My City Talks

00:00:00 Hello, and welcome to the The Healthy Project Podcast, MyCity my health edition today. I'm your host, Kira Roth, and I'm a student at The Healthy Project studying health promotion with a minor in Human Relations. My classmates and I are supporting The Healthy Project in My City on April 28, 2023. That brings University of Iowa and My City community together to discuss health equity programs and collaborations. Registration for the conference is open at MyCity MyHealth.

00:00:27 Today, I get to interview Dr. Nicole Del Castillo and highlight her work with healthcare and health equity. Thank you so much for being here with me today. Happy to have the opportunity. I'm excited for our conversation, so let's go ahead and get right into it.

00:00:42 Dr. Del Castillo, will you just tell me a little bit about yourself and what health equity means to you? Yeah. So, my name is Nicole Del Castillo. I'm the director of the Office of Diversity, Equity and Inclusion at the Carver College of Medicine at The Healthy Project .

00:00:58 I'm also a clinical assistant professor in The Healthy Project at the Carver College of Medicine or at The Healthy Project . To me, health equity really means that everyone has the opportunity to be as healthy as possible. Going off of that, will you tell me a little bit about the work that you do with students and faculty at the University as it relates to recruitment, educational enrichment programs, and then helping to create a sense of belonging? Yeah. So within the College of Medicine, within my role as a director, I think part of our office really tries to make sure that our College of Medicine, our hospitals and clinics, is really a welcoming and an inclusive place for all and also trying to ensure that folks have a sense of belonging.

00:01:50 Our patients also feel welcomed and also creating a place where there's culturally responsive care, where people can be responsive to the different cultures and backgrounds of folks from in our state, as well as surrounding areas, as well as within the hospital, we serve people from all over the world. So with that, it's really important that we can create a workforce, a learning environment that includes folks from diverse or culturally relevant populations. And so recruitment is really important in letting folks know about how unique and special University of Iowa is in our College of Medicine. And our hospital is a great place to work and train and learn. So helping to recruit folks to our medical school programs or MD program, our Physician Assistance Program or PA, and our PT or Physical Therapy, as well as our PhD.

00:03:01 So graduate students and postdocs, we also have residents and fellows that we help to recruit as well as faculty and staff to our university. So it's really important that we try and engage folks again from different cultures, different identities, different backgrounds in order to make that rich workforce and learning environment for our learners and our employees here as far as creating a sense of belonging in some of our educational programs. So we've been really working to create spaces for folks to find community here within our medical school, which is really nice. There are things called the learning communities where students are within a certain group within their medical school. So it's a great place to form community to meet folks from not just in their first year class, but in the second, third and fourth year class to create that community.

00:04:04 But we've also been really engaging our students to open up conversations about ways that we can make things better for them, ways that we can improve their learning environment for them. And then trying to not only do this with our students and our learners, but how we can engage our trainees and also our staff and our faculty to be able to have these conversations so we can make sure that we're again making this an environment that is inclusive and welcoming and that they have a feeling that they belong and that they're valued. A couple of years ago, along with some of our conversations that we've had with our faculty, staff, students, some of them had shared, especially in the clinical environment, experiencing mistreatment or engaging or sometimes the patients or visitors would say or do things that were very harmful or mistreatment in some ways to our employees and learners. And so we came up with ways that folks can respond in a respectful way when things like this happen. Because we do know that patients have a right and folks, as First Amendment, we can't control what people may say or do, but we also can say but it's also not okay for folks to be treated unfairly or said unfairly things to them.

00:05:33 So we came up with a toolkit called I Respond that really gives folks an opportunity to respond and find ways to respond when mistreatment or harm occurs. So is that response program for the providers? Yeah, it's really for anybody who engages initially. When we designed it, it was really for something for folks who are engaging in clinical duties or with interacting with patients or with visitors. But really a lot of the tools that we provide are really things that people can use not only with working with coworkers or even potentially their supervisors, but also just even I even mentioned in the recent workshop that I gave that these are tools that can even be used family members or other people that you interact in a day to day.

00:06:30 The I part of the I Respond toolkit is sharing like I statements, which is I feel X, Y, and Z when you say or do these type of things. So really trying to empower folks to feel supported in the environment that they're in and having respectful ways of responding when things like that occur. Yeah, I feel like that's so important and it sounds like the university does a great job of creating and cultivating an environment where we're trying to make everybody feel included not only for the providers but also for patients. So it kind of goes both ways. So you completed your fellowship in The Healthy Project at Harvard in 2016.

00:07:16 How did that program shape your views on the health disparities? Yeah, I think that during my medical training, which was a while ago, I won't age myself too much, but I think we talked a lot about underserved populations and I learned a lot about ways of addressing health and improving health for patients. But I never necessarily learned about the term kind of social determinants of health or aspects to one's health that are outside of the health care that we provide in a clinical setting. So I've always been driven to addressing health disparities. One of the reasons why I went into medical school and also went into psychiatry training was wanting to address not only health disparities, but mental health disparities and ways of improving care and access for folks from underrepresented populations and so or underserved populations.

00:08:18 And so in getting this master's in public health, as well as doing this fellowship in The Healthy Project , I was able to really look at how their social aspects, depending on where somebody lives, clean air, so their environment that they live in, having access to fresh foods, having access to a gym where they can exercise. Like these social aspects that impact the care that we provide in these healthcare settings and learning how you can impact folks. On a greater scale than just our one on one clinical encounters was something that I really learned from getting my masters in public health. As well as doing this fellowship, I also really was happy to gain the tools and health policy because I feel like a lot of health care providers are not well versed or understand policy that much. And in a lot of ways, if we're not understanding how these policies work or a lot of times policies can be or these decisions are made for us not only on like a large federal or state level, but even at our local level or within a hospital setting.

