a privilege, again, to provide services to the community. So at that point, I decided, you know what, this, this is what I thought, primary care, or that being the doctor in the, in the little town meant, but it's actually public health. So I'm going to do this. And later on in my career, as I had experiences working as a public health educator, I realized that I wanted to dismantle the structures of power and privilege that allow me to get higher education to live through life with, with, with, without the fears that so many people like me have to deal with. And that my colling was to be in academia, and do research with my communities, to work with communities, where that I could bring my, my knowledge and experiences and further benefit…that I could learn continuously from different communities, and also to support other Latinos, other queer people that wanted to join academia and work in the public health field. So that's, that's the long story short of my inspiration.

Gavin Rienne

So I hear that. I feel like everybody who gets into public health, we all have this, like, really circuitous route, right? None of us start because, I think, nobody really hears about public health or in my case, epidemiology first, right? I think we all hear like, I also wanted to be a doctor, I was in the US Navy. And I started responding to disasters in Asia. And so I did the same thing. I was like, well, if I want to do public health, I have to become a doctor. Because that's all I saw, I saw people doing that work who were doctors and I thought the same thing. Like I hadn't even heard terms like primary care and secondary care and tertiary care. And so, so I actually went to Michigan State for microbiology, and molecular genetics. And same thing, wet labs, all of that, and then switched over to a public health program in my master's, so I definitely resonate with that kind of, kind of oddly circuitous route to getting to this one space that really speaks to you.

Carlos Rodriguez

Well, I have to say that we are also now in a position that is very different from the exposure that we had to public health. Because now we're going to in the very near future, we're going to be working with people that has been inspired and know more about public health because we are working in a pandemic, right? We, that was not our experience. Some of us have worked in epidemics, emergencies or public health disasters, but not a pandemic. So nowadays, I think it's much, much more popular to know what public health is, perhaps what an epidemiologist is. And although we still have a lot of work and to communicate what we really do, and, and to communicate the work that we do, we certainly are in a different space. Plus we have these platforms to talk more about our experiences and making sure that others that were, that are, or will be in our positions in the very near future, get to hear the voices of others that are, that were in similar positions.

Gavin Rienne

So I guess, you mentioned growing up you had this role model, this woman who kind of really inspired you to go there, and that kind of leads to one of those conversations that we've kind of discussed in email prior, you know, what role just kind of seeing, like diversity in these spaces, you know, seeing somebody who looks like you, who reflects you both particularly in points of leadership, people who you professionally aspire to be, kind of, how did that play into or embolden you to seek those avenues as well?

Carlos Rodriguez

Oh, wow, so, you know, I think I have a, well my experience, everybody has a unique experience. Growing up in Puerto Rico, going to college in Puerto Rico. My challenge was not, not seeing other Puerto Ricans in academia, because academia in Puerto Rico is predominantly composed of Puerto Ricans. But it was for seeing people that were queer, that were interested in doing work from different perspective and challenging norms and systems. So not only being queer in terms of identity, but to do queer work. So that was a challenge for me. Fortunately, I was able to find people who brought that kind of either visibility or modeling, to me, mostly when I started doing work outside of Puerto Rico. And then now that I'm in, in the continental US, I experience these minoritized experience of being Latino. So I guess that now I experienced multiple minoritized identities that interplay in my role in academia. So for me, what that means is that I, I have had the opportunity to get where I am, because I've had mentors, and a support system that have allowed for that. Yes, I have done my part, but none of these components is enough, you know, I've had the whole network, that support growing in academia. So for me it comes with a lot of commitment and responsibility. Because unfortunately, we're still in this time of history, that we're still calling ‘the first person of so and so that is named to this position,’ ‘the first minority’ to do this. I mean, it's so unfortunate, but well, here we are. And we are changing that narrative. So I am committed to continue changing that narrative, to open doors, and to use the privilege of being a tenured faculty member, to bring others like me to academic spaces, and to leave doors open. So others can do better than I'm doing. And in the future, we will have other diversities that are still underrepresented in academia, that needs and will benefit of the work that we're doing now. Right? We are not, we don't talk much about abilities, and language, religion when it comes to diversity in academia. So I think that's the future that we are starting to work on now, even though we still have so much to do when it comes to the identities that we have mentioned.

