Health Disparities in Society with Dr. Laura Guyer

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“Health equity” will be achieved when every individual has the same opportunity to attain their full health potential because there is equal access to equal health care based upon equal need. Dr. Laura Guyer’s career has been dedicated to the mitigation of health disparities that are associated with social, economic, racial, and educational disparities and elimination of barriers in the health care system. At risk for health disparities are members of socially and economically marginalized populations due to race, ethnicity, sex, gender identity, sexual orientation, language, age, religion, disability, socioeconomic status, and geographic location.

Dr. Guyer established the only undergraduate academic program nationwide dedicated to eliminating health disparities while adding diversity to the health professions workforce. Health Disparities in Society, housed at the University of Florida, works in partnership with thirty local safety net clinics, nonprofit organizations, and state agencies to teach students about social inequities, the social determinants of health, cultural competence, health literacy and the social mission of health professions education.

Before returning to UF to establish the health disparities minor, Dr. Guyer spent twenty-five years immersed in the rural culture of north Florida. As a clinician, wellness nutritionist and community educator, she developed cultural sensitivity and awareness about the health care and educational needs of diverse individuals.

Her deep and long-standing commitment to diversity, inclusion and undergraduate education has been recognized by numerous awards including the UF Presidential Service Award for Leadership and Service Advocate of the Year (2020), Faculty Achievement Award (2019), UF Faculty Advisor/Mentor of the Year Award (2016), UF Faculty Leadership and Service Advocate Impact Award (2016) and Advisor of the Year Award (1993). Her commitment and service to the dietetics profession in Florida was recognized by the 1995 President’s Award. The hallmarks of her career include leadership, innovation, creativity, community engagement and collaboration. 

To learn more about Dr. Guyer’s work visit:

SPEAKERS: Laura Guyer, Tony Delisle, Jasmine Tran

Jasmine Tran  00:00

At risk for health disparities are members of socially and economically marginalized populations due to race, ethnicity, sex, gender identity, sexual orientation, language, age, religion, disability, socio economic status, and geographic location.

Tony Delisle  00:21

That quote comes to us from today’s guest, Dr. Laura Guyer delivered by our wonderful producer, Jasmine, who is just amazing, by the way, and love to have our support on being able to do this podcast. So thank you for reading that and I think is a really good intro into talking about today’s topic, which is public health, health inequities, aka health disparities, social determinants of health. We get into discussing really, what’s really in my heart, really have great inspiration to try and promote health and myself and my family, my friends, the community, and really carved out a great academic and professional career doing so. The work I do here at the Center for Independent Living and supporting our center staff is to do work that really ultimately I believe, is impacting the health and well being of the people that we serve and the community and especially in a group as stated in this quote that has been marginalized and experiences what’s known as health inequities. For example, people with disabilities are less likely to live the average lifespan as people without disabilities, more likely to get preventable chronic diseases, such as the top killers in our countries such as heart disease, respiratory diseases, cancer, strokes, diabetes, and by the way, COVID. So we are experiencing a rate of inequities that needs to be addressed. And how do we address it, it’s very complicated. And so the area of public health that really tries to unpack this, I think is just an amazing field to go into being very altruistic, learn a lot about ourselves, the importance of serving others. And Dr. Guyer is somebody I met along the way in this journey. And we share a common belief about a solution to addressing these health inequities. And that would be leveraging what we call community academic partnerships. So you got the community, you got the academics for the job, post secondary institutions, which can be universities, can be colleges can be community colleges. These places have resources, human resources, material resources, financial resources, that can be brought to bear to address a lot of the local health needs that are around the area. And doing it in a way that helps to serve the students perhaps of these post secondary institutions, and getting real world hands on experience known as service learning, things that you cannot get in a classroom, learning in the community working to help improve the health of a community and getting to know different groups of people that are much different than perhaps a typical college population would have enrolled into it. And so from my experiences from Dr. Guyer’s experiences, we’ve seen what happens when community academic partnerships can materialize, when people can break out of their silos, when community based organizations can be brought into the fold, to really participate and coordinate together in areas that are really ultimately helping locals to improve their health, local civic community, that are very important to the community. And the role that post secondary institutions play in addressing a lot of the health inequities that are experienced by the marginalized groups. And so I’m very honored and blessed to have Dr. Guyer on this conversation. It’s been wonderful working with her and continuing to work with her to really be a strong voice and advocate for groups that we really need to be paying attention to, is what I consider to be the most important and highest work that we need to be doing out there is really reaching those that can be the most marginalized, most vulnerable, and doing everything that we can do to be the best version of ourselves so that we can serve these community these people that deserve the equal access, the equal care based on their needs. And we’d love to hear what you think about this. So please reach out if you have any thoughts about this because this is something that I believe is the responsibility for all of us. Enjoy the episode. So here we finally are.

Laura Guyer  04:50

At long last. We’re gonna have this conversation. We’re going to actually record it for others to hear.

Tony Delisle  04:54

Yeah, and what’s really special about this for me is that You’re the first that we’ve had in person since COVID. Oh, really that like, the first season, we did a few in person. But this is like going into Season Two for us. So it’s a real honor to have you here in person. In one of the things I really appreciated about it, too, is is like you’re on my A list. And so it’s a great joy to have you here.

