Taking Action on Social Determinants of Health – Armen Henderson, MD
In this episode, I talk with Dr. Armen Henderson from Miami, Florida. Armen is the Director of Health Programs at Dream Defenders, the Founder of Dade County Street Response, and an Internal Medicine Physician and Assistant Professor at the University of Miami. He talks about his community-based work in bringing medicine from out of the confines of the hospital setting directly to poor and working-class communities with a variety of programs ranging from wellness checks and case management to Stop the Bleed gunshot wound trainings. Armen discusses how social determinants of health are rooted in racism and classism and social inequity. For example, he talks about how hurricanes in Miami are an environmental issue connected to climate change that intersects with racism and classism in terms of who is most impacted by hurricanes and do not have the resources to simply leave town when danger strikes. He explains how his team serves folks who are unhoused in a variety of ways, particularly during the COVID pandemic, which led to him being racially profiled and arrested in front of his home. Armen shares how he got into this work, which was directly connected to the murder of Trayvon Martin and connecting with Dream Defenders, who were formed at that time due to the killing of Trayvon. Armen saw a way to challenge racism and classism in medicine and organize for racial justice and medicine for the people using an abolitionist, anti-capitalist approach. I hope this conversation inspires you to action.
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Music credit:
“District Four” Kevin MacLeod (incompetech.com)
Licensed under Creative Commons: By Attribution 4.0 License
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TRANSCRIPT
Shimon Cohen:
Welcome to Doin' The Work: Frontline Stories of Social Change, where we bring you stories of real people working to address real issues. I am your host, Shimon Cohen.
In this episode, I talk with Dr. Armen Henderson from Miami, Florida. Armen is the Director of Health Programs at Dream Defenders, the Founder of Dade County Street Response, and an Internal Medicine Physician and Assistant Professor at the University of Miami. He talks about his community-based work and bringing medicine from out of the confines of the hospital setting directly to poor and working class communities, with a variety of programs ranging from wellness checks and case management to Stop the Bleed gunshot wound trainings. Armen discusses how social determinants of health are rooted in racism and classism and social inequity. For example, he talks about how hurricanes in Miami are an environmental issue connected to climate change that intersects with racism and classism in terms of who is most impacted by hurricanes and do not have the resources to simply leave town when danger strikes. He explains how his team serves folks who are unhoused in a variety of ways, particularly during the COVID pandemic, which led to him being racially-profiled and arrested in front of his home. Armen shares how he got into this work, which was directly connected to the murder of Trayvon Martin and connecting with Dream Defenders, who were formed at that time due to the killing of Trayvon. Armen saw a way to challenge racism and classism in medicine and organize for racial justice and medicine for the people using an abolitionist, anti-capitalist approach. I hope this conversation inspires you to action.
Hey, Armen, thanks so much for coming on Doin' The Work. Really excited to have this time with you. So, just to get things started, maybe you can let us know a little bit about what you currently do.
Armen Henderson:
Yeah. Well, first of all, thanks for having me. I'm a doctor in Miami, but also, I work as an organizer with Dream Defenders, and I have been since I started residency six or seven years ago. And I also started a nonprofit that focuses on taking physicians out of the hospital, outside of the hospital doors, and putting them in the community, working alongside poor and working class individuals.
Shimon Cohen:
So, tell us a little bit more about that with the Street Response, like what does that look like when you're actually going out in the community, what are you doing?
Armen Henderson:
So, the organization is called Dade County Street Response, and we have different teams of individuals that work and do specific things, but also, work in concert of those things as well. So, for example, we have a disaster relief team that basically educates physicians and community members about the effects of environmental justice in climate change, and how it interacts with racism specifically in a place like Miami. But also, if a disaster does hit, then, we organize physicians, medical students, and training physicians to respond to vulnerable communities during disaster by setting up clinics and things of that nature as well.
Armen Henderson:
And then, we also have a street medicine team. The street medicine team goes out, and basically, services the unsheltered population in Overtown, downtown Miami, and Liberty City. We do wellness checks, and basically, case management, getting individuals access to the services and the procedures that they may need, refilling medications and things of that nature.
Armen Henderson:
And then, we also have a gun violence team which teaches individuals how to bandage gunshot wounds in the community, because a lot of people were saying that they are experiencing levels of gun violence, but weren't prepared to respond to it. A lot of people were seeing people getting shot and bleed in front of them, and they wanted to know how to respond. So, we were teaching them the same methods that people in the military use called Stop the Bleed. We also have an advocacy team, and we're starting this alternative to 911 line, as you know.
