Category Archives: Public Health

My work and the craziness that goes along with it.


Morning palm

There is a convenience store within walking distance of my new office. I can’t quite see it from my desk because of a large, thorny mesquite and clump of date palms. If I could, I’m sure that even in the middle of the afternoon, when temperatures in Phoenix made the distant sidewalk wavy with heat and ozone, there would be a group of folks huddled together in the shade of the store’s red awning.

Most would have $.89 Styrofoam cups full of soda and crushed ice. Some you can smell before you see them, as it goes with living on the streets in Phoenix in the summer. Others have loud, angry conversations with the spirits the rest of us cannot see. Many are missing teeth. A few wear clothing revealing tattoos that have become blobs of ink after years of weight fluctuation, and lots of hard living.

These folks are there in the morning when I stop for coffee on my way in to work. And they are there when I drive past, as the orange sky fades into another pink desert sunset.

In downtown Phoenix, there is a large homeless outreach where many of the city’s nomadic homeless sleep at night. In the morning, they are awoken early, given a basic breakfast and shuffled back outside. Some panhandle. Some find shade in a park to take refuge until they are allowed back inside the shelter. The Big Gulp Group hangs out at the local Circle K.

They watch as the cars come and go first thing in the morning. Folks in khakis and polos and A-line dresses file out of their compact cars inside for a morning hit of caffeine. Their shiny state badges reflect the morning sun. Their cars drip steadily from over-worked air conditioning, leaving tiny pools of iridescent coolant on the pavement.

Rarely do the Big Gulp Group and the employee cohort converse. Those who are filling up before filing up the stairs of the nearby health department keep their heads down, down. The homeless talk to each other but usually do not ask those coming and going for a thing. Both groups seem to pretend the other doesn’t exist.

There is little I know for certain about working in behavioral health yet; however, I do know it is often a matter of genetics for those who end up under the awning sipping a Big Gulp vs. those in corner offices sipping lattes. All of this is determined by some great wheel of DNA luck, spinning some of us to early death and others to high-end long term care facilities as centenarians.

Folks who suffer from severe mental illness die on average 25-30 years earlier, of preventable diseases, than their non-mentally ill counterparts in the community. That means most of these folks are dying in their 30s and 40s of preventable illness.

I’ve been rolling this statistic around for a couple weeks, trying to understand how it can be truth.

I am but one cog in this huge programmatic wheel. One more that punches in, and punches out, and could become an apathetic, ineffective drone – meeting the government employee stereotype. Thankfully, I work with a team of people who are passionate and love their work. They inspire. It feels like we are working on something that could make the state’s health better, especially for those like the Big Gulp Group.




Ignite Boulder 17

A few weeks ago I spoke at Ignite Boulder 17. My spark was ” V is for Victory Gardens.”

The more I volunteer with hunger organizations, the more I realize this is a policy not supply issue. Rather than tackling the economic and political reasons causing hunger in the US, I am focusing on what individuals can do to pitch in. Planting a garden to supplement your neighborhood food bank’s shelves is one easy way to help feed hungry people good food. If you need help getting your garden started, or finding a local community garden or food bank where your energies would be much appreciated, let me know. I’ll do whatever I can.

As for Ignite Boulder — my platitudes are sincere: a thoughtful team of wacky and creative folk who put this event together. They should be applauded for their community-mindedness and their ability to pack a theater. 850 people, 15 presenters (or so) and oh, so much fun. A great experience!


1 in 4

food stamp brochure

I attended a community meeting a couple weeks ago for an organization called Hunger Free Colorado. They are the lobbying arm of the Feeding America-fueled food banks in the state. They take direction from the five food bank leaders state-wide on what to lobby with local, state and federal officials to better meet the needs of hungry Coloradans.

In Arizona, the Association of Arizona Food Banks handles this responsibility. The director, Ginny Hildebrand, is a force to reckon with. She is savvy, kind and damn effective. I had a chance to go to Washington DC with her once on a lobbying trip and that woman moves mountains.

As a food pantry volunteer, I was interested to hear about the systemic changes that this organization is working on for the state. I’d noticed more and more families coming into the pantry who were seeking sustainable food assistance. I’ve had this nagging concern the system at hand is failing because our “emergency” food boxes were becoming routine.