Laura Guyer  05:22

Thank you. Yeah, I, you know, I feel honored to be the first live person back, you know, it feels like life is coming back to quote, normal, but it’s going to be a new normal, I mean, COVID. And I think, Zoom, if any of us had known a year ago, what Zoom was going to do, all of this would have bought stock in Zoom, right? Zoom is has taken us places we never envisioned, you know, in the past. But you’re on my A list too, because again, the work that you do is so important. And you serve a community that isn’t on the radar of so many people, even those who are trained, and who work in public health and health care. We don’t think about disability. Other than in an academic sense, perhaps, we might know statistics, but we often don’t know people. And we don’t realize perhaps how many people we do know, live with, who live with hidden disabilities, or disabilities that they don’t talk about. There’s so much that we could be learning about health care needs and how to end disparities in this community. So I’m excited to be able to be here with you and talk about how we can go forward and make a difference.

Tony Delisle  06:37

Absolutely 100%. And that you just explained the reason why I wanted to have you on because your perspectives and and your experience. You got so many different experiences, whether it’s in the community and serving people that had rural health needs for so many years, getting hands on experience with people, with eyeballs, but also having your academic experiences where you bring in very good high level conceptual understandings that can match it alongside real life experience. And to be able to bring those both together, I think, is a recipe for very wise people. And so this is why I really wanted to have you on because you thread the needle there. Yeah, not just one, one or the other. You got your feet in both. You’re both theoretical and conceptual. But you also applied. And in bringing those worlds together, because I find that people will you kind of like compartmentalize, maybe in one, and there’s, there’s a sweet spot in there somewhere. And I really look up to the people that are able to thread the needle, and you do that very well.

Laura Guyer  07:37

I think I’m just a risk taker. You know, I started as a clinical dietitian, so started, you know, right out of school doing what I was trained to do. But very soon discovered that, although my science background was very strong, I didn’t have the skills that I needed to connect and communicate with people. And there were so many different kinds of people that I was meeting at, in the hospital, different levels of education, everything from, you know, high school graduates to, you know, very well educated professors, people from the rural community, people who lived here in Gainesville. In addition to the work I was doing with, you know, talking about nutrition, I also because I was in the food service department was teaching food service workers how to keep the food safe, and about personal hygiene practices and temperatures for food, safety zone. So many of those staff members didn’t even have a high school diploma. So what I discovered very quickly was that as a health professional, my size was sound. But I didn’t have the communication skills that I needed. So going, I went back to school through the College of Education, which isn’t a route that a lot of health professionals take. For me, it’s opened up opportunities in my career, my phone tends to ring about every 10 years. So I transitioned out of the clinical setting. And when I finished with school, actually UF was on the phone calling me to see if I would, you know, come back to UF and work in the dietetics program that I had graduated from which was really wow, an interesting experience. So then I was able to bring in the academic focus looking at at health and healthcare and people and communication. Ten years later, again, I was out at Swanee River Area Health Education Center working in public health. So then seeing really the rural community and the lack of access to care that we find in our rural areas. And then 10 years later, UF called and said, Hey, would you come back? And so that’s where I’ve been for the last 10 years.

Tony Delisle  09:41

Right. And so I almost want to back this up a little bit in the sense that your give it give it some context in the sense that you’re very inspired about health.

Laura Guyer  09:53

I’m inspired by health, by the people that I have met and worked with in this case Community. Truly, I didn’t want to stay in Gainesville when I graduated. But I got married. And at that time, my husband was still in school. So we stayed. And so, as I started working and getting to know people in the community, I began to see how big health and healthcare was. And that was more than just clinical care. And I got to know many of the nonprofit organizations like the Center for Independent Living, like Swanee River Area Health Education Center, like, Well Florida Council, which is our Regional Health Planning Council, and they are the umbrella for many other organizations. Also, that that have a regional impact. When you start to get to know people who are focused on public health care and health care. Your life changes. Yeah, so my life has been changed by being part of this community.

Tony Delisle  10:54

And so again, the change kind of comes to the door of health. I’m interested to know what what does health mean to you? Like, how do you define how, like your own definition?

Laura Guyer  11:03

You know that, that is that it certainly is more than the absence of disease or infirmity. I see health, probably much as the definition of health equity, okay, would imply that it’s, it’s equal access to opportunities for good health. So when a person has access to health care, because they have a need for health care, and they get good quality health care, that’s the same as the person that was just ahead of them, and the person that will follow them. That’s what health is all about. Being able to live life to your fullest, recognizing that all of us are different.

Tony Delisle  11:43

Wow. And so I think this might be a good time to cut to… I’ve asked you to read a quote, and it comes from your own writing. And I would read it if I had the eye acuity to do it, I probably should have committed it to memory. I could paraphrase it. But I don’t think I would do it justice. So if you don’t mind reading that statement, because I think it just really aligns with what you just said.

Laura Guyer  12:08

It’s really the the combined definitions of health equity, you know, and what is health equity. So it has that that connotation or that association with justice. Okay, health justice. So health equity will be realized, when every individual has the same opportunity to obtain their full health potential because there is equal access to equal health care based upon equal need. 

