Ask for What You Need with Dr. Larissa Estes White (#IncludingYouPodcast)

Including You Interview with Dr. Larissa Estes White

Full Interview Transcript

[00:00:35] Amy: Welcome back to Including You. I’m Amy C. Waninger, the Inclusion Catalyst. My guest today is Dr. Larisa Estes White. She is the Executive Director of All In, Alameda County, California. Since 2014, all In has been a strong and innovative force addressing issues of poverty through collaboration across sectors and within community

[00:00:56] Amy: All In serves 1.6 million county residents with a staff of just three full-time employees. Dr. Estes White, welcome to the show.

[00:01:06] Dr. Estes White: Thank you so much, Amy. Glad to be here.

[00:01:09] Amy: I’m so glad to talk to you because the scope of your work is so large and at the same time, so focused. And a little bit different than a lot of the other guests we’ve had. So, can we just start with why? Is inclusion so important to the work you do at All In?

[00:01:27] Dr. Estes White: Thank you for that, Amy.

[00:01:30] Amy: Sorry, go ahead. I meant to mute.

[00:01:34] Dr. Estes White: Inclusion is critical. With inclusion and the populations that we work with. So, we work with low-income residents in Alameda County. So, amongst those 1.6 million residents the data says that only 9.3 are actually low income.

[00:01:48] Dr. Estes White: But when you tease the data part and you start to look at concentrations of poverty, where those are located, they tend to be in low income communities of color that have been disproportionately impacted by racist policies and practices implemented by government and other sectors. And inclusion becomes very important—one, because the disproportionate disparities that these communities experience…

[00:02:14] Dr. Estes White: Wasn’t done overnight, it was done over time with many different policies and practices. We all often start with redlining, is one of them. And the other side of inclusion. So, you have to be inclusive as to who you work with in so in creating the solutions, but you also have to include the community.

[00:02:31] Dr. Estes White: And it’s really critical to be inclusive of the community, one, because they’re the closest to the challenges that they experience. They also have, often, the true solutions. And so, it’s really critical and important that you embed and work with community throughout the process of designing innovative strategies to address poverty.

[00:2:52] Amy: This notion of including in the community that you serve, I think, is so important. A lot of times when I talk to people in government sectors or non-for-profits, they’re very focused on, assembling boards that come from outside the community that they serve, right? Because the boards are typically the people with the money, the people with access to the funds, the fundraising experience and potential and…

[00:3:15] Amy: …when we don’t include the people who are actually trying to help, we often miss the mark. Have you found that to be true, that you’ll put together a solution that does not meet someone’s needs or there’s just too many barriers even to access the solution?

[00:03:28] Dr. Estes White: Not in my own experience, but I have seen what happens when you do that and, all in, we actually have a 37-member steering committee. Two of them are elected officials. Five of them are actually community residents representing each district across the county. Then the rest are a variety of nonprofit agency leaders.

[00:03:47] Dr. Estes White: And so, we do have a nice smorgasbord of representation and wanting to create a space where community feels safe to bring their concerns to challenge agencies.

[00:03:58] Dr. Estes White: In the experiences that I’ve seen or been witnessed to or have heard of, a lot of times we as government or we as individuals who are in positions of power have a tendency to set expectations of inclusion, and then we allow government structures and bureaucracy to retrain us back into what we usually do, business as usual, and that often leaves community behind.

[00:04:23] Dr. Estes White: And so, there’s a really intentional focus that you have to have in bringing groups together to have these conversations to ensure that their voice is being heard. So, some of the things that we do around there– making sure that we have work working agreements. So how are we gonna manage our time? How do we have conversation?

[00:04:41] Dr. Estes White: What are our values? Do we all agree with those values? As a moderator, I often have to make sure that if there is someone that is from the community in the meeting space, making sure that I bring them in or ask their opinion. Oftentimes when you see titles, when you hear positions, folks from the community, people that are on the ground with the lived experience step back and we want them to step up.

[00:05:05] Dr. Estes White: And so also encouraging our own selves to step back and let them step up. And so we’ve seen the dance and there’ve been many times where we’ve had to check our own selves and our own privilege to make sure that we are, making, inviting community in and ensuring that their perspective is included within decision making.

[00:05:23] Dr. Estes White: Doesn’t always happen. And when you’re in positions of power and you have to figure out where the money is going to come from. Is this, is this in alignment with our own local and state and federal policies? Sometimes it gets lost in the dance, but the important part of it is the inclusion of community, but also being transparent with community as to how that often can happen.

[00:05:45] Amy: That makes a lot of sense, thank you for that. Now, when you think about the initiatives that you’ve undertaken in this role, what do you think is having the biggest impact on reducing poverty in your community? Or where are the things, where are the places that you’re seeing the most traction in this work? And I know you do a lot of work through other agencies and in collaboration with other agencies, so I know that’s a big part of it too.

[00:06:07] Dr. Estes White: Yeah, there are two that, that come to mind immediately. First is our recipe for health work, which is a food is medicine or food prescription program, where we work through federally qualified health centers and train up healthcare providers and other healthcare staff on what does it mean to have food as medicine.

[00:06:26] Dr. Estes White: We work with a local farm to grow nutritious, locally sourced food, and then we work with a nonprofit that provides behavioral health and behavioral supports and teaching people how to be more physically active, how to reduce stress, how to engage with others, how to eat better.

