Community Health: Bridging Borders with Marco Verdeja

 Summary:
In this episode, Dr. Marco Verdeja, a physician turned public health advocate, shares his journey from working in rural Mexican communities to his current role in Utah with Intermountain Health. He discusses how witnessing preventable health issues, such as malnutrition and limited healthcare access, motivated him to shift focus toward community health. Now, he addresses health disparities in underserved populations, focusing on social determinants like housing, education, and financial stability.

Marco highlights initiatives led by Intermountain Health, including partnerships that bring preventive care directly to families, especially within the Hispanic community. Through programs like screenings facilitated by students and increased access to affordable housing, Intermountain Health aims to alleviate chronic and mental health issues affecting these populations. Marco also discusses his work on mental health and opioid use reduction, underscoring the importance of community-wide solutions and eliminating stigma.

Encouraging listeners, Marco shares his optimism for public health’s future, emphasizing the value of upstream, preventive approaches. For those interested in public health careers, he stresses that the field is full of potential, as healthcare increasingly recognizes prevention as essential to long-term health and well-being. 

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

Transcript

Cougar: [00:00:00] Marco Verdeja, welcome to the Y-Health Podcast, my friend. How are you? 

Marco: Doing good, thank you. 

Cougar: I really appreciate you are one of the busiest guys I know, and yet you've taken some time out today to come and chat with us. I really appreciate it. Would you mind giving us just a broad introduction to who Marco is, and then we can lead into your career and all the exciting stuff 

you're doing. 

Marco: Sure, happy to so Marco Verdeja. Studied medical school in Mexico and I graduated and worked in Mexico for about three years in the and medical practice at a private institution. So I saw a lot of interesting things there, but also a lot of hardship. It was a very rural area with a lot of need. 

And so having seen that, I saw this huge need for population health, community health initiatives. Many of the patients that we would see very often would come when they were very grave and very ill but with things that were so preventable [00:01:00] that could have been avoided very easily. And having seen that, I really wanted to go deeper in how could we. 

Work in a way that benefited everyone, not just a one on one, right? There's great feeling of saving a life or bringing a kid into the world when they're just being born. But also, a great sadness in thinking of all those other hundreds of kids that were not receiving any attention because of transportation issues, because of lack of trust in the medical system, because of lack of access financial instability, housing instability, and all of these things causing their health to go take a turn for the worse. 

So then having worked there for those years, I decided that I wanted to work in community health. So I moved here to Utah and started my master's in public health and graduated. And then having been here, I, I started [00:02:00] working for Intermountain Health. And I've been with them for four years and a half almost, working on various initiatives, mostly around health disparities, improving health outcomes, particularly with communities who have been typically underserved, underinsured, and that take on the brunt of most of our chronic illnesses and disease. 

So having been here. I fell in love with the community and with the people. And so I'm still here. I thought I was going to go back to Mexico. But I found a community that I could support and help. And so we stayed. 

Cougar: I love it. I'm so glad you did. You've just given us essentially an overview of the social determinants of health in so many ways, Marco, and you recognize that at the clinic and with the patients that you were serving in Mexico. 

Have you been surprised to see how influential the social determinants are here? In Utah, in a place where we have generally very good access to [00:03:00] care, and yet we still right under our nose have a great many of our friends who don't have those, those social determinants met. 

Marco: Oh, definitely. Back in Mexico, there's this child, he had pneumonia and so we were doing some rounds and got introduced to the case and he was three months old with, with pneumonia because of He'd been exposed to smoke because where they lived they had nothing else but just wood, well stove, and so he'd been exposed and so he'd gotten pneumonia and I thought, geez so many different ways that this could have been avoided, right? 

And yet, all of them. created this issue where lack of awareness, lack of access to, to different ways to, to cook and having no other way to prepare their meals that led to this issue. And coming here, you see the exact same thing in different ways, right? You don't have this particular case, but you still see individuals having the [00:04:00] same access issues, the same lack of awareness needing an education and not having either financial stability or housing stability to really take care of their health. 

