Welcome to Community Spotlight: Changemakers–a series of conversations with thought leaders, community members, and healthcare industry experts.

The series shines a spotlight on community leaders and members who know the burden of social and racial inequities, and health disparities and are taking steps to change it. As we expand the conversation beyond simply addressing social determinants of health, we hope to draw inspiration from them and deepen our understanding of what diversity, inclusion, and equity in healthcare mean.

We invite you to join us, follow the Health Equity Research blog, and read about the Changemakers who realize the immense potential of community-based solutions to achieve health equity. If you would like to recommend someone who's making a positive impact in your community, contact us at pereira.kanaaz@mayo.edu

INDEX

• George Maxey–Empowering from Within
• Amanda Nigon-Crowley–Planting Equal Roots
• Warren H. Stewart, Sr.–More Work, Less Talk

 

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George Maxey–Empowering from Within

Tell me a little bit about yourself–how did you become involved with 2nd Mile ministries? What is your role as executive director?

I became executive director of 2nd Mile Ministries just before the pandemic in 2019. I’m in the Brentwood community (north of downtown Jacksonville, helping kids and trying to develop leadership amongst young adults and children in the community–helping them realize that they don't have to leave their community to find a level of prosperity.

The whole purpose behind 2nd Mile is youth development, in areas of health, education, and economics, and trying to build a platform where they can take leadership within the community–to help grow their community from within.

Why is it important for communities to engage and partner with institutions like Mayo Clinic? What are the benefits of doing so?

The benefit of partnering with Mayo Clinic is that the Clinic has a reach that we would never have, as an all-black nonprofit in Brentwood. Engaging with larger institutions creates a level of accountability, and publicity, and increases the level of discussion. Mayo Clinic may not be able to solve every problem, but it can be an advocate for communities, and bring people to the table so we can have discussions for potential solutions.

Are there any barriers to engaging with larger institutions like Mayo Clinic?

The flip side of partnering with non-profits like Mayo Clinic is ensuring they're being intentional and hearing the voices of the people they are trying to serve. It has to be a relationship–a two-sided conversation, and not just telling people what they need to do.

Take obesity, for example. Historically, we know that African Americans are overweight, leading to hypertension, high blood pressure, and diabetes. Large healthcare institutions talk about data that shows the benefits of a Mediterranean diet, eating more greens, more protein, exercise, etc. But it's important to take the time to listen to the people in the community because then you will hear them say–

• "We live in a food desert"
• "Our grocery stores don't provide these organic foods"
• "I know I need to drink and eat healthily, but I can't afford it"
• "You tell me to exercise, but it's kind of dangerous. We don't have sidewalks, there is a lot of crime, and I don't feel safe walking around my neighborhood"
• "We don't have a gym, and even if we did, I can't afford the gym"

Larger organizations need to take the time to see life through the community's lenses to find solutions to problems rooted in poverty and racism.

Phrases like "health disparities" and "social determinants of health" can become jargony at times, and are not always well understood. How would you explain the distinction between ending racial and ethnic healthcare disparities and the goal of achieving health equity?

I think the goal of achieving health equity must start with really understanding it. What started in 1694 (slavery), and what is taking place in our country right now, has been transferred–not just mentally but via DNA!  Certain habits and certain mindsets are generational.

We have to start by acknowledging that racism does exist, poverty does exist, but not just talk about it–we must ask why people feel like they're not part of the process or why they’re excluded from the process. Why do certain biases still exist within the process?

Solutions can't be just program-based; they have to be movement-based–something that takes place over an extended period. It’s about doing a deep dive and realizing what my (individual) role is; what are some of the things I can do as an agency, or as a policymaker to create the change I want to see.

How can we, as individual members of a clinical research community/healthcare institution, take steps towards achieving cultural competence that leads to diversity–more so in clinical trials?

A lot of underserved populations don't have access to resources that institutions like Mayo Clinic offer. The first step (in my humble opinion), is making sure there is money in a clinical research budget for marketing and networking.

Monica Albertie (Mayo Clinic) realized this very early on–budgeting for clinical research should include paying people (participants) for their time. That’s called networking! She also realized the significance of marketing, like identifying community leaders or connecting in a hair salon, barbershop, or maybe in a black church–utilizing your marketing campaign to identify key stakeholders within an area, and identifying the target audience.

For example, let's say the target audience is 18- to 35-year-old black males. How do we get the information to them and get them to participate in research studies? You might find them at the local barber shops; or, depending on the time of year, what’s the biggest thing that happens on Saturday mornings? Pop Warner football! That's where the kids will be. So, it’s taking the time to identify key stakeholders who can offer rich ideas on how to reach individuals within a community to get them to participate.

