Changing Public Health Systems as the Key to Achieving Health Equity
An Interview with Shavon Arline-Bradley
Shavon Arline-Bradley is the Founding Principal of R.E.A.C.H. Beyond Solutions LLC, a public health, policy/ advocacy, faith and executive leadership firm. She is also a Co-Founder of The Health Equity Cypher Group, a collaborative of nationally recognized health equity experts designed to expand the work of health, equity and diversity & inclusion in all sectors. Prior to this role, Shavon served in the Office of the United States Surgeon General as the Director of External Engagement and senior advisor, where she managed all congressional, corporate, non-profit and advocacy organizational relationships. Prior to her tenure in the Office of the U.S. Surgeon General, Mrs. Arline-Bradley served as the Executive Vice President of Strategic Planning & Partnerships and Senior Director of Health for the national NAACP.
Mrs. Arline-Bradley has over 19 years of experience in the areas of policy, advocacy, board relations, social justice and community & stakeholder collaborative relationship building. She is a co-author of “The Queens' Legacy,” a journey of the trials and triumph of phenomenal women and a published author of public health articles. She is also an ordained minister and serves as an associate minister of the Alfred Street Baptist Church.
Lillian Sparks Robinson: Thank you so much for agreeing to do this interview for the Social Impact Review. Please tell us a little bit about how you got started in your public health work.
Shavon Arline-Bradley: I took the route of a lot of public health folks who thought they were going to be medical doctors. I was ready to be a pediatrician and then organic chemistry came and I said "I'm not doing this!" I was taking an anatomy class because I ended up getting into exercise physiology and exercise science, which I did love and then I thought I was going to be a physical therapist. I’ll never forget, my professor, Dr. Tim Church, an exercise researcher and medical doctor at Pennington Biomedical Research Center at Louisiana State University and chief medical officer at ACAP Consulting, said to me, "You have to get into public health. You believe in changing lives." I said to him, "Right, how much do they make?" I did not fully appreciate his statement until I started learning about public health. Public health for me became the answer because it is consistent with many of my deepest convictions. My mom at the time had been recently diagnosed with diabetes.
I started seeing a lot of illness around me and I started to learn more about systems. I understood social constructs of race, but I was not necessarily connecting structural racism to health outcomes yet because this was the late nineties. I went right into my MPH (Masters in Public Health) program at Tulane University, and I'll never forget going to my first evaluation class and to some of those project evaluation classes and project planning classes. I realized I was learning all these different theories and I was also having to do some practice and the theories were not always lining up with what I was seeing in practice. Public health gave me a space to be able to explore Critical Race Theory and the role of systems.
I graduated from the MPH program and went right into a critical CDC (Centers for Disease Control and Prevention) project. REACH (Racial and Ethnic Approaches to Community Health) was about to be started in the CDC and I began my public health journey there immediately after I graduated. When you go to the CDC, you learn building block information and that's what I did. I thought I was going to be a public health program person and learned right off the bat that you have to be able to expand your territory as you think about public health, because there's so many different things you could do. I wasn't as interested in epidemiology or just evaluation, but I was definitely excited about understanding the way that we change systems in public health. So that was my public health story, and I've never left the work. Instead I expanded the work and engage with it daily.
Sparks Robinson: That's amazing. It's so interesting how we always start off in what we think is going to be our career, our journey, and then end up doing something else that someone always saw in us. They're able to see our talents and gifts and we fight it and then when we come around to it we're able to excel. In addition to starting your own company, you're also the co-founder of the Health Equity Cipher Group. Can you please explain what is meant by the term health equity and why it is an important issue that everyone should care about today more than ever?
Arline-Bradley: I hope to help people simplify equity. Equity for me is removal of barriers to have an optimal experience. That is the best way for me to explain equity. When we say remove barriers, I mean that we must remove barriers that are unjust and unfair and do not allow for an individual, a community, or a group of people to have the access or the opportunity to succeed or reach their highest potential. You can dig deeper into that because a lot of people fight about equity. “Well, what does it mean to have optimal health, health equity? What does it mean?” And for me, that definition is in the eye of the community and the eye of the beholder.
