Working In Global Health: Tiffany Treviño

Growing up, Tiffany Treviño remembers struggling to breathe.

To doctors in her hometown of Kingsville, Texas, the problem was simply an infection—treatable with medication. But Treviño knew it was much deeper than that.

“In my town, many people live at or below the poverty line,” she says. “There’s pretty low college education rates and tons of health burden.”

In Kingsville, where 110-degree weather is a typical summer day, those inequities looked like houses with cheap insulation, forcing families to run air-conditioning units nonstop and causing mold to develop—mold that made breathing difficult and led to health conditions like asthma.

“Many of the physicians that we had were not from the area,” she recalls. “They were not versed in systemic inequities.”

For Treviño, who has since controlled her asthma, those days serve as a reminder of the health disparities she and so many others had to deal with, routinely—and what she’s now determined to change.

A Personal Connection

Treviño is a Learning and Impact associate with Partners In Health United States (PIH-US). Launched in May 2020, PIH-US grew out of PIH’s work in Massachusetts in response to COVID-19. That work has since expanded to several states, cities, and counties across the United States, focused on strengthening health systems through technical advising, a learning collaborative for public health professionals, and advocacy.

In her role, Treviño supports the Learning and Impact team, which provides resources for public health departments, community-based organizations, and health care organizations as they respond to the pandemic in their communities.

It is work that Treviño finds rewarding—and deeply personal.

As the daughter of an immigrant, she recalls the story of how her father’s family came to the U.S. from Mexico, because of a relative’s health condition.

“They all moved to the United States because my dad’s younger sister contracted polio while they were living in Mexico,” she says. “And they were really poor. I mean, like dirt poor.”

Galveston, where her father’s family relocated, offered the chance to start a new life—her relative was able to access treatment, and the family found some stability.

But quality health care was far from a guarantee—especially in Kingsville, where Treviño grew up.

Most doctors weren’t from the community. And, unlike many families in Kingsville, most hadn’t lived paycheck-to-paycheck, skipped meals to save money, or had the lights shut off over an unpaid bill. And few spoke Spanish—a language spoken at home by 38% of residents.

“I feel like the doctors and the health care system in general tended to overlook those things, despite living in an area that is over 70% Hispanic and where many people lived at or below the poverty threshold,” says Treviño.

Asthma—though often tied to systemic inequities—was treated as an infection. Obesity—though often connected to poverty and food deserts—was pegged to poor lifestyle choices.

As she watched clinics with revolving doors of patients, their health needs never fully met, Treviño knew something had to change—an instinct that led her to a career in public health and, ultimately, PIH.

A Passion for Public Health

It was in a grad school classroom that Treviño was able to put words to some of the things she had seen growing up—situations where single moms working two jobs and feeding their kids fast food, because it was all they could afford or had time to prepare, were now understood through the lens of academic concepts like the “double death.” New to Treviño, it was a term one of her professors used to describe malnutrition among patients living in poverty: how some were too poor to eat and others could only afford unhealthy foods.

Learning about the cycle of poverty and related poor health outcomes helped Treviño understand the systemic inequities behind the health disparities she had grown up around—ultimately fueling her drive to change them. As she worked toward her master’s in public health from the University of Otago in New Zealand, Treviño knew she wanted to pursue a career focused on health equity—a decision that led her to PIH.

Now, just months later, she is an integral part of her team, supporting public health professionals nationwide in accessing the resources they need, amid a fast-moving pandemic. It is work that inspires her. Though the cities in her day-to-day projects are varied, the work—with local communities—often reminds her of home.

“I think of it from a small-town perspective,” she says. “Whenever I think about the work I’m doing, I’m like, ‘Okay, what would it take for me to do this kind of work in my town?’”

Kingsville comes to mind in other ways, too.

PIH-US works in several communities, from Immokalee, Fla., to Pima County, Ariz., with significant Hispanic and Latinx populations—a cultural identity that, while vastly different depending on location, is familiar to Treviño.

“There’s this community feel that the Latinx community has,” she says. “We trust our families. We trust our friends. We trust our people. We’re very tight knit...I feel like public health workers, whether they’re from that area or from the outside looking in, need to understand that.”

That cultural understanding has been critical amid the COVID-19 response, as Hispanic and Latinx communities in the U.S. have been disproportionately impacted by the pandemic due to decades of systemic racism, xenophobia, and inequities in the health care system.

As a Latina public health professional, Treviño is determined to call attention to these systemic inequities—and find solutions.

One of those solutions, she says, involves a program at the heart of PIH’s approach, both in the U.S. and worldwide: community health workers.

Community health workers are recruited from the communities they serve and trained to provide basic health services, such as medications or screenings, to patients at home. Since hiring its first community health workers in Haiti nearly three decades ago, PIH has built a workforce of nearly 11,400 community health workers worldwide—delivering care to thousands of patients, when and where they need it most.

“I feel like community health workers, specifically, are like the golden key right now,” says Treviño. “There’s a need for public health organizations to utilize their community health workers—the people who are doing the groundwork, who can speak the language and that know the culture—to just get the work done.”

For Treviño, the impact of community health workers resonates more than anything learned through a class lecture or textbook reading—it’s a concept she can understand on a personal level.

“My abuela and my abuelo are not going to understand what my white supervisor is saying,” she says. “But they will understand what I’m saying, both as their granddaughter and as a member of the community—as a member of the Hispanic, Latinx community.”