Okay. In both countries there might be different particular instances at how it reflects in the population, but the issue is the same. We're all suffering from those social determinants of health where where people's needs are not met. 

Cougar: Yeah. I really appreciate that. 

You giving us two stories, both sides of the border, and I think there's a great many of our students who have this idea, this vision of doing public health and having almost a National Geographic type experience traveling the world, going to resource poor settings and really, I mean, literally saving people. 

And often I remind our students that we can do public health in our own neighborhoods and in our own communities. And I think the current state the current conditions, maybe is a better way to say that, that we're experiencing in Utah. With housing costs with insurance costs with [00:05:00] inflation, inflationary pressures that we're all feeling right now there are, there are so many that have this cushion that they can absorb some of those challenges because they have the resources. 

With which to absorb them, but for so many people who live so close to the edge to the line there of making it each week or each month, paycheck to paycheck, it really starts to illuminate those social determinants and how the social along with the individual determinants really do drive the health outcomes and how there is such just a magnitude of suffering. 

That really can be addressed and prevented, as you've talked about. Can I ask real quick, Marco, as you've worked for IHC, and you've been on a number of projects, maybe you can share some of those projects with us, and then of course your current role, but what are the specific challenges that families face when it comes to prevention of chronic disease, prevention of infectious disease, and just accomplishing the goal of wellness? 

Marco: So, at Intermountain Health as a non for profit institution we, [00:06:00] as all other non for profit hospitals as well as health departments we do a community health needs assessment. And we really take that needs assessment seriously when determining our initiatives, strategies, and priorities for the next years. 

And so, we go out into the community. We survey, ask leaders, the population in general, and stakeholders, organizations, and try to gather all this information from our communities that each of our hospitals serve. So each hospital does this. And then with all that information, we look into it and determine which are the greatest needs that not those that we are identifying, but those of the community identifies. 

And so with that, then we really use that as a blueprint or map into what are the needs and what do we need to do to improve or support those needs? We just finished at least here in Utah. We just finished the newest cycle of our CHNA. And so that for the next [00:07:00] three years, our initiatives and priorities fall under three categories which were identified by the community, and those fall under chronic disease. 

which includes basically diabetes, high blood pressure, and immunizations. We saw lots of issues with immunizations coming out of COVID, right? Lots of children that are behind in their immunizations, as well as individuals who have lost their trust in organizations or with, immunizations or vaccines. So a lot of vaccine hesitancy. 

And so addressing all of that. Then there's mental health, which we have seen a huge increase in. And so everyone recognizes that across the board in all of our communities, absolutely. And all of them mental health was the number one priority that it was identified. Even in populations that typically tended to not speak about it previously, there was a little more stigma in in, in some communities like the Hispanic community, for example, it was not the case of surprisingly not the case. 

This time, [00:08:00] everyone agreed that mental health is a big problem right now, because it is and third one from which I'm very happy is social determinants of health and, Everyone is starting to see them as this first step, this upstream cost for healthcare problems. In the past, it was common to hear why is the hospital, Talking about housing that connection was not made by people. 

 And now you're seeing a lot more people understand that if there's housing instability that stress and that inability to keep yourself safe and your family safe will lead to eventually to health problems. So preventing that actually keeps people out of the emergency room. And so seeing that change has been great. 

It, it's, it's something that's going on and a lot of people are working in but something that I'm really proud of to be working on right now. 

Cougar: I love it. Isn't it great that we can do an assessment [00:09:00] and actually go to the community and hear from them, learn from them what their experiences are, what hurdles it is that, you know, that they're facing. 

And then if you have another layer over that, we have so much data that we really can make data driven decisions. 

Marco: Absolutely. 

Cougar: And I just, just thinking about housing and if I can, I'll just share experience I had this week. We're looking at data from the democratic Republic of the Congo, and we're looking at how households deal with shocks. 

