Q&A: Ashley Hickson

Bloomberg Fellow Ashley Hickson graduated from the University of Texas at Austin with plans to become a physician. But first, she decided to get a master’s in public health at the University of Texas Health Science Center at Houston, to gain what she felt would be a “broader perspective” that would benefit her future patients. What started as the supplement to her future in medicine became, instead, inspiration to forego medical school and pursue a career in public health.

One of the things Ashley became most passionate about during her master’s studies is how economic and social conditions, like the availability of jobs and good schools and access to healthy food, affect people’s health and well being. As director of community impact at the American Heart Association for North Texas, she’s working to reduce health disparities that some communities experience by focusing on those social determinants of health. 

We spoke to Ashley, who is pursuing a doctorate in public health at Johns Hopkins Bloomberg School of Public Health in the health equity and social justice concentration, about her vision for marrying “systems” and “programs” and how she’s integrating policy change and advocacy into her work.

What disparities affect health outcomes in communities?

Life expectancy and resources vary by ZIP code. The ZIP codes with access to grocery stores, medical providers, safe parks and safe walkways are the healthier communities, and they are largely affluent white communities, not communities of color. Urban and rural areas each have their own set of factors that impact health, but some factors create disparities no matter where you live, such as limited transportation and job opportunities.

At the American Heart Association, we focus on addressing these social determinants of health and reducing their systemic impact. We create sustainable strategies to strengthen communities and build resilience. Traditionally, public health approaches aimed at socially at-risk communities have been “program rich” and “systems poor.” Programs tend to be short-term and don’t offer long-term justice for the community. An ideal model is the twin approach by the CDC, which applies a policy to an entire community as well as targeting additional interventions toward at-risk populations within that community. 

You emphasize the importance of policy change for improving public health. How are you using policy on the job? 

My courses have really enriched my work and my passion for health equity. I’ve already incorporated a few of the strategies and tools I’ve learned to use in my coursework into my plans for improving the food environment in areas of Fort Worth with less access to healthy food. For example, next month I will attend a training in Austin, Texas, on policies that use SNAP [Supplemental Nutrition Assistance Program] benefits to increase the amount of fresh produce people buy. I’ll be meeting with legislators to advocate for these policies while I’m there. I’m also learning more about lobbying and legislative actions that we can take, alongside our programming efforts, to improve the public health infrastructure in Texas. 

What policies do you hope to see pushed forward that will benefit people in Fort Worth? 

I would like to see Texas expand its Medicaid coverage. Texas has the highest uninsured rate in the country, and the number of people who are uninsured here contributes to the high mortality and morbidity rates in our state. I’d also like to see the state expand coverage for pregnant women to include the first year following birth rather than just the first 60 days. We have a high maternal mortality rate, which is largely attributed to preventable chronic diseases, such as heart disease and hypertension. 

SNAP benefits at farmers markets are important for helping people access healthy, affordable food. Farmers markets in communities where grocery stores are out of walking distance provide an economic and environmentally friendly solution to fill gaps in food access. Because of this, expanding SNAP benefits to cover farmers markets will greatly improve the accessibility of healthy food in these areas. We also need more funding to promote urban farming, which will help improve the local food system, the environment and the economy.