Tony Delisle  12:33

Wow. 

Laura Guyer  12:34

And so as we look, I know, at our own community, and we are really a model for students who come to this community, we are a model of their communities. But we also model I think, in many ways, what healthcare could look like, and what health equity could look like.

Tony Delisle  12:51

So when when you talk about, there’s three like equals, I know that I noticed that you’re in the statement here. I’ve, by the way, I love for potential in our health have the opportunity for achieving our full potential. I love that, that that that grab that you had me there. And then so going on down that statement, and we’re going to provide this in the show notes. And going down in the statement, you connect, you know, three different areas of health. Yeah, so you’re you were talking about equal access. So number one, thing, number two, health care, you know, health equity, and that in that sense. And then your third one, there was health equity need. So you know, equal access, equal care, based on equal needs. Unpack that, unpack where you’re coming from from there.

Laura Guyer  13:47

Because all of those areas are the barriers that we find to the opportunities for good health. When you don’t have access to care, because perhaps geographically you live in a rural area, or you live in an underserved part of your community where there isn’t transportation, so you’re not close to and you don’t have access or ability to get to a health provider. When you’re sick, you want to be able to see the professional that you need based upon your illness. Everyone doesn’t have health insurance. Everyone doesn’t have transportation. And again, we want to make sure that everyone has the same quality of health care. There are many barriers to health care quality, some are barriers in the individuals. People in the community, they may not speak the language. They may have different disabilities, may have difficulty with communication or hearing. We also might have patients with low health literacy. They don’t know much about their health or they may have low literacy skills. And so again, it’s difficult to implement recommendations that a provider makes, right? So again, you know, what are those barriers, they’re within the patient’s they can be within providers who don’t know how to communicate effectively. Certainly, there were many barriers in, in me when I was a clinician, because I didn’t know how to communicate with everybody. So I went back to school to develop some additional skills. And there can be barriers in the environment as well, the learning environment. If you’re in a hospital setting, there’s a lot taking place, it’s very stressful, you’re sick, if maybe you’re taking medication affecting your ability to remember, your ability to think clearly and ask questions. So sometimes the environment is becomes a barrier to effective care.

Tony Delisle  15:44

So what I hear you saying here is what I’ve, you know, have read about the social ecological model, where it goes from, you know, looking at all the different factors that are related to health outcomes. And and addressing them at each of those different levels to calibrate for quality. So what are the individual level factors? What are the interpersonal level factors? What are their community based factors? What are the larger scale societal, policy, environment? And so integrating all those different levels together? And there’s intersections there that that happen? What are some of the things that you would find helpful in terms of addressing these areas where there is a need for equal access, equal care, based on equal need? So, so given that this ecological framework, where would you say like some important things that you’ve learned, yeah, could be applied to addressing this inequity?

Laura Guyer  16:42

I would say that most of my work in my career has been focused on the education of health professionals. Okay. First of all, we need to start from the point of awareness, awareness, that science background that we have that’s so important for understanding the research and understanding medicine and understanding, you know, how your body works, very important. But equally important, is remembering that we’re going to be working with people. So how can we affect them? How can we communicate with them, all those different levels that you just mentioned in this in the model, if we don’t have an awareness that all of those factors are possibly impacting the outcome of our conversation, and then the outcome of health care, we have to have that awareness. And we need to think about how to integrate more of the social and the behavioral sciences into the curriculum, not only in at the professional level in medical school, dental school, but at the pre-professional level. Because Dr. Delisle, we have undergraduate students who, in terms of their developmental milestones, you know, all throughout life, we have developmental milestones that we reach, right? So between the ages of 18 and 22, when you’re an undergraduate, okay, at a university, what are your developmental milestones? There are several that are very significant. Number one, you are becoming an adult, and recognizing that you are independent of your parents and different from, and independent from other adults. Number two, you’re finding your place in life. Number three, you’re looking for how you can make a difference. And so when you capture undergraduate students, and you help them see the possibilities of the better health, the good health, the opportunities for health, that we can provide by training a little differently, introducing you to people in the community while your undergraduate students so that you have opportunities to take everything you’re learning in the classroom, see how it works in the real world. You know, I think about students who have worked with you over the years, undergraduate students that I’ve sent to work with you and work with your staff, to serve everybody that, here in Alachua County, that Center for Independent Living is is serving those students benefit, you benefit the community benefits, there’s nothing better than a win win. Honestly.

Tony Delisle  19:20

It’s the best and so I want to acknowledge you for for doing something that is super in what I alignment with what I believe, and that’s post secondary institutions, universities, colleges, community colleges, perhaps even trade schools, I think have the resources there, human, material, financial, to bring to bear to solve in some of the local complex public health needs that are there. And, like you said, would be you know, one hand more meeting local needs, and on the other we’re training people at the same time, and, you know, it’s just a beautiful partnership that you’ve created, because you have, you know, so many students going year round, you know, and 10 years of experience in put lacing them into different community-based organizations and other places that are around the community that does engage people. And so you planted so many seeds after 10 years of, I don’t know how many students you put through that health disparities minor practicum experiences that we’re talking about here… About 900.  A year?

