School of Public Health

Overcoming Pandemic Fatigue to Promote Health Equity

As the holidays fast approach and 2020 continues to give us a run for our money, many people are feeling the effects of pandemic fatigue. Pandemic fatigue occurs when people grow tired of practicing measures meant to slow the spread of COVID-19, such as social distancing, wearing a mask, staying away from large gatherings, etc. The feelings of social isolation, frustration, lack of motivation, resignation, and general irritability are all signs that you may be experiencing pandemic fatigue.

Health Equity 1COVID-19 cases in the United States continue to surge as we seem to be at the beginning of a second wave, although it may seem that we never truly defeated the first wave. With the holiday spirit slowly creeping into our everyday conversations and thoughts, it’s important to consider the potential effects and develop strategies to remain safe and combat pandemic fatigue.

While Thanksgiving, Hanukkah, Kwanza and Christmas are typically holidays where families and friends gather to eat and fellowship with one another, the CDC recommends limiting your interactions and travel during this time.

Strategies to enjoy the holidays and fight pandemic fatigue, while also doing your part to slow the spread of COVID-19 include:

  1. Limit your gatherings with people outside of your household. Gatherings of 10 or fewer people are associated with a lower risk of transmission.
  2. Self-care. The holidays are times when we forget about taking care of ourselves, because we are focused on being a part of the holiday spirit. Make sure to stay up-to-date with all medications and doctor’s appointments, exercise regularly, don’t overeat, and make sure to get enough sleep.
  3. Be selective. When choosing to gather in groups, make wearing a mask mandatory for everyone, frequently disinfect commonly touched surfaces, advise those that don’t feel well to stay home, choose activities or locations that will make it easier to maintain social distancing precautions, and make sure everyone is regularly washing their hands. Gather outdoors and in shorter durations whenever possible.
  4. Be gracious. This year has been hard for a lot of people. It is ok not to be ok right now. Setting realistic expectations of yourself and others can help to combat the feelings of being overwhelmed. Take a moment to yourself, try deep breathing exercises, and don’t forget that your mental health plays a part in your physical health.
  5. Connect virtually. Stay in touch with friends and family virtually. Video conferencing platforms, such as Skype, FaceTime, and Zoom allow for people to stay connected from all over the world. In fact, Zoom is lifting the 45 minute limit on free Zoom calls on Thanksgiving.  Try creating a schedule to remain consistently in touch with those closest to you.

COVID-19 and Racial and Ethnic Minorities1

Throughout the pandemic, trends in COVID-19 infection, hospitalization, and death rates have shown disproportionate effects on racial and ethnic minority populations.

Health Equity 2Racial and ethnic minorities are at an increased risk of becoming ill and dying from the virus due to several social-ecological factors: healthcare access and utilization, occupation, housing, and educational, income, and wealth gaps.

  • Decreased healthcare access and utilization result from factors including lack of transportation, inability to take time off work or obtain childcare, communication and language barriers, distrust in the healthcare system, and cultural differences between patients and providers.
  • The essential workforce, consisting of healthcare workers, farming, grocery stores, and public transportation have a large proportion of minority workers. These essential positions place the workers at increased risk of contracting COVID-19 due to the public nature of the jobs; as well as the inability to take paid sick days, properly social distance, and work from home.
  • Households with a greater number of co-habitants or families that live in crowded dwellings increase the risk of COVID-19 transmission. In addition, the financial strain caused by COVID-19 has resulted in the loss of employment, which contributes to unstable housing and the increase of household size due to the sharing of housing and resources.
  • Lack of access to high-quality education creates a domino effect in terms of income and wealth gaps. Without access to adequate and complete education, it becomes challenging to obtain and maintain gainful employment. Job availability to those that fall in this category are typically in industries with increased risk of exposure to COVID-19 and does not allow for the time or monetary flexibility that would be needed if the employee does fall ill.

With increased demand being placed on essential workers as the holidays approach, particularly those in service industries, it is important to remain mindful of public health recommendations amidst the continuing pandemic. The ultimate goal is to keep everyone as safe as possible. It is on all of us to do our parts to help those that are at a disproportionate risk of COVID-19.

Stay motivated. Stay safe. Happy Holidays.

Ashley Lamar, MPH, CPH: Ms. Lamar is an HSC alumnus and received her MPH degree from the School of Public Health. She is a member of the SPH Equity, Diversity, and Inclusion committee and is employed by the JPS division of Injury and Violence Prevention.

Emily Spence, PhD, Associate Dean for Community Engagement and Health Equity


  1. Centers for Disease Control and Prevention (CDC). (July 24). Health Equity Considerations and Racial and Ethnic Minority Groups. Retrieved November 16, 2020, from

Image Credits:

Photo: Photo credit: Drazen Zigic, creator. Retrieved from

Graph: Figure 1 image credit: KFF (2020) Racial disparities in COVID-19: Key findings from available data and analysis. Retrieved from 

Click through image: Getty images

Georgie Institute of Technology, COVID-19 Risk Assessment Planning Tool

Health Equity

Why you should vote

By now we are all intimately familiar with the horrific events that have occurred in 2020. It has been a year full of multifaceted injustices ranging from the outrageously high COVID-19 death toll that has disproportionately affected communities of color, to the violence and deaths that have resulted from police brutality. There have been substantial attacks on the rights of the LGBTQ+ community as well as substantial attacks on the democracy of the United States itself. Given the human lives and the human rights that are at stake in this upcoming election, it is arguably more important now than ever before that we exercise our right to vote.

