Black Women Taking Steps to Health: Funder & Nonprofit Explain How

240201_Conversations_CHAP_GirlTREK_01.mp3

Speaker 1 [00:00:04] Doctor Martin Luther King Jr said of all forms of discrimination and
inequalities, injustice in health. This is the most shocking and inhumane. But how do we
close these gaps and ensure all Americans have the support they need to live healthy
lives? Our guests have some important ideas. There are already making strides on.

Speaker 2 [00:00:25] We know that the primary drivers of health are really in communities.
So and not only that, but there the communities also have the resources and knowledge
and resilience and know how that will create the conditions for wellness.

Speaker 3 [00:00:41] The Community Health Acceleration Partnership says that it's
rethinking philanthropy to support community driven care. We're going to hear from one of
its leaders and from the organizer of an innovative program called Girl Trek that has a lot
of black women moving in the right direction.

Speaker 4 [00:00:58] The mindfulness it requires to open your front door every day as a
discipline and walk in the direction of your healthiest, most fulfilled life. So for us, it is a real
balance between joy and justice. And, and, and it has to be because, my God, we have to
change the face of public health from one that is just treatment to one that is real
prevention.

Speaker 3 [00:01:20] This is conversations on health care.

Speaker 1 [00:01:31] Well, we welcome our two guests to conversations on health care.
Morgan Dixon is the co-founder and CEO of Girl Trek, and we're going to give her a
chance to explain it in just a minute. But let's start with Raquel Mason Jeffers, the co-
director of Community Health Acceleration Partnership, or Chap. Raquel, you're joining us
from new Jersey. Welcome.

Speaker 2 [00:01:54] Thank you. Great to be here.

Speaker 1 [00:01:56] And I know that's where Tap is headquartered. Your aim is to, quote,
Reconnect Health by shifting care from a strictly medical approach to one that harnesses
the resilience of communities. Of course, we're big advocates in the community health
center world of and implementers of this community health approach. But where are you
seeing the need for more of it?

Speaker 2 [00:02:19] Well, I think we see, first of all, that, our origins at Tap really came
from work. That was global. We started to work in sub-Saharan Africa about ten years ago,
and we learned that really focusing on Millennium Development Goals, to have to have the
number of people living in extreme poverty. While we were doing that work, we really
recognized that it became very clear that many of the poor health outcomes that we're
seeing in Africa were also occurring in the U.S.. So we really kind of switched direction.
So, for example, there are neighborhoods in Newark, new Jersey that have worse
maternal health outcomes than Ghana, Namibia and Haiti. So really in particular, we've
been very focused on maternal health in particular. But in general, we know that the power
of community health and community health workers really is transferable, not in a
traditional Western understanding. We have ideas in the global North that can be
translated into the global South, but that there are ways that community health has been
activated in the global South that are applicable in the US. And so we've really been
thinking about, how do we bring those lessons here to the US. We've been focusing a lot

on the maternal, health epidemic in the US in particular. But really recognizing that, the
resources and resilience that exists in communities are really worth investing in, that the
majority of our investment in health care in this country has really been in the medical
system and health care systems, but that we know that the primary drivers of health are
really in communities. So and not only that, but there the communities also have the
resources and knowledge and resilience and know how that will create the conditions for
wellness. And I think that's really what Grilled Track embodies, this idea that, community
members themselves can hold the secret to their own health.

Speaker 1 [00:04:34] And I really like this notion that, best practices can be found around
the globe and crosswalk over here. So there are, teachable moments that occasionally we
have, but we're also learning and sounds like you've really done a great job in extracting
some best practices, from around the globe.

Speaker 2 [00:04:55] Yeah, I mean, I. Before coming to work at Tarp, I worked in state
government. I, one of my roles was as the director for mental health and addictions for the
state. And I often struggled with these uncomfortable facts that, most of the time,
individuals who got into care in the system got there after, like, major catastrophic life
events happened. So they were arrested or their kids were removed and they were
unemployed or on welfare or they were homeless. So what we're trying to do now is really
think about a public health approach that is going upstream, that is more preventative, and
really trying to identify disease and intervene and create conditions for wellness before the
illnesses cascade, and that the severity of illness is both has bigger consequences for
families and individuals, but also greater cost for our entire health care system.