Laura Guyer  19:31

 About 900 total for 10 years have gone through the the entire 15 credit, minor. 

Tony Delisle  20:32

That’s a lot of seeds you have planted. 

Laura Guyer  20:33

But I’ve had, gosh, I don’t know 2000 students who have taken just the Introduction to Health Disparities course. So not everybody who takes who has taken some of my courses actually fills the, fulfills all the courses to to meet the minor. But, you know, again, this is the 21st century. Medicine and health care, you know, first of all, the students are different, okay? The students up to the undergraduate students of today aren’t the same as the undergraduate students of 1950. Okay. The world has changed to you know, medicine and science technology, you know, we’ve moved forward in so many ways, but it’s, in some ways, we’re still training like we were still in the 20th century. So what can you do differently? And this is where introducing students who want to go into careers in healthcare or public health or even law and you know, but how can we introduce them to people like you who are doing the work, you you are serving a population that has health disparities, because we’re talking about people that are aren’t on the radar of so many other individuals. We have communities within our larger community. And that’s something that again, we so many times think about, well, what are the needs in our community? Well, we don’t have just this homogenous community, what we have is a community that’s made up of smaller communities, and each smaller community has its own set of needs. So as we can become aware of who those individual communities are, you know, we can interact, we can find out what their needs, then we can do what we can to remove the barriers so that they can have, again, opportunities for the most optimal health possible.

Tony Delisle  22:43

And you’re unpacking in great detail, something that I think that’s important to note, as a distinction, I think when people think about like health, health care, they think very clinical, right? We’re thinking doctors and nurses in you know, the rehab clinics, or hospitals, your ERs, your common garden variety, family doctor’s office. But you and I have an I think a much broader sense of like public health, no, is actually being in the community with the people delivering services that meet what you and I and others in the field refer to as the social determinants of health. And so one of the things that I find very interesting in terms of you were talking about the, you know, academic rigor or standards that students have to go through are very archaic, perhaps, and need to be broadened and perhaps revisit, we’ll get into that. But one of the things that I find, especially when we take on your students is that, you know, I come from the field of health, I love health, I love learning more about how to promote healthy behaviors and people, especially physical activity, and nutrition and stress management. Those are so in my wheelhouse. I love talking about how to communicate with people, health literacy, health competencies, you know, those are very important. But when we look at health behaviors, I think, from what I understand the research is like, in terms of impact on health outcomes, is, you know, relatively around 20, 25% will impact how long we live and resiliency to chronic disease and, you know, access to health care, quality healthcare, which is very important. It’s like around 20%. Social determinants are like around 40, 50% And we’re talking then, what are the social determinants? So it’s a, you know, educational level. Did you graduate high school or not graduate high school, it’s employment, it’s like socioeconomic status and income, it’s access to housing, it’s access to transportation. It’s these things that are the most impactful when I was going through the academic rigor in the system. I wasn’t trained on that area. I was trained on areas I just really truly love but tell your students coming here. This experience here is going to give you an opportunity to see how do we get people graduated how do we find people a job how do we get people house? Oh, yeah, how do we address their transportation needs and as I think it really provides that rich world rounded experience. And that would not happen if it wasn’t for you. But But I did find that that was missing. In my experience in academic…

Laura Guyer  25:10

We didn’t know this information, you know, I mean, information advances, doesn’t it? And so that’s, again, why I say we are in the 21st century. So we need to be preparing our health professionals and public health professionals, we’re passing the baton, well, the baton has some limitations. Maybe the baton has some holes in it. Because we were trained at a different time. You know, when I went to school, we weren’t talking about health disparities. We didn’t have the first published report until 1985. We weren’t talking about cultural competence. We weren’t talking about health literacy, social determinants of health. We know again, like you, like you just mentioned that those non-medical factors… 

Tony Delisle  25:54

80% of outcomes outside of the clinic.

Laura Guyer  25:56

Exactly, exactly. So, you know, how can all how can we capitalize on what we’re doing now, without losing what we, you know, have from the past to build a better doctor, build a better nurse, build a better dentist build a better, you know, public health professional? You know, part of the key I think, with health is, you know, certainly we want to prevent disease, we want to, like you said, lifestyle and our health behaviors, what can we do to to promote health more effectively, so that people don’t become sick, and develop chronic disease that needs to be managed. And that’s where the healthcare system exists, it exists to, to treat illness, to a small extent to promote health, but, but again, you know, looking at reimbursement, that’s, you know, we don’t pay our, unfortunately, in, in the US, the way that we spend our healthcare dollars, it’s not on the social services, like so many other pathways.

Tony Delisle  26:57

Yeah, after it’s already happened. So so let me go in on something that I think is really important here, too, is that so when students go through, and they get these more well rounded experiences, they can become that build a better doctor or build a better, you know, kind of dentist and clinician and those kinds of things. That’s great. When I was there at the university, I experienced this a lot where students would come in, you know, really mind and heart set on becoming a doctor, becoming a nurse. And then realizing through that academic way, often this archaic the rote memory and repeating back and a lot of the kind of standards for which people are put through medical schools and those other kinds of things. A lot of students didn’t fit into that model, but had great interpersonal skills, really good about like wanting to collaborate, wanting to do things that are really important in terms of being a community organizer, super inspired to promote health, but really had a hard time, like shifting gears. I think there’s some identity, perhaps loss of identity that they were going through it that same time, you know, telling all your parents and everybody you’re going to school, and you’re going to do this and then coming to realize, well, is that really me?

