P3 Podcast TTH Fellows Part 2 - Jonathan Butler - Draft

11:09PM Sep 4, 2024

Speakers:

Marcel Harris

Robert Lee

Jonathan Butler

Keywords:

equity

community

work

leaders

public health

san francisco

health

issues

important

programs

system

individuals

folks

faith

people

ethnicities

challenges

education

funds

spaces

Welcome to People.Power.Perspectives, the podcast where we talk to the people that are working to overcome system inequities to achieve just outcomes.

Hi. Welcome to a new episode of People.Power.Perspectives. I'm Marcel Harris with CA4Health, and I'm excited today to be speaking with faith leader Jonathan Butler, who is currently the Associate Director of the Black Health Initiative at UC San Francisco, among many other things, he's also the executive director at the San Francisco African American faith based coalition, and chair of the homelessness oversight commission in San Francisco. So to get us started, Jonathan, why don't you tell us a little bit about yourself your work and what issues you're focused on.

Thank you, Marcel, and great to be with you. My name, as you mentioned, is Jonathan Butler. I am a medical sociologist, and what that means is I specialize in the social determinants of health. I have my research is in stress and cardiovascular disease, and I'm, as you mentioned, a faith and nonprofit leader. So I'm really dedicated to addressing issues around food security, mental health, technology for seniors, education through the San Francisco African American faith based coalition, I identify myself as a bridge builder, bridging communities together, building organizations together. And other than that, I'm passionate about fitness and so all things health for me, I make sure that I maintain a level of health that's of quality, so that I could be an example to the people that I serve.

Awesome. I appreciate you sharing with us. Excited to pick your brain throughout this episode, and I have a whole bunch of questions after that introduction, but wanted to dive in and really understand a little bit more about what brought you to working in the spaces you're currently in today.

Yes, so from my involvement in my church when I was a young boy, and I saw so many individuals, older adults, seasoned saints, as as I like to call them, who had a lot of health conditions, but were very much religious and spiritual, but died early, died of heart disease, died of cancer at an early age, and that concerned me even as a little boy, and so it really sparked my interest then, and I think now it's kind of coming full circle with working with faith based institutions, working as a health professional at one of the top health institutions in the nation, And also being a part of this fellowship on the tth fellowship, where there's many health equity leaders across this state who have similar passions that I do. I think all of this has come full circle for me. The spark is all the way back when I was a little boy, and it certainly continued to spark just in my interactions with other faith leaders who have or faith and health leaders who have an interest and a passion for health equity.

Amazing. You know, it's interesting, hearing you share something that you mentioned in terms of wanting to understand why family members weren't living past a certain age. Was exactly the reason why I got involved in public health. Originally, I wanted to be a pediatrician. Then I started really understanding those social determinants of health and that built environment and what happens outside of the health offices, and I wasn't seeing family members live past 60 65 and I really wanted to understand why, and it opened up my mind to so many things that were happening that we didn't really discuss in my family or completely understand. And that's what drew me into public health early on at San Francisco State.

Wonderful I always like to tell doctors, because I work with family physicians and cardiologists, that people get sick before they come to you, and they're things that are in our society that creates that. And it starts from a very young age. Actually, it starts while you're in your mother's womb. That is some of the things that I actually do a lot of research on is, how do we look at health from a life course perspective, and then creating interventions that actually start young so that when you do become older, you have optimal health.

From your perspective, can you share with us why investing in public health leaders with the emphasis in equity is so important? And you touched upon it a little bit mentioning the tth fellowship. Would love to learn a little bit more about what that opportunity means for you currently.

Absolutely so I agree that investing in public health leaders with the focus on equity is crucial in creating the society that I feel like that we all want to be a part of. We want to have justice. We want to have a sustainable society where everybody can thrive. And I think by prioritizing equity, you kind of ensure that resources and opportunities are distributed fairly across the board to address all health outcomes. And so I believe that the tth fellowship has been important because it has really been transformative for me, because it helps us to understand what it means to actually be a leader in this space. And so we started off focusing on some of our personality traits and how we lead our teams. What's also important is networking with like minded leaders, as I mentioned earlier, it sort of motivates you. You want to sort of pick each other's brain, if you will, to see like how did you do this in this particular scenario, what would you suggest we do? So we have had exercises where we had a board of directors to sort of triage, what are you doing in some of these challenging circumstances, when dealing with your team who has experience in their own trauma, own stress, with family and work, etc, and then trying to serve a population that has trauma, and so I think being a leader and knowing how to help to inspire others to do the work is important. I think the tth fellowship has helped us to amplify our potential impact and promoting equity.