Something is obviously broken, and I’m no expert in any aspect of the policial or practical system of getting food to hungry folk. That said, any volunteer would notice many of the families coming to the pantry are stuck in a “job of being poor.” It takes a lot of time to access most basic public health services to keep a family fed. This may include visiting a food pantry or more per week — which is typically an all day affair when you are on the city bus.

If you’ve ever spent a day in a food bank, you realize there are far too many ways things could be better.

Arvada Community Food Bank

For example, how about these statistics:

  1. 1/4 of families in Colorado report not having enough food, via a Gallup poll
  2. The typical recipient of “food stamps” (called SNAP in Colorado) are a family of 4 living on less than $12,000 per year.
  3. The application for SNAP, until recently, was 26 pages long. On page 4, the applicant was asked if he/she spoke/read English. Apparently up until then, they were expected to intuitively know what they were being asked.
  4. While more than $500,000,000 has been spent on Colorado’s SNAP and food assistance software system since 2004, it doesn’t work. The state of Maine spent $15,000,000 on theirs and it works fantastically. There is little political motivation here to change what exists, even though it doesn’t work and hunger experts testified to the fact beforehand, “because we don’t want to spend more money.”  (To me that’s like not repairing the navigation system in the Titanic because the deck furniture cost too much. The system isn’t sinking. It sunk.)
  5. All this said and done, the average Colorado family is on SNAP for less than 10 months.

It is daunting and entirely overwhelming to consider lobbying political issues, and yet — we are bucket brigading a huge fire that will consume Colorado if we don’t stop to install a fire department instead. (Not my analogy — one I heard in the meeting that I thought was rather apt.) And so, we continue bucketing as fas as we can and somehow muster the spirit and energy to create bigger, better change that stops the fire from starting.

Cornbread and black bean casserole

I have to believe the basic steps we — those who don’t need food assistance — can all take, no matter where we live, look a bit like this:

1. Invite a friend over with a similar passion, or grab your roommate/spouse, and visit your neighbors. Go to each door around the block and introduce yourself. Take mental notes. Chances are, 1 in 4 of those houses you visit are hungry.

2. Invite your neighbors over for a potluck/bbq. Make it welcoming for those who can’t bring food, and get to know who these folk are. Chances are, you won’t like them all. And chances are, you’ll really like some of them. With certainty, the type of change I’m encouraging requires having civil conversations with both and recognizing public health issues — like hunger — don’t discriminate.

3. Plant a garden. Harvest it for yourself, your neighbors and your community food pantry.

4. If you can give time, volunteer. If you want to give to the food pantry — give money. They can typically buy 10 times what the average consumer can with the same amount of money.

5. Vote. Talk to local, state and federal politicians about how hunger is influencing your neighborhood. Make it tangible with stories you’ve heard and your experiences. For those in Denver, the way to communicate with such officials can be found here,  here and here. 


Community: Food and Social Justice

{Part of an on-going series on Community. Read more here.}

Chocolate baking scones

Community is a buzz word. Get a liberal in the White House and everyone starts talking about how “it takes a village.” I know, I know. You’ll be shocked to hear my all-loving liberal heart agrees.

Have you spent time with a child lately? Like a really little, totally needy child? A village doesn’t adequately describe the help needed to keep our young alive. Think of the farmer who grows the veggies, or the checker who rings up those veggies, or the pediatrician who makes sure that child doesn’t die of some weird carrot flu. Now, get more practical: the nurse who helped deliver the kid. The community health worker who put together the lactation campaign that taught the mom how to breast feed. The $8 an hour child care worker who eventually will watch the kid take his first step and nurture him to keep going when the second step lands him flat on his butt. “It takes a village” isn’t liberal commie code for “We are socialists! We should raise our babies together in yurts!” It means community is important to our fundamental well-being.

I’d say it takes a village to create a well-rounded adult, not just a child. (An example otherwise.)

Ginger cake

Community for me often involves food. Perhaps it is my United Methodist roots — those which run deep in casserole-to-celebrate-everything-soil — or that I’ve been able to travel just enough to be truly bothered by hunger. For me, being in community with someone often includes breaking of bread.

