The Healthy Choice is Not Always the Default: Here’s Why - with Dr. Lori Spruance

Ignoring the root causes of social disparities won’t solve the problem. Tune in as we analyze how these disparities affect public health. Dr. Lori Spruance joins Cougar to discuss inaccessibility to nutrition, the benefits of free school lunch, and the importance of discussing difficult topics in the classroom.


Guest Bio
BYU Professor Dr. Lori Spruance combines her passion for nutrition and education. She earned a bachelor’s of science in health and physical education from Utah State University. Knowing she wanted to do more to enact community change, Dr. Spruance completed a Master’s of Education with an emphasis in public health education and promotion from the University of Nevada Las Vegas. Later, she earned a P.h.D. in global community health and behavioral science at Tulane University. She completed her dissertation on school-based salad bars and continues her research in adolescent nutrition.

Additional Resources:

https://ph.byu.edu/the-impact-of-covid-19-on-school-meals
https://scholar.google.com/citations?user=wBHmJEkAAAAJ&hl=en

Recorded, Edited & Produced by Christy Gonzalez, Harper Xinyu Zhang, and Tanya Gale

Transcript

Cougar Hall: [00:00:09] Welcome to Y Health, a podcast brought to you by the BYU Public Health Department. I'm Dr. Cougar Hall, a professor here at Brigham Young University. Whether you are a student, parent or BYU fan, this podcast will help you navigate the world of public health. Our podcast strives to help individuals receive accurate information regarding public health. So whether it's global or local, we will discuss how it pertains to you. Just kick back and relax as we talk about why health. It's my pleasure to welcome my colleague and friend Dr. Lori Spruance onto the Why Health podcast. How are you doing, Lori?

 Lori Spruance: [00:00:46] I'm great. Thanks for having me today.

 Cougar Hall: [00:00:49] Well, thanks for joining us. I probably oh yay. Lunch or something here for taking your time this morning. I really appreciate it. Yeah. Will you for our listeners, introduce yourself, including your educational background and what you do here at BYU?

 Lori Spruance: [00:01:01] Absolutely. So I grew up in Boise, Idaho, originally and went to Utah State for my undergrad, considered coming to BYU. But at the time my sister, who I was close with, was at Utah State and I just was drawn to be an Aggie. My first year on campus, I had 11 cousins that were on campus with me, so it was really fun to like be there with family members I knew. And originally I wanted to go in as a into teaching as a physical education teacher. I feel like oftentimes those high school students were drawn to major in the things that we know or talented at. And I was a talented athlete and thought that that's where I wanted to spend my time. And during my time at Utah State, I was required in one of my physical education classes to write a paper about some sort of emerging topic I don't even remember, but I selected to study childhood obesity for this two or three page paper, and I remember being very surprised at all of the chronic diseases associated with physical inactivity and nutrition. And of course, it probably doesn't sound that earth shattering now, but as an 18 year old, a 19 year old, it was really surprising to me that I was thinking about all of these preventable diseases, that if we could get people to eat healthier or be more physically active, could have a much better quality of life. So that really set me on the trajectory of public health. They didn't know it at the time that this was public health, but I spent time, you know, studying and preparing to be junior high or a high school teacher or maybe even an elementary teacher for physical education.

 Lori Spruance: [00:02:37] At the time at Utah State, we were required to as teaching majors to have either a minor or a second major, so as a physical education major and then had to declare some other minor or major. And I spent a lot of time thinking about, oh, would I add history to that? Would I add English? Would I add what would I do? And I ended up deciding to land on school health, which seems like the obvious choice. But I just, you know, really then got drawn to the whole concept of health other than just physical education. And so that's what really led me to my master's degree was I wanted to focus on community skills and I didn't feel like I had any community skills to address health issues. So I did my master's at UNLV in Las Vegas in a program called A Master of Education in Health Promotion. It's not a degree that really exists anymore. Most of those programs have been more or less absorbed by PH programs, master of public health programs. But that's where I kind of found my people. I took a lot of the same classes as Master of Public Health students, and I was like, This is what fascinates me. I did my PhD at Tulane University at the School of Public Health and Tropical Medicine in New Orleans, and spent four years there, kind of brought me full circle. My dissertation was on school based salad bars, so I thought, This is really cool. I can combine research with my original interest of school health and wrap it all into one. Yeah, career.

 Cougar Hall: [00:04:08] Very cool.

 Lori Spruance: [00:04:09] So it took me a long time to kind of put all that together, but I love that I had this passion when I was 18, 19 about schools and kids. And now I still am exploring that passion through my research and trying to come up with evidence based practices on how to improve health for kids. K through 12.

