Navigating Air Quality Concerns: Insights from a Medical Anthropologist
A profound exploration of the intricate relationship between environmental health and community well-being unfolds during the discourse between Will Dean and Dr. Ann Cheney, a distinguished medical anthropologist affiliated with the University of California-Riverside. The conversation delves into the pressing environmental health issues faced by residents of the Eastern Coachella Valley, particularly focusing on the alarming prevalence of childhood asthma within this vulnerable population. Dr. Cheney elucidates her methodology as a medical anthropologist, emphasizing the importance of immersing oneself in the community to cultivate trust and effectively address health disparities. Through participatory research, her team has identified critical factors contributing to the high rates of asthma, including poor air quality exacerbated by environmental conditions related to the Salton Sea. The discussion articulates how socioeconomic status directly influences health outcomes, revealing a stark contrast between the experiences of residents in the Eastern Valley compared to their counterparts in more affluent areas. Dr. Cheney's insights highlight the necessity of recognizing and addressing root causes rather than merely treating symptoms, thereby advocating for a deeper understanding of the environmental determinants of health.
Takeaways:
- In this episode, Dr. Cheney elucidates the significance of community engagement in addressing public health issues, particularly in the context of environmental health.
- The discussion emphasizes the critical role of medical anthropology in understanding healthcare systems and improving health outcomes for marginalized populations.
- Dr. Cheney's research highlights the alarming rates of childhood asthma in the Eastern Coachella Valley, which are disproportionately higher than national averages due to environmental factors.
- The podcast underscores the importance of interdisciplinary collaboration among healthcare providers, researchers, and community members to effectively tackle health disparities.
- Listeners are informed about the unique challenges faced by immigrant communities in accessing healthcare services, particularly concerning childhood asthma diagnosis and management.
- Finally, the conversation reflects on the necessity of addressing root causes of health issues, such as environmental pollution, rather than merely treating symptoms.
Companies mentioned in this episode:
- Desert Healthcare District and Foundation
- UCR School of Medicine
- Unidos Porsolud
- Patient Centered Outcomes Research Institute
Transcript
The Desert Healthcare District and Foundation presents a podcast that supports your health and wellness where you live. This is Healthy Desert Healthy youy hosted by Will Dean. Now here's Will.
Will Dean, Host:Hello friends. Welcome to Healthy Desert Healthy youy Podcast. This is a brand new podcast presented by the Desert Healthcare District and Foundation.
Today I am joined by Dr. Ann Chaney with UCR School of Medicine. Dr. Cheney's a medical anthropologist and a health services researcher. Welcome, Dr. Chaney.
Dr. Ann Cheney, Guest:Thank you very much. I'm happy to be here.
Will Dean, Host:So happy to have you here. We go back a little ways. I know from the early days of our COVID19 response.
I would often see you on Zoom in a lot of those discussions as we were planning how to really bring education and testing and vaccines to our community.
Dr. Ann Cheney, Guest: That's right. Since: Will Dean, Host:Yeah.
Dr. Ann Cheney, Guest:At least if you've been able. Interacting via Zoom. And now we're in person, which is wonderful.
Will Dean, Host:It's very exciting. So I mentioned that you are a medical anthropologist. I don't know that I've heard that term a lot and I think many of our listeners have not as well.
Could you talk a little bit about what that is?
Dr. Ann Cheney, Guest:Sure. So I am a medical anthropologist.
I have a bachelor's degree in anthropology, a master's degree in anthropology, and a doctoral or PhD in anthropology. So I am considered to be a cultural anthropologist. And medical anthropology is a discipline or subfield within cultural anthropology.
When we think about a medical anthropologist, my expertise is really in critically thinking and engaging with health care systems.
It's very common for medical anthropologists to be within schools of medicine to teach medical students, to teach residents, to really be involved in curriculum, bringing a critical and social science perspective.
As a medical anthropologist in my current position, my work is really focused on mentoring medical students as well as doing public health and health services research.
Will Dean, Host:Oh, wow. So not to be too basic about it, but it sounds like you really bring the real world perspective very much in medical school.
Dr. Ann Cheney, Guest:Very much.
And the type of research that I do, the approach that I use, which very much has been shaped by my anthropological training, is to immerse myself in the community and to develop relationships, to build trust and to work with community.
In this case, I work primarily with members of the eastern Cochella Valley to empower them, to build their capacity to understand health needs of their community and then address them.