Society will try to start identifying metrics and measures that say what the means are to succeed, but I will tell you for black people in America, our definition of success may be similar or different from others. I have tried to help people understand equity as, “When you wake up in the morning and you have the same access points to optimal experiences in transportation, education, healthcare, jobs, economics, wealth building, whatever, in our communities.” Right now, we have not achieved equity. It's an ongoing conversation and so many people ask me all the time, “Will we ever achieve equity?” I just don't know because of the way our systems are in this country. We must try, we must strive. We can create policies and programs and procedures but it's so important to understand that equity is not equality.
Equity does not mean I get all the exact same things and start from the exact same place as others do. Everyone has a different experience, and everyone has a different starting point. In our country we ‘socially determine’ things and place value on those social determinants. That is why we have issues with equity. Being female and black, two named determinants in a country where white and male are more valued, white and female are more valued, you can give us all the same resources up front, but the question is, “Where do we start from?” And that's the equity conversation. Achieving equity means that there are barriers that have been historically unjust, unfair, identified and intentional, that are removed to be able to create an optimal experience.
Sparks Robinson: I love that, and it's so true. Equity is not equality. If you're already 10 feet ahead of me then you give everyone 10 feet, then you're going to be still 10 feet ahead of me. Give me 20 feet in order for us to land in the same place. Under President Obama's administration, you had the unique opportunity to serve in the office of the United States Surgeon General as the Director of External Engagement and as a Senior Advisor. So can you please share the most challenging and then also your most rewarding experiences you had in this role?
Arline-Bradley: That was such an interesting time. I came in 2015, and as soon as I got to the office, the Charleston church shooting happened. I'll never forget the next morning, walking into the office and breaking down crying because first we were in church on Wednesday night too, and second, it was a moment of just heart wrenching pain. In that moment, our office started planning a response. People don't really understand this about the Surgeon General but the Surgeon General is “America's Doctor.” We are supposed to give you factual content. The Surgeon General in the office at the time was Dr. Vivek Murthy, who happens to now have come back as the 21st, after being the 19th Surgeon General.
We started planning an overall health response to the tragedy and Dr. Murthy attended my church, Alfred Street Baptist Church, that Sunday after the shooting. He showed up in-person, out of uniform, as a citizen. In that moment, I just knew that we were a different team. We were creating opportunities to open the door for dialogue, where the American public could react to how racism has negative health outcomes and I will tell you those experiences really led to our mindfulness work. That was a contributing factor. That was significant for me as a black person, whose family (my mom’s side) was originally from South Carolina. The whole connection to that shooting and seeing the response of that office and having a part of the planning was significant to me personally.
I think one of the most difficult times for me was the election. What many people don't realize is although the Surgeon General is appointed by the President of the United States, it is actually an apolitical office. So apolitical that the office is supposed to be the office of facts, minus a lot of the partisan rhetoric. With that said, it is difficult because the President of the United States gets to choose the Surgeon General and his or her term is for 4 years. Dr. Murthy was still in office when President Trump was elected and the Office of the Surgeon General released the addiction report in November 2016. There were so many things still happening and to watch the Surgeon General’s tenure come to an end when so much critical work was taking place was the most difficult for me as a public health professional and a public servant. I tell people all the time, “The public health field is an anomaly, but it also is an offender.” It's an anomaly in that public health professionals don't always get a chance to play in political spaces, but when they do, you'll see the issues emerge, and people don't like to hear this, but racism, classism, etc. come out, in public health practice and in public health experiences. So those were the two significant moments that stood out for me -- one triumphant in tragedy, and one painful as a witness to partisan politics getting in the way of finishing really important work.
Sparks Robinson: Thanks for sharing that. To me, that's always been the most frustrating part of the job -- when partisan politics interfere with completing the mission of the agency. There were many times when I thought “Let's take the politics out, let's think about the people, let's think about humanity.”
Arline-Bradley: Absolutely.
Sparks Robinson: We just finished the first 100 days of the Biden-Harris administration. How would you rate the first 100 days? And is there anything you hope that the Biden-Harris administration prioritizes over the next four years?
Arline-Bradley: I have ratings for different things.
In the public health category, I rate it a seven and I'll tell you why. Seven out of 10 is not bad in the context of what we're talking about now -- President Biden has done a very good job of at least trying to put appropriate public health protocols in place. I give him a 10 out of 10 for a COVID response -- let me just say that right now. But the 7 out of 10 is for healthcare and public health response because of what he is trying to do, which is build on and expand the infrastructure of public health.