Laura Guyer  28:07

That’s not the best fit after all.

Tony Delisle  28:09

like speaking to people that perhaps are going through an experience where they’re realizing perhaps I wanted to go this way, but I’m actually going to go that way. And because I do see that it potentially could promote health more than even being in a clinic, but are struggling in that area to make those decisions. What would you say to people like that and making the right decision for who they are.

Laura Guyer  28:30

I don’t know this about me. But I’m living my plan B, I was a pre-med student, when I started, okay, at the University of Florida. And I, because I loved science. I didn’t know the full, I didn’t know the scope of all that I could do with my love of science. And so as I progressed, you know, in my undergraduate studies, again, continued to love science, but didn’t really love the sciences that I knew would be the foundation for a career in medicine. And I, you know, some of my priorities changed in terms of the amount of time I wanted to spend in school and the things that I wanted to do. So I found dietetics, which is, you know, another health profession, there are so many health professions that you can be part of, you can work with people to improve their health. 

Tony Delisle  29:21

But there’s a niche for everybody. 

Laura Guyer  29:23

There is, in a similar way. Public Health, though, is about prevention. It’s about the community involvement they were mentioning and so again, I’ve…

Tony Delisle  29:32

And there’s careers in this area. 

Laura Guyer  29:33

Oh my gosh, I got again for myself, every 10 years, my phone rang. So I’ve gone from that health career health profession into really public health and, and education. So there’s kind of been an addition to, you know, my starting point, it’s, I’m still working in, in science and in healthcare and in education, but with a different expression of my responsibilities. I mean, look how many people graduate. And they they really work in jobs they don’t like. It might be related to what they study, right? Yeah, I mean, there is a statistic. But the majority, it’s more than 50% of people do work in jobs they don’t like. And the majority of people end up working in fields that weren’t part of their studies when they went to college, I, that’s fine. You know, be be willing to take a chance, to take a risk, be willing to get to know yourself better, so that you really know who you are in terms of your strengths and your weaknesses and your likes and your dislikes. So you can find a career that’s your best starting point. And I say starting point only because life is ahead of us, we don’t know what’s coming. I could have never predicted I would be sitting here with you right now, after being a professor at the University of Florida two different times and working in public health, I could have never predicted that. Because from my starting point, I, none of this honestly existed at that time. Again, health disparities didn’t even exist. So we don’t know what’s ahead in our future. But if we find a good starting point, and be willing to take chances, when opportunity knocks, at least open the door and see what’s on the other side. I think that’s the most exciting way to live your life.

Tony Delisle  31:22

It’s always a starting point. I like that. I like that it likes always ahead of us. And so it’s always a starting point. 

Laura Guyer  31:27

Yeah, it’s not a right or wrong promise that you’re not going to make a mistake, you just need a starting point.

Tony Delisle  31:32

takes a little bit of courage to get through that fear barrier, I think, to get beyond that starting point, make progress. So I’m wanting to talk about an experience that we had. And I thought was very educational, my part and I and I’d like to get your take on it. But you’re we talked about a little bit earlier, but you got a really sincere interest and access, and one of the, to health care. And one of those areas of access is ensuring effective communication between healthcare providers and the patients that are receiving their health care. And this is an issue in terms of meeting the needs of people in our community who are deaf and hard of hearing, and often need effective communication that isn’t provided to them on some occasions. And really advocating for that is an important thing. And and tell us a little bit about your experience in that area and sharing, you know, equal access effective communication, you know, for this community.

Laura Guyer  32:34

So this is a community that I have started to learn about. And the more that I have learned, and the more that I continue to learn, the more it seems like this is an area of need, certainly locally in our community. But I know that our community isn’t the only one that has a need to be able to increase access to care, and increase access to effective health care by making communication possible for those who are deaf and hard of hearing. I had a group of students approach me a couple of years ago, and they were aware of a need. Because they knew some folks who had gone into the emergency department at one of our local hospitals. And that person couldn’t, there was no one available to provide, you know, medical interpretation for them. So they couldn’t communicate. And the students were really outraged about, you know, well why, how could this happen? You know, here in Alachua County where we’ve got these two, you know, very large hospitals. Well, the more that we started to investigate, the more we began to realize that this is true, not only maybe in an emergency setting, but also when people go to visit, you know, a physician or when they might be in the hospital, they often have the same barriers to care. Well, gosh, what a unique opportunity, I think for perhaps the University of Florida, because I know in speaking with you about the difficulty that you have in finding qualified interpreters. You serve 16 counties, correct. And you have six or eight qualified interpreters.

Tony Delisle  34:19

We have more on staff, we have five full time, and then we do a good handful of people that do freelance interpreting.

Laura Guyer  34:27

Well we’re talking about 16 counties. 

