Arnold grad Michael Dickey finds challenges in variety of public health venues

Posted 02/14/2007 

As Dickey recalls the last seven years, that’s really not too far from the truth.

An Illinois native, Dickey earned a bachelor’s degree from Auburn University in 1994. In 1999, he became a student in the Arnold School’s Department of Health Promotion, Education, and Behavior, earning a master’s degree in 2000.

During his studies at USC, Dickey gained experience as a graduate assistant focusing on HIV/AIDS, developing and presenting educational materials on the disease to health care professionals throughout the state.

After his studies at USC, Dickey became the director of a national program funded by the U.S. Health Resources and Services Administration to train health care professionals serving American Indians and Alaska Natives (AI/AN).

“The initial focus of the program was to educate providers about HIV/AIDS care and prevention; however, the need for better cultural understanding among the providers soon became apparent,” he said.

Dickey said HIV/AIDS has struck the Native American people particularly hard. Poverty, substance use, lack of education and lack of access to health care put AI/AN people at greater risk for HIV infection.

In addition, generational trauma stemming from years of mistreatment and acculturation exacerbates all health issues among Native Americans, he said.

Dickey said American Indians have a unique culture “that is misunderstood by many health care professionals.” And understanding those differences, he discovered, was the key to success in improving the quality of care for Native Americans.

HIV/AIDS has a particular stigma in many Indian communities. It is associated with homosexuality and sex, two cultural taboos of deep significance and a likely reason the actual disease numbers are vastly underreported.

Cultural influences manifest themselves in the health care provider’s examining room, Dickey said. “There’s a lot of nonverbal communication.  Among some Native Americans it is a sign of respect to not look a person of position or power in the eye,” he said. This can lead to miscommunication and a poor patient/provider relationship if not understood.

Dickey’s immersion in the AI/AN cultures resulted in improved quality of care, increased access to care for those communities without nearby health services and course guidelines for both health professionals and their teachers.

In mid-2005 he and Winthrop University professor Dr. Shelley Hamill discussed the HIV/AIDS issue among Native Americans in an article for the Journal of the Association of Nurses in AIDS Care.

“Cultural Competence: What is Needed in Working with Native Americans with HIV/AIDS” (Adobe PDF) not only explained the historic plight of the AI/AN population but suggested specific steps in breaking through cultural biases to enhance care and treatment services.

The years with the Indian program were rewarding, but Dickey opted to change directions when he was offered a position with the Association of State and Territorial Health Officials.

“I saw this as an opportunity to help improve health outcomes on a more comprehensive scale; instead of making quality improvements on a service or program level, this move allows me to help develop and implement public health policy which can have a greater impact on the population,” Dickey said.

ASTHO, based in Washington, is a non-profit public health organization that represents the leaders of state and territorial health agencies.

Dickey is director of public health services policy, a post in which he works with state public health officials in all 50 states, the District of Columbia and the U.S. territories.

Currently he is involved in an effort funded by the Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention to improve the nation’s public health infrastructure with state public health agencies/systems.

“There is a wide variation of public health functions and organizational structures among the states,” says Dickey. “This makes it difficult to succinctly articulate the value and purpose of state-based public health in basic terms.

 “It is our hope that defining a common scope of state public health functions and responsibilities will provide policy-makers, practitioners and the general public with a broader and deeper understanding of state public health and will advance the discipline of quality improvement and accountability within the vast enterprise of public health,” he said.

Dickey’s effort is now completing its first phase where the focus is getting state officials and public health partners on board by identifying the potential benefits of the project’s outcomes.

“The project will promote empirical analysis of the relationship of state public health infrastructure to health outcomes, provide evidence for decisions about organizational structure and resource allocation and enhance public and government support for state public health through clear consistent communication and marketing,” he said.

Dickey says identified state public health functions will also be used as a tool to guide the development of performance standards for a voluntary national accreditation program for state and local health departments.

That accreditation effort, already in its formative stages, is expected to help improve the quality and performance of state and local health departments.

Dickey says he’s enjoying life in Washington, despite the traffic and high cost of living.  He still stays in touch with friends and former colleagues at the Arnold School where he’s looking forward to visiting the new Public Health Research Center. With his busy travel schedule, you may see him in your state soon..