Vote As citizens of the United States, it is our job to be active participants in the democratic process through casting our ballots in elections. As such, it is absolutely vital to the health and to the wellbeing of our country that we all vote this fall, regardless of our excitement or lack thereof for a particular presidential candidate. Additionally, it is of the utmost importance that we make an informed decision when choosing candidates listed on our ballots. This means that we must all educate ourselves on both the political records and the platforms of each candidate on the ballot, regardless of the office they are running for. Although change can happen at a federal level, change often begins with officials elected for local offices, so make sure you are choosing candidates that stand for what you believe in.

In a time where there is much turmoil and unrest present in our country, it is imperative that we all remember change begins with us and with our votes. If you or somebody you love has been negatively affected by the COVID-19 pandemic, educate yourself on how candidates plan on handling the pandemic and choose the people you feel will make a difference in your community. If you have been devastated by the blatant acts of racism that are still plaguing us in 2020, it is your job to learn about the records and the platforms of each candidate so that you know who truly stands for justice and who does not. If you care deeply about any other issues that are influenced by policy makers, it is your responsibility to look up both the records and the platforms of each candidate to make sure that you are making an informed decision when you cast your ballot this fall. If there is not a candidate that you are excited to vote for, it is your job to educate yourself so that you can choose the candidates that will benefit the most vulnerable members of your community. If you are an undecided voter, factcheck your candidates through non-partisan resources to ensure you are making an informed decision.

In closing, if you are looking for justice, vote. If you are looking for a way out of this pandemic, vote. If you are looking for economic relief, vote. Urge your family and friends to vote. Find ways to become politically active in your community to help ensure your voice and the voices around you are heard. Use your voice to fight for justice for the most marginalized members of your community. And above all else, remember that change starts with you and with your vote, so please make a plan and make sure your voice gets heard.

Early voting in Texas lasts through October 30th and election day is November 3rd.


Kayla Tate, School of Public Health PhD student

Julian Rangel, MPH, School of Public Health Alumni


Responding to communities in need during shelter-in-place orders

In this video blog, we will discuss some community groups who are particularly vulnerable as a result of COVID 19 shelter-in-place orders.

We will also hear about how community organizations are quickly pivoting their work to respond to these urgent needs.  During this video we speak to:

Ms. Leah King
Chief Executive Officer
United Way of Tarrant County
Mr. Simeon Henderson
Southeast YMCA District Executive Director
YMCA of Metropolitan Fort Worth
Ms. Jessica Grace
Program Manager, Technology Enhanced Screening and Supportive Assistance (TESSA)
UNT Health Science Center at Fort Worth, School of Public Health

A PDF version of the slide presentation can be found at: SPH TCHD Health Disparities Video Blog

Covid 19 Shelter In Place


School of Public Health & Texas Center for Health Disparities Community Blog

Something happened!!!!!

The sounds I awoke to coming from the living room were screams. I always had intense dreams, but I know this wasn’t one of them. I knew something bad had really happened. A few weeks earlier, my mom found out that “Uncle Joe” had been diagnosed with AIDS. This was devastating but not completely surprising because he had many health issues leading up to that moment.

…………The screams and now loud crying were coming from my mom who had just received news that he had died.

 Whose fault was it? 

We knew he had heart problems, but what we did not know was this was worsened by the fact that he had HIV. Thinking back now, this made sense. He had complained about chest pain and having trouble breathing. The doctors told us that he would still be alive if he had gone to the hospital sooner. But because he didn’t know he also had HIV, and didn’t seek proper treatment, his heart problems got worse faster. HIV experts know that HIV makes heart disease more severe and not respond as well to regular treatments. If his doctors had known he also had HIV, they might have done things differently.

2019july AWhat is currently being done?

Why knowing your status is important?

To say that this is an isolated incident would not be true. Stories like this unfortunately happen far too often. One of the reasons for this is people are afraid to get tested because of what others will think of them. The truth is we see this in North Texas nearly every day – people go the hospital only to find out they have AIDS. This should never be the case because we need to make sure people are tested way before the virus is in the last stages. HIV is a very deadly disease, but what’s even worse is not getting treatment because this could lead to even more deadly health problems.

Taking your health into your hands…….

For both patients and health care providers, the key to winning this new fight is a new model of thinking about treatment. A great example of this is medication therapy management (MTM). MTM uses the services of practitioners such as pharmacists. During MTM sessions pharmacists and persons with HIV sit down in a private setting and talk about not just HIV but all of what is important to the patient’s health.

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Photo credit: Baer, R. (2005) Woman consults with pharmacist. National Institutes of Health, Public domain image


What can talking to a pharmacist do?

The pharmacist’s role in MTM sessions is mostly to help the patient know more about their medicines and their health. The pharmacist educates and works with the patient and the patient’s doctor(s) to get the best result for the patient’s medicines. Another really great function of a pharmacist during MTM sessions is to talk about lifestyle changes (diet, exercise, etc.).

What is currently being done?

Why is a pharmacist a good resource?

Pharmacists are a good source of information about medications. They are also in the patient’s community already. No long travel is needed!  As a result, patients’ can more quickly and easily be helped with any concerns about their medications that they may have.  In addition, with the pharmacist working directly with the patient’s doctor, changes to medicines can be approved  without any need for doctor’s appointment. This saves the patient time and money!

