Achieving Civil Rights through Public Health - A Conversation with Richard L. Lichtenstein

Richard L. Lichtenstein, one of the founding board members of the Detroit Community-Academic Urban Research Center in 1995, recently retired as S.J. Axelrod Collegiate Professor of Health Management and Policy at the University of Michigan (U-M) School of Public Health (SPH). He started his career at U-M SPH in 1970, working as a research assistant while finishing his master’s degree in Public Health. He also received his doctorate degree from the Department of Medical Care Organization at the U-M SPH in 1981, after which he embarked on a decades-long academic career at the school. Dr. Lichtenstein accomplished a lot during his time with the university, including establishing and overseeing the Summer Enrichment Program, an eight-week summer internship program for undergraduate students committed to eliminating racial, ethnic and socioeconomic health disparities; earning multiple awards for leadership in teaching; and co-directing the Detroit URC with Barbara Israel for more than two decades. In this conversation, Dr. Lichtenstein gives us an inside look at his career and his focus on achieving civil rights through public health.

What inspired you to get into public health?

I was in college in the 60s, and there was just a lot of turmoil. I wanted to do something that had an impact on society. I was studying labor relations at Cornell at the time and, honestly, I had never really thought about public health until a professor from Michigan came to Cornell to recruit people to come into what was then called Medical Care Organization. I also had a class on collective bargaining, which included several sections on health benefits and pension benefits. We talked about Medicare, Medicaid all these health related things. I got really charged up about this area of work and how it could help change society.

Civil rights through human health?

Yes. I decided early on to be faithful to those values.

How did you first become involved in Community-Based Participatory Research in Detroit?

I had been doing a variety of things in Detroit in the late 80s early 90s. Then you fast-forward to ‘91 or ’92, and the School of Public Health got a grant from the Kellogg Foundation to do a project involving community-engaged research. It was not called community-based participatory research then. The requirement was that you had to have a School of Public Health, a public health department, and several community based organizations. Barbara Israel and others at the School received the grant, then I joined the project, and we did work in both Detroit and Flint. It was all about Community Based Public Health and how to work in partnership. It was good practice for what we now call community-based participatory research.

What was the Detroit URC’s first project, and how did it go?

Our initial project was about training people to become what we called Village Health Workers, and the focus was mostly on maternal and child health and women’s health. So for instance, a community member could go to a village health worker and say: “I’m pregnant; what do I do?” This person would help put the person in touch with necessary resources. So we were doing community health programs at the level of the neighborhood block. We did this on the east side of Detroit. It was great. We also were still developing our partnership. We set up principles, and we worked together to plan out priority interests.

What were those priorities?

We decided on three priorities. One of them was environmental health and effects on children; that was where Community Action Against Asthma (CAAA) came from. The other priority was related to heart disease and cardiovascular health, and that was where the Healthy Environments Partnership (HEP) came into being. The last one was intimate partner violence, which was something Ricardo Guzman wanted to do through his role with Community Health and Social Services (CHASS). This led to the La Vida project. So we started doing all these things.

What was it like being on the academic side of things?

You know, historically, one of the biggest complaints about academia had been that, even if faculty had good intentions, they always stopped their work as soon as a grant ended. But the community didn’t stop. The organizations didn’t stop. There were people in the community saying: We still need this to go on; where are you people? Right from the beginning, one of the blood oaths the faculty took was that we were going to stay there even when the funding ran out, and that has happened.

How did you and Barbara come to be co-Directors of the Detroit URC?

I do not remember. Barbara was obviously going to the director, since she wrote the Urban Research Center proposal. It was her idea. However, I do not think she wanted to be called the director. She wanted to be the facilitator. In any case, Barbara was going to go on sabbatical every once in a while and would be out the country, and she needed somebody who she could trust to run the URC while she was gone. So that was me.

What would you say are the key qualities needed to be an academic partner of the Detroit URC?

Well, I think the first thing is really being committed, and second, it is being able to yield power. You cannot tell people what the project’s going to look like, what you are going to do, and what questions you are going to ask, because that totally violates the whole concept of community participation. So I think commitment, and I think the whole idea of “cultural humility” – which is kind of replacing “cultural competency.” I can’t be competent in somebody else’s culture. I can’t be competent in five different ethnicities’ cultures. So the idea is just to be humble and to ask people what they think we should do and not assert power over them. That is what really makes the difference, being a regular person and not acting like a big shot, because they will pick that up on that in a second. Another necessary attribute, I think, is being a good researcher, and being able to learn new things. When we started doing this Community Action Against Asthma project, there were faculty who didn’t know anything about asthma involved. Now they could probably talk knowledgably with a pulmonologist all about the issue.

That is impressive for faculty to be open to a whole new area, yes?