Or baking of ginger cakes and orange chocolate scones. Or hosting a community dinner. Or swapping recipes with your neighbor over the back fence. It seems no two people have the exact same view on faith, life, money, sex or politics. But food? We all love food. Perhaps not the same foods — but we can agree that eating a couple times of day? Well, it’s a nice thing to do.

Ginger cake

I listened to this podcast this weekend, as I do most weekends, walking around a lake with Nelson. I wasn’t just shocked by the story of children living in poverty in America. I was hurt. I am hurt. All the patriotic baloney I’ve swallowed over the years sat in the back of my throat as I listened to kids talk about how living in a sketchy motel is “better than the car. Anything is better than living in the car.”

Kids living in cars? I’m not so far removed from the daily grind to think this isn’t happening in America. But 25% of kids are living in poverty? One fourth of our children must miss at least one meal a day because of scarcity?

Aren’t we the nation of Neil Armstrong and Lance Armstrong? We put men on the moon. We cure cancer. We can’t feed our own people? What is going on here, America?

I don’t have any answers. But! I do have a couple of ideas and boundless optimism. To create community is to share with each other. It’s to give, sometimes until it hurts, and to be willing to listen to the same degree. It’s to gather up those around you — in your neighborhood, or say, on your blog — and suggest we have some serious sharing, listening and learning to do. Our country is fractured. We have the choice to sit around and complain about the current state of affairs, or pour our hearts into something that could wrap that break and help it heal to become even stronger.

Chocolate orange scones

Nutrition, hunger and community health are my public health passions. Putting these to work in my new community will involve:

  • finding a food bank where I can volunteer
  • understanding the local gleaning system and see how I can get involved
  • talking about hunger with my friends and family
  • and perhaps more practically, creating a bag of snacks I can give to the growing number of unemployed I see on our city corners

This is what you can do:

  • Define community. What does this word mean to you?
  • Where do you see hunger in your community?
  • What are you passionate about?
  • Listen to this podcast

The greatest social movements start with a few boneheaded, optimistic loud mouths willing to give and listen until it hurts. I don’t want to live in a country where so many of our children are hungry from lack of adequate community building. (Because let’s face it, this isn’t about a shortage of food in America. It’s about power.) Wielding my tiny power and my loud mouth — I’m in. Are you?



Nogales outreach

I spent Saturday working in Nogales, Arizona. It has a variety of economic and health issues — none unique to this border town. Nogales, Sonora — just across the imaginary line — is regularly plagued with disease that you rarely hear of in the US. Cholera, scurvy, malnutrition, etc.

When it rains, the poor drainage mixed with houses that have been built on top of each other, cause a catastrophe. The top soil has eroded. The water table is corrupt. A healthy existence is not easily found in a town where 500,000 push against a wall, waiting for their turn to cross.

Nogales outreach

With a group of volunteers, I helped in a medical clinic. I served as translator and quickly realized my Spanish skills are rusty at best. I need to find a Spanish podcast to regularly listen to and get back to a conversation group.


Nogales outreach

That said, there is something about this sort of work that makes me feel at peace. I hold hands, I listen intently and I truly love trying to figure out how we can help others. It hasn’t always been this way, but I am so glad it’s where I’ve arrived.

“The measure of achievement is not winning awards. It’s doing something
that you appreciate, something you believe is worthwhile. I think of my
strawberry souffle. I did that at least twenty-eight times before I
finally conquered it.”
–Julia Child


Social Gardening


Admiring the perfection of nature last night while cooking…

I was in a meeting this morning discussing the AmeriCorps Vista program — which puts incredibly community-minded folks in volunteer opportunities with nonprofits and other groups nationally — listening and pondering the goals of the organization. In contrast to the Peace Corps, AmeriCorps is in part geared toward ending poverty in America.