Shimon Cohen:
Yeah, you're doing a lot and this is why I wanted to talk with you about what you're doing. So, how did this kind of like come about for you? Were you here doing your residency and saw the need that was going on in the community? Is that how this came about?
Armen Henderson:
Yeah. So, when I first... Well, first of all, before I moved to Miami and knew I was coming here, I was following Dream Defenders in their work, specifically after the death of Trayvon Martin and watching the trial. I was actually on some fancy internship at a hospital. I had my master's in business association as well. And I was at some fancy hospital in Texas, and basically, teaching or showing them how to save the hospital millions of dollars.
Armen Henderson:
And I was on track to like, I wanted to be... I thought I wanted to be a CEO of a hospital or something like that. And then, on the other side, I was watching this trial unfold, and I was very upset about it. Not only because it was just fucked up what happened, for lack of a better word, but also, because I thought that I chose the wrong path. I felt helpless, and I didn't know any positions or medical professionals for that matter who are really speaking up against this.
Armen Henderson:
And so, I just felt like I betrayed my community. I'm from an inner city neighborhood of Philadelphia, and yet, all of my colleagues, all of the people that I was working with really didn't know about, or acted like they didn't know about, the struggles that were going on amongst everyday people, like it was above them. And so, when I found out I was coming to Miami, and honestly, I thought I was going to Philadelphia, but I ended up coming to Miami, I was like, I got to connect with Dream Defenders. And so, I connected with Dream Defenders as soon as I got to Miami. And then, it was just like a listening project, just figuring out how I can lend my expertise. I was doing little campaigns that had nothing to do with healthcare or what I thought had nothing to do with healthcare or medicine.
Armen Henderson:
And then, two years in, I started to make connections to the social determinants of health, and a lot of the campaign and programming that Dream Defenders was doing, not just Dream Defenders, but also, social justice organizations across the country. And doctors and researchers and medical professionals do a lot of research around social determinants of health, like we know them in and out, but we don't do shit about them.
Armen Henderson:
And so, at that point, I was just like fuck it, I'm just going to go ahead and do programs that directly impact social determinants of health, and I'm going to lead advocacy around those things as well, lend my voice when I can. So that's really what led me to encourage other individuals in the medical professional to do so, and to start Dade County Street Response.
Shimon Cohen:
It's powerful. So, watching the George Zimmerman trial, right, would you say that radicalized you a little bit?
Armen Henderson:
It radicalized me into feeling like I had to do more, but honestly, I was probably radicalized way before that in college when I was just very upset around the way I grew up in a neighborhood, and not really being able to put my finger on why all these things were happening to me, why I was a victim of gun violence, why I had guns in my face or why my community was so desecrated, why people in my neighborhood were suffering from lead poisoning, or going to jail, or their parents were addicted to cocaine and things of that nature. At first, I just thought maybe I was just unlucky about the way that I grew up. But then, I started actually researching the systems and the systemic racism that has to do with those systems.
Armen Henderson:
And so, I would say, at that point, it was just like I can't do anything else. Like, yeah, I want to be a doctor and I wanted to help people, but I just felt like it wasn't enough. You know, it wasn't enough for me to become a doctor, and then, work in a hospital. I felt there was a calling for me to do something more. And that calling was to be an organizer with Dream Defenders and to radicalize other medical professionals to do the same.
Shimon Cohen:
Yeah. I love it. I really do. You just said so much there, like when people grow up and the emphasis is on the individual, and there isn't that connection to the way these systems function, and you've made those connections. And now, you're putting alternative systems into place to address them. You know, what's the bigger vision for you here, and for this work?
Armen Henderson:
The vision is like advocacy through programming, like putting forth and advocating and encouraging local, state and federal policy that focuses heavily on those most impacted, and that's whether it be through COVID-19 in which I didn't know that we were going to have to respond to COVID-19 when we did, which led me to being arrested. But also, through resiliency, through environmental justice, through gun violence, and showing people that there's an alternative to the way that we've been told things should happen.
Armen Henderson:
Because it's one thing to say, "Oh, we should do these things," but it's another thing to actually put forth programs on a small level, and then show how, if I'm doing this with petty cash, we're doing this with little amounts of money, imagine what others can do with the platforms that they have, and really, encouraging people to do the right thing as a case for just humanity, like bringing the humanness amongst poor and working class people. Like we shouldn't be treating people this way, and here's an alternative way that we can go about doing things.
Shimon Cohen:
Yeah. Absolutely. I'm going to go back to something you said, because I don't think you can just say that you got arrested without saying a little bit more about that. People are going to be like, wait, what? For those who don't know about that story.
