Diverse personal and professional experiences led me to a career in public health, medical anthropology, and health equity. My interest in culture and equity was sparked when my family moved from New England to the Navajo Nation in Arizona (1983-1987). There, for the first time, I lived among a minority group and as a minority myself, one of few non-Navajo in the heart of the reservation. I learned about discrimination and diversity, balance and beauty, listening and learning. I gave my valedictory speech in Navajo and left for college to study anthropology and education.
My B.A. in anthropology/social sciences and education from Stanford provided academic depth and the opportunity to live and conduct research in Santiago, Chile (1990) and Chiapas, Mexico (1989-1992) under anthropologist-Latin Americanist George A. Collier.
In my subsequent residence (1994-2003) in Comitán, Chiapas, I dove into social science research at El Centro de Investigaciones en Salud de Comitán (CISC) in Chiapas, Mexico. When I moved to Chiapas, CISC was a nascent medically-oriented research group run by a surgeon to address the dismal health conditions that inspired the concurrent Zapatista uprising. At CISC, I worked with local researchers and providers to address the social determinants of intractable problems including domestic violence, maternal mortality, and elder health and care. My team (1) engaged the community in dialogue on needs and resources, (2) generated options for action via critical assessment, (3) monitored process and outcome, and (4) applied data to create appropriate strategies. My efforts helped to establish CISC as a vibrant, locally-run and internationally-funded health research center. I also became fully bilingual (Spanish/English) and comfortably bicultural, establishing deep family and professional ties.
Years of work on health and culture prompted me, in 2000, to complement my practical experience with focused instruction in medical anthropology, international health, and gender via an M.A. (2003) and Ph.D. (2007) from the University of Arizona, advised by medical anthropologist Mark Nichter. My master’s work centered on pregnancy and childbirth in Tojolabal communities around Comitán. For my Ph.D. dissertation, I returned to Comitán to address the emerging need for elder health research and intervention. The urgency of the topic and my familiarity with the community paved the way for CISC, health care providers, and elders to embrace the work as co-collaborators.
Subsequently, to apply my graduate degree to health in the U.S., I led Health Planning & Evaluation at Boulder County Public Health (BCPH). In 2008, BCPH was a cutting-edge local public health department lacking assessment, planning, and evaluation infrastructure. I set agency strategic direction and policy at BCPH by creating and then managing the Health Planning & Evaluation Program. Reporting to the Board of Health, my program served 180 staff in 24 BCPH programs across 3 campuses, 4 hospitals, 3 FQHCs, 2 school districts, for- and non-profit partners for a population of 350,000. By 2017, I had successfully led teams to:
- Co-create and evaluate evidence-based operational plans for pioneering public health programs.
- Co-coordinate the first county-wide public health improvement process, and launch BCPH health equity efforts.
- Liaise with local/state partners to collect data, including implementing the CDC’s Youth Risk Behavior Survey.
- Leverage the Incident Command System to respond to a 1000-year flood, wildfires, and disease outbreaks.
- Engage in syndromic surveillance to use real-time emergency department data for planning and evaluation.
- Develop reports about local health and wellbeing, such as the Status of Children in Boulder County.
- Develop an online health data dashboard, and use electronic health records data to monitor population health.
In 2012, I received an Associate Professor Adjunct faculty appointment at the Department of Anthropology, University of Colorado in Boulder. This allowed me to facilitate exchange of insight between Boulder County Public Health and the University of Colorado, as well as between the fields of public health and applied anthropology.
From 2017 to 2022, as Associate Director, Mil Familias Programs, at Sansum Diabetes Research Institute (SDRI) in Santa Barbara, CA, I managed research-education-care initiatives to prevent and address diabetes, cardio-metabolic conditions, and COVID-19 in disproportionately impacted populations (predominantly Hispanic/Latino). I supervised a 9-person team and managed a $2M annual budget to run a diverse portfolio of federally, pharma, and privately funded programs. My team conducted 6-8 research protocols annually, for which I managed data collection and analysis as well as ethical (IRB)/regulatory compliance. Projects required building partnerships across health ecosystems and co-creating scalable models. We propagated results by publishing prolifically in peer-reviewed journals and presenting in local and professional forums.
