2018-04-19
Story

By Kristin Jones

Jennifer Fanning is the executive director of the Grand County Rural Health Network. The Network is part of a cohort of 18 organizations across the state that are working together to advocate for health equity, with support from The Colorado Trust.

How would you describe what Grand County Rural Health Network does?

We are a health alliance that advocates for the people of our community, and ensures access to care. We problem-solve—collectively and in partnership—big-picture systemic issues in our community.

What are you most proud of in your work?

I’m really proud of not only my organization but my community, and how we’re always evolving and changing. We engage the community—the people who are impacted and involved—to really hear what their needs are. We’ve done that as long as I’ve been here.

What does that look like?

We really focus on basically whatever the community tells us is needed. Right now that’s mental health—providing integrated care with mental health, addressing access and stigma, offering patient navigation and care coordination.

What’s the most challenging part?

First and foremost is funding. A lot of what we do is systems change, and filling gaps and needs in the community. We need sustainable funding. Collaborative work is long and hard, and that also adds to a timeline. Making sure everybody is heard, and actively engaging people who are being impacted by whatever decisions are made, takes a lot of time. A lot of people want to see change, and they want to see change now. Or they don’t want to see change at all.

What do you mean by “systems change”?

Systems change is different from implementing programs. Programs are short-term fixes. Systems changes are changing the root of the problem. Instead of addressing the tip of the iceberg, we want to get to what’s down there that’s causing people to be unhealthy, and change it to make some differences in our community.

One example is integrated health care—the idea of having mental health professionals in primary care offices. Well, we have several different primary care offices, and people go to all of them. We don’t have enough population to support a mental health provider at each primary care clinic. So how do you choose which clinic? What we did is we have basically travelling mental health navigators, who help people get the mental health care that they need. That’s a program. But what it’s also doing is it’s changing the mindset of the primary care providers—getting them to recognize how and when to call that mental health navigator before a crisis. And that will impact the patient later, so it gets to the upstream work.

How has working with the cohort of health equity advocacy organizations changed the way you work?

We’ve always looked at equity, but we’ve never really articulated that and focused on equity and social determinants of health as a way to improve access to care.

From the get-go, our organization was created specifically to fill in gaps in services. We’ve always looked at things like geography, income, citizenship, insurance, and created programs and partnerships around that. But now we’ve really transitioned to looking at those infrastructural and institutional barriers that impact people’s health.

The transition has been a result of the cohort. It started with doing a deep-dive staff and board training on what equity is, how it shows up, how racial inequities impact all other inequities, the history of inequity, what that looks like in our community and in our country. We’ve infused equity in our policies and procedures and our hiring, in the way we do business, our case conferences, our meetings.

How we talk as an organization greatly impacts our patients and our clients. We’re able to work with them more effectively on meeting their goals.

What’s your vision of health equity in Colorado?

I truly think the basis of health equity, and all equity, is an understanding of the humanity that each one of us has. It’s kind of that golden rule to treat others with respect and kindness. I feel like that has been lost. My vision of health equity, and equity in general in Colorado, would be that everybody truly understands that—that everybody has humanity and desires to be treated that way—and that we respect the experiences that other people have. That would be a tremendous paradigm shift. And then more specifically, I think it looks like policies get changed so that there’s no longer a difference in health outcomes when you stratify data across race, gender, income, education. Once the data can show us that there’s no difference, then there’s equity.

What do you see as the biggest barriers to achieving that vision?

Changing minds and hearts, number one. We’re not going to change 100 percent of minds and hearts. But there’s a tipping point. In public health, it’s called the “herd effect.”

There are so many different policies in place that create inequities. It’s really undoing all of that that’s going to take so long. And then in policies in general, there’s almost always unintended consequences. So how do you fix inequities without creating more inequities?

You and your colleagues across the state have homed in on racial equity as a priority for achieving health equity. Why is that?

I have to say when the cohort first started talking about racial equity, I really struggled with it and I was vocal about it. I live in a community that is predominantly white. I was having a hard time seeing how discussing racial equity impacts the low-income community, which is one of our biggest issues here.

Now that I’ve had an education and become aware of it, I really understand that our country has basically been formed on racial oppression—slavery, specifically, as well as colonialism with the Native Americans, and mass genocide. That history is there, and policies over hundreds of years have been implemented intentionally and unintentionally to perpetuate oppressive systems.

What I have learned is that it is not my fault that all of these things have happened. Even if my family owned slaves, it wasn’t my fault. I wasn’t alive in the 1800s. But that is our history and it is up to us now to choose to take responsibility to heal from it and move forward, to treat each other with dignity and respect so we can all have healthy, thriving communities. That’s ultimately what everybody wants—to live in healthy, thriving communities.

What do you see as your cultural or ethnic identity, and how does that inform your work?

I’m a middle-class white woman with somewhat of an Italian background. I never was fully aware of the privilege that came with that. I knew it existed. I thought I was aware. But now in our work with the health equity cohort, I am truly learning what that means—what privilege means and how I show up in the world. How that informs my work is having a greater understanding of other people’s privilege or oppression, and using my privilege to make change and shift the power dynamics. That’s been a really key shift in my thinking about equity and oppression.

What’s the most surprising part of the health equity advocacy collaboration?

We’ve got all these moving parts, all these different systems coming together in one space and overlapping. I feel like not much action has happened just until the past six months; that’s just how long this work takes. It’s terrifying that we’ve only touched the surface of it. We need to continue digging deep and changing our organizations and communities. It’s that paradigm shift that just takes time.

Kristin Jones
Assistant Director of Communications
The Colorado Trust