Armen Henderson:
Yeah. Well, first of all, this disaster relief team that we have, we have a coalition of networks that works together since Hurricane Irma, where we found that the government basically, and this is well-known from the National Advisory Council since Hurricane Katrina, the same responses to disasters that individuals face in poor and working class communities is minimal in comparison to other well to do communities. Like literally, all the money and funding that these federal and public organizations get, they usually only respond or respond the best to communities that really don't need it.
Armen Henderson:
And so, because of that, we put this disaster network together to respond to people during hurricanes. But what had happened was when the COVID-19 hit, it was sort of similar, like a similar disaster in which we knew that poor working class and unsheltered people were going to be the most affected. So, the coalition that we already had built, jumped into action and was responding to the unsheltered community in Miami-Dade County, which happens to be all Black and Brown men, majority of them.
Armen Henderson:
And so, while we were doing that, we started like a 12-hour shower site that was open every day for just for people to have access to testing, showers, washing their hands, clothing, toiletries, and things of that nature. We served hundreds of individuals every day. And through that, you know, I always say this is not some feel good thing where people are just going to come and like, oh, clap it up, we did a good job. It's like, no, this is fucked up. We shouldn't have to do this. This is the government's job.
Armen Henderson:
And so, we were calling a press conference basically with like 40 news organizations while we were giving out tents to individuals who were sleeping on the street because a lot of them were saying they have to walk miles to use the bathroom. And business owners were saying, oh, people are shitting in front of my store, and they weren't really understanding that these unsheltered people are being shut out everywhere else, and they didn't have a place to go. Like it was a third world country.
Armen Henderson:
And so, we were calling that out, but also, drawing connections to the fact that the one, the person, Ron Book who runs... he does own... because he's usurped the whole organization, he runs the Homeless Trust. He basically is also one of the most powerful lobbyists in the state of Florida. And he's also the lobbyist for the largest prison group, GEO Group in the country. And so, I thought, personally, that this was a conflict of interest. Like how can you be, you know, for the best interest of individuals that usually end up in jail and getting all the care that they need basically in jail, and you're knocking these individuals up.
Armen Henderson:
So, the day before, the morning before I was supposed to go and speak at this conference with Dream Defenders, a police officer pulled in front of my house, said I was littering. And then just put me in handcuffs. And that story basically spread around the world.
Shimon Cohen:
Yeah. I saw the video, and your wife had to come out, right? And show the officer that you actually lived there.
Armen Henderson:
Yeah. Yeah. So, it was... Yeah, my wife had to come out, she had to show the ID, was really trying to escalate it. You know what happens when Black people feel as though they've been wronged in front of the police, as soon as you start acting out, understandably so because who wants to be put in handcuffs in front of their house?
Shimon Cohen:
Right.
Armen Henderson:
Then, they use that as a justification for use of force. So, I already, we already know like the deal, so I was able to stay calm. But the interesting thing is that the police officer who arrested me, he had 12 use of force complaints, he had 12 civilian complaints, and he was promoted, and it just shows the type of corruption that goes on in the police department, which is actually being called out today.
Armen Henderson:
Our new police chief... Actually, the police chief stepped down. When we were calling out the corruption amongst the police chief, he stepped down, and now, we have this new police chief that just came in from Houston. And he actually submitted a report to the DOJ saying that the city of Miami is using, the commissioners are using the police force as their own personal, like army, taking out vendettas on people. And so, it just makes sense why these people who are creating these laws weaponized, basically, the police against me. And so, full circle, we're going to have this testimony around the criminalization of homelessness. And I'm going to call that out specifically. But yeah, a lot has been going on around that politically.
Shimon Cohen:
You know, you hit on so many issues in this work that all happen at the same time, right? You've got police violence and the system that's behind that. You've got health inequity, systemic racism. To bring it back to the community level in our conversation, what do you see as some of the biggest issues that are facing the communities you're working in like Liberty City, Overtown?
Armen Henderson:
I would say all the things related to social determinants of health, so there are no access to jobs that pay a livable wage, the housing is inadequate. The rent is too high. Mortgage prices are way too high. Liberty City and Overtown just happened to be like the highest elevations outside of Miami Beach within Miami. And so, the majority of people living there are Black and Brown, and yet, the houses being sold there do not reflect the amount, the income of individuals that live in those spaces. So, they're being pushed out.
Armen Henderson:
So gentrification, climate gentrification, regular gentrification, police violence, racism, all those things together, environmental injustice. It's so many things impacting the individuals that are living in the communities that we serve. There are not enough shelter beds. It's too hot outside for individuals to be even sleeping outside because the weather is getting hotter over the years. Individuals don't have access to quality healthcare. Florida was a state that didn't expand Medicaid. And so, poor people don't really get access to the proper healthcare that they need.