Now, when you talk about equity, the concept of equity has become a buzzword in many discussions, especially when you think about social justice and inclusivity. And I think everybody means well when they talk about equity, it certainly aims to promote fairness and justice by acknowledging like systemic inequities. It's certainly important to recognize that even though it sometimes can be inclusive of many groups, but it also inadvertently excludes groups as well, despite the intention in promoting equity some members of certain communities. You know, I've had conversations with members of the Black community who voice feelings of not being included and fully represented in the discussions and initiatives that are focused on equity. This can stem from this already designed system where there is systemic racism and discrimination that perpetuates disparities in various areas, as we know as housing, healthcare, education and employment, and it's so entangled into our system that even when we bring up the conversation about equity, systemic racism and discrimination sometimes seeps in. So I think having a conversation about equity and defining it based on people's experience and how they feel about equity. That's how we kind of truly achieve equity. In my mind, you have to engage in meaningful dialogues with communities within the black community, to understand their perspectives and their experiences around that.

I've been in spaces where we talk about it, and I've had a question, what does equity mean to you, because what it means to me as a black man, and this is from a community member, is absolutely different. I feel excluded in that conversation. So I think it's important to recognize that equity is not a one size fit all solution, and that different communities may have unique experiences that must be considered in the pursuit of a more just and equitable society that we actually want. Everybody wants that. So I think that as leaders, it's essential for us to yes, to have that conversation about equity. We know that equity is striving to address health disparities, promote social justice, improving population health, but it's different for certain communities, and how, how we do that, and we have to make sure that we articulate that clearly when we're especially when we're talking with community.

I couldn't agree with you more, and really appreciate you bringing up how equity is received or not received, and the importance of having that dialogue around it. I think in some of my work, I've been surprised, even in a progressive state, so to speak, like California, the pockets of places where individuals can't say the word equity, we're working with local health department leaders, and they didn't even want equity in the name of the group. I've been somewhat surprised on the pushback. But then also, I think that that's the beauty and the challenges within equity work, because if you you're doing it right, and you're doing it, there is going to be that pushback. I wish that there were more spaces for equity, in terms of in the community, at organizations, especially for those that are tasked with helping to improve outcomes. I think those spaces aren't created to have really fruitful and safe dialogue.

Yeah, just imagine, I mean, I live in San Francisco, right? It's the equity of all equity. We're so progressive, right? But when you think about the conditions of black individuals in San Francisco, we represent about 4% of the population. There's a disparity in annual household income where blacks are. Their average annual median income is 27,000 compared to whites is 101,000 that's a huge when you think about our population, 40% black individuals represent 40% of the homeless population. So when you think about equity in San Francisco for blacks, is totally different every negative statistic we're at the top, and the gap is so huge from all other race, ethnicities, and so even that's one of sort of the issues.

And the reason why I am addressing the things that I address, like food security, I feel like food security is sort of the key to unlock the doors to understanding some of the other challenges that community has, which we've been able to do with the faith based coalition and dealing with food security and education and mental health and technology for seniors. And you wonder, you know, why are we doing this? Well, I think a lot of programs and and talk about equity, a lot of programs focus on one aspect of an individual, and not realizing you gotta address the total person. And even moving beyond addressing the total person, you can't just feed a senior without feeding the entire household of seven individuals that are in that household. So you have to look at the the total household. And then you can't just start with seniors and start intervening on their health conditions. You got to start with the the toddler, the baby, the infant, and create interventions through their life course so they won't be on the path to poor health outcomes, the equity buzzword, again, that's an example of how it's actually excluding a population and not focusing on the real issue of how to create programs interventions that support the entire person, the whole person, to make them whole.