 Cougar Hall: [00:04:27] So refreshing. I think my background is also school health education and sometimes we feel like there's this artificial divide between public health and school health. I don't know why. I think I see schools as another setting and students as another population, and we're promoting health. And the cool thing about about using students in schools, they're young, they're still impressionable. You have you have broad exposure because most students are in schools and it just it just makes sense to me. So you are my people. We have we have met up. There's there's all sorts of reasons why why you and I are here together talking this morning and that that is just that connects us. Sure. Absolutely. Yeah. I love your passion. Across the board, you are one of our best instructors. You're one of our most prolific researchers. And congratulations, by the way, maybe our audience doesn't know this, but you you recently obtained the BYU version of tenure, which we call KFS or continuing faculty status, and that is quite a hurdle. And so congratulations to you, Lori. Thank you so much. I am so thankful that you are in the hallway here and that we're colleagues. Tell me about. Some of the research that really is of interest to you right now. What are you doing right now with your research time and your research efforts?

 Lori Spruance: [00:05:49] Yeah. So one thing that's been really popular in the last couple of years because of COVID is exploring this idea of we call either universal school meals or healthy school meals for all. And the concept behind that is that for the last two years, the federal government has waived the requirements to qualify for free, free meals through the schools because of pandemic issues. They were like, you know, let's just make school meals free for everyone, regardless of their income status. And so that's something that I've been exploring recently, too, is with the idea that these waivers are going away. In fact, they're going away in September, that the next academic year school meals will no longer be free for kids. And so that's been something that I've been exploring, is what are the benefits of those? Are lawmakers on board with considering continuing to make them free for kids? How many kids have begun participating in school meals because they've been free for every child? And I know there's a lot of sometimes concerns about just providing stuff free for everyone, you know, well, where's the self reliance or, you know. Is that the best way of reaching everyone, that sort of thing. But it's been really fascinating to me to think about, well, kids, we should care a lot about kids.

 Lori Spruance: [00:07:13] And, you know, of all things to provide for, I think feeding kids is probably not the worst thing we could consider doing, but just also kind of exploring some of those perspectives. But one of the things that really is near and dear to me is the idea of reducing stigma for kids. You don't want to be the poor kid who is getting your meals for free at school or, you know, all your other peers to know that you come from a background that's not as privileged as someone else. So that's one thing I really like about the concept of universal meals or free meals is that it eliminates a lot of stigma for kids who need to participate in these meals and may face stigma relative to it. Another cool thing about school meals that I spend a lot of time thinking and researching and advocating for, so to speak, is the healthfulness of school meals. And I have a lot of conversations with parents, with other folks who are invested in child nutrition, so to speak, is that there's oftentimes a big stigma around school meals. You know, and I'm not saying that there's no room to improve school meals. I absolutely think that there's there's place to do that.

 Lori Spruance: [00:08:23] But sometimes we get caught up between the difference between appeal and nutrition. And sometimes nutritious foods are appealing and sometimes appealing. Foods are not nutritious. And the school's mission really is to provide nutritious meals. And the research, by and large, says kids who eat meals at school have more nutritious diets than kids who bring food or eat food from any other location. I think that's surprising to a lot of people because they think, well, I do a good job packing my own kids lunch or they're in charge of packing it and they know they're supposed to have a fruit and a vegetable and that sort of thing. But I always try and reiterate that, you know, we try our best to make healthy choices in our home, too, but we certainly don't have nutrition requirements in the home that if my husband brings home a loaf of white bread, I don't check it out and say, well, it's not 50% or more whole grains, so we can't eat it, you know? So I think that that's something that's really important to consider, is that meals kids get at home or at school or the research says over and over again are healthier than any other place that they could give food.

 Cougar Hall: [00:09:36] I love that perspective. I'm not near as knowledgeable as you, Lori. I have done a little work in this space and primarily before I came to BYU, when I worked in the public schools and tried with some vigor to remove vending machines. And it wasn't because I wanted to limit the students freedom, because just of how how detrimental that was to the federally funded school lunch program and to learning. Yeah. And that. And so I think we're concerned about students health, physiological, biological like their health. But also there is this very strong connection between a student's health and their academic outcomes. The healthy student is the better student academically as well. And so even if even if there's a parent out there who's not all that concerned about, oh, fry high fructose corn syrup or, you know, the added sugars or whatever it is, that's just not their thing. I don't know a parent who's not concerned about their child's learning. So to make that connection and this is where I think public health really does there's this mesh point with policy. And again, you're in this space working, but it's not just the content, but it's also the timing of lunches. We find that students if if recess is directly after lunch, they want so bad to get to the monkey bars.

