TBA

           New SNA Leadership Announced!

BASTYR

The Importance of a Public Health Perspective

Interview with Rebecca Finkel

​By Mirit Markowitz

I was 19 when I met Rebecca Finkel at university Jewish Community Center I worked at part time. I cannot remember the first time we talked, but both of us being loud, boisterous, social justice loving Jews we always chatted as if we knew each other our whole lives. At the time she was at Bastyr finishing the MSN-DPD track and I was busy trying to finish undergrad. Her legacy at Bastyr includes starting both the Teen Feed team and Top Chef charity event to the SNA’s mission.  Today, Rebecca works at Odessa Brown Children’s Clinic in the Central District of Seattle and has a strong legacy of overlapping her Jewish values of giving back to the world, social justice, and nutrition. 

Mirit Markowtiz: Rebecca Finkel, it's so nice to see you again.

Rebecca Finkel: Thank you.

MM: Let the conversation continue. Just tell us a little bit about yourself, Rebecca, and how you came to nutrition.

RF: Okay. I am a New York Jew. I came to nutrition by a very circuitous route. I was heading in the path of becoming a film professor. I was in an MA program at Tisch at NYU studying film, and was dealing with a lot of my own health issues at the time. I found that they were causing tremendous stress and my health was suffering. When I finished my Masters, I decided I was not going to go to PhD, but that I really needed to take care of myself and spend some time traveling around Israel, like many Jews are prone to do when they are searching. I ended up taking a job, primarily for the health insurance. I realized that was a problem. I didn't have health insurance when I was done with school, and needed a job for the health insurance. During [this time] I also spent that time seeking out remedies and ways that I could care for myself better. I ended up with an integrative physician who led me to an integrative dietitian.

I saw that there were other ways to approach health. I had worked with about five dietitians in New York over maybe seven years of dealing with my own health problems, and found many of them were - some of them were more effective than others, but I just really connected with the more integrative approach. I wanted to learn more, really, for myself, and decided to go back to school in order to do that and then make a career out of it. I thought, "This will be something where I will hopefully gain the tools to both care for myself and give others the tools to do the same." It was selfish in nature.

MM: Is that how you ended up at Bastyr, is this more integrative idea around nutrition and how to care for yourself and things like that?

RF: Yeah. I think I really wanted to learn more about food. I wanted to approach nutrition from through a food lens. I had a friend in New York who graduated from the Natural Gourmet. She was a chef, but again, her lens into food was looking at it therapeutically. I wanted to do that without going to culinary school. I was talking with her casually over dinner about if she knew any nutrition programs that offered, for lack of a better word, a more holistic approach. I was also looking for something where I could gain credentials that would be recognized and allow me to actually work with the general public and not just with those who are more prone to alternative medicine.

MM: You started Top Chef and Teen Feed and all these great things that are all so well-known. Can you talk a little bit about how you got into those activities when you were at school, and what led you to them?

RF: Sure. While I was at Bastyr, I was also just trying to get more acquainted with Seattle and with the food and nutrition scene in Seattle. Not so much the food scene as a foodie. I'm not at all a foodie, but there's just great food here in general. Learning a little bit more about the landscape, about the communities that are here and also, as part of the requirement for volunteer hours for the program, I ended up volunteering for the Cooking Matters program through Solid Ground. I worked with many different communities through that program. Then, through the University of Washington's Jconnect program, I just started volunteering with Teen Feed there. I really enjoyed it. It just seemed like such an obvious way for my classmates, who were so passionate about food and health and feeding people, to really offer that. Also, to enable them to be out in the community and really see some of the needs that are right in front of our eyes in Seattle on a regular basis, and get more in touch outside of that Bastyr bubble.

It was a merging of those two things. There was so much knowledge and passion around food at Bastyr, and I just wanted to bring that excitement and that intention into providing these warm, delicious, nutritious meals and allowing for interaction around that food. Not just being in the kitchen but also coming out and serving it and sitting with the teens who were coming on a regular basis.

MM: When did social justice, for you, become an interest? How does that intersect with your food journey and your own healing that happened around that?