Gavin Rienne

Definitely. And I know Lorraine, I don't think you and I have talked a lot about what your experience looks like as a woman of color, kind of navigating varying academic spaces. I know you do a lot of work in your country, but also kind of figuring out what that looks like if you want to move to the continent like, you know, if you want to move like California or somewhere, what does that transplant looks like? And how does that kind of compare to our kind of discussion that what we also know about Dr. Rodriguez’s experiences in his academic track and professional career.

Lorraine N. Vélez-Torres

Yes, thank you for the question. Definitely. I've, I've been trying to work on the visibility of women in science here in Puerto Rico, and getting more girls to know about science through different programs that we have in Puerto Rico with Sciencia Puerto Rico and by mentoring girls. But I haven't had the opportunity to go like to the United States to work there. Or go to a lab. I went to a research lab with Dr. Felix Rivera Mariani. It was like a one-week internship. And it was a great experience. But it was like he was part of the family. He's a fellow Puerto Rican scientist. But I haven't like had those struggles or faced those struggles yet. But let's see in in the future, I go to postdoc there.

Gavin Rienne

So then, kind of, out of, from my perspective. So, you know, I grew up, so I grew up kind of in California, a couple different places throughout the US and then served in the US military. But I grew up as a Black queer man in America, and like, you know, from California to Michigan, or whatever. But what is it like being American, being a person of color, and being Puerto Rican, where a lot of people don't realize, you know, a lot of you don't think of the connection between the two, right? A lot of people, you know, so when you come when you do research with other academics? You know, I know, I have heard language that, you know, kind of seems to demonstrate that people don't know, don't know about the connection, don't know, oh, wait, they these people are, they're here. They're part of they are just they're equal to everyone else, ignoring the political systemic issues and difficulty. So what has that been, like, from both of your perspectives, trying to again, navigate the mores and challenges of becoming professional scientists.

Lorraine N. Vélez-Torres

Yes, please. Dr. Rodriguez.

Carlos Rodriguez

So I think that the experiences have changed over time for me. When I was a student, I remember when I went to Michigan, I felt that I was not even ready to go, mostly because of language barriers. And then I realized, oh, we were ready, it's just that we do not use English in Puerto Rico on regular basis, because we don't need to. In terms of the academic work that we do constantly, we, we use English as a primary language. And still, you know, I felt that it was a challenge. And in the process of working with communities, I realized that it was an asset, the fact that I was bilingual. And I fortunately, also speak other languages. But I will only say that I'm bilingual, English and Spanish, because those are the languages that I dominate the most. But, but I found that it was kind of a blessing, that I could communicate with my communities in the language that they needed to receive information. When it comes with, to working with professionals, yes, you're right, I'm still sometimes, get the kind of surprised reaction of people about being Puerto Rican and being a US citizen. To me it’s happening less, it’s happening less and less, I think, mostly because of the work that I do. Like I have written papers, claiming colonialism as the structural determinant of health in Puerto Rico. So if somebody knows my work, probably have come across that paper. And so I get more questions that are informed by that work, still coming out of curiosity and not fully understanding the socio-political relationship between Puerto Rico and the United States. Now, that being said, I would like to also argue about the differences and the notion or understanding that we have to have about the heterogeneity, heterogeneity in the Latino communities in the United States, right? Because when we are in Puerto Rico, we do not use terms like Latinos or Hispanics to self-identify in the context of Puerto Rico because we are Puerto Rican, right? Those labels were created to categorize people in the continental US, right. So, but the minute we come to the United States, we are Latinos or Hispanics, right? However, we have a very different experience than other Latinos and Hispanics. So that, for me has been an extremely humbling and learning opportunity to work with my own Latino communities. Right now here in the Washington DC area, because most of the Latinos in the area and Latinas, Latinx, they have an experience of migration and mobility that is very different to mine. And, and I have been othered by Latinos. Yeah, yeah, sure, you're Latino, but you have all these privileges, right? The minute you moved here, you have a right to vote, you're a citizen, you're in academia, so you know, you're a somebody else. And initially, I was shocked and almost said, like, oh, this could be negative. But on the contrary, it adds value to the diversity within our community. I have learned a lot and it's also helpful to highlight diversity within our communities and how, by just capturing various, unspecific data about people, we are doing bad public health. And I hope that we get a minute to talk about the research I've been recently doing on Latinos and public health emergencies, because one of the big issues is how we are first of all collecting data among, among Latinos. And what do we do with that data? When really it doesn't mean a lot? So I hope that I answered your question.