 Cougar Hall: [00:10:54] They want so bad to play soccer out there. Just they just throw the lunch away and get out. There's there's so many things that we can do as we have good data that can inform good policy, we can tinker and we can certainly invest better in children and both academic and health outcomes. What is your perspective? Because you and I, about a year ago, we were asked to to be a part of a diversity, inclusion and belonging. And it was a little bit of an ad hoc. It's like, oh, the university has starting to really dial in on this. We had a a campus wide survey and we thought, well, we want to know what's going on with our students, what's happening with the students that are majoring in public health. And so we created a survey. It was it was similar, but also diverged a little bit from what the whole campus climate survey did. Tell me about that process. Tell me, where do your concerns related to diversity, inclusion, belonging, where do they come from? What makes you such a strong advocate for BYU students?

 Lori Spruance: [00:11:55] Yeah, absolutely. First of all, I think the roots of my advocacy for students come from a variety of different places, some of them before I have even became a faculty member here at BYU. But one of the first experiences I remember here as a faculty member is I had a student of color approached me in my office and she expressed that she felt she experienced racism in my class and that was like a dagger to the heart because I feel like I try and create. A safe place for students.

 Cougar Hall: [00:12:29] Sure.

 Lori Spruance: [00:12:30] But. Some of those students still weren't experiencing safety. And so her and I had a long conversation about, well, you know, what do you feel you experience? And can you give me some examples? And not that I was trying to interrogate her or in any way, but I just needed to know or understand. And that became a realization to me that when I think it's a safe place, that doesn't mean everyone in the classroom feels it's a safe place. And it always kind of brings me back to what we learn from as an example from Christ that he reached out to the one who was suffering. He didn't look at the 99 and say, Well, 99% of people are fine. Like we want to give ourselves a big thumbs up because, you know, 99% is pretty good. He spent his time learning and reaching out to those folks who were struggling. So that's where a lot of my advocacy comes from, is thinking about those students who aren't having a positive experience here at BYU. And while many students are, there's many who feel isolated, who don't feel like they belong here for a variety of reasons. It's not just because of race, but it could be because of where they're in their testimony or if they're part of the LGBTQ community. So many different reasons. And so that really has inspired me to try and work, continually work to make our department, my classroom spaces, a place where people can express, if they're struggling, that they can hopefully come to me if they need some support and of course, continue to be an advocate on how can we make our department better.

 Cougar Hall: [00:14:12] Love it. Let me ask a question about this. I know that there's some degree of criticism of professors who really are taking that approach, wanting to be more inclusive. There's some criticism from those on the outside, primarily looking in, saying, so what's going on is is BYU all about identity politics and intersectionality? In other words, we have this gospel perspective that we're all brothers and sisters. It's very much a common humanity. And yet there are. There are certainly. Currents, cultural currents that are saying, well, no, we're not one big happy family. There are many of us who feel like we're on the outside looking in and have historically been oppressed or been marginalized. And so I think there are there are folks that are criticizing some efforts at BYU, saying, you guys have gotten away from this common humanity. We're all brothers and sisters. And rather than focus on our similarities, you want to point out the differences and rather than be hopeful and inspiring, we're actually creating victims. And you're going to feel, oh, let me show you how you're so you're a person of color and you're a female and you're look at all of these intersections where you've been oppressed. And I personally haven't sensed that at BYU. I've actually since what you described. But let me just allow you to speak to that. Where do you where do you balance belonging and inclusion and reaching out to the one? And. Trying to really instill hope across the board and point people to Christ?

 Lori Spruance: [00:15:56] Well, I think a lot of this to me is rooted in what I have read Christ does. That's where he would want us to spend. Our time is with the marginalized communities.

 Cougar Hall: [00:16:08] The foundation of public health truly is social justice. It truly is concerned about the burdens and the benefits of society. How they're distributed and whether it's looking for equal opportunities, I think is the version that we've adopted in our department as far as we want equal opportunities for all or whether it's a little bit more of equal outcomes for all, there's there's probably some tug of war between those objectives in public health and social justice. But tell us how you navigate that space and how you feel we're doing in our department.