I really appreciate you bringing that up. I think, as someone who spent time in health ed and in public health, I think that was some of my pet peeves with folks and and not understanding that we really don't live these single issue lives, and not understanding the intersectionality, or even designing programs to really leverage resources and address the full person. Not to say that you do this, but I've come across folks in public health where we have a tendency at times to really put blame on individuals, without really understanding the context of the environment and the structural barriers. How do we adapt programs and change those systems to really meet the needs of all rather than continuously perpetuate and expand these health disparities.

Absolutely, I was going to say, I believe we can address in like, root cause issues. And a lot of times, programs are focused on disease specific interest, but like, root causes really unlock solutions and upstream, especially among marginalized communities. And I agree, I think a lot of the blame is on individuals, and not necessarily the blame on the system, which perpetuates, sort of the inequities that exist and the reason why. And it's designed that way, okay? And it's important for leaders, TTH leaders, health leaders, you know, we have conversation and dialogue about how to sort of dismantle, if you will, those types of systems think differently about how we approach this work. So that's one transformative example of like what we do as far as our fellowship is to really get at what ways can we do different because if we do it the same way, we'll get the same results, right?

Definitely. You touched on it a little bit on some of the issues that you're currently working on, but I was wondering if there's anything additional that you wanted to share, and then with that, what are you hoping that it'll change?

Yeah. So as I mentioned, we are addressing issues of food security, education, mental health, technology, we are trying to look at it from a life course perspective, and "we" meaning the Faith Based Coalition in San Francisco. I think the other issue is about consciousness, raising education, letting folks know the design of the system, and understanding how we're better collaborating with other organizations than we are in our silos. When you think about our city, they provide grants of $150,000 for example, to do a tumultuous amount of work. You never succeed with that, because you don't have the capacity to actually do the work, yeah, a certain amount of money. So I think we try to think about how collaborating with organizations, creating a plan, and then going to our public leaders, our department heads, and saying, this is actually what we need to do it right, versus them coming to us and say, we have an RFP out, this is what you gotta do right. And I think you get that. From making sure that, first of all, community knows the challenges with the system, and helping them to create a vision of what they want to see in their community, and then the strategy, which involves the advocacy of getting there.

And so that's one of the things that we can be focused area specific, but at the end of the day, it really is about advocating for what we actually want and not necessarily just taking scraps, if you will, of what they're going to provide. So I think that's one of the issues that we try to to get. I believe it's possible just providing people with education. There's a theme in our church for the year is, read baby read, learn baby learn and serve baby serve. And so we sort of live by that is to you know, you have to be able to read, learn, be in a space where you can learn, so that you can serve better. And so that's the kind of idea of what we're trying to do, is get people to understand what's happening in society, to learn from it and be of service that is meaningful based upon what we know.

That's powerful to hear and see. And I also like the way that you worked in advocacy in there, and I feel like that's a, at times, a missing element within this public health work, which I always felt coming in, that at its core, advocacy was a component, a very critical component, of public health, speaking of holding systems accountable, working with the community to change outcomes, co create solutions. We don't we don't do that enough, or have enough of those opportunities, and sometimes the funding dictates what is possible or limits, you know, folks from calling out the very entity that maybe is providing the funds. They could do a better job. And it's all interesting, but I feel like policy is a really important element of this equity work and systems change work that at times were quick to say, Oh, we don't have the money to make it happen. We have funds. I think it's just about leveraging resources and appropriating accordingly.

Absoloutely advocacy awareness a big deal. I think advocating for like the policy changes, but raising awareness, as I mentioned, about systemic issues that are affecting communities. What better way than the faith based organization to do that? I mean, when we think about our sort of prophetic leader of the centuries, Martin Luther King, was a faith leader, I have the awesome task of bringing together 23 faith leaders, and just imagine the power that is to amplify the voices of their parishioners. And so I think part of that is about education. That's how we have meaningful progress. You know, when we have we come together and sort of advocate with the collective voice. From a faith based perspective, we feel like, especially for the black community, the faith is the foundation, the bedrock, of our community, no matter if you go to church or not. When the times of crisis, people come to the church. That certainly was the case during the pandemic. I think it's important for all faith leaders and allies to come together to understand the conditions and advocate. Be in the boardrooms, be at the school board, write the letters, call the elected officials, get to know them, build relationships. That takes time away from what they have to do on the day to day. But it's certainly important. That's what I call real ministry.