The speaker elaborated on Vista volunteers receiving a small stipend monthly that barely covers their cost of living. They are to live poor to be more motivated to work for the poor, in theory. In the Peace Corps, I was paid $56 a month and you wouldn’t believe how high that placed me on the social ladder. I had my own home, never went hungry and had plenty of pocket change for bus trips back and forth to the major cities. (The buses rarely ran and were a complete pain in the ass — think 20 people, animals and babies in an 8 passenger Toyota van — but cost wasn’t one of the challenges thanks to someone similar to Intelligent Van Leasing.) In all fairness, I probably lived a more secure financial existence on that $56 dollars a month in Cameroon (as short as this adventure lasted) than I did on the $124 of financial aid per month I made work for three years of college. I did go hungry. Scraping together enough money for Taco Bell learning to rely on friends was humbling, at best. Regardless, neither situation made me feel sincerely poor or without hope. I always knew I had an education, good health and a strong family on which to rely.

Capturing the beauty of nature

Fundamentally, that’s the difference between true poverty and temporary class experiments. While Vista volunteers may have to creatively stretch every penny they earn to get by, chances are they’ve seen a dentist, are up to date with their immunizations, have never gone days with hunger, and have an address book full of friends and family who would take them in and help immediately if given the chance. I always had the ability to pull the ultimate “uncle!!” card in the Peace Corps, which I did after just five months. I returned to the capital and demanded my return ticket to the US.

The poor are without financial legacy. Most children born into poverty in the United States are born to children. The cycle of poor education and health is yet again planted in the worst neighborhoods, only to produce seedlings who will one day bare the same fruit. We all know of the bootstrap stories of those who’ve pulled themselves out of this routine. President Obama, potential Supreme Court Justice Sonia Sotomayor, and President Bill Clinton are in the minority. They had that je ne se quois to break through their environment for greater possibilities.

Portabello bliss

I’m not sure what we do to change these systemic flaws in American culture that keep certain sectors of society always planted in the same garden of despair. I admire the Vista volunteers working knee deep in the quagmire. Reminding those of the American dream — that you can be anything you want to be — must be far more complicated when dreaming itself is a luxury.


A Caroling We Went

Last 2008 Community Dinner

BEFORE: And the commotion begins. I took on a bit too much for this dinner; from beginning to end, it took about six hours to prepare and clean up afterward.

Last 2008 Community Dinner

Last 2008 Community Dinner

Last 2008 Community Dinner

Aztec squash soup

Aztec squash soup

Turkey chile

Turkey chile

community dinner 121108 038

Buttermilk biscuits

Last 2008 Community Dinner

Last 2008 Community Dinner

Carbs o’ plenty

community dinner 121108 047

AFTER: phew.

Last night’s communiy dinner menu included: crockpot turkey chile, aztec squash soup, buttermilk biscuits, cornbread, carrot cake, brownies, homemade hot chocolate with candy canes and marshmallows and a partridge in a pear tree. The prep for this dinner took quite a bit of time, but it was well worth it. There was plenty of food, lots of cheer and even a dozen friends who stuck around to go caroling afterward. We walked through the neighborhood singing a variety of tunes completely off key and completely enjoying ourselves. We agreed the night was well worth embarrassing ourselves when we came to a house where an older gentleman opened the door and his wife, bald from what we guessed was cancer treatment, cheered us on.

Last 2008 Community Dinner

Last 2008 Community Dinner

Last 2008 Community Dinner

Last 2008 Community Dinner

We spread a bit of cheer and walked off those calories in the process. I had a lot of fun and am really thankful for my friends. I realized last night as we tromped through the street that I have some incredible people in my life, willing to do the ridiculous to make me happy.

Emerald, Lime, Olive, Kelly

Fall in DC

DC was excellent; I had such a great time at the Green Festival with Mike and Sam. Let me tell you — these two know how to hosts guests.

The Tuck's home

The adorable Tuck home.

They not only drove me around for three days, set up a hotel room in the city so we could walk and enjoy our time without worrying about driving back to the burbs, and spoiled me silly with chocolates on the pillow, awesome food and gobs of time, but they did so graciously. They didn’t make me feel like a guest, but like someone they’d really been looking forward to seeing and I couldn’t be more thankful. We also spent a night in Georgetown singing Billy Joel songs at a piano bar, surrounded by hot men in suits. (Seriously, DC? Good work on the men. Well-dressed eye candy abounds.)
It was a blast, and I’m pretty sure everyone within a five-foot distance — as far as my shouting voice could carry over the piano — knew that there were no such venues in Maricopa County. Phoenix, we need a piano bar, lots of Billy Joel and more suit-worthy weather.