Everything is about the patient……

The patient should be at the center of every medical decision. This is why it is important that we make changes to the way we treat HIV/AIDs patients.  The patient and their health needs should always be top priority. MTM therapy is a great option for the patient because it ensures the patient gets the best results in a short period of time.

2019july CWhat is currently being done?


Ryan Chishimba is a pharmacy student and is part of the graduating class of 2021 at UNTHSC. He is very passionate about public health issues and a very vocal member of the “humane” society. What motivates Ryan Chishimba is his faith, family, friends and nature. This is why helping people has become a second calling and why discovering his mission in life has been an immense superpower. His future plans include continuing to work to help and discover solutions in the treatment of chronic diseases.


Promoting Diversity in Research Training  (PDRT) scholar

President of Christian Pharmacist Fellowship International  (2019-2020)

Research reported in this publication was supported by the National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number U54MD006882. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

2019july D

Grow Southeast: Fighting Food Insecurity, One Farm at a Time

School of Public Health & Texas Center for Health Disparities Community Blog


Linda Fulmer, B.S.W., M. Ed.
Executive Director, Healthy Tarrant County Collaboration

June2019 1In 2014 we met with the community leaders in East and Southeast Fort Worth to ask what they thought could help make their neighborhoods healthier. They pointed out that while many organizations offer nutritional and cooking classes, there were not enough stores nearby selling healthy food.

East & Southeast Fort Worth covers about 72 square miles, and today has only four supermarkets to serve its large population—not nearly enough. There are over 100 convenience and dollar stores in the area, but most of these stock beer, wine, lotto tickets, unhealthy snacks, and pretty often, gaming tables.  The region has a high percentage of low-income families, along with high rates of obesity and chronic diseases.

In 2016, our Plan4Health grant allowed us to test retail strategies for expanding healthy food access in the area. More about our array of healthy food access work was recently posted on Moving Health Care Upstream’s Examples in Action site.

During Plan4Health we met some residents who owned land they wanted to farm. They believed that urban farms could help their neighbors gain new job skills, and also expand healthy food access. So, what was stopping these future urban farmers?

  • Their land was zoned for residential or commercial uses; not agricultural.
  • They had plenty of land and passion but lacked the means and structure to turn those into productive urban farms.

We started meeting monthly to share information and resources. Over time more people joined in, either to start their own farms, or to offer technical assistance and support. Today this project is known as Grow Southeast.


To address the land use issue, we encouraged the future urban farmers to put the City of Fort Worth’s Urban Agriculture Ordinance into practice. This allows urban farms to exist on land zoned for residential or commercial uses. While the process has been slow at times, together we worked through the challenges, providing feedback to the City to help improve the ordinance.


We also applied for grants seeking seed money for start-up costs. We received a small grant for equipment, which helped us buy a BCS 739 2-wheel tractor with a rear tine tiller and rotary plow attachments. This powerful and versatile tractor is available for any of the farmers to borrow.

June2019 2
We also started recruiting people willing to volunteer at the farms!


June2019 3

Would you like to be a Grow Southeast urban farm volunteer?  We are always looking for more people to share their time and talent at one or more of the farms.  If you are interested, please contact me at or 817-451-8740.
Research reported in this publication was supported by the National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number U54MD006882. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

June2019 3

Understanding and Responding to Moms with Postpartum Depression in our communities, in our families

School of Public Health & Texas Center for Health Disparities Community Blog

By Luvleen Dharni

Whether the first or third child, having a baby brings tremendous responsibility and readjustment in the daily routine. For many, the new life brings joy and happiness, but along with these celebrations, unexpected challenges may arise.

For the last 15 years, Dr. Amy Raines-Milenkov who has extensive research and community experience working with families in Tarrant County says, “pregnancy can be an exciting and busy time for a new mom to be. After the baby has arrived, however, many mothers find themselves isolated. The all-consuming care for the baby, physical and hormonal changes, sleepless days and nights and changes in relationships can leave mothers vulnerable to depression. Simple Blogmay2019acts of reaching out to new families with tangible support or creating opportunities for mothers and fathers can make the difference in a positive transition to parenthood.”1


How common is it? The Postpartum Roller Coaster

The most common misconception about postpartum depression is that it won’t happen to everyone. Did you know that almost 80% of new moms experience normal “baby blues” symptoms such as crying for no apparent reason, feeling angry or uneasy, and suffering from anxiety in the period after birth? However, these symptoms should taper off within two weeks post-delivery.2 If not, you could have Postpartum depression (PPD). PPD symptoms last longer and can be much more severe (See Figure 1).

Blogmay2019 1
Figure 1. Postpartum Depression in the United States [infographic].4


In the United States, approximately 15% of women and 8% of men experience postpartum depression symptoms, though the numbers may be higher as people might feel embarrassed to talk about or know they have a problem, and may not have people around them to help.3 In fact, PPD is the most common complication of childbirth and for half of women diagnosed with PPD, it is their first time dealing with depression.4

Some people may feel like they are in a downward spiral and feel suffocated in this journey. Since people may not feel comfortable talking about it, only 15% women report receiving professional treatment for postpartum depression.4


Why is this important? Big! Not so blissful, changes

            The postpartum period is a time of major changes for new parents. Even though you might have a completely healthy and happy baby in your lap, your mind is occupied elsewhere. New parents may not feel comfortable discussing their fears, failures, or challenges with friends, family or providers. Low levels of social support for the parents and their own struggles with stigma, fear, and guilt is found to be associated with increased risk of both depression and anxiety postpartum.5 Parents who are unable to find a balance between the physical demands of being a parent and fulfilling other tasks is one example. For single parent households, the challenge can be even more overwhelming. After delivery, the focus naturally shifts to the new member in the family and the parents can feel a burden to be well-rounded or model parents. For example, breastfeeding or following a routine to help parents and their child sleep can seem like tasks that are too hard. Simply put, parents do not think they have enough hours in the day to get everything done.