Gavin Rienne

Yeah, you know, exactly where we're going, that really leads into that primary next question, which is, so, you know, myself, so right now, I'm working on children's mental health after a disaster. My current research project is on Hurricane Harvey. So I'm looking at children's mental health over time. And so what, you know, we have, of course, a diverse racial diversity and that, but one of the difficulties there, we, we know that cultural differences have major impact on how data is collected, how we understand, how we diagnose different, you know, different mental diagnosis and things like that. And so that really kind of leads into that question, how do you feel like researcher diversity and diversity of the people who are designing these experiments in these programs? How do you feel that impacts public health work, not even just, of course, research, but public health work as a whole?

Carlos Rodriguez

Yeah, so, you know, you don't have to be part of a community to be culturally competent or culturally appropriate, or have the cultural humility to do good public health work. Now, when you are part of the community, or have common experiences with the communities that you work with, you have a level of sensibility that you cannot learn in school that you cannot learn just, you know, from reading. So that's, that's an added value. And values are core to the approach that we decide to take on the work that we do in public health, particularly for those of us doing community health work and developing interventions. So I think that also speak of the unfortunate scenarios that we still have in communities where we, people who are diverse, period, are based on race, ethnicity, and in so many other areas are underrepresented in academia, and in public health leadership, including public health academia. So then, for those of us who have the experience, and are able to teach or bring students and mentees to the field, so they can also learn those experiences and learn how to work with communities, we have limited opportunities. So that's why we need to work on the pipeline of the future of public health in such a way that we are as diverse as the communities that we are meant to work with. And with this, I'm not saying that we need to close the doors to other people who are interested in the field. Everybody's welcome. But for so long, we have been teaching a public health that is for the majority were actually the public health we should be teaching is to work with the minorities, who are systematically affected by the actions and inactions that we take in public health.

Gavin Rienne

I agree, I think one thing that is often, I've given, you know, various talks to various groups and things like that, and one thing, especially when I'm speaking to, you know, largely Caucasian groups, you know, they're trying to understand why diversity matters, and why we really need to focus on disadvantaged groups. And, you know, I always try to really emphasize that it's about efficiency, right? If everyone does better, the entire community is improved. And I think that's something that's often overlooked, I think, both in kind of mainstream discussion, and then of course, in academia and academic research and figuring out who goes in leadership. You know, I think sometimes people think it's just some ethical and moral push. And it should be, of course, there is, you know, especially because we know that it's not because of inability, that these various groups and disadvantaged groups aren't there. It's because of intention. Its legislative intention, it’s, you know, systemic intention. But it's also because with more people at the table, who have the variety of views and things like that, it improves the quality of our work and the efficiency of our work and outreach effectiveness.

Carlos Rodriguez

Well, similarly as, as, the way we think of public health as an interdisciplinary science and we bring knowledge from different areas, experiences from different areas include, including cultural, linguistic, and other experiences are as valuable. So it would be ideal to have an overlap of those diverse identities and diverse competencies on the table.

Lorraine N. Vélez-Torres

Yeah, sorry, I agree with all of the key things you have mentioned. Previously, I work in, I did a master's in public health, but I was I currently work more in research at the lab in microbiology. But we had to go to the community to take the air samples. And, and that is critical, you know, to have the people that have a connection with the community, and to, told our, say our results to them, so they can use them for to better their health. And in that line, I wanted to know what, it's your current work, in what, what is the focus of your current work on health and racial disparities in the face of COVID-19? And what are some key findings or aspects of your work that you think that have been overlooked?