Speaker 3 [00:05:59] Rachel, I, I noted that the Rockefeller Foundation and their
philanthropy was, an important advisor, for a and interestingly, as you may know,
Rockefeller was actually the funders for the very first, excursion of the founder of the
community health movement in the United States to Jack Eiger to go to South Africa, and
study the model there. So there's a synergy among all of these, different, people,
organizations, and countries. But I'm very curious, when you made the transition, from the
work or expanded the work in sub-Saharan Africa to focus on community health in the
United States, what were the lessons, that you learned from the experience in Africa
relative to community health workers, in particular, about informal versus formal
structures? And, you know, in America, people say we like to turn everything into formal
academic, or certification program. But in other countries, much more staying at the
grassroots level, was it tied to public health departments or indigenous organizations? Just
share a little bit with us about what you saw about how it was structured in Africa to what
you've replicated here in the US?

Speaker 2 [00:07:11] Yeah, I think one of the most important things that we've most
important lessons that we've tried, we're bringing to the US is that, many in particular the
individuals who are trying hardest to serve, who are the hardest to serve, black,
indigenous and people of color. We are there's a tremendous mistrust on the health care
system and, community health workers in particular really carry that message of trust by
being members of the community with lived experience who can speak to the actual
circumstances and lives and engender trust and really builds a bridge. There are many
people who will never enter or are, not feeling ready to enter any kind of formal, system of
care. That's probably particularly more so true of the mental health system in particular.
Maybe because of stigma, maybe because of historic institutional racism. But those,
structures there are like big chasms. So that we have really recognized that there's a
workforce at the community level of people with lived experience. And we also bring the

trust of community members with them that can be trained and connected to communities
so that, they can also they can carry messages of health and well-being, but also help
individuals navigate health systems. I think we saw this in Covid, that the greatest
messengers around some of the preventative messages for Covid were really community
members themselves. So the first thing I think we learned is that we have to to really
mobilize communities in and build trust in order to engage people in health and wellness.
The second thing I think we learned is that the role of philanthropy is not to replace or
disrupt government. It's really to work alongside government and, to really understand that
the role of philanthropy is almost like a tugboat and working with the mothership of
government to help it, to help bring that ship to shore. Because often government funds
are not very agile, it's hard for them to make investments in small, community based
organizations. It's hard for them to change their own systems. But philanthropic dollars can
be wisely used to really help. That ship, turn its course and make more and more
meaningful and more trusted connections with community members. So I think those are
two of the major lessons, and that really drives a lot of our work in the US, that it should
always be locally driven and network supported, so we can continue to inform that very
local movement, but, really empower it with knowledge from across the country and across
the world, really.

Speaker 3 [00:10:21] It's interesting how chap tailors its resources and activities to
accomplish what you call the integration of the community health workforce into an
ecosystem of care. And one way this is occurring is through its support of Girls Track. So
Morgan Dixon, you help lead girls track, which we understand is powering a mass
movement for health justice. There are many parts to your program, but tell us about this.
And how did it start?

Speaker 4 [00:10:48] Girl Trek started with two friends. And now we are over a million
black women who walk, talk, and solve problems together in their communities. The
mission is to increase the life expectancy of black women by ten years. In ten years. And
so it started about a decade ago. And we have, movement builders and organizers all over
the country, all over the United States and all over the world in about 40 countries.

Speaker 1 [00:11:15] Well, speaking of many countries, Morgan, we find you in Ghana
today. We're so appreciative of you coming. And you know, you're encouraging black
women and girls to use walking as the first practical step to leading to healthier, more
fulfilled lives. And there are other efforts, including prayer track, with nearly 3000 churches
taking part in Black History boot camp, I think our listeners would be interested in all of
this. Can you share more with us?

Speaker 4 [00:11:44] All right, so the 18th U.S. Surgeon General, Doctor Regina
Benjamin, is on our board of directors. And she says that if she could, encapsulate walking
into a pill, that it would be a miracle drug and she'd prescribe it to all the patients in
America. Walking is such a powerful intervention for everything from, chronic disease to
also if you walk in groups to loneliness. Right. At Girl Track, we also, walk collectively to, to
increase, life expectancy. Right. So all of this to say, we do this, we encourage women to
walk by meeting them where they are. Many black women are in churches. So we do
something every year called a prayer trek, where for nine days we walk according to a
scripture called The Nine Fruit of the spirit. So that's one of our programs. We have
another program called Black History Boot Camp where you log on, you put your earbuds
in, you take a walk, and in 30 minutes we teach you something in black history as you are
walking. And that was really powerful for women during the pandemic, because lots of
women were walking by themselves and it was helpful to be on the line live with, you

know, thousands of women, sometimes 100,000 women, all walking together, learning
together, oftentimes crying together, laughing together. It felt like a really beautiful
community that we created. Wow.