RF: I wish I could point to something really profound and say, "That's when it started."

MM: Tikkun olam? (Jewish value central to religion, translates to “heal the world,” or a dedication to social justice and service.)

RF: Actually, for me, I was raised with the concept of Tikkun olam, but it wasn't a really formative one. I think, in the Orthodox community, there's an emphasis on chesed and kindness and serving others, but not in the same framing as some of the other denominations, if you want to call it, of Judaism where there's really that emphasis on going outward, Tikkun olam. I just found a real sense of peace and satisfaction when I was working outside of my community, learning about other people, and that it was restorative for me personally. Some of my early service projects…I felt nourished by them in some ways. I think my interest began to grow. I just saw the inequities, and that it's not just an issue of access, but really deeply-rooted injustices that perpetuate poverty that perpetuate our system, racism, just ongoing oppressions.

Seattle is interesting because it's so segregated. Coming from New York City, there are certainly tremendous disparities in wealth, but everyone rides the subway together. You may live in the same borough and regularly interact with people of different races, religions, ethnicities on a regular basis. In some ways, that might make you more insular in your private life, potentially, but there's just something about having that diversity in your daily interactions that was a really stark difference when I moved here and I moved to North Seattle and felt really disconnected from that. I think part of it, for me, was also, I come from a place where there are all walks of life. I missed that. I was excited when I started to gain access to other communities and have meaningful interactions with them. It wasn't necessarily under the guise of social justice. I wasn't out to be a crusader. I was really filling in what felt like it should be normal life.

MM: It sounds like social justice for you was not: you come in, you were an activist trying to create change. You just saw that you were seeking in yourself, much like when you got to Bastyr, you were seeking your own healing. You were seeking more interaction with other communities, and then noticing what was going on in those communities as far as their needs and food needs?

RF: Yeah, I think so. Again, spending part of my days at Bastyr, which geographically is isolated, and then ideologically...has the bubble. I wanted to bring down some of that from the ivory tower, to both take my classmates out of that context and bring them down into the community, and also bring some of the messaging. Not to be didactic, but to bring some of the passion for food and maybe direct it toward service.

MM: Then, you ended up going into an internship that was more community-based, and ended up at your position now at the Odessa Clinic. I'm wondering if you could talk a little bit about the work you do now and the community you serve, and things like that.

RF: I work as the (I call myself the nutritionist and other folks do as well) the nutritionist at Odessa Brown Children's Clinic. Odessa Brown is a community clinic of Seattle Children's Hospital. We provide primary care along with dental and mental and behavioral health services to all families, regardless of their ability to pay. Historically, the clinic was founded for the African-American community within this Central district. That's where it still is located today, but we serve families from not only all over King County, but even far beyond that. It's very much a community clinic where we have multiple generations of patients. We'll see parents who come in who went to the clinic as kids. Now, we're seeing a lot of refugee and immigrant families coming in. The clinic is just really a warm and a safe and supportive place where families' entire needs are considered. Everything from transportation and housing to food security, and really thinking about not just the child who is the patient, but everything about their health and how that is dependent on their situation in their home and in their community. It takes that into consideration. We have medical legal partnerships that assist families as well.

MM: How is this experience for you, at this clinic, different from your experience at Bastyr? That might sound really obvious, but even in small and large details, what have you noticed as far as the difference in service and needs and approaches, ways to approach nutrition? What's it look like?

RF: I remember when I was being interviewed, and I was asked what I would say if a family asked me if they had to eat organic. That, to me, symbolized one of those things. I'm coming from Bastyr. Surely, organics or sustainability, those considerations are going to be my primary drivers or some of the high priorities when I work with families. What I said at the time and what I still think today is that if a family asks me about organics, I'm never going to tell them what to do. I can give them information about it. I can give them information about the ways in which our food system disrupts our environment, the way it disrupts our bodies' environment and ecosystem and the impact that pesticides can have. I can describe the differences and point them to the Dirty Dozen list and say, "There are certain foods that are more likely than others to raise pesticide levels." I can also say, "This doesn't mean that you need to choose organics. This doesn't mean this is information that is for you."