Carlos Rodriguez

Yeah, well, so I've been fortunate to dedicate most of my time in the, in the last few years to intervention development. So for public health intervention, so describing the problem, working with communities to identify strengths, and opportunities to intervene, to improve, or to enhance the ability to do something that is good for health. And if you were to ask me, in March 20—when is that the epidemic started, 2019? 2020. Yeah. So well, at the beginning of the pandemic, if you were to ask me, can you do some COVID related work, I would laugh and said, I have no idea of COVID virus, viruses, I don't know what's going on. But that changed very fast, mostly because well, first of all, it’s an infectious disease. Very different to other infectious diseases that I have studied. And what was very obvious for those of us that have done work with minority groups, and HIV, who, which is one of my areas of expertise, is that we were seeing just happening again, that it disproportionately affected populations by other social structural factors were being in the worst, were showing the worst outcomes early in the pandemic. So I was, I was invited by a colleague, who was at that time doing some very initial research on COVID in the Black and African American communities in the United States. And he said, listen, we have the data. Let's do some work with the Latino population, can you lead it? And I was like, you know, at that time, I was, you know, moving all my activities to my small apartment, shutting down the office, the teaching online, I was unable to collect data. I have projects in Puerto Rico, the team in Puerto Rico was in the same position, it was like, well, okay, so sure, let's take a look at the data. And then well, from there, it was an act of lot of passion. And it turned into a very important part of the work that I've been doing more recently, including the overlap with the intervention work that that I've been doing in other areas. And just to give you an example of work that I'm doing now, that is connected to COVID. I use data from the very first three months of the pandemic and we were able to identify the disparities of the pandemic, and particularly how Latino communities were being affected. And it was across the board. In communities where we had more Latinos, we had worse indicators in terms of COVID morbidity and mortality when compared to other groups. And we did a very elaborated analysis, we were able to identify even, you mentioned air quality, Lorraine. So we use EPA data and we identified that where we had poor air quality, and the community was predominantly Latino. We saw more cases of COVID and more mortality, right. Surprise to nobody who understand health disparities because we know that this is an issue of health, justice, of environmental justice, you know, many minoritized communities are in geographical spaces where the air pollution is high. So, but that was not necessarily part of the narrative on COVID, right? It's like, wait, you get COVID because the air quality is bad. No, that's not the message. It’s that it was affecting the morbidity and likelihood of mortality, because it's, it was part of the, the different elements that in this case, a social component that was affecting the COVID outcomes. So nowadays, I am doing work here in the Washington DC area, specifically with HIV services. Because as many other services, health services, the HIV services were disrupted during the pandemic. People having to take the medical visits or healthcare appointments with health care providers via Zoom, having a technology gap, not having internet, or what about the issues of mobility, privacy, all that. So currently, I am finishing the analysis of data that we collected from providers and consumers of HIV prevention and care services. And we are using implementation science frameworks to inform strengths and barriers that challenge the provision of HIV services during an early stage of the pandemic, with the idea that there are some changes that we can make right away, and will help during the current pandemic. But also thinking about the future, it's very unlikely that this is the last public health emergency that our generation will experience. So we need to learn from this experience, so we could be ready for the next. So that's the kind of work that we're doing. So we have, I am not reinventing HIV services, but I'm trying to provide information to strengthen or improve areas in which we were not ready to do what we needed to do, because we didn't have either the resources mechanisms or knowledge of what to do.

Gavin Rienne

Right. And that actually speaks to kind of our last topic. So, you know, months ago, when Lorraine and I were really kind of putting together what we wanted to do with you—one of my areas of work is green and urban infrastructure and public health, how do we use these moments to improve community health, and incorporating urban planning. And you know, in those, in those spaces, we talk about, you know, resiliency, and Lorraine was like, oh, I have this great resource, and he does not care for the term “resiliency.” And he has, he taught, he's talked extensively about the negative impact of that word. Now, as a person who has been doing, you know, a lot of work on public health and urban planning, I was like, that doesn't make sense, this is a really important word, because it's, you know, it's very common. It's such a common and important indicator when we're talking about how to improve that. And so I have since, of course, learned a bit more about your perspective, but I was hoping that you kind of take a little bit of time to expand upon, you know, to other people who would also think, of course resiliency is important, that's about improving the preparedness. So, you know, for you to take a little bit of time to talk about, the impact of the word resiliency in these conversations.