Love it. You know, I'm curious in your perspective and your experiences, what challenges either have you experienced or you foresee, and then any possible strategies to address those?

Yes, several challenges, right? One of the thing is, what we talked about is just education, taking time to educate yourself, educate your community, owning the critical issues that we face, learning the the data, the information, understanding the root causes of issues. I think that's a challenge. I think people really need to buckle down and understand what are the issues. And you know, one of the major challenges, this is at the top of my list. I should have said this one first is resource allocation, securing adequate resources to implement comprehensive programs, $150,000 for years not going to do it. And so we try to talk with all funders about, you know, we need to not actually do the program, but have the capacity to do it.

And when you think about, as I mentioned, the economic disparities with blacks and whites in San Francisco, nobody's going to subscribe to a part time position, and it only be secure for one year. So as an organization, it's hard for me to actually bring on somebody and help to train and sustain that. Overcoming that right is partnerships outside of the city, foundations, philanthropists, allow for a little bit more flexibility and how we spend our funds. And I think there's conversation about sustainability. So I think that's important, local organizations, collaborating with each other, putting funds together, I think is important and showing like results, which is another barrier for us is, as a researcher, we can do exceptional programs, but we don't even have the capacity to let you know how it turned out. We don't have like data collection and evaluation metrics to measure the impact, because we're not enough money for that so that we can see is this truly working?

Obviously, we have observation and qualitative data people are appreciative of, like food coming every month. Obviously, we know that that's happening, but at the root of it, there's not enough funds to actually assess how effective we're actually doing. And then also think another huge challenge is communities across race ethnicities not coming together on a common goal. Food has no it does a discrimination with no race or ethnicity, right? That's a basic need, and unfortunately, a lot of folks in California are hungry, but what we tend to do is isolate ourselves by whether it's the geographic location, whether it's race, ethnicity, whether it maybe religion, and we go after funds and we keep it for ourselves without coming together across the spectrums of differences on one key thing, like, everybody wants to eat, has to eat.

Everybody has to be under a roof, or wants that. Everybody should want education. So my program shouldn't just be my program. To get money for my program without saying, okay, like, how do we bring this all together? I'm tutoring. Is anybody else tutoring? Right? How can we collectively come together and have this comprehensive tutoring program across the city, across race, ethnicities? Obviously, we celebrate differences, but there's still room to have that sort of intersectionality, if it's education that's connected with food, for example. And if I have a food program, it's just not to feed people, but it's actually to feed people for them to take their medication properly, for them to learn properly.

So I think having this new way of thinking about our individual focus areas and how you bring that together across these organizations, across race, ethnicities, I think will make even better impact. And again, it is a system that is designed to keep us divided that way. Again, it involves a lot of consciousness raising about that and then the strategy, what vision like? You know? What? What do we envision as the perfect world, and then for us to come together collectively and strategizing about that.

I appreciate you bringing that up and the importance of collaboration. Would love to see more funders stretch the terms of funding to it. I think I'm used to the one, two year, maybe three year. Never really heard of the four or five year, but it takes time to establish those relationships. For me and my experiences, it hurts the most when you know you go into a community 12 months and then the work, the issues don't stop after 12 months, but you no longer have funding, and I think that that's been a challenge for me in some nonprofit spaces, of how the funds dictate the work, and then it's put on pause. The issues are still continuing the community like, Hey, what happened to so and so?

And then it makes it that much harder when you try to go back into the community, because you have to repair those relationships. And I think that there's also issues with trust, in terms of how these systems have historically exploited folks. How to build that trust, sustain it, and then the importance of really foundations and other funders supporting the work, but realizing it takes time to establish it, and then really working through how to collect some of those outcomes. I've always been amazed at times of how many people were in the room, other than like, what's the quality of that experience for if it was one or two folks in the space, but really understanding folks' experience through programs and uplifting the importance of it.

