The Colorado Poverty and Health Initiative (COPHI), a growing collaboration among University of Colorado Anschutz faculty and community partners to understand and address the connection between conditions of poverty and various health concerns, is at the forefront of critical work aimed at improving health among some of the most vulnerable populations.
“As long as I’ve been a physician, the vast majority of the diseases that I’ve taken care of in people either arise from or are exacerbated by structural issues,” says initiative founding director Joshua Barocas, MD, professor of infectious diseases in the CU Anschutz Department of Medicine. “Diseases can put a person into a condition of instability as well. Addressing these issues is something that is fundamental to improving both individual and population level health.”
COPHI’s focus is on the whole picture: social conditions of poverty including incarceration, housing, transportation, and economic instability, and health conditions such as infectious diseases, general medicine, occupational and environmental health, childhood vaccines, immigrant health, and other epidemics. Looking at symptoms and root causes creates opportunities for the initiative to address everything from emergency medicine to surgery to public health.
Key players that make up COPHI’s team also include director of education Sarah Brewer, PhD, MPA; director of research Elizabeth Carlton, PhD, MPH; director of community impact Devin Miller, MPH, DrPH; Alyssa Haberle, MBA; and Sarah Staron, MPA. The initiative has an internal, on-campus advisory board and is forming an external strategic advisory committee with members from the community, ensuring that their vision aligns with both campus-wide work as well as the needs of Denver, Colorado, and the nation at large.
Barocas’ interest in creating the program stemmed from his work with syndemics, clusters of two or more concurrent health epidemics within a population. His research has always focused on how conditions of poverty feed a bidirectional pathway between disease and poverty. With support and direction from chair of the CU Anschutz Department of Medicine Vineet Chopra, MBBS, MD, MSc, and division head of infectious diseases Wendy Armstrong, MD, the idea for COPHI grew into an initiative with a synergistic approach to care, addressing a person and their health within a social and structural context.
“So often these issues around poverty are siloed from health, and our approach at COPHI is to un-silo them,” Barocas says.
Early wins for the program include a partnership with the Colorado School of Public Health to develop micro-credential programs focused on poverty and public health geared toward people on campus as well as those in local and state public health, focused primarily on community health workers and peer support specialists. COPHI’s Rapid Impact Projects to Inform Decision-making and Efficiency (RIPTIDE) funding program functions as an incubator for community-based programs in partnership with campus investigators and clinicians. They also have a National Institutes of Health (NIH)-funded research education program for early-stage clinician investigators that want to integrate homelessness into their research.
Another milestone in COPHI’s first year is opening applications for free membership. Whether it’s a community member looking for knowledge and awareness, faculty member on campus seeking specific mentorship, or an external professional with an active record of work related to poverty and health, Barocas and his team want to create a community where everyone feels like they have something to contribute.
Over the next months, COPHI and its leadership team are hoping to strengthen relationships with local public health agencies across multiple counties. They plan to continue developing a Breakfast and Learn series, currently hosted with the Colorado Coalition for the Homeless, where they provide current information on infectious diseases along with a meal. Future iterations of this series will expand to additional community-based organizations and federally qualified health centers.
Extending their work into the business and philanthropic communities is another priority coordinated to provide more scope and support for COPHI’s endeavors. The team wants to gather input from various sectors to properly help the community where they are most needed. Comprehensively, COPHI aims to lower the monetary and time restraints that often prevent academic institutions from making rapid and demonstrable change.
“We are all one missed paycheck away from housing instability, one big insurance bill away from economic instability, one disease away from social isolation,” Barocas says. “Our shared vulnerability is a reminder of our shared responsibility. We do this work because everyone deserves the opportunity to live with stability, health, and dignity. This is foundational to a thriving society.”