And this is a location in the world where we've had a decade plus of civil war. We've had droughts we've had volcanic eruptions. We've had, there's all sorts of shocks that can really throw a family off. And yet we're just this week looking at this baseline round of data and the number one shock. 

It's food prices, how sensitive these families, these households are to the cost of rice or the cost of grain, whatever milk either going up or going down and just how close to the edge we're living. And I think about housing and I'm so glad you mentioned that one. Because that does [00:10:00] drive poor health outcomes, like, and I'm so glad to hear that IHC is looking at that and recognizing, Hey, we're a non profit. 

We need to be able to run things, you know, with some financial prudence and we need to be able to take it. But that's health care. That's just as much health care as how we train our doctors and you know, How often and how long the clinic is open and where it's at is like, these things absolutely determine household health. 

Can you share with us is there a particular program, a particular intervention? Because once you know what the community needs, it can be difficult to move resources and to pivot, you know, your goals and your objectives as an organization. So how does that look? And maybe you can give us an example of how we're trying to meet those needs at IHC. 

Marco: Oh, 

yeah, of course. I was just thinking of something you mentioned that I thought was really important. When people are close to the edge, right, anything could make them drop off. And it be it housing or food prices or inflation. And we think of the example you provided, but that's happening here as well. 

Those [00:11:00] people who have no social network to support them. Could end up homeless, in a homeless situation because they, they don't have anyone else to, they can rely on and any small change can really be the cause of that. So thinking that way Intermountain thinks of itself as an anchor institution, meaning that as The largest employer in Utah, there is a social responsibility. 

To support not only our patients, but also our employees, as well as our community in general. So everyone, because we think that a healthy community benefits everyone, right? Keeping people out of the hospital actually is good business for the hospital paradoxically enough. And so to do that, well, The intention is to leverage all of the system's power and resources to create better solutions for the community, even outside of the health care that we provide. 

So as an anchor institution, we [00:12:00] have basically four pillars. Which we work on. So Impact Investing being the first one, where we think of how can we invest the resources, the financial resources that we have to improve the housing needs of of our communities, where those needs require it. 

for example. We provide loans, so those loans go out into the community to provide under very specific requirements, really low interest rates. below anything else out there. So that organizations, non for profits, or anyone else thinking about creating housing solutions for those who cannot afford extraordinarily expensive housing right now. 

So, they can request those loans and then provide low income housing at affordable rates for our families here in the community. So that's one of the ways that we're supporting. The other three is through our supply chain. We try to create solutions by [00:13:00] trying to buy what we can write from trying to be very innovative in. 

 Buying local, buying from women owned businesses, buying from diversely owned businesses, so that we're really making a change and supporting those individuals here and improving our communities. The other way that we Try to be an anchor is through our hiring. So improving our hiring requirements in a way that we are more inclusive, more diverse. 

We provide greater incentives for our diverse population and really promote them in a way so that they'll stay grow and become leaders in our community. And the last one is our sustainability efforts. So, thinking about air quality water conservation energy conservation, trying to be good stewards of, of those resources and in any way that we can try to reduce waste in any of the processes. 

 And you think of all of the trash that goes out of your house, for example, right? Which [00:14:00] might feel like a lot in a when the trash comes by. But think of that for a system of 50, 000 individuals. For 60, 000 individuals, that's a lot of trash. So making small changes can make huge impact in the amount of trash that goes out our doors. 

Cougar: Those are all things you're thinking about. Yeah. I do feel like I put a lot of trash out on the curb, Marco. That's just my household in one week. And I think about a hospital, think about an entire network throughout the valley of care centers and insta cares and hospitals and children's hospitals. And yeah, so all of those small changes. Do make a tremendous impact. I hadn't heard the term and an anchor, but you really are an anchor in the community. You're an anchor in the profession. If I can just share a thought that I've had over the years, and my background is school health education. 

I'm a, I'm a little bit of a transplant here in public health. And yet I have had the thought multiple times over the last decade or so that, Some of our [00:15:00] very best public health practitioners have a medical background. They have a similar journey as you Marco and that they were, they were working in clinics and they were providing life saving treatments and surgeries procedures. 

