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Environmental Health is Changing Health Care for Women

Published on December 8, 2020

As a board certified Women’s Health Nurse Practitioner (WHNP-BC) and attorney, Sue Kendig has combined her passion for public health and the law with her goal of improving health care.

A Nurse with a Law Degree

Kendig’s nursing career, spanning four decades, has focused on women’s health providing care before, during and between pregnancies, addressing women's gynecologic issues and on pretty much any issue that affects women, she said. She also has a special interest in women’s mental health.

She has practiced in hospitals and clinics, always working in public health, along the way earning a law degree from the University of Missouri (MU) School of Law.

Earning a law degree, dovetails with her work in public health, women's, and population health. She has also coordinated clinics for women who were pregnant and had substance use disorder, assisted pregnant and parenting teenagers and then she developed a specialty clinic for women who had physical disabilities needing women's health care. She had noticed working in the  communities and with community partners they had issues with people not having access to the care they needed or there may have been a good program that was grant funded. When the grant eventually went away, so did the program.

There have been a lot of barriers placed on access to health care and assuring it was safe. “So, I decided I would fix health care before I died and felt that obtaining a law degree would help me to do that.” she said. “Going to law school was truly the best thing I have ever done. I am so glad I did.” Her law degree allowed her to understand how laws are made, how to read and understand statutes and regulations, important skills in addressing health related policies.

Her WHNP and public health experience allowed her to look at what those laws and regulations actually mean on the ground and how they affect the reality of people's lives. This turned out to be a powerful combination. Her career has focused on policy and strategy in terms of how to partner with communities, patients, clinicians, and health systems to build the best health care system they can.

“Having a law degree has been extremely helpful because it helps me better understand the law by looking at the intent of the law, through the language of the law,” she said. For example, she explained, “if a bill or policies are written, we can look at that language and consider, does this really meet the intent of what our policymakers are trying to do? Is there better language they can use to convey what they need to say? The flip side of that is, whenever I look at policies or statutes as a clinician throughout the policy making process, I ask myself, how will this affect women's health and health care for women? Since my specialty is women's health.”

She looks at the effect of healthcare for women through an equity lens and the many health care disparities she feels exist. “When drafting policies or thinking about strategies that are going to impact health, we need to consider health in all policies, because basically everything we do impacts health. We know that there are disparities  in outcomes as we have certain populations that don't have access to care, or even if care is available, the system may not work equally well for everyone. 

“Maternal mortality or deaths during pregnancy through the first year postpartum is something that I've spent a lot of time working on. We know that black, American Indian and Alaska Native women, experience maternal mortality at much higher rates, three to four times the rate of their white counterparts. We have to look at how we create systems and supports that work equally well for everyone, so that we can mitigate that risk, and we can close that disparities gap. We want everybody to be doing well. So, when I'm looking at policy, I think about those women's health questions. I also think about who's advantaged and who's disadvantaged? Are we inadvertently setting something up that is maybe going to have a downstream effect that nobody's thought about, and if there is a disadvantage or an advantage to specific groups? If so, how do we mitigate that difference so that we are creating systems that work equally well for everyone?” she said.

 As a women’s health nurse practitioner and a lawyer her special interest has been looking at factors that affect overall health, with an emphasis on helping people to stay healthy. Prevention has always been a part of public health; her secondary interest is access to health care through creating equitable systems of care.

When people think about access to health care, they think about going to the hospital or a clinic, which is extremely important, but there are a lot of factors that affect health. We need to think about how people can access all of the services in a community that they need including transportation,  or addressing nutrition when they live in a food desert without access to healthy foods, she said.

Evolving Interests

Her interests are how to create systems of care that touch all those elements of health and importantly figuring out a way to pay for it so that it’s sustainable. Recently, she has been leaning more about how environmental health impacts health, specifically maternal and child health, and where that fits into the bigger picture of maternal mortality and system change.

Environmental health has become a new language for her to learn. She’s read research that has been published from around the world, about “the effects of pollutants, climate change, and so forth, on maternal health is really a bellwether for what health is going to look like, not only for that woman later in her life, but also for future generations,” she said. “My interests are how do we establish the trust of the public and trust in science so people will be armed with the information they need to make decisions about environmental factors, both in their community and in their individual lives? And then how do we craft policy that supports environmental health?” she said.

Serving as the Director of Policy for the National Association of Nurse Practitioners in Women's Health's (NPWH) exposed her to a lot of the issues, giving her the opportunity to work on national policies and national programs targeting maternal health, as well as the broad scope of women's health.

“This is where the marriage of my background in women’s health nursing and law came to bear, she said. Within that role, she works with many interdisciplinary groups that are working on a variety of issues across women's health, but for the past five years, the emphasis has really been on maternal mortality, because the country has figured out that women are dying during pregnancy and postpartum and it's a problem, she said. A subset of those meetings are around environmental health, women's health, and maternal child health.

In Washington, D.C. the NPWH is a partner organization that works with a nursing coalition dedicated to environmental health. Within that framework, she is working with them to elevate this issue.  

Changing Health Care for Women

Kendig said she's been “really lucky” in her career. She learns about most things by saying yes to everything, because everything is exciting, and it gives her a lot of opportunities. “I just don't want to miss anything. When I look back at everything that I've done over my career. I've had really good opportunities and really good experiences and had I not said yes, I probably wouldn't have had as much fun and as much flexibility as I've had,” she said.

The national work she is currently engaged with is probably her favorite thing she has done. “There is such an opportunity to touch not only women's lives but to touch people's lives in a positive way, and to really provide input into policy and programs and initiatives that can be meaningful since she gets to look at them from both that clinical and that policy lens,” she said.

“I think the things that are most satisfying to me, is when I have the conversations with policymakers or when I have the conversations with stakeholders and we're able to help them really craft something that is going to truly make a difference in terms of improving health,” she said. Her work doesn’t feel like a job. She is excited about the environmental work that is just emerging, it’s quickly becoming one of her favorite parts of her career that includes the Women's Preventive Services Initiative (WPSI). “It’s changing health care for women and helping them to get the services they need. So, I think those two things right now are my favorite,” she said.

Public Health is in Good Hands

She continues sharing her knowledge as a consultant to the Missouri Foundation for Health (MFFH) for the past 10 years, most recently on their infant mortality reduction initiative. They utilize her as a subject matter expert in maternal child health along with being a professor.

This semester she was an adjunct professor teaching  the foundational maternal child health course for the graduate level Masters in Public Health (MPH) students, a specialty course for the School of Public Health and Social Justice (SPHSJ) at St. Louis University (SLU). She was asked to teach due to her experience of teaching in directing the Women’s Health Nurse Practitioner program at the University of Missouri – St. Louis (UMSL) College of Nursing for almost 20 years, as well as her experience working with many of the departments. Teaching this class was an extension of bringing that public health and policy background to the table. Every time she teaches, she feels like the students are so much smarter than she is, and they have done incredible and amazing things. Sometimes, she thinks, “you know, why am I here? The students, our future public health professionals, are just so amazing. So, I feel like we're in good hands with public health.”

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