Carlos Rodriguez

Yeah, so let me start by saying that I am not against resilience. Right. It’s when do we use the word “resilience.” In the area of infrastructure, for example, resilience is very important. And I am, I am not challenging the use of resilience in that area. Because resilience, if we were to explain it in lay terms, is the ability to have more than one way of doing something, right. So whenever something fails, we have a plan B, to execute. Now, I'm a community health scientist and in community health, we have used resilience as a proxy to, well, people are not, the communities are not in great shape. But still, they're able to thrive. They are “resilient.” We don't give them anything, but they're still resilient. Right? And to me, that's the wrong way of using the word “resilience,” but because even if we look at the seminal work on resilience, when it comes to human experience, you have to have something and some resources have to be provided to you so you can be resilient. Right? I think that we can agree on that. The problem is that it's becoming kind of a buzzword to, not to admit that often we work with communities that lack everything, and we do nothing and the communities still thrive, or at least survive. And that is not resilience. Right? That to me is resistance. Because even, even when you, you, meaning the government or society, is leaving us behind, we're still doing something here. But don't call it resilience if you're not contributing in any way for us to survive, or to thrive. And the initial thoughts on this came after my own personal experience living in Puerto Rico, during the impact of the Hurricane Maria. Where like I was in Puerto Rico, that was before I moved to Washington, DC, and I had the privilege of having access to some channels of communication, including the internet, very early after the hurricane. And the, the whole imagery that it was being presented of Puerto Rico, in the continental US and in the rest of the world, was like Puerto Rico is a disaster. It's been destroyed. But the community is resilient. And there they are, they are working to get back soon. Come on. That was not resilience. We were abandoned by all the structure that had the resources to do something. What we experienced in Puerto Rico was resistance. We did our thing, and we survived months without electricity or without water, or without proper communication, because we resisted dying, we resisted not, you know, throwing in the towel. And in that context, is that I'm against the use of the word “resilience.” Because honestly, that's not resilience. Going to a country, a territory and throwing a paper towel is not contributing to the resilience of a community. And that is, this is a disaster. And it's, it's, we are ashamed of the fact that that's part of our history. But to me, that was a speaking point of saying, you know what, I have to say something about this. And as a, again, there are communities, there are people who are resilient. But if you're going to use that terminology, let's use it correctly.

Gavin Rienne

No, I agree. I think, a specific group we're talking about, you know, obviously, in this midst of COVID, there's so much going on. And because of staffing issues and things like that, and there's, you know, there's a story, kind of loosely where you have these high school kids who have to basically take over driving for ambulance workers. And there's, it's been lauded as this, like feel good story. And for the, the volunteers, they're amazing. They're doing, they really stepped in and they're really helping. But it's being like presented as this amazing story of resilience. Like no, no, no, that's, that's not good. That means the system, the structure that's supposed to help in these times of crisis is not working. And when Lorraine, you know, when I did some reading, and after Lorraine kind of presented me your discussion about that word, you know, it really kind of made me think a bit more carefully about when and where that term is used. Because not only do I, you know, urban planning work, but I also do a lot of community health work. And so, you know, I started thinking more carefully about when, you know, how often the word resilience is used, you know, oftentimes to cover up failings of structural issues.

Carlos Rodriguez

Yeah, I thank you for that. And I appreciate that. If anything, it's inviting us to think about how we use certain terminology. I will say that I am more critical when it comes from government. Because, hey, you are responsible. So you should not be proud that communities are resilient, we should not be in that place to start with. So let's, let's think about what it means and what it means for the future or the way that we can do with those communities.

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