Speaker 3 [00:13:06] Well, Morgan, you know, we talk about health disparities, and
disparities in health care, often on this program. But we always think it's important to
ensure we have the details and that we share them. Black women are more likely than
other racial and ethnic groups to die from cardiovascular disease, including hypertension
and stroke, from lupus, from multiple different cancers, and twice as likely as white women
to develop diabetes over the age of 55. And of course, the maternal morbidity and
mortality crisis is very much on the minds of everybody. When it comes to black women,
the statistics are overwhelming. But I'm really curious how how are you informing
educating black women about these facts without leaving them with a sense of despair or
helplessness? And I would imagine the lived experience makes it something that people
are already quite aware of and already, feeling, overwhelmed by. Tell us about that. How
how are you addressing that in the conversations on your tracks?

Speaker 4 [00:14:08] No, I love that question. Thank you for asking. Yeah. We're facing a
health crisis. And the health crisis, can be completely overwhelming. So black women are
dying a decade earlier than their sisters of other races from preventable diseases. And so
we could talk about statistics around, isolation, around inactivity, around injustice, which
we call the three deadly AIS. We can talk about those things, and we do, because public
health education is really important to all track members. But more than that, we want to
talk about solutions. And for us, walking is such like, a cross-cutting solution to those three
I's of inactivity, isolation and injustice that we really talk about the agency of putting one
foot in front of the other, the mindfulness it requires to open your front door every day as a
discipline and walk in the direction of your healthiest, most fulfilled life. So for us, it is a real
balance between joy and justice. And, and and it has to be because, my God, we have to
change the face of public health from one that is just treatment to one that is real
prevention. So at Girl Track we try and strike a really beautiful balance there.

Speaker 1 [00:15:24] Well, that's that's. So important and and equally important is really
your goal, in terms of how you're going to address this disparity that both you and
Margaret were talking about in terms of, of black women dying, much earlier than white
women. And then you have, you have a program to increase life expectancy, for women,
black women by ten years. In ten years. Tell us about how that program came about and
how far along are you on that on that track?

Speaker 4 [00:16:00] I appreciate that question. So when we first started, we set a mission
to inspire a million black women to walk in their neighborhoods for better health, to inspire
our daughters to reclaim the streets of our neighborhoods. And we achieved that mission
in 2020. And so everyone wanted to know what happens when you get a million black
women to walk together. Well, we asked a million black women what next? What do we do
next? And the prevailing answer was we want to live. We want to live long. We want to live
well. We want to live our most fulfilled lives. You know, it is a part of the American dream.
This kind of life, liberty and the pursuit of happiness. And so one of the things we thought
is, okay, well, what is the truest measure of justice when it comes to living? And it really is
life expectancy. So we looked at the statistics and we looked at our sisters who were
Asian-American, our sisters who were, white, our sisters who are of all races, Native
American, Latino. And we fared, worse than most women in the country. And one of the
things we, we thought is if we could just live that last decade, what what power could we
unleash, to the world and like, our lives like, that is a really important thing for us to be able

to live, our longest, healthiest lives. So we set a mission, about a year ago, to increase the
life expectancy of black women in America by ten years and ten years. So we're currently
living to be about 78 years old. And our goal is that in ten years, by 2035, we'll be living to
be 88 years old. My God, that is a hard goal. It is much harder than getting a million black
women to walk in their neighbor. What it's going to require is a roundtable of really
powerful partners, everyone from public health systems, to influencers to, new economies
that really support this population health goal. So we're prepared to build a big tent of
people, and, and invite people in who care that black women get to live as long as
everyone else.

Speaker 1 [00:18:15] Tell me what you've learned from other parts of the globe in terms of
how they're addressing these issues, and how have you crosswalk some of those back, to
here to the United States.