How can we help? Be Supportive

If you know of any new parents, sometimes giving them a word of encouragement and telling them they are doing a good job can go a long way. Some other ways to support new parents is to start by asking them what they need. This could be offering to help them prepare meals for the week, a grocery run to the supermarket, taking care of the child while the parent can get caught up on chores or sleep, going to follow up doctor’s appointment with the family, or buying them a gift card to their favorite restaurant or spa treatment. Many of these suggestions as well as others, can be found on a new App developed by Dr. Teresa Wagner under Amy Raines’ mentorship, What About Mom? The App also educates new moms about postpartum warning signs indicating they may have a medical emergency that requires emergent care.

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Mom can click on the icons to explore symptoms she might be experiencing and her helpers can click on the icons to find tips for helping her whether around the house or handling her new role.

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Even if she doesn’t tell you how she feels right away, she will likely appreciate the gesture. Health providers should screen all women during and following pregnancy with validated screening tools and be prepared to refer for appropriate treatment, whether that be medication therapy, counseling, or support groups.6 As a community, we should provide new parents resources including an open discussion/forum (with family, group of friends, or parent café’s) allowing them to share and acknowledge their emotions or seek help for severe depressive symptoms. With support and treatment, new parents can feel heard. If their emotions are validated, we will be able to see more people talking about their challenges and seeking the support they need.



  1. Raines-Milenkov, A. (2018, December). Email communication.
  2. Healthy Children. (2016, May). Depression during and after pregnancy: You are not alone. Retrieved from
  3. Postpartum Support International (n.d.). Pregnancy and Postpartum Mental Health Overview. Retrieved from
  4. Hetherington, E., McDonald, S., Williamson, J., Patten, S., & Tough, S. (2018, June). Social support and maternal mental health at 4 months and 1 year postpartum: analysis from the All Our Families cohort. Journal of Epidemiology and Community Health. 72: 933-939. Retrieved from
  5. LARKR On Demand Mental Health Care. (2018, April). Things you might now know about Postpartum Depression [infographic]. Retrieved from
  6. The American College of Obstetrics and Gynecologists (ACOG). Depression and Postpartum Depression: Resource Overview. Retrieved from


Research reported in this publication was supported by the National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number U54MD006882. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


Why is Spring the most important time to talk with your teens?

School of Public Health & Texas Center for Health Disparities Community Blog

Why is Spring the most important time to talk with your teens?
“I came to MADD (Mother’s Against Drunk Driving) in the months after Helen Marie died a sudden, violent death by an alcohol- and marijuana-impaired teen driver. Just as suddenly, we faced the impossible tasks of funeral arrangements and criminal court proceedings, of organ donation and boxing up her things forever. We faced a grief so profound it hardly seemed survivable. Until that sunny afternoon in our hometown of Miami, my husband John and I had our dream family: a boy and a girl, named for each of us. John and John. Helen and Helen Marie. Our daughter came first. When John followed three years later, Helen Marie was thrilled, until she learned he wasn’t going back.  But she learned to love him, deeply. They were imperfect, well-adjusted children. They were everything my husband and I had prayed for.

On June 1, 2000, our dream family was torn apart. It was a normal day, except that Helen Marie was nervous. She was going to direct a school play the next day, and although she’d acted many times, this was a new role for her. She wanted to go rollerblading to work off her stress. I wanted her to stay home; I’d been traveling for a few days, and we had so much to catch up on. But as she laced up her rollerblades, she told me not to worry. She stuck to a regular route. She used the crosswalks. She would be right back.

John, 13, wanted to go, too, but she asked me to keep him home because she wanted to go fast. That was Helen Marie – always quick. We called her HM because it was so much faster.

At the end of the driveway, she spun to face me. She blew me a kiss and told me she loved me. And she took off, blonde hair flying behind her. This is how I choose to remember her.”

–  This is Helen Witty’s story, one of the many found on MADD’s blog.

National survey data shows that among high school students during the past 30 days, 30% reported drinking alcohol, 14% reported engaging in a heavy-episodic drinking (i.e. 4/5 drinks or more for women/men, respectively), 6% drove after drinking alcohol, and 17% rode with a driver who had been drinking alcohol.  Although alcohol use in general is problematic in this age group, specific events such as spring break, prom, and graduation have been associated with excessive alcohol use among teens. Our research has shown that these events are particularly harmful above and beyond typical drinking, as these events are associated with a sharp increase in alcohol use and related consequences, especially among those who normally do not drink heavily. These event-specific windows of risk are particularly important to consider during adolescence as negative consequences in this population usually result from short-term heavy drinking episodes rather than from long-term heavy use over an extended period of time.

Photo: Informed Families

Why the focus?
Events such as spring break, prom, and graduation are all known windows of risk and as such are optimal times to use event-specific prevention. Event-specific prevention are prevention strategies that assume timing and content of the intervention are important in targeting known windows of risk. On a practical level, these high-risk events are generally predictable as it is relatively easy to determine when most specific events will occur far in advance (e.g., spring break, prom, graduation). Second, specific drinking events are usually time limited and therefore if we know in advance when teens are going to be more likely to engage in behavior that could harm them, we should focus efforts on those events.