Green festival, DC

Spicy chicken wrap with local veggie salad: $10. This was about three bites and the one thing I’d change about the festival was the commercial angle. They charged $1 for a cup of water — as in they charged you for the cup and then you used the faucet. Pretty silly.

Felted hippie bag in action

Africankelli bag being rocked at the festival by Ms. Sam.

Green Festival, DC

Books for sale a the fest. I didn’t buy any books. I spent my cash on an ionized foot detox instead. The photos are here, but be forewarned, they are horrifying.

We also heard Marion Nestle and Amy Goodman speak. Nestle is one of my public health heroines and she did not disappoint. Goodman gave me an entirely new perspective of the media. I learned gobs and felt right at home with my fellow Birkenstock-wearing, earth-loving, tree-hugging friends.

Green Festival, DC

My notebook, ready for some Marion Nestle insight…

Green festival, DC

Dr. Nestle, who within five minutes of taking the stage made me reconsider everything I eat. In a nutshell: the US now imports the majority of our foods (and preservatives and pharmaceuticals) from China, India and Mexico — noteworthy because of their lack of quality control in areas such as preservatives and pharmaceuticals. Or so she and the recent dog food/melamine/baby formula scandals would suggest. Scary. Her talk made me sit up straight and think of all the foods I’d eaten in the last two hours that had countless preservatives, most of which probably came from an unregulated source. Yikes. Time to make some serious pantry changes.

In response, we decided not to go out for dinner after the conference. Instead we celebrated with a homemade meal and lots of local incredients:

roasted acorn squash stuffed with turkey, sage and apples

Roast acorn squash filled with apples and garlic…

roasted acorn squash stuffed with turkey, sage and apples
roasted acorn squash stuffed with turkey, sage and apples

Turkey, sage and squash simmering with onion and olive oil.

roasted acorn squash stuffed with turkey, sage and apples

Voila — the perfect meal to end a fantastic weekend. We included local Tarara wine, which was excellent.

There is certainly something to eating fresh, local and eventually vegan.

Three cheers to the Tuckers at Washington DC. I’m smitten.



When I listened to Lauryn Hill in college on repeat for two years (seriously, ask Finny how silly obsessed I was with that album), I never thought 10 years later I’d be working with actual refugees. There is a lot of confusion about refugees in America and I am new to this field. Here’s what I’ve recently learned:

~ A refugee is someone living outside of his or her home country and is unwilling or unable to return due to a well-founded fear of persecution. This could be because of race, religion, nationality, membership of a social group, political opinion, etc.
A current example are the Sudanese lfrom Darfur who are fleeing to camps in Chad and Kenya to escape persecution. The Janjaweed Arabs of the north are committing active genocide against the African tribal folk of the south. (I am over-simplifying a mass migration of people, but you get the idea.)

~A evacuee is not a refugee. An evacuee is someone who has been evacuated. Simple enough, right? You can imagine the confusion when after Katrina political leaders started referring to evacuees as refugees. No dice. Evacuees who were born in the US could not be refugees. Make sense?

~An immigrant is a person who has moved to a second country by will or through refugee status. Refugees are therefore immigrants. Immigrants are rarely refugees. Only 1% of refugees living in refugee camps around the world make it to a third-country, such as the United States, for immigration.

~ An illegal immigrant is a person who has moved to a second country without the permission of authorities in the second country.

~ An asylee is a refugee who reaches another country through their own devices. For example, Cubans who reach the shores of the US are asylees. They are able to seek asylum in the United States. Another example is Martina Navratilova, who requested political asylum from her home country of Czechoslovakia. She later became a US citizen.

Refugees are brought to the United States from dozens of countries. In Arizona, there are refugees from more than 90 countries. How do these refugees get here? The United Nations High Commission for Refugees asked a dozen or so countries to help with the 12 million refugees worldwide; 80% of these are women and children. Most of the men die during the conflict that led their families to flee. Some 70% of these families live at least 10 years in refugee camps, outside of their native countries.