Speaker 4 [00:18:27] Yeah, we have been very lucky to be a part of many global
fellowships like Echoing Green, like the audacious ideas that come with TEDx on the
global stage like Ashoka and Aspen Institute. These are institutions and fellowships that
bring the top social innovators of the world together, and we have learned so much that
what any solution needs to be, affordable, accessible, and it needs to be people powered.
And so one of the things that we're not that interested in is this kind of top down systems
change if we are going to truly change behavior and real narratives of what it means to be
healthy and what it means to want to live. We have to engage a critical mass of people.
So, for example, in America, nearly 10% of all black women in America are members of
girls, right? That's what we need in order to change population health. So as we start to
expand, expand beyond the borders, we're now in 40 countries. The question is, what is
the single most powerful thing we can do and promote to increase longevity? How do we
use that? That's victory. In order to, attract the kind of resources and partnerships that are
required for systems level change. Right. So, but you know, where we are democratizing
public health by creating demand for systems level change. And then we've just been
inspired around the world by, people like one Gary Mattei in Kenya who, inspired women
to plant trees. Right? And they planted 50 million trees and brought Kenya back from the
brink of environmental devastation. So the question for us when we started is like, what is
our tree? What is our unit of change? And for us, it is asking us to want to improve our
health and then to come back and get her neighbors. And then as they walk and talk, they
then begin to solve problems together that are barriers to health in their communities.

Speaker 3 [00:20:29] Well, these are, audacious goals, as they should be. And, every
good, audacious goal needs some, grounding strategy to make them happen. I'd like to,
maybe, ask you about this. I understand that you really see, the community health workers
and other community workers, being able to achieve certification, for their services, to be
reimbursed for them to be paid, as part of this solution. Tell me about this, what type of
certification are you looking for and does, in fact, the fact the services are reimbursed and
people are paid help address some of the fundamental health disparities of which income
inequality is certainly one.

Speaker 2 [00:21:11] Margaret, I'm so glad you asked this question, because this is really
at the heart of how Morgan and Top came together to partner. What? Girl tech was asking
this question. They have an entire volun, entire volunteer movement up until this point, and
they've begun to ask this question. What about if we could? There are neighborhood
captains who lead walks. And what about if some of them, not all of them, wanted to do
more and wanted to get paid for their role? So we started to put our heads together to
think maybe girl trackers could be community health workers and get certified and

potentially paid through that funding stream. One of the things that we've learned as
funders is that we really try to take on trust based philanthropy, where we really listen and
we're willing to pivot when we're wrong. So we're on a journey with our partners, and we're
not trying to kind of fit a square peg in a round hole no matter what. So what happened?
What we what we began to understand is that community health workers, as they're
understood and reimbursed and certified in the US, are not exactly what girl trackers are
doing. And I love this term, girl trackers, really understanding them, their role as
community health activists. Right. They're really that the fact that they're walking and
talking is a really important part of the model. So we have been working together to identify
what are the funding streams and the right certifications, or do we need to invent a new
certification so that we are really celebrating the strengths, resilience and motion that girl
track has really brought to the table, here as a solution. Rather than asking girl track and
their movement to fit into the existing constructs of our health care system. So that's really
been the focus of our work together. And we have learned a lot at Chop about what it
means to be really committed to the full picture of the goals and achievements that girl
track is trying to reach, and to allow ourselves to be, to accompany them and be allies with
them in the truest sense of the word. So I would love to ask, Morgan to also chime in about
the issue of certification, because I know that you've also been really thinking about how
you're training, girl trackers to go to the next level.

Speaker 4 [00:23:45] Yes. So. We learned a story just recently about how para medicine
started in America. And I encourage, listeners, there's an episode of Black History Boot
Camp called freedom House. If you type in Black History Boot camp, freedom House, you
can listen to the story. But essentially, you had 20 something African American men in
Pittsburgh, who became trained in something they knew called para medicine. It was
never invented before. It was never it was new. So they got taught defensive driving,
intubation, IVs, delivering babies, defensive driving. Did I say that? And CPR, which was
this new fangled thing where you pump on people's chest and save grandma. Right. So
this was all a very scary thing. Long, long time ago. But fast forward to now. There are
paramedics all over America because their pilot worked. They were certified in something
that was really valuable in their communities. So one of the things we like to think about is
like, where are the gaps in public health and how can we provide door to door care, and
what kinds of certification are required for that door to door care so that we can meet
women at their points of need, but also we can provide workforce and workforce
development for women who are really, really battling the health epidemic of poverty.
Right. And so how can we do both at the same time and have this double bottom line? So
for girl tech community health activists are really three fold, not even double meet our
neighbors at their point of need with with really specific care. Employ women to go door to
door, deliver said care and then, equip women to be advocates in their community for
systems change. And we believe that is a different model that hasn't been tried before.
And we're excited to do it more.