Armen Henderson:
So, it's so many things going on all at once. And they're all affecting people equally. And then, on top of that, disasters make those things... Disasters are a threat multiplier on those things as well. So, if a hurricane comes, it's like, oh, I didn't have no money before, now I definitely can't leave. So now, I got to stay and just bear out this hurricane. Sometimes, outside, or without hurricane impact windows or with a roof that is about to blow off. So, it's just so many things going on at once.
Shimon Cohen:
Yeah. And the interventions need to happen at multiple levels, like you were saying, that work one on one with folks, but then, also like the policy level. And I know one thing... I mean, you and I have started doing work together, so I just put that out there. But one thing we've been talking about is the response to these issues too have not always been, what's been best for the community either, right? We've talked about the way that government has responded to violence, for example, by increasing surveillance, increasing police force. And then, how that then connects back to violence and to the health within a community. Could you talk a little bit about that?
Armen Henderson:
Yeah. I mean, specifically with gun violence, I think the main concern is that impacted folks are not leading the conversations. You know, it's people who are able to woo local and state, federal governments who traditionally have been like White men who have access to the research and the institutions who are leading the work, and they don't know what's going on on the ground. And so, what we're calling for is for folks who are most impacted, folks that are on the ground experiencing the trauma to lead the work.
Armen Henderson:
And when you listen to those individuals, they say that since the police are one of the main causes of trauma in the community and are untrusted, then, why would you put all the services in the police department? And I think that that's echo not just here in Miami, but all across the country.
Shimon Cohen:
Absolutely. And these police budgets, I mean, I was shocked when I learned the size of the police budget here. I don't have the exact number off the top of my head, but I'm pretty sure it's-
Armen Henderson:
It's like a half a billion dollars.
Shimon Cohen:
It's a lot of money. Like the county alone, I think, was over 700 million. Right?
Armen Henderson:
Yeah.
Shimon Cohen:
So, how can folks who are listening get involved and support this work? I mean, there's going to be people who are listening across the country, some folks who are international, how can people, if what you're saying is resonating with folks, get connected, or start doing this work where they are?
Armen Henderson:
Yeah. I mean, it's so many causes that individuals can take up. And I would just say, definitely, get involved with people who are doing programming for individuals who are most impacted. So, that could be a social justice organiza... I mean, there's so many, social justice organizations. I would also say you should also do your research. A lot of these organizations are starting to pop up within the last year or so since the death of George Floyd, because they're monetizing, it's a lot of money around it. But go with trusted organizations who are doing real work. In particular, there are some national affiliates like the Poor People's Campaign and things of that nature, which I think really lead good work.
Armen Henderson:
I would also say unions, and those organizations that support working class individuals are also very, very good organizations. Any tenant rights organizations, I would say, are good. But I just... just to make sure you're doing your research and that people are not.. just writing grants to get the funding, and not actually doing the work. If you get involved with the organization that you see is not really doing what they say they're doing, or making the impact that you think they should, then, you should definitely speak up about that and bring those concerns to the forefront as well.
Armen Henderson:
And if you're in Miami, then, definitely get associated with Dream Defenders. I think moving forward, Dream Defenders is trying to figure out how to bridge the gap between other organizations that are national, and figure out how to take what we do outside of Florida on a larger scale. So definitely, look out for that as well. But, yeah, I would say those things, for sure.
Armen Henderson:
One of the things that we do with disaster actually is, you know... Like Hurricane Ida hit Louisiana. And so, in order for us to really respond to people in Louisiana and Mississippi, we had to identify organizations that were trusted organizations on the ground for us to support. And I think in that same manner, wherever you are, you got to do your research. Just don't support any organization.
Armen Henderson:
And also... I'm not sure if it's a good idea to actually start anything either, because there are so many organizations that are doing really good things. It's just a matter of doing your research.
Shimon Cohen:
Yeah. I know we don't have a lot more time left, but I wanted to just put it out there to you since you are on this platform. Is there anything else, you know, you want to use this opportunity to get into, to put out there?
Armen Henderson:
I would say... I mean, I don't know, there's so much going on. I'm hoping to really start to engage with the United Nations, soon. I know this documentary is coming out on October 12th, that followed a lot of the work that we were doing here in Miami called Convergence. And that's on October 12th on Netflix. And really, what it looks at is like a breakdown of governments and society, not just here in Miami, but they follow someone in Iran, in China, in Brazil. And it really looks at how governments were also failing individuals across the world.
