When 'Global' Means Home

by Julie Chung

My hour-long commute to my internship required me to drive from the southernmost point of Los Angeles to a small city east of Downtown called Alhambra, famous for its authentic Szechuan cuisine and boba shops on every corner. To pass the time, I alternated between cranking up the local NPR station, the fuzzy Korean AM radio, and the Spanish-speaking music channel in my car. Stuck in traffic on the 710 freeway, I felt the most at home, immersing myself in the culture, news, and events that ground me in the wonderfully diverse and culturally-rich environment of my hometown, Los Angeles.

This summer, I interned at Los Angeles County Department of Public Health, Substance Use Prevention and Control (SAPC) through the Harvard Global Health Institute. Returning home to Los Angeles was an homage to why I became interested in the field in the first place. Growing up in Los Angeles, I relied on County-provided Medicaid, while parents and other family members lacked access to health insurance until creation of the Affordable Care Act. I became especially conscious of how health policy and programs affect the day-to-day lived experiences of individuals when my aunt in Koreatown passed away my senior year of high school. Her diagnosis: a preventable cancer, if only she had better access to healthcare in her life.

As a student of Global Health and Health Policy, I have challenged myself to broaden my scope of thinking about issues of health inequity, which pervade the structures of global systems. I’ve learned how legacies of colonialism impact global health interventions in Mexico or how political ideologies of Western nations can hinder healthcare delivery in Tajikistan. Harvard’s global health education has incurred a deeper sense compassion for the health issues that impact the world’s most under-resourced populations.

However, while my education has deepened my understanding of global health issues, I have also grown wary that this widening lens might conversely shield me from the disparities and challenges that existed in the population around me every day: the homeless individuals searching for shelter in Harvard Square, the Southeast Asian youth I serve at Revere Pediatrics, and the communities of color suffering from environmental contamination in Greater Boston. Because so many efforts at Harvard tend to focus international scale, outsiders may often misconstrue the “global” as “foreign.” Other students sometimes questioned how it was possible that the Global Health Institute funded my public health efforts in Los Angeles, a metropolitan area of a well-resourced state. But my instructors in global health never fail remind me, the “global” in Global Health necessarily includes the United States, Boston, and Harvard.

For me, the global also means home. Coming back to Los Angeles gave me opportunities to both give back to the city that took care of me in my youth and to address the disparities that persist amongst its 10.2 million residents today. Serving individuals experiencing substance use disorder (SUD, colloquially known as drug or alcohol addiction) seemed especially timely. In 2016, there were more than 63,600 drug overdose deaths in the United States. In Los Angeles County, heroin-related hospitalizations, emergency department visits, and deaths increased by 68 percent from 2005 to 2013. Yet the SUD care system remains one of the most underdeveloped aspects of healthcare delivery in the United States today.

 

Julie Chung

Caption: An outreach event spreading information about SUD care in Los Angeles. I was able to participate in outreach events in the town I grew up in and interact with individuals seeking services at the County social service centers.

The majority of my projects at SAPC involved improving access to care for the County’s underserved and vulnerable populations. These projects fall in line with the County’s multi-million-dollar endeavor to provide SUD care under California’s Drug Medi-Cal fee waiver and My Health L.A., a county-specific insurance plan that also covers undocumented residents. I took part in designing a proposal to increase SUD care to justice-involved youth and analyzed data regarding language and disability barriers in SUD treatment amongst SAPC’s provider network. When facing the multitude of challenges that arise from such a diverse population, I grew most inspired by my team members, who are constantly asking, “Where are the gaps? What more can we do? How can we better serve our population?” They challenged me to think about the individual patient rather than the population at the end of the day.

Upon engaging in these projects, my understanding of the “global” shifted yet again. More than half of residents in Los Angeles speak a language other than English at home. My analysis of language services examined 12 threshold languages (those spoken at a high proportional rate according to Medi-Cal regulations) in Los Angeles, the greatest of any county in California. These languages include Arabic, Spanish, Korean, Vietnamese, Russian, Tagalog, and Farsi. Los Angeles is a microcosm of the world. With that view in mind, I saw how interweaving global and local forces all came to impact the health of the city I call home. The language barriers faced by thousands of immigrants represented the complex global socioeconomic factors that bring together individuals from all over the world. The County’s commitment to caring for its undocumented population reflected an act of greater compassion amidst tense politics with our southern nation. Its approach to holistic treatment rather than criminalization of SUD demonstrated a departure from SUD stigma imparted by racially discriminatory policies during the 1980s War on Drugs.

While I thought I would be coming home to Los Angeles to learn about the local scale of global health, I ended up learning about the world. The “global” in Global Health indicates more than physical or geographic scale. It is a way of approaching healthcare and a recognition of the complex forces that weave together stories of indigenous health in Mexico, post-Soviet medicine delivery in Tajikistan, and SUD care in Los Angeles in one “global” discipline.

 

Bio: Julie Chung is a junior concentrating in Social Anthropology with a secondary in Global Health and Health Policy. She is interning at Los Angeles County Department of Public Health, Substance Abuse Prevention and Control, which leads and facilitates the delivery of a full spectrum of prevention, treatment, and recovery support services proven to reduce the impact of substance use, abuse, and addiction in Los Angeles County.