And yet at some point they felt like I need to get ahead of some of this. I want to work on the prevention side. To alleviate suffering and get things, you know, nip it in the bud, so to speak earlier, so that we can prevent chronic disease, cardiovascular disease, cancer, stroke, diabetes, Alzheimer's, some of these things that really drive health and disparities. 

So. I just want to say thank you because it almost always comes at a tremendous sacrifice, not just going back to school and doing some of those things, but there's typically a financial sacrifice that's made as you leave clinical care and come into health promotion and community health. But without you and without others like you. 

I don't think we have the same voice. I think your voice and being able to share your [00:16:00] background and your experience and your perspective as someone who worked in an emergency room or worked in a hospital, worked in a clinic and be able to say, Hey, these things are really important. We, we have to get out to these communities and do what we can, not just because it saves a hospital money on the back end, because it's the right thing to do for humans, this for collective humanity and who we are. 

 So I just want to say thank you. I don't know. I don't think we're done. I hope we're not done with our discussion, but I'm just sitting here. I need to, I need to say thank you because you are one of those giants in public health that comes with that background. I appreciate it. Let me ask. I'm, I'm a little dry and I don't ask the best questions. Marco is our listeners. Now, I think the best thing is sometimes to hear a story. So we can really, you know, cause we, we, we, It's just so many words until we have a story and we can relate with that, whether it's, it's something recently or just over the last four and a half, almost five years that you've had working in community health. 

Is there, is there something that makes this real [00:17:00] to us? Can you tell us an experience? And I had some cool experiences during COVID, but is there an ex in experience that will connect our listener to the principles that you're trying to teach and explain? 

Marco: Happy to. Yeah, there's lots of experiences and lots of initiatives, but let me use one as an example through before COVID one of the initiatives that we supported was screening for pre diabetes high blood pressure and social determinants of health. 

So we would screen individuals on these three domains and In different events, fairs, health fairs anywhere we could find a large gathering, we would go and try to screen those people who typically end up not going to the hospital Unless they have to, right? So once you're not talking about prevention, but you're talking about treatment. 

So in order to get ahead of that, screening is one of the tools that we have. So we would do that constantly over many years. Then when COVID happened. We [00:18:00] couldn't do it, right, because there were no events, and there was no health fairs, and there was no gatherings to go and screen folks, right? 

Because everyone was separated. 

Cougar: Social distancing. 

Marco: That's 

Cougar: right. Isolating ourselves. 

Marco: And so we had to get innovative, right? Think of how can we find folks where they're at? So we looked at a partner in the community who provides leadership classes and is Latinos in Action. They're in all of our high schools, middle schools, and I think they're moving into elementary schools now. 

And so they, they have all of these classes across the whole state and even outside of the state where they, they, they teach our children. Are Hispanic children. Well, one of the largest populations that are really hard to find is those Hispanic parents of those kids who for some reason, whether it be that they don't have insurance or there's mistrust of the medical system or of just institutions in general, are won't go to the for any type of preventive screening [00:19:00] to the hospital. 

So we created a partnership with Latinos in Action, who's an institution that teaches classes of leadership and prep college prep across all of Utah. 

So we would go to those classrooms and teach the kids about social determinants of health, pre diabetes high blood pressure, the symptoms, and what can happen if it goes untreated, and then how to screen for them. So that way, the kids were learning about this. We were increasing awareness and education. 

But then we would give them an 

assignment. They would have to go to home and screen three to four individuals at home for these. Once they screened for those, those who were found to be at high risk would then be provided with resources and education and phone numbers to call and additional resources for them to get help. 

So the [00:20:00] kids did what we couldn't do, right? Get into these hard to find homes, hard to find individuals, and then get them the resources and services that they needed. And they did it in a way that was Much more trusted by those people, right? Even when I was in Mexico, if I, I told certain people, you need to eat better, and lose some weight, and do some exercise, they, they would say, oh, well that's what you would say, of course you're the doctor. 

