Episode #445 When Communities Define Public Health
- Feb 24
- 7 min read
On This Episode Of The Public Health Epidemiology Conversations (PHEC) Podcast
A Native Hawaiian elder sits in her doctor's office for a diabetes appointment and finally says what she's been feeling for years: "I don't feel seen when I'm here." That moment of honesty changes everything because it exposes what data alone can never capture.
This conversation explores what happens when we stop telling communities what public health should look like and start listening to what they already know. Through stories from end-of-life planning in Chicago, clinical research with Native Hawaiian patients, and youth mental health work in Baltimore, three public health professionals reveal how care becomes transformative when communities lead the way.
The textbook version of public health focuses on interventions, outcomes, and evidence-based practice. Consider the Uber text from a friend after a night out, the grandmother who wants her diabetes care to acknowledge that she still dances hula, or the formal community councils that protect research integrity by requiring permission before programs begin. These moments aren't extras. They're the foundation.
Kandis Draw, Nina Lopez, and Dr. Augustina Mensa-Kwao work in different contexts, but they share something essential: they recognize that listening comes first. Trust must be built before programs are implemented. Communities have always practiced collective care, even when systems failed to acknowledge it as public health work. In uncertain times, when infrastructure weakens and funding disappears, care and community become the bedrock we stand on.
This conversation won't give you a textbook definition of public health. Instead, it shows you what public health looks like when communities define it for themselves.
Communities as Experts in Their Own Lives
This conversation brings together three distinct perspectives on public health practice: end-of-life planning in Chicago's Black community, clinical outcomes research with Native Hawaiian patients in Honolulu, and youth mental health work in Baltimore. Despite working in different contexts, Kandis Draw, Nina Lopez, and Dr. Augustina Mensa-Kwao share a common foundation: they recognize that communities already know what they need. The challenge isn't convincing people to care about their health. The challenge is building systems that honor what communities tell us matters most.
When Care Work Becomes Public Health
The professionals in this episode describe moments that rarely make it into academic journals. These include a text message suggesting an Uber ride after a night out, a grandmother who wants her diabetes care to acknowledge that she still dances hula, and an advance care planning conversation that addresses dignity and respect alongside medical preferences. These aren't peripheral to public health. They are the substance of it. When we separate clinical interventions from the relationships and cultural contexts that give them meaning, we miss the point entirely.
Building Trust Before Programs
Nina Lopez describes the power of formal community councils in Hawaii, spaces where researchers and program implementers must seek permission and guidance before entering communities. This isn't bureaucracy. It's wisdom. When communities have structured ways to define what public health means for them, to approve research questions, and to shape how interventions unfold, the work changes. Programs become partnerships. Data collection becomes dialogue. Public health transforms from something done to communities into something communities lead.
The Courage to Listen and Believe
Perhaps the most radical act in public health is believing what community members tell us. When patients explain why they miss appointments, when elders describe what dignity looks like at the end of life, when young people articulate what mental health means in their daily experience, our job is to listen and then design systems that match what we hear. We should not explain why their perspective doesn't fit our framework. We should not convince them our evidence base knows better. We must genuinely redesign our approach based on community expertise.
Care and Community in Uncertain Times
This conversation lands during a moment when public health infrastructure faces significant threats. Funding cuts, political attacks, and workforce instability create real uncertainty. Yet Kandis Draw points toward something essential: when systems weaken, care and community become the foundation we stand on. Communities have always sustained themselves through collective effort, mutual support, and relationships built on trust. That work has always been public health, even when institutions failed to recognize it.
About Our Guest
Kandis Draw
Kandis Draw serves as a senior community health worker at the HAP Foundation (Hospice and Palliative), where she specializes in end-of-life education for Black communities. Her work centers on helping community members understand the differences between hospice and palliative care, planning for dignified end-of-life experiences, and ensuring that research approaches prioritize community voices and expertise. Kandis is completing her master's degree in public service leadership at Loyola University Chicago and brings nearly five years of experience in community health work to conversations about serious illness and advance care planning.