 Lori Spruance: [00:16:38] So first, I think conversations have to continue to happen, you know, and I think that we despite maybe some of the political climate surrounding all of this, that we it's easy to try and shy away from those. I want to shy away from them sometimes because it's like I don't I don't want to be on some clip on the Internet or, you know, my my words taken out of context. But I have to remind myself that I'm if I don't do it, I if I don't have these critical conversations, I'm doing a disservice to my students. So a lot of this, the conversation that in any of my classes that surround this sort of thing really comes in one of my master's classes where we focus on community building and organizing. And one of the key skills in public health that I'm trying to reiterate is that communities frequently know what's best for them. They may have fewer access to resources or may not have political power to advocate for themselves, that sort of thing. But we're rarely going into communities and saying, I have the solution for you. Listen to me. We might have some of the key skill sets in order to help them reach the outcomes that they desire. But part of that requires being able to listen to community members. And if we don't have the skills to be able to listen to what to them, then we really are doing a disservice to the communities themselves. So a lot of the skills that I'm trying to build with my students is how to help them listen to community members and recognize that sometimes they come into a community space with privilege and power that the community members themselves don't have access to.

 Lori Spruance: [00:18:17] And so we really should be approaching problems in public health. As not, I'm the public health person in charge or responsible for solving the problems, but I may have more knowledge and more privilege or power than you do as a community member. So let's work together to solve the problems. And I think oftentimes as young adults, we come in not being cognizant of some of the privilege we had. I certainly was that way. In fact, it took me a long time to recognize that I might have any privilege because I often just attributed it to, well, I'm a hard worker and not to discourage or take away from the fact that many of us are hard workers, but sometimes it's just easier to get things done because of certain privileges that you had. So I really try and still critical thinking in my students. One thing that we do in in this in this particular class as I have them think about a health disparity on a certain characteristic, it could be from race or gender or sexuality. And I say, okay, there are differences in maternal mortality outcomes between blacks and whites. Start thinking about the root causes. So what are the root causes that cause that you know, and maybe it's an education level.

 Lori Spruance: [00:19:40] Well, why is there a difference in education level? Well, maybe there's different access to schools that they grew up in. Well, why are there different access to school types of schools that you grow up in? Well, because the money and the community 11. Well, but why? And I just really keep making them ask the question why? So we don't just say, oh, well, it's an education issue. Well, so where can we potentially resolve that difference so that the upstream or the downstream consequence will be that we have better maternal outcome rates and it could be any sort of public health issue. Almost every single public health issue has some sort of disparity, either by gender or by race, by sexuality. There we see so many differences. So I really try and get students to think deeply about what those root causes are. And oftentimes it comes back to societal structures. And I know that's not necessarily the popular opinion sometimes, but it's like, you know, because of redlining in the past where individuals couldn't get access to certain home loans, they. We're then in a more impoverished community. And these are things that have gone on for generations, but that are still having long term outcomes today. So we need to think about how can we address the upstream root cause so that we can address some of these health outcomes. And of course it's super challenging, but that's the work we need to be doing as public health folks.

 Cougar Hall: [00:21:18] I sometimes have students and actually some other relationships I have outside the university where people will criticize me and say, You just want to talk about the social determinants and you're completely removing individual responsibility and agency, and those are foundational truths. And I say, no, we're not actually we believe in the individual determinants of health as well. We do believe that we have agency where agents under our selves understand that this is the profession, this is the profession, it's called public health. So our purview is populations. If you want to talk about an individual, you can go to exercise and wellness because that's what they do. They talk about working with individuals. You can go to many, many aspects of health care where it's a practitioner and a patient one on one. And they're talking about those individual, individual determinants. They're talking about individual behavior change and decision making. And that's great. We don't disagree with that. What we're saying is there are also overlapping social determinants and we're all about populations and we're about prevention. And if if we can provide good data and that data can lead to better policies that help. Those communities that have traditionally been impacted by things like racism, and we can move forward like that's that's the low hanging fruit. We've just improved outcomes for an entire community and it just seems that many people fall into this all or nothing, thinking where it's like, Oh, if you're talking about social determinants, you don't think there's any individual accountability? No, on the contrary.

 Cougar Hall: [00:22:56] And if you're talking about individual determinants, then you don't think that there's societal wide issues that lead to these disparities? No, I think everyone would say, yeah, absolutely. So. It just feels like we get we get kind of siloed in our thinking. Most of the challenges we have, if not all, they're far more nuanced. I just don't I just think we're in a time period where it's just soundbites, it's hashtags. And to understand that communities and society, it's much more nuanced. It's much messier than many people want to admit and want to discuss. I really appreciate the balance that you have in really asking those hard questions. There's a difference, I think, between teaching students what to think and teaching them how to think. And when we and when you're following up with a student response saying why and why you're not telling them why you're asking them, I need you to think more critically. I need you to take all the information, you know, and really get a little deeper. Why are we seeing this phenomena? What's going on? What's going on at the community level? That for me is education.

 Lori Spruance: [00:24:04] And so sure.

 Cougar Hall: [00:24:05] I just love it.