Armen Henderson:
And so, these are not ideas that we're wrestling with that just affect us in the United States, these are things that foreign working class people are having to deal with across the world as well. So, being able to make those connections, I think, is good, and watching the documentary might be a start.
Shimon Cohen:
Yeah, for sure. And this'll go live in November, so folks listening, it's November, or maybe they're going to listen even after that. So by then, this'll already be out and people can check it out. One other thing I did want to ask you about before we go is just, it seems like there's been a growing, I don't want to say it's like new because it's not new. It's been happening for a while, but there's been a growing movement within medicine to address racism, and to address systemic oppression. Right? But there's also a lot of backlash to that that's still happening. Right?
Shimon Cohen:
I actually saw something yesterday that was this, someone at Yale writing about the problems with critical race theory in medicine and how doctors should just be practicing best medicine, period. And it was like, how can you practice best medicine if you don't address racism?
Armen Henderson:
Yeah. I was supposed to be writing a book that talks about that, but not just racism. There's a problem of racism in medicine, and there's also a problem of class in medicine as well. A lot of the physicians that graduate in med- or a lot of the training medical students that graduate in medical school, 80% of their parents are already doctors. So, there's this growing sentiment that of these White well-to-do doctors who are being graduated that are already of a certain class. And so, they just don't worry about what's going on outside of that.
Armen Henderson:
And so, one of the reasons why I'm doing what I'm doing is also to change the minds of medical students as well. For example, last weekend, we had a foot washing event where we were washing the feet of unsheltered people in Liberty City. And again, it was a call to action as well, because these are the people that we're supposed to be serving. And outside of that, teaching a class at University of Miami around climate change and environmental racism and drawing in connections there, and so, it just really takes for educators and physicians to be radical. And I want to set the example because I don't really see a lot of physicians that are really calling out the things that I am around race and class and things of that nature.
Armen Henderson:
The other thing that I think is important to mention is that there's a divide amongst physicians right now. Physicians 45 and over traditionally have become millionaires, very easily. They could open up practices and things of that nature. And they did very well for themselves. Those that are 40, 45 and under are in a massive amount of debt. And that debt is so crushing and so bad that the suicide rates and the drug use amongst physicians is astronomical, way more than what it is amongst the general population. There's high burnout. There is this competition amongst nurse practitioners who are replacing a lot of physicians in many fields.
Armen Henderson:
And in a way, it's like, oh, these things are happening in a vacuum, but I'm like, no, this is what capitalism does. This is the corporatization of medicine. And the same way in which they keep out working class individuals from moving up, now, they're just doing it generally to physicians. And so, I'm calling for physicians to unionize and to identify with working class people. And the best way to do that is to teach about the history of working class people through the lens of racism.
Armen Henderson:
And so, it really just is a dial, a readjustment, a retraining of physicians' minds about why these things are important to talk about. And I do it through this thing called social determinants of health in action, which is bringing people to these events, and signing them up for programming and saying, "Oh yeah, yeah, it felt good. Right? Yeah. Well, let's really talk about why we're here, and what this means in the grand scheme of things."
Armen Henderson:
And for the most part, I think I've been really successful in doing that here in Miami, but I hope to write about it and to spur a movement amongst medical professionals across the country as well.
Shimon Cohen:
Yeah, for sure. People need to know about the work you're doing, that's why I really wanted to get you on here. I know you're really busy. And so, even getting this little bit of your time was real important. I ask myself a lot like how you actually find the time to sleep. [mutual laughter]. Because I know you have so much going on, and you have a lot of stuff going on that I don't know about. But I feel really fortunate that our paths have crossed and that we're working on some projects together.
Armen Henderson:
Same.
Shimon Cohen:
Just feel super honored. And finally, feel like, after all these years living in Miami, I finally found my people, honestly, because it's been real challenge down here.
Armen Henderson:
For sure.
Shimon Cohen:
So, I wanted to just, again, thank you for coming on the podcast, and thank you for doin' the work in the community.
Armen Henderson:
No problem, man. Thank you for having me. And I'm looking forward to doing good work and to bragging about it, and showing people that there's a different way, and look what we're doing over here. There's no excuses.
Shimon Cohen:
Absolutely.
Armen Henderson:
Wonderful.
Shimon Cohen:
Thank you for listening to Doin' The Work: Frontline Stories of Social Change. I hope you enjoyed the podcast. Please follow on Twitter and leave positive reviews on iTunes. If you're interested in being a guest or know someone who's doing great work, please get in touch. Thank you for doing real work to make this world a better place.
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