The whole country didn't even know what public health was when President Biden took office and all of a sudden they're like, “Where's my public health department?” They've been here for 200 years, but nobody really understands this until there is a pandemic or something major. Then everybody's like, “Where's the public health?” So I think really making public health a part of a standardized infrastructure is where President Biden is doing a good job. However, I wish there was a call for transparency in data collection efforts. Race and ethnicity are a primary target in data collection in order for us to be able to tell these full stories. President Biden has done a good job of that -- I have to give it to him. I said 7, I should probably give him an 8 out of 10 because he's really been trying to push for more transparency.
Another thing that he's done really well is use his messengers. I have appreciated that it is not always President Biden speaking on health. I've also appreciated that Dr. Fauci is not the only person speaking as well. He's really an infectious disease specialist for those of us who know this stuff; he's never been political. He doesn't even have that function and so that's why I appreciate the administration. Let’s put all of our players in and use the messaging. He has a heart. I think President Joe Biden has a heart for a lot of different things. The President is well-intentioned and he's going to have to figure out how to play the way he used to play inside of a very progressive bubble, otherwise he's going to take himself down a road that he can't come back out. You're talking to a centrist -- I am not completely progressive, I'm not completely conservative. I'm right in the middle of that. Obviously there's some progressive things that I agree with, and there's some conservative, fiscal things that I agree with. I'm an entrepreneur, so my context is a little bit different, but I wholeheartedly believe in paying my fair share and stand by my convictions about what is fair and just.
I think he should consider how he caters to certain bases. This was President Barack Obama's biggest challenge. People were like, “He (Obama) has to do this for black people” and my response is “Politically, he has to deal with every constituent base.” I speak as an advocate now -- I'm a health, faith, and political strategist. I do all three because I understand that you have to be able to speak the language of those that have interests, but you have to speak a lot of different languages and it can't just be one.
Sparks Robinson: So after nearly 20 years in the public sector, you are now working in the private sector as the founder of your own company. A lot of people that are participating in this program, the Harvard Advanced Leadership Initiative, are making the opposite transition. They are going from the private sector into the public sector. What advice do you have for them and how has the transition been for you?
Arline-Bradley: Run! No, I'm just kidding! I'm glad I did it the way I did. My advice is never lose contact with your previous life -- stay the course with who you know, and what you know, because you never know if you have to go back or not.
I think the second thing I would say is have patience with the bureaucracy. If you have never done this before, this work is going to wear you out and you're going to be cussing and thinking “This is ridiculous, I didn't sign up for this crap, this is crazy.” Also, learn how to make relationships inside of the bureaucracy. We were able to get things passed quickly through processes because we made friends, we didn't make a lot of enemies.
Another thing to remember is that the government is one part of a bigger solution so bring in your innovation, because the government and some spaces can resource it. Don't let innovation go away because they tell you “it's not going to happen here.” Don't accept that upfront. Say, "Well, what can we do? How can we make it work?" Change your language, go in with an asset frame and not a deficit frame. Go in with a growth mindset -- no matter the venue.
The last thing is, have an exit strategy. Know the amount of time you want to spend working on this project before you are ready to leave or move on. Know your timeframe and then have a plan for your exit strategy. Think about what you want to accomplish in this role and then how you want to land after it, because it'll either be completely retirement or is it retirement and philanthropy in a different way. Learn a lot of different moving parts because you'll be able to find ways to actually help the government, or the public sector.
Sparks Robinson: That's excellent. I love the asset framing versus deficit framing. Absolutely.
Arline-Bradley: Yes, It's hard.
Sparks Robinson: It is. It is funny because Harvard talks about the concept of asset framing, but then we had to turn in this two page narrative that was called our “problem statement” and I thought “What is this?” So I changed it. It is now my purpose paper and I framed my approach around the purpose of why I'm doing this project. Here are the gaps that exist, here are the strengths that we're going to utilize, and here's the framework that I'm going to use.
Arline-Bradley: Framework, yes.
Sparks Robinson: I have a few more questions. What are the areas in the health domain that you think could benefit from great public, private partnerships and collaboration? So basically where do we need public private partnership (PPPs)?
Arline-Bradley: In COVID vaccine access. COVID in general. I would also say technology. Making things accessible electronically. How do we streamline a lot of paperwork and processes and utilize technology to do that? Another place is in contracting. How do we improve access, particularly for communities of color, to interface? There are 8(a) programs, but what does that mean? How do we include SBA into a larger engagement through technology to access business owners? That's one of my next moves is to become an 8(a) certified firm.