Well that is the CBPR view. The other view about faculty expertise is to become an expert in one narrow little area and just stay with that because that is how you are promoted in academia, which is kind of the opposite. Unfortunately, there are lots of disincentives for faculty researchers to be involved in CBPR, the biggest one being, like it or not, when you go up for tenure somebody’s going to count how many papers you’ve published. They are not going to say, “Whoa, this is like the greatest paper ever written.” They are going to say, “You need to have “X” number of papers,” and that number keeps going up. The best way to do that is to take data from your dissertation, or somebody else’s data that they have already started analyzing, and just pick out little pieces of it and write papers about it. You could write 10 papers and then, if 10 is the number of papers needed, you could be promoted. However, if you start doing CBPR, it might take two years before the data even become available, and by the time you have enough papers, it might be too late.

How did you manage to keep up with papers and CBPR?

Well I was old enough so that I had a bunch of papers already. I was promoted to associate professor in ’86 before the URC started or any of it started. I had the luxury of being able to do what I wanted to do, so I focused on the Summer Enrichment Program and the Detroit URC.

What are you most proud of with the Detroit URC?

I think the fact that we have such powerful alliances, that we have such a strong partnership. I think the fact that we are still going is amazing. When we first started out, if you wrote a paper that involved CBPR, there were no people to review it. A journal would just assign some bench scientist to review it and they would reject the paper because they did not know what it was. Then, over time, the Center for Disease Control started talking about CBPR. The Robert Wood Johnson Foundation work was very important. The American Public Health Association said that CBPR had to be a part of graduate education for an MPH. It was a big deal. We went from being totally unknown, with only a few people talking about CBPR, to CBPR being something that virtually everybody (in the public health arena) now knows about. We have trained a bunch of faculty, most of them people of color, to go off and do community health work and CBPR. Now there are all kinds of CBPR scholars all around the country.

What do you think it is going to take to take the URC into the next 20 years?

One of the things we need is a source of funding. I think it is going to have to be a private source, maybe some agency or foundation that could just say, “Here is a million dollars, and you do what is right.” On the other hand, an individual person could do it. I also think a big issue long term is succession planning. There are people that we are starting to communicate with and trying to get on the board. The whole CAR Network and these things are part of our outreach to a generation of people who are going to do this work into the future.

Is there anything else you would like to share?

The Detroit URC is a terrific thing, and I love being involved. However, my number one has really been running the Summer Enrichment Program for underrepresented students of color. That was my thing. The idea was to try to get people of color into the Health Management ranks and policy ranks. I actually had 620 students over 30 years, and many of them are now major administrators and PhDs in Public Health. SEP was sort of more personally mine, and I think that was great.

How would you summarize the common denominator between SEP and Detroit URC in terms of your career?

It is all about trying to eliminate inequalities around health. With the Detroit URC, we are working with people to develop programs to attack health issues and deal with the social determinants of health. With SEP, we are helping to develop new leaders who are going to do something about these issues, and they’re learning from the people who have done it before.

The Detroit URC Board Member Joneigh Khaldun, the Executive Director of the Detroit Public Health Department, was in SEP, correct?

Yeah, there are several such cases. There is also a physician at Henry Ford who was went through the program, and several health executives in Detroit. I run into people from SEP all the time. It is incredible to see the impact and reach the program has had.

Any particularly memorable moments you would like to share?

The best moment for me had to be the celebration for my retirement in 2016 and then the next day we had a symposium for SEP for the 30th anniversary. We did it at the Marriott in Detroit, and we had 300 or so people. I ran into some people this year who said that was the best retirement party they had ever been to. We also made money to go to the SEP program. It was spectacular.

What are your goals for retirement?

Well, I had a part in hiring my own successor to head of the Summer Enrichment Program, and he is an SEP alum. I am not going to get in his way, but I am just going to be around if they need advice. I am also on a bunch of boards, and I’ll keep serving on those. For example, I’m the Chairman of the Board of URC partner NSO in Detroit.

Outside of public-health related activities, I want to travel, read books, and listen to music. I have about 400 vinyl records I have not listened to in 25, 30 years. So that is something I would like to do. I am a jazz guy, but only music produced before about 1971. After that, I was working – and in the 1980s having kids -- and I never got a chance to listen.

Any other final words?

No, I just hope it all continues. I think it is important that the University of Michigan stays connected to Detroit in a meaningful way, not just with lip service. I think this year there has been some good movement on that. I think it is a great thing for faculty members to get involved with the Detroit URC. I have learned so much through my work with the URC. It helped my classes. It helped my research. It is just a great thing. Moreover, you have the added benefit of feeling as if you have done something instead of just writing a paper. I mean you could write papers that are very significant and that really change things, like Medicare funding or something, but that is rare. However, if you actually improve the health status of people, or help people to get jobs, that really makes a difference.