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What can be done?
In line with event-specific prevention, MADD recently rolled out an expanded version of PowerTalk 21, a program that focuses on the importance of parents taking advantage of all opportunities to talk to their teensline  and set family rules about underage drinking and using other drugs. Although teens spend an increasing amount of time with their friends, parents remain an important source of support and continue to play a key role in the lives of their adolescent. Parents influence about tough issues like underage drinking and drug use are likely to have a substantial impact.  This year, the PowerTalk21 program targets the period between March 1 and May 31, which includes several high-risk events for underage alcohol and other drug use including spring break, 4/20, prom, and graduation.  MADD encourages parents to use the tips and tools provided in MADD’s Power of Parents materials to include both alcohol as well as other drugs, all of which can cause long-term damage on the growing mind and body. You can get involved through workshops, social media, media releases, and local events. MADD hopes to reach as many parents as possible to get them talking to their teens about underage alcohol and other drug use during known high-risk periods of time; thus putting event-specific prevention into action.

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Melissa A. Lewis, PhD, Professor of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center
Dana M. Litt, PhD, Associate Professor of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center
Kim Morris, National Vice President of Programs, Mother’s Against Drunk Driving

Research reported in this publication was supported by the National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number U54MD006882. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


Reflections on equity, diversity and inclusion

School of Public Health & Texas Center for Health Disparities Community Blog


Last Fall I was asked to chair an ad hoc (temporary) committee to develop a diversity and inclusion plan for our School of Public Health (SPH). This seemed like a fairly straightforward task for a couple of different reasons.  First, our accrediting body, the Council on Education for Public Health, provides us with a clear set of questions and sound logic to proceed with our plan.

Second, issues of cultural competence and diversity are considered foundational in our public health base of knowledge and skills.  Among the 22 competencies expected of our Master of Public Health degree graduates, 5 include explicit language related to equity, diversity or inclusion and most others cannot be successfully accomplished without incorporating these concepts.

Furthermore, much of our focus in public health is on the extent to which conditions of where we live, learn, work, and play affect our health.  2019march Bloga1These conditions are referred to as the social determinants of health and form the basis of the US Office of Disease Prevention and Health Promotion’s  Healthy People 2020 framework.  As part of our teaching, research and service, we routinely discuss issues of health disparities and inequities. Our monthly blog often addresses disparities in the social determinants of health, such as highlighting racial inequities in prostate cancer mortality and youth drowning, or gender inequities in maternal mortality and intimate partner homicide.

Humbled and Transformed

Despite the fact that my daily work evolves around promoting public health competencies and engaging diverse communities, I found the experience of chairing this ad hoc committee to be both humbling and transforming.  It has set me on a journey of discovery and reflection, added another lens to view the world, deepened the piles of books in my home and office (as well as the virtual ones in my Audible library), and strengthened my resolve to continue this work.

Before I share the details of this transformation, I believe it is important to explain where I began.  I am a white, heterosexual woman.  I grew up in a middle-class family with two parents who hold graduate degrees and provided a nurturing environment with high expectations and healthy boundaries.

In other words, I have lived a very privileged life and I continue to benefit from these privileges. This is important, because whether we acknowledge it or not, the decisions we make, and our interactions with one another are shaped by our privileges and our socialization.

During my life journey, a number of experiences have sensitized me and helped me understand my privilege. These include having my dad come out as gay during my early adulthood; living as a statistical ethnic minority in Miami, Florida for seven years; marrying a man with a different race, ethnic, and socioeconomic background from me; giving birth to and parenting a mixed-race child; and experiencing years of microaggressions as a mixed-race family in Texas.

Too much information?

Why am I sharing these personal reflections? Because what I’ve learned is that doing this work in a meaningful way requires you to question all of your beliefs and decisions. As a school, we are in the process of examining our policies, procedures and practices through a lens of equity and inclusion.  Because many of us identify ourselves as social scientists, we want to believe that we are doing so with objectivity. However, without personal reflection, the “objective” criteria that we are using may in fact be influenced by biases rooted in privilege, history, and socialization.

Our Committee

One of the best parts of chairing the ad hoc committee was working with the committee members, who each contributed valuable perspectives and engaged in thoughtful discussion. The committee included UNTHSC administrators, faculty, staff and student volunteers, as well as community members, and a UNT system administrator. These 12 people brought diverse perspectives, as well as experience in promoting equity, diversity and inclusion in higher education and community settings. This productive group worked intensively between November 2018 and February 2019 to develop and draft an initial plan.

Our process

In a little over three months, we accomplished the following expectations set by our accrediting body:

  1. Identify and define priority under-represented groups of faculty, staff, and/or students
  2. Establish goals to increase representation of the under-represented groups identified in #1.
  3. Identify the strategies used to advance and evaluate the goals established in #2.
  4. Describe the strategies planned to create and maintain a culturally competent environment.

We also developed a School statement on Equity, Diversity and Inclusion, as well as a logic model framework to show how we will achieve our goals.