Will Dean, Host:Right. So let's talk about how that relates to your work in terms of environmental health. When did you first get involved in that, in that topic?
Dr. Ann Cheney, Guest: reat question. So I would say:Slowly, because of the work that I do, community gauge, participatory research, the needs of the community have really driven me into this space or guided me into this space. The original work that we did was a needs assessment, a health needs assessment.
And we did that in collaboration with communities in the Eastern Coachella Valley. And one of the main topics that came up was childhood asthma and other related conditions like nosebleeds, as well as allergies.
And so we started there from what we heard from community as a priority and began to develop research around that topic of childhood asthma.
Will Dean, Host:And because you were beginning to see large amounts of children affected by the air quality in terms of asthma.
Dr. Ann Cheney, Guest:Right. So, well, our work, my team's work, we refer to ourselves as Unidos Porsolud because we are a community academic partnership.
It's myself as the academic investigator, and then Maria Conchita Posar is the community investigator. Conchita oversees our team of promotores who are community health workers. They're leaders in their community.
What we began noticing is that there was a real concern among caregivers of these complications that their children had. And it wasn't just that they maybe had asthma.
They were confused because their child may not have had a diagnosis of asthma, but the healthcare provider prescribed them albuterol, so a medication for asthma. We started investigating that to try to understand really what was going on.
And it was a lot of questions around healthcare services use, healthcare access.
And a lot of what we've learned over the years is that it's an immigrant population and many are utilizing emergency care services because it's available when they are available. And in an emergency care setting, you typically do not get a diagnosis for childhood asthma.
You would need to go to your primary care, to the pediatrician. So we started to investigate those types of topics.
What we do know from the epidemiological literature that has primarily been done in Imperial Valley with children within school systems in the Imperial Valley, is that the rates of asthma are upward of 22%, which is double the state and national average of childhood asthma.
Will Dean, Host:Double.
Dr. Ann Cheney, Guest:Double.
Will Dean, Host:Wow. What you were saying about the emergency room situation is that they tend to treat whatever is ailing you at the moment. That is not a diagnosis.
Dr. Ann Cheney, Guest:Exactly.
Will Dean, Host:Okay.
Dr. Ann Cheney, Guest:Yes. So what we have found, if families are able to, meaning they're able to cross, they're able to bring their child across the US Mexico border.
Their preference, at least in the eastern Coachella Valley, again, it's an Immigrant community. The majority of individuals speak Spanish as their primary language.
They cross the border into Mexicali to access healthcare services, because there they're able to get a diagnosis, a diagnosis that they understand, and then a treatment plan.
Will Dean, Host:Okay.
Dr. Ann Cheney, Guest:And we noticed that this is the preferred approach to being able to address their children's healthcare needs.
Will Dean, Host:Wow. So that was the beginning for you. How has that translated into other work around environmental health in the valley?
Dr. Ann Cheney, Guest:Yeah, so one of our most recent projects was funded by pcori, which is Patient Centered Outcomes Research Institute.
And we had funding for two years to build the capacity of different groups, caregivers, community health workers, physicians, medical students, to partner in research and to work with us to identify essentially what steps we should take to begin to address childhood asthma. And I thought we would go in the direction of, well, let's train our physicians on how to better communicate around.
You know, the ER may not be the best place to be able to get a diagnosis and a treatment plan for your child.
I thought our research would go in that direction, but it actually went in the direction of community wanting to understand what is actually on the lungs, in the lungs of children. What's the organic matter? What is it that's entering from the environment into their body and getting into their lungs and causing these problems?
So our team is moving in that direction.
We're partnering with biomedical scientists as well as we work with an atmospheric physicist who really takes a look at the particulate matter within the environment. And then the biomedical scientist, she takes a look at what is in the lungs, what's the organic matter?
So our team is moving in that direction to identify what is it in the environment that is creating inflammation and causing problems within children.
Will Dean, Host:And is that because the residents wanted the more scientific answer?
Dr. Ann Cheney, Guest:Exactly.
Will Dean, Host:That's fascinating.
Dr. Ann Cheney, Guest:It is fascinating, and I was a bit surprised, but I'm really excited that the community has directed us here. It's very interdisciplinary work, and it's work that really needs to be done.
What the community had shared with us is, sure, we could focus on the signs, the symptoms, the healthcare services use, but that's essentially just looking at the problem rather than the root cause. And they asked us to take a look at the root cause, which they know that the root cause is in the environment. It's where they're living.
