Distinction in Population Health
Population health is the study of health patterns and determinants of a group of people. At Dell Med, the third-year distinction option in population health gives students the opportunity to make a local impact right away by addressing social determinants of health like income disparities, institutional racism, housing instability and more.
BROOKE’S GOAL THIS YEAR
“I want to answer some basic questions about what it’s like for senior citizens living in Austin’s public housing to get a sense of what their unique health needs are and how they can be better supported.”
For Brooke Wagen, the goal is to help her neighbors.
Wagen moved to Austin with her family nearly two decades ago, and spent time with the people surrounding her home in east Austin while volunteering with Meals on Wheels. Fluent in Spanish and naturally inclined to help those around her, she began to informally assist her neighbors with navigating the health care system — everything from calling insurance companies to joining in on doctors’ visits.
The health disparities she noticed were a motivating factor as she considered applying to medical school after years as a stay-at-home mom. Now, as she pursues a distinction in population health during her third year of medical school, she is returning to her neighbors to systematically uncover common threads in the health challenges they face through an exploratory, or qualitative, research study.
“As a long-time Austin resident, Brooke has a unique perspective and rapport with those she looks to serve,” says Elizabeth Jacobs, M.D., Wagen’s project mentor and professor of population health. “In many ways she embodies what Dell Med is here to do: improve the health and well-being of the communities in Austin and Central Texas.”
This year, Wagen is focused on one particular group of neighbors: seniors living in public housing. Chalmers Court, one of the first public housing developments in the country, covers two city blocks just steps away from her home. Along with seniors living at Chalmers Court, which is home to people of all ages, Wagen will also interview seniors living at Lakeside Apartments in downtown Austin, which caters specifically to senior citizens.
While she knows her neighbors well — and vice versa — conducting a research study is completely new ground for Wagen. But it’s worth the challenge:
“I want to capture what I think is a quiet story. The folks who are older, less able to get around and be out in the world, perhaps, are not at the table when it comes to making decisions that ultimately impact their health,” Wagen says. “My questions have to do with how to age well and what supports people need to do that. I’m not doing this because I have an idea of what people need — but because I’m sure that I don’t.”
Brooke Wagen is wading through stories.
In actuality, they’re data: interviews she conducted with more than 25 Austin public housing residents about their health and experiences. They comprise a valuable collection of narratives about her neighbors’ lives — how they relate to their communities, how they support one another and how that affects their health and care.
Some of the results have been surprising. For example, it’s typical for subjects not to have much to say about their health care provider or the health care system at all. They often share more about their neighbors or their needs beyond medicine — a working stove or a sense of community, for example.
Other results are revelatory: the residents who are happiest with their health care, for example, are often the ones whose providers make house calls, and thus holistically understand the residents’ life circumstances. The finding offers clues about how to better support aging populations.
“My interviews have been a huge privilege,” Wagen says. “They have been intimate moments where people tell me, in their own home, about their experience living in public housing, growing older and their experiences with health. They have opened up about all sorts of different things — both good things and also hard things. To me as a medical student and a researcher and as a neighbor, it has felt like a gift to begin to understand the experiences of these individuals.”
Wagen is conducting interviews in both English and Spanish, and is aware that themes are beginning to emerge between the different housing units she’s focused on. But she’s not rushing to any judgments; she’s carefully analyzing the data, and learning what it means to summarize information in a way that is valuable to the community. Wagen’s partnership with the Housing Authority of the City of Austin means that her work will tangibly inform projects impacting residents’ health going forward.
“The aging population in Austin is only going to keep growing,” Wagen says. “We need to understand what the needs truly are and how we can meet them both at the clinic and in their homes.”
Isolation is a major theme emerging in Brooke Wagen’s interviews with older adults living in public housing.
“People really value being heard,” Wagen says. “When you've perhaps moved away from your family, or you don't have access to the resources you might need, or you haven't gotten to know your neighbors really well, that contributes not only to the emergence but the ongoing feeling of isolation. It’s hard to break out of that. As a future physician, I keep thinking about home visits as a crucial way to close the gap.”
These insights are among the staggering amount of data she’s collected in 27 interviews, and she’s beginning to publish and share her results at forums like the Society of General Internal Medicine annual meeting.
Other organizations are recognizing the importance of her work, too. Wagen has worked in partnership with the Housing Authority of the City of Austin over the course of the year; the authority recently hired community health workers to assist residents living in public housing, and they asked Wagen to train these workers in effectively serving older adults.
Local nonprofits like Family Eldercare, which serves older adults throughout Central Texas, are also benefiting from the insights found in Wagen’s interviews. Joyce Hefner, Family Eldercare’s director of housing and community services, noted that these observations are already helping the organization reassess the approach to some of its programs for those living in public housing.
“We knew residents were feeling isolated, but we didn’t realize the degree to which that was barring them from physically approaching us to receive services,” Hefner says. “And Brooke has also given us a sense for how we can reframe our questions to get a better picture of a resident’s health. Having someone who can see both the housing and medical side of the health equation is such a valuable thing for our community.”
Brooke Wagen’s local roots are stronger than ever.
Caring for her neighbors was a factor in her decision to go to medical school in the first place. And now, after interviewing 27 of those neighbors and learning of their health challenges and successes, their stories are forever ingrained in the way she’ll approach practicing medicine.
She’s been presenting some of the insights from those stories — such as the near-universal reports of isolation by residents of public housing — at national conferences on aging, and helping to shed light on the intersection of housing, aging and health.
“There’s so much more to be known about aging in place,” Wagen says. “It’s a body of knowledge that researchers all over the world are gathering as people continue to age. We’re doing a better job of keeping people alive, but with aging comes newer, more complex health challenges.”
And her local partnerships with groups like the Housing Authority of the City of Austin (HACA) and Family Eldercare — partnerships she hopes to continue — mean that her work is providing valuable insights for organizations who are already doing work to serve Austinites, and aiming to improve that work.
“At HACA, we’ve worked on assessments to capture the ‘what’ of residents’ health,” says Rodolfo L. Rodríguez, HACA’s Director of Health and Wellness Ecosystem. “The interviews Brooke conducted begin to help answer the ‘why.’ Bringing her to the community partner table to help inform our work has been invaluable, as has her approach to listening deeply to elderly residents about their lives and health.”