Tony Delisle  34:30

Sure, yeah, finding certified interpreters absolutely huge need for us. I mean, we’re definitely if they’re in the area, you’re certified interpreter, check the show notes.

Laura Guyer  34:40

And I told the students that honestly because they’re very interested in this, you know, it’s like, really, they’re interested in learning sign language just said listen, we could put those skills to very good use.

Tony Delisle  34:49

The people that we have that do sign language interpreting first both in staff and the freelance. It’s amazing, their abilities, their fluencies their heart being in the right place and to attract more people to our community that have this talent, you have this heart is a good thing. And like you and I were talking about earlier, it’s like why not? Why don’t we have a school here that certifies people?

Laura Guyer  35:12

And I think we’ve got two incredible institutions here, we’ve got Santa Fe College, what the number one college in the nation, right, we’ve got the University of Florida and they’ve got, you know, College of Public Health and Health Professions. It seems to me that a certificate program would be ideally placed in one of these two institutions and just think of the needs in our community, the needs in your 16 county service area, and you know, it just, it’s a ripple effect, it goes out from there.

Tony Delisle  35:44

Now we noticed and the other schools that will get people to the level of getting the credentials needed to be a certified and qualified as well is, allows for the community then to have more interpreters that live in it, a lot of them will stay in the community where the schools are, Deaf communities may then you know, feel safer and better living in those communities too. So becomes a community that’s more welcome, right for, like you said, a population that’s not getting, you know, the equal access to the equal health care and obviously, based on their needs, not getting what they can. And it just seems like a win win win win win. So yeah, again, again, we can keep advocating, we’ll keep putting the word out. But I like to see that being because like we said, health care field here, the public health field here. And in Alachua. County, it’s got to be one of the biggest industries in town.

Laura Guyer  36:35

And you and I were also talking earlier about the fact that Alachua County and the city of Gainesville, we’re going through a planning period right now. So we are preparing to develop our 2030 comprehensive plan for the city of Gainesville. Well, what is a comprehensive plan? Well, it’s looking at how we will allocate resources over the next decade. You know, this is, again, what you know, when we work in silos. And sometimes health care and public health are two silos that work independently from one another. Education is another silo that works independently. And here, look, you and I were just talking about all three of those silos. If we stay in silos, we will never see an improvement in access to communication for people with disabilities. We’ve got to work across the silos. But now let’s think about the comprehensive plan. We need to make sure that our city planners are aware of the fact that there’s a need in our community for residents who are deaf and hard of hearing, they don’t have access to many of the services in the community including healthcare and others, because, again, we’re not aware of their needs, how do we help them connect? You know, how do we help them communicate? This is something that is a community issue, and we all need to be aware. So, you know, for those of us, you know, I know, I feel a personal responsibility to get involved with, you know, the city and with, with, you know, what’s taking place with planning, and, you know, with the health department, when we have our Community Health Needs Assessment, you know, are we, are we making sure that we’re learning about the needs of all of our individual communities, so that as a larger community, when we start to look at the data, we can say, oh, okay, well, we need to allocate some resources to this group into this group in this group, because look at the unmet needs that they have.

Tony Delisle  38:30

And if we’re not communicating those needs, like you’re saying, then it’s not going to be identified in the plan, if it’s not identified in the plan that is identified in the resources that will be allocated to meet the needs that are in the plan.

Laura Guyer  38:40

And then people go with unmet needs. And see the reason we have health disparities is because we have a social problem. The social problem is the fact that we don’t value all groups equally. Social inequity, social marginalization, right. And so those groups that are marginalized, kind of like if you were having a banquet, you know, when you looked around the table to make sure that everybody was there, you know, you would, there would be people in your mind that you would be looking for, right, because you invited them to come to this banquet and sit around the table. So when we, I guess, in our community, when we have a banquet, are we looking for the members of the individual communities? You know, people who have disabilities, members of the LGBTQ community? Are we looking for people who don’t speak English as a first language? Are we looking for, again, we could just kind of almost go down a checklist of making sure that everybody’s around the table so that we can get input from all. That’s how we achieve health equity, again, you know, getting input from all.

Tony Delisle  40:12

So when you say we, so obviously you and I are in a privileged position to be able to invite to the table. And, and so I think you’ve bring a good awareness to people that may not have it, where some blind spots might be, you know, in getting inviting people to the table. What recommendations do you have for the people that we’re inviting to the table to also find their way to the table when they don’t have that invitation extended to them? So we’re probably still have some blind spots of people we need to invite and where we need to do better and learn. And so I also know that, you know, again, the people that I end up do inviting that I’m aware of, you know, there could be some biases, and just like, you know, just knowing them. And so I know that I know, I don’t know, a lot of people. So the people that, you know, perhaps don’t have that extended invitation, how did they get to the table?

