Before Krystal Reyes packed up her life and moved halfway across the country to Tulsa, she didn’t have any connections to her new city — other than a love for Bob Dylan, whose archives are stored there.
Formerly a New York City public health official focused on child and family health, Reyes now oversees the health of an entire city as Tulsa’s chief resilience officer. Reyes is responsible for developing programs and policies that help Tulsans access the healthcare they need — and, on a big-picture level, help the city overcome historic racial inequities that lead to disparities in mental and physical health.
Not every city has a chief resilience officer, as the job itself is relatively new. In 2013, The Rockefeller Foundation implemented its “100 Resilient Cities” initiative. With the goal of increasing resilience to social, economic and health challenges, the initiative provided 100 US cities, including Tulsa, with the resources to create a CRO role.
We spoke with Reyes about how resilience affects wellbeing, how Tulsa is overcoming historic racial disparities in health, and how the pandemic has created an opportunity for her city and others to help people access the care they need.
TPG: How does a city’s resilience affect the health of its residents, and what role does a CRO play?
Reyes: Resilience helps individuals, organizations or whole cities survive, adapt and even thrive when they experience chronic stress or acute shock. When people are healthy and resilient, they can withstand difficulty. My dream as a CRO is that “resilience” is incorporated into all our decisions in Tulsa, because I really believe it’s the overarching lens of individual and public health.
Every city has a challenge to its resilience, and it’s our job as CROs to implement strategies that overcome these barriers. Tulsa’s primary resilience challenge is racial equity. Everything we do in our resilience strategy is rooted in making sure people have access to the information, tools and programs they need for health, no matter their race.
Healthcare alone isn’t enough. We need to have policies in place that help people actually access that healthcare.
This, of course, includes programs in our communities, but also our policies and practices as a city. Healthcare alone isn’t enough. We need to have policies in place that help people actually access that healthcare.
For example, in Tulsa, that means making sure we have linguistically accessible documents for everyone. The City of Tulsa translates every COVID-19 press conference into Spanish, Burmese and Zomi. We’ve also partnered with the Tulsa Health Department and community leaders to launch a communications campaign to increase public awareness amongst the Latinx community about COVID-19 prevention and testing, and what to do if you test positive.
Can you give an example of how you’re improving access to healthcare at a city level?
Community involvement is one of the most important parts of meeting needs in the city.
Right now, we’re working on implementing a community health worker program to build access to health and mental health services. Community health workers are paid employees who link those in their own communities with the care and services they need to be healthy. They speak the language, they know the culture and they have trusted relationships.
For example, there’s a big Burmese community here in Tulsa. A community health worker would be a Burmese resident who can help us identify what barriers stand in the way of healthcare access for these individuals.
How do racial inequities show up in Tulsa?
In Tulsa, racial inequity means that living in one zip code leads to a shorter life expectancy than living in another zip code. There’s an 11-year life expectancy gap between a zip code in North Tulsa, an area that’s predominantly African American, and a zip code in South Tulsa, which is mostly white. There are also disparities in rates of home ownership, addiction, reading scores and rates of child abuse, all of which impact public and individual health.
COVID-19 has definitely highlighted existing disparities in health outcomes due to race and ethnicity, but it’s also created an opportunity for us to overcome them as a city.
Many of these things are a direct result of structural racism, so [we need to work on] remedying the systems that created those inequities. For example, we regularly host Equity Dialogues, events that gather residents to normalize conversations about race and racism and encourage a more equitable city. It’s the start of a conversation that’s long overdue for a lot of cities. In Tulsa, we’re normalizing it and working to bring government, non-profit and business sectors together to tackle this inequality.
Practically, what are some of the most common barriers to healthcare, including mental healthcare, in Tulsa?
Language is one barrier, and it comes with many areas we need to fix. For example, there’s a need for bilingual and bicultural practitioners. But it’s not just about practitioners who speak other languages. We also need messengers and organizations who can help us get the word out that this care is available. In some communities, there are stigmas around mental health, so we need trusted allies to create an awareness around services that are available and covered by insurance.
We need better public education about mental health and wellbeing. Beyond that, we need to help people get access to the care they need.
Currently, there are significant transportation issues in Tulsa. Without a car, you can’t really get to places quickly here, which poses access problems for certain communities. We haven’t had a robust public transportation system. We’re working on improving it by creating a new, rapid transit bus line that runs along a busy corridor, where everyone is within a certain distance of a stop. It’s our job as CROs to make sure there are systems and policies in place that make these health tools as accessible as possible.
How has COVID-19 affected how you help people access healthcare?
I believe crisis can exacerbate inequities, but in resilient communities, it can help us overcome them. COVID-19 has definitely highlighted existing disparities in health outcomes due to race and ethnicity, but it’s also created an opportunity for us to overcome them as a city.
In Tulsa, we are seeing that for those who have existing conditions or are in poor health, COVID-19 will just impact them more. Looking at the prevalence of chronic diseases among our community, we know who will be more impacted by COVID. Latinos in Tulsa represent 14 percent of the population, but about 22 percent of the COVID cases. There’s also a disparity in Native American communities.
On top of highlighting what we already knew to be true, the pandemic is helping us figure out how to support the community. Right now, we’re working with health workers to identify common barriers to healthcare and testing access for communities with a higher incidence of COVID-19. Pinpointing these things will help us overcome other systemic barriers to care, so we can help these people to be healthier long-term.
What role do the city and community play in public health?
We as a city want to see everyone have a good quality of life — to have a good foundation for economic wellbeing and overall health and wellbeing. We want people to be able to access healthcare when they need it, in a way that’s culturally appropriate in a language they understand.
To make this happen, there has to be a holistic approach. Health isn’t purely individual. Yes, you can choose to not smoke and you can choose to exercise. But there are social determinants of health that have nothing to do with your choices. For example, choosing a healthy meal is easier when you have access to fresh food at a grocery store.
And we know not all people have equal access to nutritious food, because there are also structural determinants to health. For example, there may not be a grocery store in someone’s neighborhood because of inequitable housing policies. We have to address these things as cities — to give information to residents about how they can live healthier lives, to put policies and incentives in place to increase access to these amenities, and to change the policies that led to these inequities to begin with.
Right now, for example, we’re developing a policy that creates access to the internet for all residents. Especially during COVID-19, this has become a fundamental component to health that a lot of Tulsans don’t have access to.
Having someone dedicated to this work is important in any city. But this work can’t just be in one office and one system. We all have to work together to address the systems that surround people and create the choices that determine their overall health.