 Lori Spruance: [00:24:06] Students arrive at what I would arrive to and this I make them draw this assignment, that sort of thing. And sometimes I'm like, That's exactly what I would have come to. Sometimes it's not. And that's okay. Both solutions to the but y question are important and yeah, I want them to come up with it and be able to think through the but why question? So I'm all for whatever they arrive at and sometimes they're similar to mine and sometimes they're not. I wanted to add one other thing that I was thinking about as you were talking about individual choice is this idea that we can't have individual choice if there's not an environment that supports individual choice. So a lot of this for me, especially in the nutrition angle, came when I lived in New Orleans. And of course, there's some very impoverished communities in New Orleans. And some of the faculty that I work with did some grocery store studies to look at the types of foods that are offered in different grocery or corner store convenience store locations across the community. And there were certain communities that the only access to grocery stores or corner were corner stores. And you'd walk in those corner stores and they're really what you would imagine, you know, candy, alcohol, chips. Those sorts of items. And sometimes if they had fresh fruits or vegetables, they'd be, you know, brown bananas or.

 Lori Spruance: [00:25:36] Soggy apples. I'm trying to think of some of the examples. And if we are trying to tell individuals make the healthy choice, they're like, well, in order to do that, I'd have to take a bus. 15 miles across town. And that is a huge barrier, you know, to shop at a house. So if there's not a place for them to access healthy foods, then how are they going to make the healthy choice? And I mean, this might be a silly parallel, but it got me thinking a little bit about gospel things as well, is that we believe in the restored gospel, that if someone didn't have access to the truth that they won't be held accountable the same way as someone who had access to the truth. And I'm like, It's kind of the same thing. You can't choose the gospel of Jesus Christ if you never heard about it. You can't choose the healthy item if you don't have access to it. And I know those are kind of silly parallels, but oftentimes that's really the gospel of Jesus Christ is what informs my thinking of the world. And I think, yes, individuals need to choose, but if you don't have a choice, there's not a choice to be made.

 Cougar Hall: [00:26:49] I don't find that to be a silly parallel at all. In fact, when I try to describe what public health is for a friend who only has 10 seconds to listen, I say public health is making the healthy choice the easy choice. It really comes back to opportunity. And almost everyone I know would agree with we want we should have equal opportunity. Now, once you have those opportunities, it's hard to guarantee equal outcomes, right? Because we're going to make individual decisions and choices. But that's what public health is trying to do. It's trying to it's trying to grease the skids a little so that the healthy choice becomes more of a default setting. It's easier to select the healthy option. It's easier for me to wake up and go for a walk or go for a run because I have a safe place in which to do that. And I don't think that's silly at all. I think you've nailed it, actually. Those opportunities, that's what we're about. I love it. I've taken a lot of your time. I really. I could talk to you all day, Lori. I really could. I just. I just love these conversations. What are you reading right now that's inspiring you? That's. That's just really charging your batteries.

 Lori Spruance: [00:27:56] Yeah. So I am reading a book by Nyla McBain. She's a historian, researcher here in the state of Utah. Actually, it's called Pioneering the Vote. And her book is all about looking at the history of regard regarding women's suffrage and the Mormon pioneers and how really women of the church at the time, at that time were on the forefront of advocating for women's rights. And I find that really inspiring, that our early leaders within women leaders within the church had such great insight to know that it was so important for women to have access to education, to have access to vote, those sorts of things. So I'm reading and learning all about the origins of the women's suffrage movement that a lot of it I wouldn't say started in Utah, but a lot of the individuals, members of the church in Utah were huge advocates for women voting rights. So I've been learning a lot about that, and I've just been really inspired by the faith and the testimony and the advocacy of these women and trying to embody some of the things that they stood for in my own life. And yeah, that's what's inspiring my reading right now.

 Cougar Hall: [00:29:17] I love it. I need to add that to my list. It really is like we had some very strong actors in that first wave of feminism. Huge, remarkable.

 Lori Spruance: [00:29:26] And you know, being the first state to grant the right, we weren't the first state to grant the right for women to vote, but we were the first state that women had the opportunity to exercise the privilege of voting. And it's been fascinating. So yeah, added to your list, it's not a terribly long book, but it's again inspiring to think about the impact these women had. On the country.

 Cougar Hall: [00:29:51] I love it. Thanks for sharing that. And I just again, you you are an inspiration. So thankful that you're a colleague and that students at BYU get to learn from and discuss these important issues with you. Thanks, Lori, for sharing your time with us this morning. And all the.

 Lori Spruance: [00:30:06] Best. Of course, such a privilege.

 Cougar Hall: [00:30:08] Thank you for joining us today. Catch us on our next episode and don't forget to subscribe to Future Y Health episodes.