What does it mean, then, that that food is more expensive and that it's prohibitive, and that most families can't afford that? That points out an injustice in our food system. I don't think I have to hide that from any of the families I work with. They experience that firsthand every day. In all honesty, it's not a question I get very frequently. When I do, it is usually out of outreach where families say, "How come organic is so expensive? How come I can't afford that? How come I go to PCC and it's really beautiful and Whole Foods and it's really beautiful, and I can't shop that way every day for my family, and I want to?" I don't think we have to hide from those conversations. Rather than saying, "This is, it's a moral obligation to eat this way," it's more of a, "What does it mean that we can't all eat this way?"

The other aspect of it that I encounter that is different is the aspect of working in pediatrics. Really focusing on family health in a way that I was not prepared by my education. That's not just a gap at Bastyr per se, but it's not a requirement of a general nutrition degree to go and study family systems and family counseling. Other than the basics of life cycle nutrition, I definitely needed a real primer on child development and on family interactions and on understanding how to speak with families when just the child is the patient but the whole family dynamic has to be assessed. There are many levels in which my work is very different than it was at Bastyr. Those are some of the more glaring examples.

MM: To refer back to some of the things about organic not being accessible and having that come up as a conversation, something that you and I have talked about is this idea of you're serving this mostly black population here in Seattle. You're a white practitioner. What are some examples of the issues that are coming up in terms of power dynamics that might come up in the room, but then also, organic being an example that you brought up. The way that our education is basically made for people who can’t afford it. That can mean poor people of all nationalities, ethnicities, backgrounds, immigrants, refugees, everyone except this small group of highly affluent middle class white northern Seattle people. That's a big question, but anything that might come to mind around that?

RF: Right when I started, I contacted Solid Ground because they take anti-racist approach and really look at the root causes of poverty. I asked them how their staff does their training to work with communities in need and communities of color. They told me about the People's Institute training. I decided that I was going to do that. I took that on as my own obligation, as a prerequisite to my job. It wasn't actually required, but it seemed like, in order for me to really understand, like you were saying, what are those power dynamics, what does it mean for me as a white woman to be in a room giving medical advice to a poor minority population? What does that mean?

I went to the training. I don't think I expected it to really have the power that it did, but it forced me every single time I was in the room with a family to understand that there were a lot of dynamics that were at play that were bigger than me, that were outside of me, that were outside of us. As much as possible, to just know that they're there and to take every opportunity to get to know a family, get to know an individual, a patient, a parent and their experience, and to spend as much time building rapport as possible, knowing that that's not going to in any way even the playing field, but it might give me a greater lens into what's really going on here and to gain their trust. They have every reason not to trust me. I understood that. I think that's how it started. That's how I started. It's something I think about and I talk about with colleagues, and I still try to understand and unpack.

I work with a lot of medical interpreters. That introduces another level of challenge. They're a tremendous resource, and yet also a barrier, too, in some ways. Making sure that my language is clear and it's made me really cognizant of even just some idioms and regionalisms, coming from the Northeast, and just the way that I speak, trying to be as clear as possible and trying to learn a lot from the families I work with. Whether it's about their individual Ramadan practices - if they are observing - and not to assume that if they're observing, they're observing it the same way that another family is or that I understand it to be. Getting to know what their cultural foods are and when they refer to 'our foods', which foods? Even for myself, to learn more about those, and when I can, go to some restaurants and try to eat foods that are unfamiliar and learn what they are. That's challenging for me, because I keep kosher. It's challenging for me on many levels, but I hope that it also makes me a better dietitian.

MM: Just touching on some of the stuff we talked about, this idea of access, this idea of culturally being in the room, noticing the dynamics and the differences, and things like that. Now that you've had this experience, you've gone to Bastyr. You now have been working at this clinic with a completely different population for the last how many years?

RF: This is my third year there.

MM: Yeah. Then if we can take an even broader lens and just look at nutrition as a field, as a whole, have you noticed any discrepancies? What are things you've noticed or things you'd like to see, and some stuff you think we could all be working on, just based on these experiences you've had as this professional working for a while?