Nina Lopez, MPH
Nina Lopez is a doctoral candidate in health informatics whose research sits at the intersection of clinical outcomes, social determinants of health, and population health analytics. With a master's in public health focused on health informatics and epidemiology, she specializes in bioinformatics and predictive analytics while maintaining a strong commitment to Indigenous health, particularly Native Hawaiian health outcomes. Nina's work demonstrates how listening to patients transforms clinical data from numbers on a screen into stories about belonging, trust, and community connection. She recently relocated from Honolulu to the Washington, DC area.
Augustina (Tina) Mensa-Kwao, PhD
Dr. Augustina Mensa-Kwao is a postdoctoral researcher in the Department of Mental Health at Johns Hopkins Bloomberg School of Public Health, where she studies how urban environments affect youth mental health. Her research focuses on preventing mental health challenges before they emerge by understanding the complex relationships between place, community, and wellbeing. Tina recently completed her PhD and brings both local Baltimore expertise and global perspective to questions about supporting young people's mental health through environmental and community interventions.
Listen To This Episode Of The Public Health Epidemiology Conversations (PHEC) Podcast
Conversation Highlights
Public health thrives when communities define what health means for themselves.
Rather than imposing academic definitions or clinical frameworks, effective public health begins by asking communities what thriving looks like and then building systems that match their vision. When Native Hawaiian patients explain that care should reflect their whole identity as grandmothers, hula dancers, and beloved community members, that's not feedback to incorporate. That's the assignment.
Trust must be built before programs are implemented.
Formal community councils in Indigenous populations demonstrate the power of structured consultation before research or interventions begin. This approach recognizes that communities hold expertise about their own needs and have the right to approve, shape, or reject public health initiatives. When we skip this step and move straight to implementation, we undermine the very relationships our work depends on.
Care work has always been public health work, even when systems don't acknowledge it.
The friend who texts you about taking an Uber home, the grandmother teaching traditional healing practices, and the neighbor checking in during a difficult time all engage in acts of collective care that sustain communities and prevent harm. Recognizing this work as public health validates what communities already know and honors the labor that mostly falls on women and marginalized groups.
End-of-life planning is a public health issue that centers dignity and respect.
Everyone deserves to die with dignity, and that requires advance planning, community education, and conversations that address the whole person rather than just medical interventions. When end-of-life care incorporates what matters most to patients, including their relationships, values, cultural practices, and hopes, it becomes true public health rather than simply clinical management.
Mental health is inseparable from physical health and community wellbeing.
When young people can't separate how they think, feel, and behave from their physical experiences, that's not confusion. That's wisdom. Mental health interventions that honor this holistic understanding and address the environments where young people live, learn, and grow have far greater potential than approaches that isolate mental health from context.
The most powerful public health work happens when we listen and believe what communities tell us.
When patients explain why they miss appointments, when community members describe barriers to care, when young people articulate what support they need, our responsibility is to believe them and redesign our systems accordingly. Skepticism about community expertise undermines trust and ensures that interventions miss the mark.
In times of systemic uncertainty, care and community become the foundation.
When public health infrastructure faces political attacks, funding cuts, and workforce instability, the relationships and collective care that communities have always practiced become even more essential. This isn't a fallback position. It's recognition that community-based care has always sustained health, often despite systems rather than because of them.
"Public health is the space where people get to define what thriving looks like for them. Our job is to listen and to believe them and then to build systems that match their definition and not force our version of what public health is that we learned in graduate school onto them." - Nina Lopez
"When I know when public health is doing a good job, most people don't notice because we've already stopped the issue from happening altogether. It's like when you get a text message from a friend and they're like, hey, I think you should Uber after a long night of being out instead of getting in your car. That is an act of public health." - Dr. Augustina Mensa-Kwao
"I think care and community are going to be the only two things to really rely on because I see that systems and things that I think that were guaranteed at one point are no longer as strong as they once were, or even in some cases about to be taken away." - Kandis Draw
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