Disparities in healthcare for people of color have been longstanding challenges and have existed for decades. What would it take for the next 15-20 years to tell a different story?

This is where socio-economic issues play a role. Very often, especially in impoverished black communities, there's no trust in doctors. Why? Because the medical profession is not something they utilize. For most inner-city black communities the doctor’s office is the hospital or the emergency room. But you can't develop a relationship in emergency medicine–you’re there to triage! And, since there’s no building of a relationship, there’s no creation of that trust.

The problem we are running into is trying to get people past their inability to trust and form relationships–which are formed over time and need consistency. Most individuals in our community don't have doctors’ offices or don’t have proper medical insurance, anyway. They don't have a primary care physician. Well, you can't create consistency, especially with the state of healthcare today. We no longer have “down-home” doctors; now we have Walmart clinics, Walgreens clinics, etc.

For example, a person goes to one of these clinics and starts developing a relationship with the doctor. But they (doctors) will likely have moved on to bigger and better jobs–which leaves the patient feeling like he/she has to start all over again with a new doctor!  "Are they going to prescribe totally different medication?" "Will I have to repeat tests?" All these uncertainties lead to a lot of frustration for the individual. But they are not frustrated with the Walmart or Walgreens clinic–they are frustrated with the medical profession.

Are there certain issues that most affect the health of your community?

I think the primary issues are the same–obesity, hypertension, cholesterol, diabetes. The challenge is that although there's a lot of research being done about these problems, there's very little research done on finding practical solutions from a poverty perspective.

For example, when we provide information, brochures, pamphlets about a healthy diet, we are talking from the prism of the middle class. But what is healthy eating for a community where the grocery stores are Family Dollar or Dollar Tree? We know it's healthier to grow your own vegetables and fruits. But (we) live in a small apartment; there's no room!

Instead of trying to find solutions based on what we know, we need to do things based on what they (community) know–what is it that they know and how can we do it better? There has to be a paradigm shift in how we come up with solutions.

George Maxey is an experienced educator (over 25 years), community change leader, and the Executive Director of 2nd Mile Ministries–a Christian community development organization empowering the people of Brentwood to elevate the neighborhood and surrounding communities through the Gospel and holistic transformation.

Connect with George Maxey:

• Email: george@2ndmilejax.com 
• Twitter: @maxeyg1911

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Amanda Nigon-Crowley–Planting Equal Roots

Tell me a little bit about yourself–how did you become involved in your current work?

I'm a. mental health practitioner by trade and also a farmer. After starting my family, I was looking for part-time work and started working with the Diversity Council in Rochester. That's where I met Kim Sin, who is a strong advocate for the Cambodian community and also for all marginalized groups. He's also an entrepreneur, always starting new business ideas, and he has a very creative mind.

We got together and talked about how there was this need in his community–the Cambodian elders felt very removed from society, and many of them were looking for access to land to grow their own food. With my passion for community health, and mental health and a background in farming, I have a lot of resources in Rochester, so it just made sense for us to combine our energies. We founded the Village Agricultural Cooperative in 2019 and have really grown from there with a lot of great community support and partners.

How would you describe a community garden?

I would describe a community garden as accessible land and water, where people can grow what they need for themselves and for their families. In our community gardens, we grow a lot of culturally specific foods. We have over 22 countries represented within the Village, and we grow foods from all over the world. That’s what community gardens are, for recent refugee populations–they are really important in helping preserve a lot of those indigenous agricultural practices, recipes, and traditions that are so important to preserving culture.

Could you talk briefly about the process of gathering information about the needs of a community, and how you engage with them?

The biggest thing is just being present–we meet them on the ground. During the first two years, we talked to a lot of people about what they needed, what the problems were, and where the best areas for land access might be. For example, some people need it to be on the bus line, some don't want to travel very far, or they don't want to travel to neighborhoods they're not familiar with or don't feel comfortable in…really just being able to have a place where they feel safe and where they can work together.

In your opinion, what are the benefits of engaging with larger organizations or institutions like Mayo Clinic?

I do think it has strengthened our community, particularly our Latino community and Spanish-speaking communities. Mostly, that has been due to Mayo Clinic bringing Spanish-speaking leaders into the community on a routine basis and building relationships. For example, we see the same farmers coming and attending events over and over again because they've gotten to know Miguel (Valdez). They feel comfortable asking him questions because they not only trust Miguel, but can relate to him in their own language, and they also know that he represents a major medical institution.

Financially, Mayo has really supported us so that we can continue our program–that is extremely beneficial because we don't seek much in terms of fees from our farmers, but we do have a lot of expenses. Sadly, farms are not cheap to operate!

On the flip side, do you see any challenges to partnering with larger organizations?