The Refugee Act of 1980 created specific US funding to help aid those fleeing persecution. Before then, refugees were handled on a case-by-case basis. Considering how many people from Eastern Europe immigrated as refugees after the World Wars, it is surprising it took until 1980 to pass formalized legislation and funding. The cap on refugees accepted into the US each year is 70,000. In 2007, 41,000 refugees were resettled.

The process is entirely political. There are countries we would gladly accept refugees from — think North Korea and Iran. There are countries were the trickle of folk come in, but it isn’t as politically glorifying — think Africa. In Arizona, our largest current refugee populations are coming from Afghanistan, Iran, Iraq, Somalia, Sudan, Bhutan and Burma.

I’ll cover the life of a typical refugee family resettled in Arizona in the future. And yes, I am loving this job.


You Can Do It: Badge #41

You can do it

It’s been quite a while since I’ve browsed my copy of “You Can Do It” — a book blogging project I’m doing with Aimee. Rather than do the badges in order, I’m skipping ahead to badge #41: Eat It.
Essentially the idea is to take a closer look at what you are eating, see how it makes you feel, eliminate junk and add more healthy stuff. This isn’t that big of a leap; I’m neurotic about what I eat. I grew up in an athletic home. My mom taught aerobics for ten years, my dad and brother were great swimmers, and I’ve recently dug in my heels to become a triathlete. You feed your body crap, you feel like crap, you swim/bike/run like crap. Einstein, I’m not.
So, knowing how to eat healthy is in my DNA. Doing so habitually, and eating an appropriate serving size, is not.


Fruit-free breakfast that screams: time to go to the grocery. 1 cup of fat free cottage cheese, one Western Alternative bagel, 2 tablespoons of fat free cream cheese: 272 calories, 1 gram of fat, 38 grams of protein.

Specifically the badge suggests you:
1. Food journal for a week to take a nutritional inventory. I like Sparkpeople. It’s free and comprehensive. Also, I like having a buddy. Colleen encouraged me to stop drinking soda and I feel worlds better having made this little change.
2. Follow the guidelines. Know how much you should be eating vs. how much you are eating. Here’s a great tool.
3. Learn serving sizes and how to read nutritional labels. (I am also on alert for high-fructose corn syrup in my food. It seems to be in everything these days and there is nothing about “corn” or “syrup” that is going to make me healthier. In simple terms: the feed corn and other grains to animals to fatten them before slaughter. Old McDonald, I’m not.)
4. Make a meal plan and shop with taste in mind. Fresh produce and spices are easy and healthy ways to make your meals much tastier. This is an area where I need to change; I go to the market about once a week and never have enough produce in the fridge. With my new job, I’ll walk past the market each way everyday and I hope this helps nudge me to be different. Also, I’m getting more involved with the Phoenix Farmers’ Market.

I also figure a great way to have ready access to fresh produce is getting off my lazy duff and gardening. I’ve lamented countless times how my patio garden is tiny and gets the wrong sunlight and a dozen other reasons why it won’t work to grow a thing. However, the main reason nothing has grown is because I haven’t been here long enough to keep it watered and pay it enough attention. And frankly, I want a magic garden too! This resource for Phoenix gardeners and my new schedule are giving me hope this will change.

Peter Hoffman was recently interviewed in Bon Appetit. Hoffman is the owner of several restaurants in New York City and is a champion of buying local, supporting farmers’ markets and eating healthy food. A bit I enjoyed, while we’re on the topic:

Bon Appetit: Why should Americans support local farmers’ markets?

PH: Buying from local farmers is about getting off the grid — not the power grid, but the food-system grid. Money stays local, our outlying regions can remain agriculturally productive, and the landscape is preserved. The food tastes better because it hasn’t traveled as far and is fresher.

Bon Appetit: If someone says to you ‘I don’t shop at farmers’ markets because they’re too expensive,’ how do you respond?

PH: Get with it. That is the real cost of food. Vote with your fork and your belly, and support the opportunity to buy directly from farmers — and eat better food by buying from them.

Getting with it, Peter.