Right? And they wouldn't trust that very much. But people listen to their family. And people listen to their kids a lot more than we give them credit for. As well as, the kids are there. Not just that one time that you told them to eat better. But they can remind you. They're there for that next time that you're, you know, They're Eating that unhealthy choice for the nth time that week. 

And I can remind you, you better take care of yourself. You're at high risk for diabetes. So we did that. It was a great success. And so that we continue to do it that [00:21:00] way. We still go and we still do this, we have this great connection and it's a great program where, social determinants of health in a way are taught, but also applied, right? How can we find these hard to find people and give them the access that they don't have otherwise? Because they're not going to go to the hospital if they're not feeling sick. So instead we go to their homes. 

Cougar: Love it. Just last night I was Leading a discussion in my evening class, there was a statistic in the chapter that we were reading, and it said that 87 percent of people will make a health behavior change, I should say, for a family member. And the example that we talked about in class is, if I'm dad and I'm a smoker I'm not going to stop smoking. 

Maybe I've tried. I've probably tried six or seven times. I've taken a few smoking cessation classes, but when my child comes to me and says, dad, I want you to walk me down the aisle when I get married, dad, I want you to be around to throw the ball. Or to go to my game or like, amazing. It's amazing what can happen. 

We will change behaviors, really difficult to change behaviors [00:22:00] for our loved ones. Not for doctors, not so much for doctors, but for her family. So really cool. Sorry, just making that connection, but I love that just last night, that discussion we had. So family and family health is something that we're really taking seriously here in our department. 

Thank you. So many wonderful colleagues that are really learning a lot, studying a lot, publishing a lot in that area. So, boy, there are so many opportunities for us to crisscross and understand what we do in our individual worlds and how we're trying to promote health and improve health outcomes for people, for families, for communities. 

Marco there has to be a lot of excitement around this because every day there's new challenges, there's new opportunities for you to stretch and to try new things and to look at the feedback from whether it's a community health assessment or if it's data at the, at the hospital, like. 

Is this exciting for you? Is this something, can you give an encouraging word to maybe one of my students who might by chance to listen to this podcast? Like what advice do you have as far as, Hey, you know, the future is bright. There's a lot to do in public health. Any thoughts? 

Marco: Oh, there's [00:23:00] so much to do. 

There's a lot of optimism. At least I have a lot of optimism for the future for public health. There's still a long ways to go, right? You know, most of our funding goes to treatment rather than to prevention. But there is some change going on, and a lot more folks thinking about prevention. Example, CMS just changed, that it'll start next year. 

Where all hospitals are required to screen for social determinants of health in their inpatient wards. And because we've been so involved with this, we're ready to just, starting January, start doing it. Because we have been doing it with other and so now everyone's going to have to do that. 

And there's a lot more appreciation for the need. Of taking public health and looking at that upstream solutions, finding those ways that we can prevent things from even happening in a way that will [00:24:00] keep our healthcare system afloat, right? In so many ways right now. Cost prohibits so much of what we do, but that's pushing us to think of these upstream solutions in a way that we hadn't. 

So if you're in public health right now, it's a great time to be in it because there's so much to do in everything that we do, right? There's always a Lens of pop health, community health that you can provide, bring in and make any solution better. 

Cougar: Yeah. It feels like years ago when I came to BYU, we would frequently have these discussions about how can public health get a seat at the table? 

Like, how can the treatment side, the, you know, the clinical side, the care side just call it health care. How can we show our value to them so that we can provide all the things that we know are going to be helpful for families and communities? It feels like that discussion is kind of in the rear view mirror now because, and I don't know that public health convinced healthcare of the importance of prevention. 

I think healthcare came to that finally on their own [00:25:00] because it makes financial sense. Prevention isn't just the right thing to do for humanity. It's the right thing to do for the bottom line in healthcare. And it feels like IHC is leading the way in that to some regard in some regard, I should say, because recognizing, let's get in front of this, or as you said, let's get upstream of this and see what can we do to prevent this, you know, prevent some of these chronic ailments and diseases. 