One more place where I think PPPs can be helpful is around the Hatch Act and advocacy. There has to be some lifting of some limits on federal government employees. For example, I'm an ordained minister who was helping my church do separate work, but I had to get 12 different approvals to do the constitution and bylaws at my church. I could not preach and get honorariums without scrutiny and review. It's great work and you do it, but I lost so much money and potential revenue and a lot of work I did for free for a long period of time, just to stay relevant but that was a big issue and sacrifice.
Sparks Robinson: Yes, and we don't think about those things as we're doing this work, because we love the work and know the overall impact it will have in the end. It’s the same thing in Indian Country, you are thinking about the work and not the money, but you end up short-changing yourself. So lastly, what skills do you think are necessary to be a good advocate? And what skills are necessary for a good leader?
Arline-Bradley: To be a good advocate you've got to have your pulse on facts first. You have to ensure that you have relevant data that is evidence-based to support the issue that you're advocating for. That's number one. Passion without paperwork is a killer. You've got to have context with real evidence behind it. Advocacy also requires patience because long hard work is what advocates do. If you are a short-term campaign person don't be an advocate, be a campaign person. You get to win and you go on to the next thing. If you're in advocacy that means that you're signing up for a systemic change experience. You want to change systems. You want to change legislation, which is policy. You want to see it implemented. I think the other thing for an advocate is to know your partnerships. Advocates get caught up in what they can do and if you don't have a partner, it's going to kill you. You have to have partners.
You and I met at Scott Hawkins Leadership Institute. It saved my life and career. There's no doubt about that. One of the best programs -- while it was long it was great -- and we were pregnant too. So it was just ridiculous timing but it was so worth it.
Sparks Robinson: New moms. I was a new wife. It was a lot.
Arline-Bradley: I didn't know what was happening. I was nursing, writing papers, doing assignments, and I was like “Jesus Please be a Fence.” It's crazy but Scott Hawkins has taught me so much about leadership, so much so that I fell in love with leadership training. In my company, we do a lot of coaching of leaders and the first part is really about the transparency. Transparency, and servant leadership are for me, the most important skills. Transparency in that you tell your story and be upfront with your team in an appropriate way. Be upfront and tell the truth. “I don't know all the answers. I'm not sure about this, but I'm going to surround myself with the right people.”
Servant leadership is my favorite model. You have to expand the capacity of those around you. If you pour into your team, they're going to pour back into the production and the productivity of the company. Hard nose leaders don't always win, they're feared but they're not respected and when you're fearful, you flee. But if you have respect, you'll figure out how to solve the problems with the leaders.
Another thing about leadership is that I'm a relational leader. Diversity and inclusion work requires you to think about relationship, race relations, and the way that we engage. Equity, diversity and inclusion is so connected to how leaders lead from a human place, the heart and the head. How are you clear on strategy, clear on plans and how are you also aware of the essential human needs of your team?
Last thing about leadership -- leaders have to always be able to confront conflict. Conflict is not fun, but having a conversation is important. Leadership is a continuous and constant and daily practice.
Sparks Robinson: This has been so informative. I really appreciate you taking the time to share with me your thoughts and your experience. Thank you and we look forward to hearing about the next amazing thing you will do!
About the Author:
Lillian Sparks Robinson is a 2021 Harvard Advanced Leadership Initiative Fellow. A member of the Rosebud Sioux Tribe, Lillian has worked in Washington, D.C. for 20 years, devoting her career to supporting the educational pursuits of Native American students, protecting the rights of indigenous people, and empowering tribal communities. In 2010, Lillian was appointed by President Obama, and confirmed by the U.S. Senate, to serve as the Commissioner for the Administration for Native Americans (ANA). In this role, she worked on programs and policy impacting Native languages and education, social development, and economic development for American Indian, Alaska Native, and Native Hawaiian and Pacific Islander communities. Prior to her service at ANA, Lillian served as the Executive Director of the National Indian Education Association (NIEA), where she worked extensively on education policy and appropriations impacting American Indian, Alaska Native, and Native Hawaiian students. Lillian is now the owner and CEO of Wopila Consulting, LLC, a small business that provides strategic planning, policy, and program development services to Federal and Tribal governments and organizations.
This interview has been edited for length and clarity.