It's the air they're breathing.
Will Dean, Host:Focusing on the root cause. That is not to say that doctors still do not need to improve communication.
Dr. Ann Cheney, Guest:Correct.
Will Dean, Host:Around what's going on with children and the air quality and asthma.
Dr. Ann Cheney, Guest:Exactly.
One of the things that we've heard frequently from caregivers because we work primarily with caregivers of children who have asthma or co presenting conditions. And we will hear caregivers say to us, well, the doctor said, really, if I want to help my child, I need to move.
I need to move to a different location.
Will Dean, Host:Move.
Dr. Ann Cheney, Guest:And when you think about the residents of the eastern Coachella Valley, again, it's a very, it's an immigrant population, primarily Latinx Spanish speakers. There's a very large Prepocha community which is an indigenous group from Michoacan.
They are working in the fields and many of them are living in poverty and don't have the ability, the resources, the support to be able to move to another area. And then it's very costly to live in California. Many are living right next to the Salton Sea because of the low cost of living. It's more affordable.
Will Dean, Host:Right. And the Salton Sea presents all kinds of challenges in terms of air quality.
Dr. Ann Cheney, Guest:Exactly.
So, you know, we know that the Salton Sea and what it happened in terms of water politics and decision making around water to the sea has really affected the playa. The exposure of the playa. And because of climate change, we're seeing that that's much more rapid than I think we originally anticipated.
And that means that there's more dust around the Salton Sea. And there are dust storms that pick up that dust and they bring that toxic dust into community spaces and into children, families, homes.
Will Dean, Host:So that brings me to a question I have for you.
Just in terms of what you consider to be the biggest deterrence to people being aware of what's going on in terms of air quality and other environmental health issues and actually doing something about it in our community.
Dr. Ann Cheney, Guest:So I think that increasingly people are more aware that they are exposed to poor air quality.
And I would say that those who are living and working in environments located in very close proximity to the Salton Sea are at a heightened awareness. Why?
Is because that area, it's typically individuals who are working in the fields, who are working outside, and they are experiencing the effects of climate change. Increased heat, working in the hot summer months within the fields.
But they're also exposed to the elements of the Salton Sea environment, of the toxic dust, of the sulfuric smells.
And I think that those communities are particularly aware of what's going on because they're feeling in their bodies, they're breathing the poor air, they're experiencing heat, the stress of heat.
I think that there is certainly an increased awareness also in the Western part of the valley, there's an understanding that most recently because of climate change and because of recent hurricane, that there has been the effects on the environment and that people are recognizing that they too are vulnerable. So it's around the valley, residents are vulnerable to the conditions that they're living in, the environmental conditions.
So I just think in general, because people are experiencing the changes within their environment directly, that there's more awareness, but particularly air quality along the Salton Sea.
Will Dean, Host:Right. I think people are saying, especially since tropical Storm Hillary, that was such a dramatic event in our community, something we rarely see.
And that really raised the awareness in terms of air quality and what was in our earth and our dirt and our dust that was stirred up by that.
Dr. Ann Cheney, Guest:Exactly.
And you know, the after effects of Hillary have been really pronounced in terms of people recognizing that things need to be done and there needs to be action, particularly in the western valley.
And I think that's important that we recognize that because there hasn't been that type as much attention to the environmental effects on human health in the Eastern valley.
So it's kind of like the event of Storm Hillary really pushed all residents to consider how are they vulnerable within the desert to environment, climate change and its effects on health.
Will Dean, Host:Okay. How they themselves are affected by it, but not necessarily how people in the eastern valley are affected.
Dr. Ann Cheney, Guest:Or I think there's now a heightened recognition that all persons in the valley are vulnerable.
Will Dean, Host:I see. Which is a good thing.
Dr. Ann Cheney, Guest:Yes.
In my mind it's a good thing because for me it speaks to, well, there can be a better recognition of the suffering of those in the Eastern Valley who have endured arguably for more time, the negative effects of environment and climate change. And so it creates more of a collective voice.
And for me, I'm a social scientist, I'm an anthropologist, and my training is very much to look at things critically. When we think about the impacts of environmental environment on the health of those who are more vulnerable.
Not everyone in the valley is as vulnerable as every. Right. There's, there's a variation in vulnerability.