RF: A lot of things, I would definitely love to see more diversity. That's diversity in every way. That's diversity of gender, diversity of race, diversity of size within the field. I think that would bring a tremendous, not just, I think that it would serve the public better. I'm not thinking we need diversity because it's good to be diverse and it's good to have different faces in the room and bodies in the room and perspectives in the room. That's true, but I think that there are tremendous missed opportunities. I think there's a lot of messaging that can be heard better from other people than, I know, for example, or I often feel that I may be the one delivering this class right now, but I'm probably not the best one. I'm the best out of what there is right here and right now, and I'm going to do my best job, but there's probably someone who will connect better with this audience. I will do my best to do that, and to prepare in every which way that I can.

It's not about me, ultimately. What I hope to do is, as much as possible, to fade into the background and to be there as a guide, as a facilitator, but ultimately, a lot of families are looking to me as an expert. They're coming to me as a medical professional. I would love to see just a wider array of colleagues to refer to, because just like with therapists, it's not a shortcoming to say that you don't connect with every client. That's just reality. That's temperament. That's tone. There's a lot that can happen in a therapy session. You try it out and see, is this someone I can work with? I feel like the same is true or should be true with nutrition. Just because this is the person at the clinic or the person may not mean they're the right one for you. I would like to have that kind of, that range.

MM: Wider network, yes.

RF: Within a network to say, "Maybe we didn't click and we didn't work for whatever reason." That could be so many different things, but I would love to have more variety of choices, more variety of styles of experience and backgrounds. I think that enriches the field and the work and provides just better care to the families and patients.

MM: To have more people in different communities engaged in our field probably would do nothing but enrich the field for all of us, it sounds like, as far as having that network of people to be able to go to, as well.

RF: Yeah, I think there are a lot of barriers. I think that it's not so simple. I'm a dietitian. While the Academy might kick me out for saying it, I don't think every nutrition professional has to be a dietitian or should be a dietitian. There is a tremendous amount of work that can be done by someone who has a degree in nutrition and does not go those next steps. The cost, the ability. Is it locked up?

MM: Tell me more.

RF: Okay. The ability of someone to pay for a program in nutrition, to live a year as an intern without an income and to pay for that program, I just don't think that's realistic. That sets up tremendous, tremendous barriers. To even get an internship now is so competitive. I don't see that as the answer, but I do think that the community, I think that nutrition as a field, and it does have certain pockets, certainly. There are practice groups within the Academy that are composed of certain specific religious groups and ethnic groups, but I think we're still a far, long way from where we could be. I think it would just make a world of a difference.

I think size is also an underestimated factor. I'm very aware of my body when I'm in a nutrition visit with families, of my size. That became even more pronounced when I became pregnant, because it became okay to comment on my size. I heard a lot of comments that people maybe think lots of comments about bodies all the time, but it's only appropriate to suddenly make them when a woman is pregnant. It made me very aware of my body when I returned after pregnancy and got more comments, because it's okay after pregnancy as well. Just thinking about that, I think there are a lot of assumptions about weight and size that, they're just implicit in nutrition and in nutrition visits and in nutrition goals. I don't think they have to be. I don't think they should be. Nutrition and eating well to support your health, to support your functioning, to optimize your quality of life, does not have to be tied in any way to the size of your body or the number on a scale. I think there's an opportunity there, as well, to normalize a variety of sizes.

MM: I feel like every time I read about [the nutrition field], it's comforting and not. "You're going to have a job forever." This idea of, every time you read a study, the diabetes statistics are worse than they were the last time you read it in our country. The heart disease statistics are worse than the last time you read about. There's some disconnect. As nutritionists, this is all we're talking about day in, day out. This is all we're addressing is these statistics getting worse and worse and worse. Yet, the change isn't happening or it is happening but at a slower rate than we would like. What would you say in your opinion, based on your experience, is the disconnect? Where does that come from?