Really cool stuff. I think my students will be really excited to hear from you, Marco, and I'm sure our listeners will, will really enjoy your perspective and your experiences. Maybe as a final thought. And of course, you can go any direction you want. I'm not tired of talking to you, that's for sure. But is there something that you're reading? 

Something you're listening to? Maybe there's a podcast out there. It's probably much better than this one. That's continuing to expand your knowledge, your horizon, your perceptions. I think we want to demonstrate to listeners that Marco's a smart guy. He has a Master's of Public Health. He has a medical degree. 

He has years of experience. But I think [00:26:00] you recognize that there's always more to learn. There's always more for personal growth and you know, professional preparation and where those things mix as well. So, so what's, what's got you excited right now? What are you listening to? What are you reading? 

Marco: Yeah. 

So, well, right now, a lot of the work that we do falls under mental health. There's a huge need of, of, of mental health. Initiatives nationally, but here in the state as obviously as well. And so, thinking of how can we support that, that increasing need has been a lot of the work that we, that we do. 

So Right now there's a lot of different just great books as well as series and movies around the opioid epidemic. And that's a huge problem right now here. So I've been delving into that and just watching everything and reading anything that I can on the topic. So anyone that wants to Get involved with or learn a little bit more about that. 

I think there's plenty out there to look into [00:27:00] and start watching a movie or start watching one of the series that are out there because they'll get you in to that conversation of how big that problem is right now. And How can we be a solution for that opiate epidemic? We might not see it, but it's big and it's causing a lot of struggles with, with a lot of homes and a lot of folks. 

So right now from a system wide perspective the hospital really is leading in. Best practices for prescription. How can we reduce prescriptions in a way that still provides the pain relief as appropriate, right? But also looking into, okay, what other ways can we provide pain relief? How can we teach people to find alternatives to opioids and improve their life that way? 

And their mental health. So anything that we can do we're trying. And we've done great reductions in that. But as a society we also have a responsibility on not [00:28:00] marginalizing individuals, giving them help avoiding stigmatizing them in any way because of this issue. 

Because right now it can happen to anyone, right? All it takes a knee surgery and the need of opioids having a predisposition and maybe having an overdose, accidentally. And that's not your fault, right? But we need to provide solutions for folks that way. And so I think that's a topic right now that really needs attention and it's getting it, but there's, Anything that we can get our hands into learning a little bit more about that, I think it will be great. 

Cougar: Oh, I love it. Amen. There are some really good documentaries. I recently read a book called Dreamland. You ever dreamland? 

Marco: Yeah. 

Cougar: Sam Kenyon is, I thought the history, the history provided in that book was fantastic, especially when the medical profession began using pain as one of the vital signs. And then of course, just the advent of synthetic opioids And just there's a [00:29:00] fair amount of misinformation early on and that's not to blame physicians or the pharma or the pharmaceutical industry per se, but I think that book really lays things out and it's very readable and it's tough to put it down. 

So I so appreciate you sharing that with us and the connection by the way, between the opioid epidemic and mental and emotional health runs, runs two directions at a minimum. And so what a, yeah, what a heartbreaking, but what a, what a terrific topic for everyone to learn about and educate themselves and remove the stigma and you know, stop if it's been our disposition to engage in victim blaming or make opioid addiction a moral issue. 

I think just even a little bit of education allows us to retreat very quickly from that perspective. And recognize that these are victims and we need community wide solutions now. So, Marco, you have blessed our lives. That's for sure. [00:30:00] You've blessed my life. The experiences we've had together, I think on a daily basis, I recall the experiences we had together in Peru, working on childhood nutrition and just being able to see you in action here. 

You're, you have a genuine and Care and concern for others. And it shows, I know that our listeners will hear that in your voice and in your experiences. So you probably need to get back to work. I say thank you for your time today. And thanks for joining us on the Y-Health Podcast. Thanks Marco. 

Marco: Oh, thank you.