We began with a systematic review of information, which included:

  • Demographic (race, gender, ethnicity) information about our faculty and students, as well as other Schools and Programs of Public Health
  • Demographic information about Texas, the North Central Texas region, and our surrounding county
  • Information about the operations of our school, including but not limited to: (1) curriculum design, (2) student recruitment practices, (3) faculty research areas, (4) faculty and staff search and hiring practices, (5) faculty, staff and student involvement in the community.
  • Published reports and articles addressing issues of equity, diversity and inclusion in higher education and our surrounding community,
  • Best practices and approaches to promoting equity, diversity and inclusion
  • The mission, vision and values of our institution

During our review, we talked about the importance of preparing our students to practice in the surrounding community, engaging and serving the community with respect and competence, and addressing barriers to recruitment and retention of diversity faculty, staff and students. We discussed what we believe we’re doing well and reflected on areas we need to improve.

We spent hours developing the following statement on behalf of our school:

Our commitment to equity, diversity and inclusion
Our work, rooted in social justice, leads to solutions for a healthier community. We aspire to create an academic environment where an equitable, diverse and inclusive culture is part of our core values. We seek and embrace diversity of thought, people, culture, and experiences. These principles enhance our ability to prepare the public health workforce, generate knowledge, and make positive contributions to our community.

We determined that it is important for our faculty, staff and students to demographically align with our surrounding region and set a specific goal to: Establish a culture of equity, diversity and inclusion that supports the recruitment and retention of African-American and Hispanic students and faculty.

 We selected a variety of strategies to achieve our goal and stated commitment, including:

  • Changes to how we recruit, hire and retain faculty, staff and students
  • Implementation of a life course pipeline development perspective to mentoring and engagement of faculty, staff, and students
  • Establishing a standing committee on Equity, Diversity and Inclusion that allows us to evaluate, monitor, and make recommendations to improve the culture of our school

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Our plans were shared at faculty and staff meeting and with additional feedback, we are moving forward with our long-term plans.



(Turner, 2018, p. 11)

A call to action

Last November, I went from feeling relatively well prepared to facilitate the process, to recognizing that this wasn’t just an ordinary committee.  We were embarking on a careful and difficult journey to improve the culture of our school. We were tackling issues that are hard to talk about. We had to prioritize certain under-represented groups, which inherently involves choice and selection. We had to use the information about our faculty, staff and students that was available to us; which did not include religion, disability status, sexual orientation, or other characteristics that often form the basis for bias, discrimination and exclusion.

The magnitude of these challenges left me feeling humbled and under-prepared. As a result, I began reading books and other materials that have helped me better reflect on the lens I use in my work and daily life.  A few major take-ways from this exploration are as follows:

  • It is important to distinguish between prejudicial beliefs, discriminatory actions, and racism (sexism, or any other -ism). We all have biased and prejudicial beliefs and sometimes we act on those beliefs with discriminatory behaviors. Racism, sexism, heterosexism, classism, age-ism, able-body-ism and all other “-isms” are rooted in structural inequities based on power differentials.  If we are in a position of power and privilege, we have to carefully dissect the assumptions we make about policies, procedures and practices. If a process consistently yields disparate outcomes, then it is upon us to not only examine reasons for the disparity, but to consider ways to correct the inequities.
  • People of color who work in a primarily white institution face barriers and carry burdens that frequently go un-noticed. This has been referred to as “invisible labor” and “cultural taxation” (June, 2018) due to the time and energy they invest in un-recognized mentoring and being asked to provide their perspective on behalf of under-represented groups. A poignant concept addressed in the book “White Fragility” (DiAngelo & Dyson, 2018) was that we can’t expect under-represented groups to continuously educate us about their life circumstances. We must educate ourselves by reading books, watching films, and finding other materials to help us gain understanding and humility.
  • A long-time sociology theory proposes that situations perceived as real are real in their consequences (Thomas & Thomas, 1928). I have found it helpful to consider this logic in the context of microaggressions and discrimination. Under-represented groups face forms of covert discrimination on a regular basis. If I make a decision that is not based on bias and prejudice, but could be potentially interpreted as such, I need to consider the potential harm that could be done. Leaving a person to wonder to if they were treated differently based on an under-represented status can be harmful, even if the harm was unintended.  While this doesn’t mean we shouldn’t make decisions that might be mis-interpreted, it does mean that we should give careful consideration to all of the intended and unintended consequences of our actions.
  • Structural inequalities are so pervasive, we don’t always perceive them as contributing to prejudice, discrimination and the variety of -isms. We are all products of our socialization, which means that we may be entirely unaware that some of our behaviors are harmful. As a white person, the question I must ask of myself is not whether or not I am racist, but what beliefs and behaviors do I hold that are rooted in structural inequalities based on race? Are there ways that I unintendedly perpetuate inequities and exclusion? What else can I do to prevent harm?

 What are your take-aways? Next steps?  What can YOU do to make your work environment more equitable, diverse, and inclusive?

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Image credit: Global Policy Solutions, Allies for Reaching Community Health Equity, Retrieved from:


Blog Author:

Emily Spence-Almaguer, PhD, MSW, Associate Dean for Community Engagement and Health Equity, Associate Professor, School of Public Health
Director of the  Community Engagement and Dissemination Core, Texas Center for Health Disparities
University of North Texas Health Science Center

I wish to offer great appreciation to members of the SPH Ad Hoc Committee on diversity and inclusion and others who supported these efforts:
Sushmitha Ananth, MPH student, SPH

Carolyn Bradley-Guidry, Associate Professor, Director of Diversity and Inclusion, Dept of Physician Assistant Studies, UT Southwestern Medical Center; DrPH student, SPH

Wanda Boyd, Director of Equity, Diversity and Inclusion, UNT System              

Jose Gonzalez, Vice-President, Center for Children’s Health (retired), Cook Children’s Health Care System