And those living in poor, low income communities who are immigrants, racial, ethnic minorities, indigenous, they are much more vulnerable to the effects of the environment and climate change because they have less resources, they have less ability to prevent the external from affecting them in their internal homes and in their bodies.
Will Dean, Host:That's really interesting.
And I want to emphasize a point that you made and something that actually came up in a recent report that the District commissioned is that the residents of Eastern Coachella Valley are very much aware of the Effects on them and their families. And so they need to be listened to and they need to be brought to the table in terms of addressing solutions to this.
Dr. Ann Cheney, Guest:Yeah, well, when we think about it, you know, if you consider the livelihoods of individuals between the west and the Eastern Valley, if you think about the types of occupations, the jobs that the majority have in the Western valley compared to those the majority in the Eastern Valley, there tends to be a divide that's based on more affluent, higher class, more professional lifestyles. You could could say in the Western Valley there's much more infrastructure and resources.
And then when you think about the Eastern Valley, it's poor infrastructure. Many of the communities are unincorporated. They have to rely on the county for resources for their governance.
There's a lack of professional, you could say employment or employment that would put them in office spaces versus being working in the field.
So when your daily life is outside in 100 plus degree weather and you are exposed to dust storms in which you are breathing the air and the poor air within your region, you're going to be much more aware of how your environment affects you versus someone who's able to get in their car and they're able to go to an office space and they're able to work out in a gym, it's just so very different. And have a home that protects you from the outside, from the external elements.
Will Dean, Host:That is a really great point. I wanted to touch on a little bit, the environmental Health Summit. You were there, you were a panelist on the air quality in your health panel.
I was just wondering what your takeaways were from that event, from that panel discussion. Anything that really stood out to you?
Dr. Ann Cheney, Guest:Well, what I really like the event in general, what I thought the event did, was bring individuals who are interested in health care, who are interested in environment, and who are interested in community engagement together. And that's really unique. It may be the first time that the Valley has done that, at least at such a grand level.
So when I walked away, I thought, wow, we really have such really great leadership in the valley. We have very knowledgeable individuals. We have incredibly passionate community members and community organizations.
And there is a lot that can be done if we're able to build trust amongst each other and collaborate if we have a shared vision, which I imagine that vision is to improve health for all and to mitigate the effects of climate and environment on our health.
Will Dean, Host:Absolutely. Collaboration, that is the key.
When we started talking about and planning that inaugural summit, a point that was made over and over again is we need to eliminate silos and bring as many of the stakeholders and residents together.
Dr. Ann Cheney, Guest:Absolutely. And you did that well.
And I would have to say what I so appreciate from that conference was the ability for people to converse with each other in different languages. There was an excellent interpretation service.
And that might seem very minute, but it actually, it is so important to be able to break down the barriers between community and.
When I'm talking about community, when we think about individuals who are primarily Spanish speaking, it's usually also associated with being an immigrant and being of lower class status or lower financial resources.
That ability to be able to get across that barrier, to be able to speak within an environment in which they have leaders of healthcare systems listening to them, is incredibly important and valuable.
Will Dean, Host: al health summit in September: Dr. Ann Cheney, Guest:Hmm. That's so great. That's a great question. Well, I think I'd like to see a little bit more networking.
Will Dean, Host:Okay.
Dr. Ann Cheney, Guest:And maybe a little bit longer. It was kind of short. I think it was a day and a half.
It would be nice if there could be maybe more representation from youth, not only on the second day, but throughout the conference. Because youth are so important.
When we think about the health of our planet, when we think about really needing to make changes happen in action, it's the youth who are going to push us to do that. They need to be front and center in what we're doing.
Will Dean, Host:I think you'll be very happy to know that we are very much aware of that and working on that. Because the youth, they are inheriting the planet.
Dr. Ann Cheney, Guest:Exactly.
Will Dean, Host:So we want to make sure that they are involved in solving all these issues.
Dr. Ann Cheney, Guest:Yeah, exactly.
Will Dean, Host:I want to thank you so much for being a part of this podcast. I really enjoyed our discussion and I hope that you'll come back and we'll have future discussions about environmental health or health in general.
Healthy Desert health use Go to address all health matters in the Coachella Valley. So I'd like to have you back.
Dr. Ann Cheney, Guest:Thank you. I really appreciated your invitation and I'm happy to come back.
Will Dean, Host:Thank you for everyone listening. If you'd like to subscribe to this podcast, you can find us on all the platforms where you enjoy your podcast. Thank you again. See you soon.
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