Laura Guyer  41:02

That is such a good question. If I could give you the answer, we could solve a lot of social ills. You know, because the same group, the same groups that are marginalized, they aren’t valued the same in healthcare, that disadvantage expresses this health disparities. In the legal system, it expresses as greater rates of incarceration, you know, in the education system, it expresses as more likely to drop out of high school, talking about the social determinants of health we’re talking about, than individuals who will be economically marginalized, you know, they won’t have the same education to get those same good jobs. I think a big piece, you know, lies in keeping the conversation going, this conversation going. I know, last summer, you know, we started to talk about Black Lives mattering. And they must matter. Well, did they matter only for last summer? Well, we’ve seen some, some changes, some social change that has been deliberate to overcome some of the biases, okay, that we have about, you know, what we expect from different communities, from people who are different than ourselves. The only group that we can really know is the group that we are part of, but we can want to know more, we can create a safe place, at least as we understand it, and then ask, invite people to, to come into that space and, you know, help us understand, you know, what needs to change to make it perhaps even more conducive for conversation? I think we have some hard conversations that we just need to have more of.

Tony Delisle  42:56

Yeah, and I think the conversations are an important part of this, and having them in tandem with doing the work, right. doing the work, I think is a like a key part of this. For me and my experiences, I found that I’ve been able to enter into those communications and conversations on a very deep level, when working alongside the community. Yeah. And so what advice do you have then, in terms of networking out with communities, or with other agencies to break down those silos? What do you like to see as being good to overcome a lot of the different barriers and connecting with community working alongside them? Yes, and not be expert driven. And you’re working with other agencies, especially if you have competing resources or whatever they are barriers are there. What are some things that you found a value that can really help facilitate some of those connections have a community or agency collaborative level?

Laura Guyer  43:57

Right. I can tell you that I can give you a good example of an organization that I think does this really well, and that’s Gainesville For All. Because Gainesville for all has is broken into different committees that really represent some of the different power silos of power in the community. So we’ve got, you know, education, we’ve got health care and transportation, we’ve got, you know, law enforcement, we’ve got housing. So you know, we think about all those as you know, individuals siloed, you know, groups but Gainesville For All, all of those committees are working together on the same problem. And the problem that they’re addressing is the the inequity, the social, economic racial inequity, between East and West Gainesville. So how can we I think, in the groups that we are part of, how can we look for ways to be more inclusive to bring in people different than ourselves or people with interests that will help complement or solve some of the issues that we’re dealing with? So, you know, earlier I said, you know, here, look, we’re talking about health care, public health and education, you know, needing to work together on the issue of how do we find ways to have more certified, you know, translators and medical interpreters. So again, who’s going to be part of the solution for the problem that you’re dealing with? Often you don’t have the expertise just within your own silo, you need to go find a couple more silos to partner with. And and the tough thing is knowing well, who are they who are those, those people that I need? But it’s, you know, it’s with the relationships that you build and talking to other people asking, you know, well, who would you invite? Who do you think could help us, you know, solve this problem. Sometimes you need to bring law into a problem that, you know, has to do with health care, and maybe education. So, you know, think about those partnerships that will, that are needed to find a solution.

Tony Delisle  45:58

And in finding those partnerships, and cultivating those relationships, and doing the work and communicating along the same time, and having these conversations that you know, maybe hard to lean into, I think is so integral and so that’s again, why I really enjoy having conversations with you, that you’re very applied. And again, have the conceptual framework to be able to, you know, be able to talk about, discuss, unpack, think about, test, revisit the tool to be able to do that, integrate it together, and I really appreciate that about you Dr. Guyer.

Laura Guyer  46:31

Well, I appreciate about you, Dr. Delisle, the fact that this is what I see you doing, you know, how do you keep people living at home empowered and independent? Again, you don’t do that by staying in your own silo. And not only do you have a lot of county and all of its silos to deal with, but you have Alachua County as a silo. And then you have Marion County as a silo, all of the counties that are in your 16 county service area are very different. So there is… 

Tony Delisle  46:59

It’s a big responsibility. 

Laura Guyer  47:00

It is a big responsibility. But again, I know that part of your philosophy is is to again, collaborate, and cooperate, and you know, build, you know, those relationships. It’s the only way that we really can can get the work done.

Tony Delisle  47:16

Yeah, unity through disability. Yeah. And so one of the things that I think, is really interesting, I’d like to get your take on and it impacts all the different marginalized groups that you’re you had mentioned there. But as stigma, and stigma being an inhibitor to, you know, even accessing health care, or even wanting to get to the table, not feeling psychologically safe, right now, to even be at the table, we got to recognize it, you know, like, for right now, in our time, right now, there’s, there’s many, you know, Asian American, I’m saying a broad umbrella term that. So, right now, don’t feel safe to go outside, to don’t feel safe, you know, to be able to even then communicate or get to a table to address a need and do all these kinds of things. It’s important for us to recognize, you know, that’s almost beyond stigma that says, like more, you know, your personal safeties, and be insensitive to that. And then the broader stigma that these groups go through. It’s very tough and can be problematic to access and those kinds of things. What do you have to say in terms of how we can overcome a lot of the stigmas that the marginalized groups tend to have upon them so that we can help to promote health outcomes?