00:09:38 How important policies are that impact the care that we provide to our patients as well as the community that we live in? So I was really fortunate and glad that I was skilled in learning a lot about policy and how important that is in impacting health. It sounds like on such a huge scale, the policies are obviously a big deal. But then it comes also down to those little things that some people don't really think about outside of just health care. The social determinants, like is there a bus stop in the place that we need to have one or do they have access to healthy food and just so many little things like that.

00:10:18 Yeah, I think if I can add one other thing.

00:10:24 I think even before, like, in medical school, really interested in schools and school mental health as an avenue to not only reach patients, like, there are some models where we're providing direct patient care within school settings, but also just providing education. And just a lot of times in public health, we talk about upstream factors. So ways of before harm has occurred or before somebody has developed, like trying to work on ways of prevention, basically is what that is. And so what are some ways that we can work towards preventing health care factors or mental health care? And so I found schools to be a really great avenue to reach not only educators and educating them about mental health students, but also families about the importance of mental health factors to look out for improving wellness.

00:11:26 And I feel like it's a nice way to also reach folks who might not necessarily come to a psychiatry clinic or reach access or due to stigma, due to other factors that might or just barriers to care that might limit them from reaching mental health care services. So I've been really fortunate to be a part of the Scanlon Center for School Mental Health within the School of Education here at the college or at The Healthy Project and have an opportunity to be an affiliate faculty member within that center. So it's a really great opportunity for us to impact mental health and improve mental health of Iowans. So I'm super excited about that as a way of addressing kind of health disparities. Mental health disparities, yeah.

00:12:20 Awesome. I feel like schools would be a great target as well because getting the conversation started for kids, that seems like a great way to start a conversation. So what are some of the things that you hope to see change over the next five years in regards to health equity? Yeah, I hope that we continue to have these conversations, continue to have resources that are looking towards helping to continue to push. My hope is that this is not a conversation that we've made a lot of strides as it relates to health disparities.

00:13:00 Thankfully, within a lot of accrediting institutions, accrediting bodies, they recognize that disparities exist. They recognize that it's important that we address these things not only from like a this is just a good thing to do from like a justice standpoint, but financially it's costly. Like, health disparities are costly. So if you can address them, it saves everyone, really improves. So we're seeing that in medical education accreditations, that there's more talk about education, about health disparities from even Jacob, like, to be an accrediting hospital, there's new requirements for hospitals.

00:13:47 In order for them to get to be like, an accredited hospital, they have to address kind of health disparities, show how they're addressing the social determinants of health for their patients. And so this is a great way of us kind of pushing the needle going forward to address these disparities because if not, it's just going to we're just getting sicker and folks will get sicker. And economically, our health care system is hard to support this. So I'm happy to see that more folks are recognizing this, seeing the need, and also backing up that in order to be accredited, in order to get to be a legit or program or hospital or whatever it might be, you have to be addressing kind of these health disparities because they're so important. Yeah.

00:14:44 That kind of leads me to my next question. What is one of the most rewarding parts of the work that you do? I would say mentorship is something that I really enjoy doing. We have a program through the college of medicine. It's a pathway program that allows for students to kind of get an experience in different health professional careers, especially medicine, dentistry, pharmacy and public health.

00:15:19 But through that, I have an opportunity to do a lot of mentorship with prehealth students as well as one of our organizations that we have on our undergraduate campus here. So I just enjoy kind of the mentorship that I'm able to provide, kind of giving back to students the things, the mistakes that I made to not do, as well as tips of things to do, and connecting folks, I really enjoy being able to connect people with other people who can help them along the way too. So just the mentorship at all levels, from the high school, even grade school level up to undergrad, to our current students and trainees that we have here, to do that, to be involved in that mentorship, is something that I just am so grateful for and love that I have that opportunity. Yeah, I feel like The Healthy Project I was City conference will be a great opportunity to also put all that into action. What are you most excited about for the my City my health conference?

00:16:27 I'm excited to meet folks. Being in My City, I did my training here, my psychiatry training here, and was away for a bit and then came back right before the pandemic. And so interestingly, I just have not been able to meet a lot of folks in our community who are doing a lot of this work. And so I am really excited to make connections to meet folks and connect them. Like I said before, I love connecting people.

00:16:57 So to be able to connect folks, that will help me but also connect them with other people that will elevate their work and their things that they're doing, I'm super excited about. Awesome. So what is the biggest thing that you would like our listeners to take away from our conversation today? I would say something that I would love for folks to take away from. This is the opportunity for us to that really the work of health equity is not really one entity and not even really the healthcare system as itself.

00:17:35 I think a lot of it is something that a lot of systems are involved in. The school system, the justice system, the housing system are all part of us achieving or getting to that point of health equity. And so I'm really excited about us having these conversations and bringing folks into the community who are part of these different systems of care outside of just the healthcare system, who talk about how they are addressing health equity. And have us thinking more broadly about health and ways to help to improve health and reach health. Equity is not just the healthcare system, but other systems can really be impactful in making that change.

00:18:23 Thank you, Dr. Del Castillo, for your time and your wisdom today. I have learned so much from you and I'm sure our listeners have too. It's been such an honor speaking with you and thank you listeners for joining us today. You can check out more of the The Healthy Project podcast, mycitymyhealth edition on The Healthy Project website.

00:18:41 Thank you so much.