Beth Hargrove, Director of Admissions, SPH

Simeon Henderson, District Executive Director, McDonald Southeast YMCA of Metropolitan Fort Worth, Director, Center for Diversity and International Programs (CDIP)
Associate Professor, Microbiology, Immunology and Genetics, Graduate School of Biomedical Sciences

Melissa Lewis, Professor, Department of Health Behavior and Health Systems, SPH

Sumihiro Suzuki, Chair, Biostatistics and Epidemiology, Associate Professor, SPH

Erika Thompson, Assistant Professor, Department of Health Behavior and Health Systems, SPH

Teresa Wagner, Assistant Professor, Department of Public Health Education, SPH


*Special thanks to Shlesma Chhetri, Terry Voss and Nellie Berunem for their support and assistance



Association of American Medical Colleges (2016) Diversity and Inclusion in Academic Medicine: A strategic planning guide, 2nd edition. ISBN: 978-1-57754-154-7,

Chronicle of Higher Education (2018). Idea Lab: Colleges Solving Problems: Faculty Diversity. Washington DC:

DiAngelo, R. & Dyson, M.E. (2018) White Fragility: Why it’s so hard for white people to talk about racism. Boston, MA: Beacon Press.

June, A.W. (2018) Labor of Minority Professors, In: Idea Lab: Faculty Diversity, Chronicle of Higher Education, pp. 26-30.

Turner, A. (2018). The business case for racial equity: A strategy for growth. W.K. Kellogg Foundation. Retrieved from:

Research reported in this publication was supported by the National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number U54MD006882. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

2019march Blogc

An Almost Forgotten but Still Important Health Risk: Tuberculosis

School of Public Health & Texas Center for Health Disparities Community Blog


Public Health Irony
An irony of public health is that the more effective we are the less visible we become—we work to prevent disease, to keep bad things from happening.

The constant chatter in social media isn’t focused on what isn’t happening in society, but on what is happening.  Prevention isn’t flashy, it isn’t dramatic, and as a result there is little or no focus on much of what public health professionals and researchers really do.  It’s easy to recognize and count things that happen; we track life expectancy and infant mortality and flu cases every day.  In prevention, our success is measured by what doesn’t happen. Therefore, it can be easy to lose sight of the importance of these health protections.

UNTHSC’s School of Public Health works very hard to make sure we don’t lose sight of an almost forgotten but still critically important US health risk—tuberculosis (TB).

Jan2019 1History
The slow-moving plague of TB has been part of the human experience longer than civilization, and until relatively recently there were few people in the US who were not affected by TB in some way.  Before effective treatments and successful public health campaigns, the deadly threat of TB was just something people lived with daily, much like we still live with the ever-present risk of injury or death in a car accident.

In fact, the entire unincorporated city of TB patients and staff, called Sanatorium, Texas, came into existince due to the large number of Texans with active TB in the early 20th century.  More formally known as the Texas State Tuberculosis Sanatorium, the city sprang up in Tom Green County near San Angelo in 1911, and many, many Texans lived and died there during the ensuing decades.  My own family has a history with Sanatorium, and my great aunt died there in 1921 at age 19.   By 1949, Sanatorium was home to over 1000 people, with it’s own power plant, elementary school, hog farm, dairy, library, post office and (!) the Chaser, it’s own newspaper. Sanatorium eventually dissolved with the advent of antibiotics and the post office officially closed in 1965.

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Postcard from Sanatorium, Texas

The antibiotic era turned the tide band ushered in a period of steady progress toward TB control in the U.S. But TB remains a daily reality in much of the world.  Even two decades into the 21st Century more people die of TB than any other infectious disease.  In 2017, 10 million people became sick with TB, and 1.3 million died.

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Dorthea Lange’s “Migrant Mother,” was left a widow by TB.

Today’s Efforts
My research colleague, Erica Stockbridge, as well as other UNTHSC and SPH colleagues, and I have been a part of US TB elimination efforts for many years. We are proud of what we have accomplished to improve public health.  Just in the last decade our work has cut TB incidence in Tarrant County in half, driven other gains across Texas and the US, and established the standard of care for TB treatment internationally.  Just as importantly, our research has contributed compelling justification for policymakers to continue providing critical support for the TB protections that have kept the US an island of safety in a sea of danger.Jan2019 4

Over the years, continued efforts to eradicate TB have taken me to many of the places where it remains a daily reality. I have seen first-hand the suffering that comes without a strong and effective public health system.  Disease doesn’t respect borders. Really, all that stands between our grandparents’ past and much of the world’s present is the diligent work by local, state, and national public health agencies to control and prevent TB in the US.

Are You At Risk of Developing TB?
People can be infected with the bacteria that causes TB but have no symptoms and be unable to pass the disease to others. However, over time, 5-10% of these people with “sleeping,” latent TB infection will become sick with dangerous, active TB disease that can be passed to family and others.  This progression from latent to active TB is preventable with treatment, though.

Up to 13 million people in the US have latent TB infection, and most future cases of TB disease in the US will occur in this group. This means that the best way to protect yourself against TB is to 1) determine if you are at-risk, 2) get tested for latent TB infection by your primary care provider or your local health department if you are at-risk, and 3) take and complete your medication regimen if you test positive and are a good candidate for treatment.