Yeah, the perfect example of that is we did it well during the pandemic. Why did we do it well? Because these city agencies, they allow community to lead. Now we're reverting back to pre pandemic, whereas we're giving the authority now back to the city leaders, and we're worse off than we've been. The idea is community folks know what they need. Let them lead leaders like city leaders, and you know, funding was flexible. It was available assess. And we did the work because it was a crisis. And I feel like the leaders may not feel like we're in crisis mode still. We were in crisis before the pandemic. We're in crisis mode still. And you have to keep this as if it's an emergency crisis, and we haven't done that as a society. And the demand for food now is more than it has ever been.

People are struggling, yeah, to get housing. This past Sunday, three people came to me, I need housing, and it has increased in terms of the requests of I need housing. I'm sleeping on someone's couch, and I have my son that can't go to school and learn because he's concerned about his housing condition, not getting enough food. So we're in an emergency crisis, and I think there's hope, though, because we have health equity leaders that understand that we'll eventually be in a position of power to be able to make those type of decisions on how to allow folks on the ground to actually lead up and listen to to them, to implement what is it that they desire and need. Challenge, but definitely hopeful.

Challenge, accepted. Love it. As we wind down here, you know, I'd love to hear from you what kind of support is needed to help move this work forward, whether it's from the community, funders, anything that you can think of, but would love to touch upon that.

Yeah we could just summarize what we have talked about, education. Educate yourself. There's workshops, events that happened, being able to participate in those things, like we do, health fairs, etc. Community is providing these resources for folks to come out, and not just to come out to get those resources, but to network. I think one of the things that we as a community should be intentional about is, especially black communities in like San Francisco, where there's not a lot of us, is to be intentional about going into community settings and just being around your people, I think one way to do that is to volunteer. People. Have the opportunity to volunteer of organizations, volunteer to tutor a child, mentor, etc. I think that's what community can do.

Obviously, we need our allies with money to donate, fundraise, and then, most importantly, I think all of us, need to use our voice, use our voice to advocate for the policies, and making sure that people that we put in place to make decisions are people that represent our interests. And so we're in an election season in the city, in this nation, and one of the things you should ask your elected officials, as you know, as a black individual in this community, what is your agenda for me? You know, are you thinking about me when you are looking at your policies and and your plan for the city, especially when I only am a part of 3% like, are you going to ignore me, and sometimes you have to learn about what they've done in the past that has helped you know certain groups, and that gives you some guidance on what they'll do when they're in office.

And so I think there's important aspect of all community members need to be able to not only just advocate, but again, educate yourself on who you're putting it in the office to make decisions for you, so that you at least know how to galvanize folks and how to vote. So I think if there's anything to leave your audience with is please get educated. Know who's in office. Advocate for what you need and hold them to task like if they promise something for you, you gotta make sure that written down, articulated, and people around holding that person accountable. There's a lot of work for us to do as a community. One of the things that I do know is that there's a lot of resilience in the city, especially amongst blacks who, in spite of the odds, have stood up and have kept fighting. We certainly, in this moment, need allies to help us, but there's still hope for the world and the community.

Love it. You know, if anybody listening wanted to connect with you, check out your work. Reach out to you. What is the best way that folks can connect with you or or follow some of your work?

Yeah, so I'm going to start being more involved in social media. So it's @ButlerPhD, on social media platforms. I do have a website which is Doctor Jonathan butler.com, you can certainly Google like San Francisco, African American faith based coalition, or even bhi, which is the black Health Initiative at UCSF. Bhi.ucsf.edu so any of those platforms you can kind of follow the work that I do.

Well, I really appreciate you sharing with us. I feel like I could probably go another hour just picking your brain, and whenever I'm back in the city would love to connect with you and grab some lunch, and I just wanted to give thanks and appreciation to our speaker, bridge builder for today, Jonathan Butler, to our audience, thank you for listening to another episode of CA4Health's People.Power.Perspective.