Laura Guyer  48:35

Yeah. You know, one of the first examples that comes to mind is mental health, the stigma, you know, associated with a diagnosis of a mental health disorder, I know that I have seen a real change over the last 10 years, when I think about the students and their interest in talking about mental health. I have seen the development or the emergence of probably five new student led organizations related to mental health and promoting mental health awareness. And I think for some of the issues that are associated with stigma, again, continuing the conversation, I think we need to look at our media, as places where we want to look at how people are portrayed. We want to look at the comedy, you know, who are we making fun of and, you know, what does that really say in terms of continuing stigma or discrimination or some of the other, you know, negative outcomes. And again, just continuing to normalize mental health as one more dimension of health. I, you know, tell people that, especially if you want to go into health care, the first patient you’re going to care for is you. So if you can’t take care of your first patient, how do you ever expect to care for somebody else? And I use myself as an example and and I will tell students who want to go into health care, listen, for myself for to maintain my health, I take care of my physical health, I see my primary care physician at least once a year, I see my dentist because from the chin down belongs to my primary care physician and then I go to my mouth somehow that’s not connected to the body, it’s got a different person, but I see my dentist, okay, at least twice a year to maintain my oral health. And who takes care of what’s between, you know, from my mind, that’s my, that’s my brain, my emotional well being. I’ve got a therapist that I see at least once a year, because I don’t want to wait until a problem becomes big and immobilizing. I want to have a mental health checkup just like I do my oral health checkup and my physical health checkup. And let’s not forget the spiritual dimension of health and well being. And so let’s make sure that we’re paying attention whether we’re part of a faith tradition, or part of spiritual practices, including mindfulness, that we’re taking time to connect with some thing or someone bigger than ourselves. That’s how we can be healthy. And that’s what we need to be modeling. And if we can’t take care of ourselves, we sure can’t help anybody else.

Tony Delisle  51:24

That’s beautiful. And I think this is a good place to kind of round the corner on in terms of like taking care of ourselves so that we can be the best version of ourselves to be able to serve others, I think is a tall calling. And I think along the way, I love what you said, taking care of that first patient, you know, and I’ve heard it also in leadership. If you want to be a good leader, lead yourself, you know, when no one’s looking and the choices you make or don’t make or do, don’t do, even when no one’s looking in, especially when no one’s looking will matter when you are leading. And there’s no compartmentalizing or siloing that absolute. It’s just the nature of who we are. And so it’s kind of like walking the talk and being about it as well. So if we’re going to talk about it, we’ve got to be about it.

Laura Guyer  52:10

Absolutely. Yeah. If you can’t look at that person in the mirror, who’s looking back? Yeah, because that person will always find you out.

Tony Delisle  52:19

Right? Yeah, if you’re not living in, if I’m not living in alignment of my values, I feel it. It’s just the things are off. And that’s a good sign. Yeah, to be aware of, like you said, with mindfulness, right. And to go back in there. I love how you really tied in the multiple dimensions of health, mental, emotional, spiritual, those are very important.

Laura Guyer  52:36

I think those are kind of four biggest categories. And you can look at different holistic models and find other dimensions as well. Like, you know, your your career and sure, and others, but it just kind of, kind of captures it.

Tony Delisle  52:49

I love what you said about spiritual, I’ll kind of end it here. But I think it’s always important to ask our question. Yeah, so like you said, it doesn’t have to be religiosity. But you know, who are we? Yeah, why are we here?

Laura Guyer  52:59

Why am I here? What am I here to do? And invariably, I think answering those questions will take you out of yourself, to look at those around you. And that’s what this conversation has been about.

Tony Delisle  53:12

I feel like my whole life’s about getting over myself and learning what I’ve already learned. And, you know, finding that path towards remembering what I forgot. And I think, you know, you helped me to remember what I forgot. What I need. to unlearn. So I look forward to having more conversations with you. We still have, we’re just scratching the surface and so many things here. Yeah, certainly a good introductory conversation to to bring you to our podcast world.

Laura Guyer  53:12

I appreciate the invitation. I always appreciate the time. 

Tony Delisle  53:12

Yeah, no, this is the type of stuff we talk about when the mics are off and everything. And so I really appreciate about you and so many others that we share orbits with and do this really great work. And it’s very, it’s very fulfilling and humbling and all these wonderful things and to do it and union in partnership with someone like you, it just makes it all the better. And I want to thank you for all the all this beautiful seeds that you’ve planted, you know, within the students and within the community with those, it’s you’ve touched and continue planting very good seeds. Here’s the, here’s the best. I know that they those students that we have planted seeds in you, you and me, they will come back and someday take our jobs. And won’t that be honestly the best day of all to see them? You know, that’s the full passing of the baton for them to come back now and step into our spots and go the next the next steps. We’re preparing them better world for them so that they can prepare a better world for us. 

Laura Guyer  54:44

Absolutely. 

Tony Delisle  54:46

And we’ll do our last one song here. But Dr. Guier Thank you. Thank you for being on here. Yeah, well, we like to sign off onward and upward.

Laura Guyer  54:56

I love that. Absolutely.

Amy Feutz  55:01

Thanks for listening to the independent life podcast brought to you by the Center for Independent Living of North Central Florida. If you like what you hear, please rate review and subscribe. And if you know anyone who might benefit from listening, share this podcast and invite them to subscribe to for questions, suggestions, or if you have a story you’d like to share, please email us at cilncf.org@gmail.com or call us at 352-378-7474. Thanks for joining us. Until next time, support, advocate and empower each other to live the independent life.