BARBARA FERRER, PhD, MPH, MEd
DIRECTOR, LOS ANGELES COUNTY DEPARTMENT OF PUBLIC HEALTH
Dr. Barbara Ferrer leads the Los Angeles County Department of Public Health which protects and promotes health and prevents disease among LA County’s more than 10 million residents across its 4,000 square miles. She oversees a budget of $1 billion and directs a workforce of over 4,100 public health practitioners. Dr. Ferrer is a nationally-known public health leader with over 30 years of professional experience as a philanthropic strategist, public health director, educational leader, researcher, and community advocate.
Q & A WITH COMMISSIONER FERRER
As someone who spent a number of years managing programs to prevent chronic diseases and promote healthy behaviors in Massachusetts, is prevention also a priority you are working on in Los Angeles County? If not, what are the most pressing health issues you have identified? How are you leading the Los Angeles County Department of Public Health to address said issues?
I think that health equity is the most important issue for public health. It is intolerable to think that here in LA, right now, Black, Native American, and Native Hawaiian babies are dying at more than three times the rate of white babies and that the rate of death for black babies now is higher than what it was 20 years ago for white babies. We need to make sure that at the very beginning of life, every baby has an equal chance of survival and that their survival is not correlated with their race and/or ethnicity. I just don’t know how you don’t say, “We have to fix this!”
Unfortunately, there is no silver bullet. There is no one solution that can address such a complex set of issues. However, acknowledging the impact of racism both in terms of distribution of resources and opportunities, and in terms of its ability to create high levels of chronic stress for people of color, makes it imperative that we join with others to build a more just society, where everyone has access to what they need for optimal health and well-being.
Los Angeles County has an extremely diverse population with complex, diverse needs. How do you define health equity and what recommendations do you have for improving health equity in the county and beyond?
We need to start by recognizing that an equitable, as opposed to equal, distribution of resources is needed to achieve good health for all. We should acknowledge that communities of color and marginalized communities may need more and different resources to make up for chronic under-investment and then shift our resources appropriately.
What I learned from so many others during my time working to build health equity was the importance of working closely with community residents and community-based organizations who lead efforts to build social, economic and racial justice. Public health needs to support these movements and understand that we have an obligation to lift up the lived experiences, voices and wisdom of those most affected by long-term injustices and ill-health.
Information is a powerful tool. Data can help us better understand what drives the health inequities we see and then we can use this information to dispel false narratives. For example, data shows us that neither education nor income explain the differences we see in infant mortality rates by race. Babies born to black women who are well educated or have a modest/high income are more than one and half times more likely to be low-birthweight than the infants of white women who haven’t graduated from high school or who are very poor. Similar information also shows us individual health behaviors such as getting into prenatal care early and not smoking also fail to explain the differences in infant mortality rates by race. Having this information is powerful because it leads us to examine the policies, systems and practices that may be contributing to the health inequity and to capture the stories and lived experiences of black mothers. Hopefully, we change our strategies from ‘fixing people’ to ‘fixing systems.’
I know it takes a lot to pivot when you are part of a large bureaucracy; my hope is that here in LA County, under the courageous leadership of the Board of Supervisors and community leaders, we will feel empowered to acknowledge that what we are doing now to promote health is clearly not working for so many residents and embrace change and take risks so that our future efforts make a difference. If we were to eliminate the gap between the death rates of black and white babies in LA County, an additional 60 to 70 black babies would live every year. We need to figure this out.
Managing a staff of over 4000 health professionals is no easy task. Where do you see shortages in your department and the health workforce at large? What message do you have for academic institutions, training programs, pipeline programs or community stakeholders working to increase capacity to meet demand?
Our 35,000-member workforce across the Health Agency are deeply committed and skilled professionals, with a passion for caring for our most vulnerable residents. As we acknowledge our need to focus on preventing disease (and not only healing), we will all need to embark on a learning journey to acquire or strengthen the skills to do health equity work. For example, we all need to build our skills around respecting and honoring diversity, including cultural humility and linguistic competency. We need to know how to confidently speak about racism and its generational impact on health, while simultaneously elevating the voices and experiences of the people we serve. We need to figure out how to defer to and embrace community leadership. People have the inherent capacity to understand themselves, their circumstances, and the solutions to address their challenges and we must be prepared to create spaces for meaningful ongoing interaction and problem solving.
As our academic and workforce training partners help prepare the next generation of healthcare workers, our hope is that increased opportunities will be available for under-represented youth and residents to participate in health career training and academic programming, so that the health care workforce represents the diversity of the residents we serve. We would ask that an emphasis is placed on creating career paths that honor lived experience and reflect team learning through a culture of continuous improvement.
What are you hoping to accomplish as a member of the California Future Health Workforce Commission in the coming months?
I am deeply honored to have this opportunity to work with so many leaders from across the state and look forward to learning more about current efforts in California and across the country. Given my background as a former headmaster of a district high school focused on health and technology, I am anxious to strengthen ‘pipeline programs’ for under-represented youth that prepare young people for leadership and meaningful careers in health. Equally important is broadening the focus to include preparing a workforce that is skilled in public health and primary prevention, acknowledging that these fields require different competencies and skills from more traditional health care fields focused on clinical treatments. Perhaps our work together offers an opportunity to discuss supporting the important role of promotoras/community health workers, mid-level oral health practitioners, public health disease investigators and prevention workers, and peer health educators.
Any words of wisdom related to developing California’s future health workforce that you would like to share with fellow commissioners, policy makers, or funders or stakeholders?
I am looking forward to being involved in and supporting system, policy, and practice change that…
- Acknowledges the importance of addressing issues of implicit bias and discrimination;
- Promotes healthy communities; and
- Advocates for aligning resources with those in most need.