In this capacity, I managed multiple diabetes and disparities initiatives by, among, and for underserved populations including:
- Mil Familias: 6-year longitudinal cohort study (Eli Lilly, NCT 03830840) of Latino families with type 2 diabetes providing genetic, biological, psychosocial, behavioral, and environmental data via exams, questionnaires, labs, apps, and wearable digital health devices (e.g., continuous glucose monitors [CGM], Fitbits, ActiGraphs).
- Farming for Life: 4-year study (USDA, NCT 03940300) of up to 400 adults with or at risk of diabetes, receiving prescriptions for free fresh produce and health metrics indicating improved cardio-metabolic health, food security, and glucose levels.
- Digital Diabetes studies: CGM & Meals (NSF, NCT 04991142); Digital Diabetes (Elsevier Foundation, NCT 04820348).
- Food as Medicine randomized clinical trials: Vegetables & Semaglutide RCT (Novo Nordisk, NCT 04938388).
To propel diabetes and disparity research, I focused on democratizing research and developing Hispanic/Latino community members as paid Community Scientists. I mentored undergraduate and graduate students and teams from UC Santa Barbara, Santa Barbara City College, Westmont College, Cal State, and beyond. My team curated daily online research posts regarding diabetes and COVID in lay Spanish and English.
In 2022, I was drawn to the Santa Barbara County Education Office (SBCEO) due to its permeating ideal of health equity and deep respect for the abilities of community health workers to promote health and social wellbeing. I joined SBCEO’s Education Services Department and affiliated Children & Family Resource Services (CFRS) team as Manager, Health Linkages, to support a team of 65+ community health workers (promotores) across Santa Barbara County who initiate and strengthen the links between health, safety, social services, and education. This is based on a strong longstanding partnership with the Santa Barbara County Promotores Network/Red de Promotores.
Upon identifying gaps in health and social services in Santa Barbara County, I plan and organize countywide Health Linkages programs. By developing procedures for the programs to include research-informed and best practices, I monitor program performance and evaluate outcomes. This work entails liaising with SBCEO staff, regional and national organizations, and promotores. Supporting the promotores includes providing in-depth thematic training, recruiting qualified promotores for specific tasks, providing relevant health and educational materials, and ensuring they are paid as independent contractors. I directly supervise regional coordinators, from selecting staff to assigning and monitoring work to setting performance standards and providing professional development. I collaborate with the CFRS Director, SBCEO fiscal department staff, and administrative staff to establish billing and reimbursement procedures for community partners seeking to work with promotores. Promotores’ activities are supported by over a dozen funding streams, from multiple federal grants (e.g., CDC, ARPA) to various local grants (e.g., Santa Barbara Foundation, Cottage Health). I am responsible for grant writing, management, and reporting. I actively initiate and participate in relevant committees, workgroups, meetings, conferences, and trainings, and act as spokesperson representing the interests of Health Linkages programs.
All my professional roles have required me to secure funding, then develop and achieve objectives within budget. To do so, I coordinate collaboration with health, academic, industry, research, policy, and community allies. Responsibility for quality and integrity rests on my shoulders. I must constantly innovate and improvise to solve problems and jump into the trenches alone or with help to assess, plan, act, and assure. My success rests in part on my strong interpersonal skills and bilingual Spanish-English communication, as evident in my frequent presentations and numerous publications in peer-reviewed journals, including Lancet, Health Equity, Nutrition & Health, and Social Science & Medicine as well as books. Ultimately, my impact rests on my dedication to promoting equity through health and health through equity, with attention to culture.
In sum, my commitment to health and equity emerged while living in the Navajo Nation and Mexico, and grew with a PhD in medical anthropology. I now have three decades of experience in leading collaborative efforts to disrupt illness and inequity. I am excited to apply my insight to these wicked problems in this unprecedented era of risk and opportunity.