Speaker 1 [00:25:38] I want to ask you about Ozempic, and I think there's probably no
conversation in America that either I or, Mozambique is mentioned, and obviously it's a
new pharmaceutical treatment that's really taken off, and that, weight loss injections, and
they come under many names. But it was one of them. Millions of people have received
prescriptions so far in the US, and reports our patients are indeed losing weight. But I think
the more important question are, are are we still seeing disparities here and are diverse
populations getting access they need to these treatments? Or do you believe that really it
is maybe an adjunct to a fundamental let's start walking first campaign and then look at
other perhaps pharmaceutical interventions.

Speaker 4 [00:26:32] Yeah, well, I am no researcher. And in fact, I was on the phone with
the leading researcher on obesity today, one of them out of Duke University, doctor Gary
Bennett, who's also on our board. And he has lots to say about this. So I, I will pretend to
be Doctor Bennett but what I, I well there are a couple of things. One. Obesity is not is not
the single cause of, of death for black women. Right. So it is we need to also, have
interventions and solutions that ameliorate all of the other causal factors of early death,
including things like stress, right, or loneliness, which is deadlier than cigaret smoking. So
in many parts of the world, we were having a global conversation before. Women have,
larger B or their BMI or indicate that they are heavy, but they are not they are still not are
overweight or over a healthy weight. But they're not they're still not, dying from the
preventable diseases that we are. And so weight loss in and of itself is not going to save
all of our lives. And one of the things for us to consider is access to these drugs. And, and
I and I want to make sure that in the interim, while we can get, pharmaceuticals affordable
enough to be, available and, to the masses of people that we have interventions that are,
that are just, for everyone and walking is, is incredibly powerful. It is healthy from a mental
health perspective and a physical health perspective and a community health perspective.
And we believe that's the best intervention.

Speaker 3 [00:28:11] Well, Morgan, I have, one question that I really want to ask you. I'm
curious, just so we don't, make the men feel left behind. Are there similar efforts for guys
do you see within your neighborhood groups, people being inclusive of other genders, or
do they need a different approach? Maybe. Walking's not the answer for everybody.

Speaker 4 [00:28:34] Oh, I love this question. Our number one core value in Girl Trek is
one called Radical Welcome. How come every single person listening to Take a Walk with
us? And that shows up with generations of people walking, strollers, grandmothers,
mothers, but it also shows up with families and shows up with neighbors, people of all
races and colors. We support and serve and love black women just because we know that
if we can solve for the, those who are struggling most in our society that we really can
inspire, like widespread change and black women really are suffering disproportionately.
But it doesn't mean we don't welcome radically every single person in our lives. And then,
the other half of your question is I was at a think tank one time, I think it was with New
Prophet or some incredible organization. And, they asked who were the exemplar or
organization. It's like, oh, the civil rights movement in terms of grassroots organizing and
pickup basketball in terms of scalable public health interventions. And people thought I
was joking and I definitely was not joking. The accessibility give or and and the kind of
widespread nature of pickup basketball where you can go to any community across
America on a Saturday morning and all you need is a basketball and sneakers and you
can have a pickup game is how ubiquitous we want girl truck walking, walking crews to be
across the country. And so I think listen, I think our men have something, you know, have
something we could learn from, quite frankly. And they're also invited to our walks.

Speaker 1 [00:30:09] Because that is so wonderful. We want to thank both of you for
joining us for this great conversation. From new Jersey to Ghana. We had a great,
conversation about the work that both of you are doing. Thanks to our audience for being
here. And be sure to subscribe to our videos on YouTube and find us on Facebook and X
with our account name, CHC radio. As always, you can go online to CHC Radio.com to
sign up for email updates. You can also share your thoughts and comments about this
program. Thank you both, for your inspirational work and for taking time to talk with us on
conversations on health care.

Speaker 3 [00:30:48] This copyrighted program is produced by Conversations on
Healthcare and cannot be reproduced or retransmitted in whole or in part, without the
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