Early in our process, United Way approached us and asked us to write a grant. But they had stipulations and wanted us to survey our farmers and obtain their demographic information, their income levels. We weren't willing to do that–we don't want to treat our farmers like they are research subjects! Many already feel like they're not part of the community, so we don't want to “study” them like some sort of specimen.

We haven't seen any of that from Mayo Clinic. It’s just something that we're conscious of while working with a larger institution–that we keep the privacy and the respectful nature of our farmers and growers in mind so that they continue to feel comfortable carrying on what they're doing.

Do you include the farmers and growers in decision-making like land development or planning and management?

Definitely! For the first two years, they just watched and didn't interact too much. But now, as we built trust, and built a really strong community, several of them have developed as leaders who are very comfortable in vocalizing their needs and getting things done.

We rent the land at all of our locations and initially, our farmers were nervous to approach the landowners. Again, that's another relationship we have really fostered and built so that they (farmers) now know, I can do this on this property, or I can go and talk to Matt (facility manager) if I can't get hold of Amanda–there's been a lot of confidence built.

What are the challenges regarding health disparities, in the communities that you work with?

Honestly, our people are healthy, physically. But what I hear over and over is the financial stress they're under and their workloads. We've been working closely with three Latina farmers, doing some research on tomatillos. It’s going super well, but two of them have taken extra jobs working in hotels. That’s very physically exhausting for them! They also have young children. I think it's the financial stress that they face, and the exhaustion of working multiple labor-filled positions, laboring on their farms, and caring for their children.

So how do community gardens and agricultural co-ops help in reducing these challenges and health disparities?

I think a community garden is a place where they really feel like they belong. We have over 200 families registered with us, and over 95% of them are people of color. We have a few from Ukraine and Russia, but they all identify as recent immigrants. It's a place where it doesn't matter what their language or background is, it doesn't matter what kind of foods they're growing–the common bond is that they're all there to grow food.

Farmers are a special breed–there's a very specific culture to people who like to play in the dirt and grow their own food. It's a common bond of knowing that they're all there for the same purpose and that they work well together. They share together, they help one another out, and they've built a strong community–in a place where they don't always feel like they fit into other parts (around Rochester). Being able to grow and share their food is so important to them. Almost every time I show up at one of our farms, I'm given something and told how to prepare it. The pride that is expressed is just awesome!

For instance, while growing up we didn't have a lot of money, but we always had fresh, delicious, healthy food. And that makes you feel rich in a way like your basic needs are being met. It's the same for our farmers because they're very focused on sustainability and they’re able to provide.

Another benefit we've seen is that even though the cost of everything has exponentially gone up with the pandemic, our farmers did not feel the financial stressors as much because they were able to grow their own food. And the farms are great spaces for children to play in–our farmers can safely bring their children and not worry about the cost of childcare.

From left to right: Chandi Katoch, Board Vice President; Kim Sin, Board Chair; Amanda Nigon-Crowley, Executive Director (Photo credit: OlmstedCounty.Gov)

What kind of future dialogue do you hope your work evokes?

Continuing to build confidence within our community, and helping our farmers gain their own farms.

In Minnesota, 99% of farmers are white, and many of those farms are inherited or passed down to people who don't even farm. Subsequently, that land goes to big agriculture. We would love to continue to empower our farmers. Many of our farmers come to us because they live in apartments or rental housing where they're not allowed to have gardens or farms. We've been working with the USDA Farm Service Agency and introducing our farmers to some of their programs because we want to promote land ownership––there’s huge power in owning your land!

To increase our visibility, we started a farmers’ market. We have a partnership with Renewing the Countryside, and they've been opening market hubs across the state of Minnesota. They approached us and offered their support to open our own farmers’ market (every Tuesday at the History Center from 4 pm to 7 pm). It's been so amazing to see our farmers happy to share the foods in their culture–we've been talking about putting a recipe book together.

One of the nursing homes recently approached us because they were having a really hard time accessing food. And we were like, “Hey, we've got a lot of extra food and our farmers would love to sell it to you.” This interaction with the public has extended our visibility and is opening a lot of doors for our farmers who would not have been reachable before.

Have restaurants shown any interest in getting food supplies from your farmers?

Definitely! Renewing the Countryside's design is for the hub to actually operate as an aggregate hub. We would have an online platform where the community can shop, and we want to do more wholesale–we’ve already sold some to a few of the Mexican restaurants in town.

We have 650 tomatillo plants for our tomatillo research project, and we’re producing a lot of tomatillos on a very local level. Local food trucks and a couple of restaurants have supported that; the Asian food store in town has also been buying food from some of our farmers for several years.