RF: I think that's a great question. There are a lot of levels there. One level of disconnect seems to be that, for some reason, in this country, we're fixated on this idea that if you know something, you will act accordingly. That makes no sense, because we've never seen that to be the case. I know that smoking causes lung cancer. That was not the campaign that successfully got people to stop smoking. I am a big fan of Public Health, but I think Public Health has also come a long way from saying that if you know that eating certain foods is more likely to cause heart disease, that people are necessarily going to make those changes. We all know eating is very different than smoking, because you can't stop eating. Eating is tied to so much emotionally. It's tied to so much culturally. There are so many levels. I think one big mistake is that if we get more information out there, people are going to change their behaviors.

I think that a backlash or an unintended consequence of the focus on nutrition, is that it has caused more disordered eating. We have also seen a rise in the diet industry, sending a lot of mixed messages that leads people to do all sorts of crazy diets, and then get into a cycle of diet, success, weight gain, failure, weight gain back more. They get caught in that trap, and also in that way of thinking that foods are good or bad, or I am good or bad, or that there's a morality tied up in the way that I eat. That, I think, causes a lot of stress and a lot of confusion. Beyond that, I think that there's also just this huge focus on food, good or bad and obesity causing chronic disease without looking at a lot of other underlying factors, the racial disparities, the health disparities caused by all the stressors, the strain on people and their resources.

Giving people more information is not necessarily going to undo and won't undo some of the other really huge risk factors that really set them up for chronic disease. There's a lot of interesting work, looking at birth weights among different races and how much that correlates with racism and internalized racism and stress. So much of health now and nutrition also has a lot of environmental, genetic and other factors that are still being looked at in the research. I think there's also just a lot more to unpack to really understand what we're looking at with the chronic disease, the increase with chronic disease all over. Again, which populations are we seeing it in and what else is going on there? Is it just about education? Is it just about getting more information, or is it even just about giving more food stamps? I don't think that's the solution either.

MM: Sometimes, I wonder if it's actually us that needs to be more educated instead of the other way around.

RF: I think, oftentimes, that is the case. One of the reasons that I became really interested in the social justice aspect of nutrition in particular was that when I started to work with and even volunteering with communities where I understood that the cost of food, the time to prepare it, the access to it at all was so prohibitive that, how could I even make recommendations? How could I even suggest, "Just move to a whole-foods plant-based diet, primarily organic, if possible, and made from scratch every day?" That just seemed completely up in the sky, out of reach. I think anyone working in nutrition who believes that the best way to feed yourself is to do so on this kind of diet has to then question, how can we say that if most of the people you're going to work with or many people in our society, this is completely out of bounds. This is not even in the realm of possibility. I think that's where it has to be built in. It demands that.

MM: Our education?

RF: I think there has to be some component. There has to be really creative thinking. I don't think the solutions that are out there or the resources that are out there, they're not adequate. They don't address all of the different ways in which our current food system or political system, our economics, everything impacts it.

MM: I think that all practitioners are going to have to head this way eventually, but especially nutritionists. It's the first health field I've really noticed where you need to be both a public health expert and a clinician, so you need to understand the macro and the micro. The old model of thinking is, “the clinicians are the clinicians, and the public health officials are the public health officials.” They're separated, when [in reality] they're not separated at all, especially in the work that we do.

RF: I will say, I think that nutritionists and dietitians that I've met are extremely resilient and resourceful. Despite maybe some lack of preparedness in their training, have come up with some really creative ways, have partnered. Those that are most successful have partnered with local agencies, with local leaders and have figured out ways to make inroads in those communities and to do it in an appropriate way. I think the field of nutrition struggled for a really long time for legitimacy in the medical field. That may be why, in the training and now, just a lot of the emphasis became, "We're clinicians", when actually, so much of it is also the behavioral health component, which I know is a strong part of your training, but not in a traditional didactic program, not as much. The behavioral health component, the Public Health component, all of those really need to be in sync. Then there's also just the general family stuff and other things that I mentioned.

MM: It has been really awesome to talk to you. Thank you so much.

RF: Thank you.



Resources:

Odessa Brown Children’s Hospital Clinic

The People’s Institute for Survival and Beyond - Undoing Racism

 Next Teen Feed:


Friday, May 26th

​5-8:15pm

sna

Next  Meeting:

student nutrition association