Ask your primary care provider about your risk of latent or active TB. People who are most at-risk include those who:

  • Were exposed to someone who was sick with active TB
  • Were born in a country where TB is common
  • Have spent a month or more in a country where TB is common
  • Are residents or employees of institutional residential facilities (e.g., prisons, homeless shelters)
  • Have HIV infection
  • Are taking medications that suppress the immune system (e.g., TNF alpha inhibitors such as adalimubab, infiximab or etanercept; organ transplant medication; long-term steroids; current cancer chemotherapy)
  • Have leukemia or lymphoma

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Thaddeus Miller, DrPH, MPH

Erica Stockbridge, PhD, MA

If you are a health care provider, you can learn more about TB and latent TB infection by visiting the CDC website: ( and the US Preventive Services Task Force website: ( and reading recent literature reviews on the topic: (

Research reported in this publication was supported by the National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number U54MD006882. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Medicine: Are you taking what you think you’re taking?

School of Public Health & Texas Center for Health Disparities Community Blog


The Problem
Every day, millions of people across the globe do not take their medications correctly. They might be taking too much or too little. The results can have bad consequences. These might be accidental overdose, poor control of chronic disease or death.

Recently, my coworker told me a story about his dad. His dad keeps his gabapentin, a medication used for treating pain, in the refrigerator. In the past two days, he hasn’t been sleeping well because his hip pain has been keeping him up at night. It was later discovered, he had been taking acidophilus instead, an over the counter probiotic. He also keeps acidophilus in his refrigerator. As a result, he started taking more of his pain medication “to make up for it”.

His hip hurts because he had fallen recently, and it had to be surgically repaired. Taking too much of his pain medication can make him drowsy putting him at risk of falling again. This cycle of increased risks from improper medication use can be seen in the stories of different people’s lives every day.

What can be done?
Medication reconciliation is the process of “comparing a patient’s current medication regimen against a physician’s admission, transfer, or discharge orders to identify discrepancies (any problems)” (MATCH, 2012). During healthcare appointments, patients are usually asked what medications they take and how they take each. This patient list is compared to the current list on file with the doctor to create a single medication list as the “one source of truth”. Unfortunately, the list of what the patient should take at home isn’t always easily communicated by providers or readily understood by patients.

Image Credit: Jeffrey Hamilton/Getty Images

Better Communication
Taking the time to check provider communication success along with the patient’s understanding of their medications may save time and money in the long run. Correcting misunderstanding can prevent adverse events that lead to unnecessary hospitalizations, emergency room visits and added health care appointments. Low Health Literacy contributes significantly to adverse events and the increased cost of care (Weiss, 2007). Poor outcomes from problems understanding how to use medication have led this topic to receive national attention.

Health literacy is more than just reading and writing. The Institute of Medicine (2004) defines health literacy as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.”

Problems understanding medication are a health literacy concern. Lack of good communication may not only cause adverse events but may also limit ability to achieve medication adherence (taking medication as prescribed for general health maintenance). Current strategies for safe medication use have not been effective. These strategies not only fail for the general public but especially people with limited health literacy.

Although, more than half of patients have greater or equal to one unintended medication discrepancy (taking a wrong medicine, taking more than one of the same type or not taking a prescribed medicine) at hospital admission, 61% have no harm potential (risk of an adverse event) but almost 40% of patients have either moderate or severe risk of harm (Figure 1).

Figure 1: Potential Harm from Unintended Medication Discrepancy (Cornish et al., 2005).

Health Literate Care
All health professionals should embrace the problem of limited health literacy to improve health outcomes. This can help people get healthy and stay healthy. For medication adherence, providers from all professions need to implement strategies for clear communication in order to improve medication management. For example, new health literate labels are one solution to improving understanding and usability of medication information.

Old, more complex label.
New, health literate label.








Additionally, Pharmacists specialize in Medication Therapy Management (Figure 2) and can review your medication list. They reconcile medications to help ensure that people are taking them correctly. These services help you create and maintain a good, correct medication list. It is important to have good understanding of an up-to-date medication list and have a caregiver or significant other also understand that list. Remember to bring your medications or at least your list each time you go to the hospital, emergency room, or doctor’s office. This helps ensure that the providers caring for you have the most accurate and up-to-date information when making decisions about your care. This leads to SaferCare!

Figure 2: Medication Therapy Management is a systematic process that spans multiple steps to ensure personalized medication safety and efficacy for patients (MATCH, 2012).

Marian Gaviola, PharmD, BCCCP, Assistant Professor of Pharmacotherapy, UNT System College of Pharmacy, Fellow, Steps Toward Academic Research (STAR) Leadership Program

Teresa Wagner, DrPH, MS, CPH, RD/LD, CHWI, Assistant Professor, UNT Health Science Center, School of Public Health, Senior Fellow, SaferCare Texas, Fellow, Steps Toward Academic Research (STAR) Leadership Program

Cornish, P., Knowles, S., Marchesano, R. et al. (2005). Unintended medication discrepancies at the time of hospital admission. Archives of Internal Medicine, 165, 424-429.

Graham, S., & Brookey, J. (2008). Do Patients Understand? The Permanente Journal12(3), 67–69. Retrieved from

Institute of Medicine (IOM). (2004). Health literacy: A prescription to end confusion. Washington, D.C.: The Institute of Medicine & The National Academies Press.

Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation. Content last reviewed August 2012. Agency for Healthcare Research and Quality, Rockville, MD.

Weiss, B.D. (2007). Health literacy: can your patients understand you? 2nd ed. Chicago, IL: American Medical Association and AMA Foundation.


Research reported in this publication was supported by the National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number U54MD006882. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.