Any interest in selling at the big Saturday farmers’ market in Rochester?

We did enroll two of our farmers to sell at the Saturday market, but they never did––they felt a bit intimidated. That was one of the reasons we wanted to start our own farmers’ market. As we continue to build more confidence, they might be willing to do so in future years.

We have two farmers from the main market who are also selling at our markets, and they have been such a great addition. They've taken a “leadership” role, teaching our farmers how to label products, how to market products, and how to create a profile on social media platforms like Instagram–essentially creating a business model that people can see.

Amanda Nigon-Crowley is the Executive Director of  The Village Agricultural Cooperative, which is a collaboration of "people from all over the world who are growing food together in a way that is more sustainable to our community." As a former mental health practitioner, Amanda believes in the intersection of community health and our connection to the land. As a co-founder of the Village, she uses her local agricultural connections and experience as an advocate to connect people who want to grow food to their local communities in a meaningful way, which includes the preservation and regeneration of our soil.

Connect with Amanda:

• AmandaNC@RochVillage.org

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Warren H. Stewart, Sr.–More Work, Less Talk

Tell me a little bit about yourself and your organization; how did you become involved in your current work?

My name is Warren H. Stewart, Sr.  God has blessed me to serve as the Senior Pastor of the First Institutional Baptist Church in Phoenix, Arizona, since July 1, 1977, the first and only church I have ever pastored.  This congregation called me to pastor them right out of seminary after completing my Master of Divinity and Master of Sacred Theology degrees at Union Theological Seminary in New York City.

Why is the Black Church important?

The Black Church is the delivery room for servant leaders who are called and equipped to address the holistic ills of our everyday existence. It is God’s Church given to the Black community as a place of refuge, redemption, restoration, and revolution which has historically been engaged in liberating Black people holistically from the restraints that have been forced on us by others, and sometimes by ourselves.  It is the most independent voice of and resource for people of African descent and others in the USA.

You have accomplished so much! You've brought about meaningful change in your community, and impacted so many lives–what inspires you to persevere as a “soldier of justice”?

Yours truly is created in the image and likeness of God who, with God’s help, is endeavoring to advocate for JESUS AND JUSTICE by love in action for every human being in my circles of influence.  My aim is to fulfill the purpose for which God created me and Jesus Christ saved and called me to witness for Him.

In your opinion, what perpetuates the state of health disparities today?

Regrettably, in Arizona and across our nation, health disparities among people of color, especially African Americans, are pronounced, painful, and pathological.  It is an oppressive oxymoron that systemic racism continues to permit and perpetuate injurious and deadly health disparities in the greatest country in the world.

How can the church and an organization such as ours use its time, resources, and talent to advance equity?

By following the guidance of the Holy Spirit in using our time, talent, and treasure to represent Jesus and justice whenever and wherever injustice raises its destructive head to limit life in its fullness, especially for Black people and other marginalized peoples.

Do you feel it's important for communities to engage and partner with larger institutions like Mayo Clinic? What are the benefits of doing so?

Mayo Clinic and other similar larger institutions have been abundantly blessed with resources to improve the lives of countless human beings.  Therefore, by partnering with communities of color, especially the Black Church, those institutions can learn from communities of color and our communities can learn from Mayo Clinic and other similar institutions.  It is a partnership that goes both ways to the benefit of all.

What types of institutional and social changes are necessary to address health inequities?

Confessing of systemic racism (even in Mayo Clinic) and repenting, that is, going in the opposite direction to right the wrongs done to people of color intentionally or ignorantly.  As far as the health inequities, naming them first, claiming them, and reframing them until they are reduced and eliminated.

What are some current challenges that you see in your community?

A report on the state of health of Black people in Maricopa County revealed that African Americans lead seven of the eight reasons for mortality in the county! The only category (cause of death) in which Black people did not lead was suicide.

Health disparities and societal inequities have existed for a long time–for decades. What will it take for the next 20 years to tell a different story?

Much more work than talk!

Dr. Warren H. Stewart, Sr., is Pastor of the First Institutional Baptist Church of Phoenix, Arizona, and has served there since 1977. Over the years his humanitarian efforts have focused on housing, health care, and immigration reform, and he's committed to defending civil rights and paving the way for social justice in Arizona. Pastor Stewart served as the first General Chairperson for Arizonians for a Martin Luther King, Jr. State Holiday,  which contributed significantly to the legislative passage of Arizona’s Martin Luther King, Jr. holiday on September 21, 1989. He is recognized as “a man of conscience, commitment and dedication to the cause of moral leadership, human rights and a soldier of justice and equality.”

Connect with Pastor Stewart:

• Email: whstewartsr@fibcaz.org
• Twitter: @Whstewartsr