[00:06:44] Dr. Estes White: And we put all that together in a really nice package that has been shown to decrease hospitalizations, ER visits. It’s been able to show, it’s been able to show that there’s an improvement in blood pressure, anxiety, and depression spores, and the big piece about that is we started with a little bit of government funding from the USDA. We started also with philanthropy, but we were able to successfully advocate, in partnership with other community partners, for food and these services to be a covered benefit.

[00:07:18] Dr. Estes White: So, it’s medically supportive foods as a covered benefit under our current state Medicaid waiver. So, we’re actually using state and federal dollars to help pay for food prescriptions. And if you think about cardiovascular disease, if you think about diabetes, that’s all tied to food and our behaviors and our activities around food.

[00:07:41] Dr. Estes White: And if that’s the– if healthy food is the solution, then it should be part of how we treat people. Instead of going all the way to the prescription, right away, there’s an opportunity to prevent, mitigate, as well as treat those type of chronic conditions.

[00:08:01] Amy: So, in this example, the doctors are actually writing prescriptions for kale and broccoli and lean meats. And then people can take those prescriptions along with their Medicaid vouchers and go purchase the foods or along with the Medicaid card?

[00:08:14] Dr. Estes White: So how it works is a patient is screened at a local, federally qualified health center. They are given a food prescription and connected in with basically the farm.

[00:08:25] Dr. Estes White: And what the farm does is they put together either bag of groceries are almost like a CSA box full of fresh produce. And that is delivered to the patient’s doorstep weekly for up to 12 weeks. And that was a pivot we had to make ‘cause we started this in the middle of the pandemic. Initially we had farm stands or what we called food pharmacies set up in the clinic waiting rooms.

[00:08:51] Dr. Estes White: And when the pandemic happened and we had the shelter in order– or shelter in place order, we had to pivot very quickly, and so we worked with our farm to get access to delivery vans and create delivery routes so that people still had access to their fresh produce. And each bag or box has about 16 servings of produce every week.

[00:09:12] Dr. Estes White: And then if further prescribed to join the behavioral health side of this, where they’re learning how to be connected, self-regulate or co-regulate, eat better and be more physically active. They’re doing that over zoom. Previously they were actually doing it onsite at the clinic, but with the pandemic we had to get innovative and innovative very quickly.

[00:09:33] Amy: And I’m wondering how many of the folks that you serve are also living in food deserts where this a double whammy approach because not only are they getting healthy foods, but they’re getting access to foods at their doorstep as opposed to having to catch a bus across town or, sometimes food shopping can be a whole day affair if you live in a place where you can’t get access to good food.

[00:09:53] Dr. Estes White: Yeah, and we are in, gosh I’m, yeah, we’re in about five clinics right now, across Alameda County, and many of those clinics are within food deserts. And the beauty of this model is we’ve been able to create dignity in these spaces. You know, I don’t know about you, but I ordered Instacart a lot during the pandemic, and this is almost their own– this is almost a different version of Instacart, working with a local business such as a farm and keeping that dollar moving circular within Alameda County, we actually have a, an initiative that has been built out of this called the Circular Food Economy. Where we are trying to keep that food dollar in the food system and support entrepreneurs more locally.

[00:10:33] Dr. Estes White: And so, we’ve watched this evolution going from what is a simple food prescription into a larger initiative to better support access to healthy, nutritious food, as well as create jobs.

[00:10:46] Amy: and a solution like that where it’s solving so many problems at once. sounds really sustainable because you’re supporting the farm, you’re supporting the community, you’re supporting the local workforce all at the same time.

[00:11:11] Dr. Estes White:  Yeah. It’s actually been quite remarkable to watch. This has actually just happened since 2020. Like I can’t even, this is stuff that often Takes 5, 10, 15, 20 years. This is generational type of shifts and it’s been in thanks to the leadership in Alameda County with the Alameda County Board of Supervisors and particularly Alameda County supervisor Dave Brown…

[00:11:21] Dr. Estes White: and his predecessor who we lost tragically a year ago, supervisor Wilma Chan. And they saw the vision of what this could mean to not only provide food, but get it embedded in policy. And then how do we grow it so that we are supporting jobs, that we are supporting access in just a really comprehensive way.

[00:11:42] Dr. Estes White: And the Board of Supervisors has really shown that through its investments in Recipe for Health as well as its investments in the, we call it all in eats circular food economy.

[00:11:53] Amy: That is incredible. Incredible. Now, how many people does that program serve? Do you know?

[00:11:58] Dr. Estes White: Ooh gosh. We were up to, I believe, 1500.

[00:12:02] Dr. Estes White: So, it was a study and with it now being part of Medicaid and being reimbursable through Medicaid, it’s likely to increase pretty– we work directly with Alameda Alliance for Health, which is a managed care organization to identify the patients that would be eligible through Medicaid to receive this service.

[00:12:20] Dr. Estes White: We’ve also worked with our county partners as well as philanthropy to identify ways to close gaps for those who may be patients of the federally qualified health centers, but not Medicaid clients. And so finding ways to close that donut hole to ensure that they also have access. So, it really was an all hands on deck opportunity to work across sectors to solve several problems and create really innovative solutions.

[00:12:46] Amy: And do you see this as having a scalability to the rest of the community that needs it?

[00:12:51] Dr. Estes White: Absolutely. I think Medicaid is just the first step. We’ve had conversations with other health plans across the region. I know that there’s been interest and you’ve– we’ve seen it in other areas of the country.

[00:13:05] Dr. Estes White: And. actually, this work led to a recent White House conference on hunger and nutrition just a few weeks ago. And it was the efforts of representative McGovern out of Massachusetts, which a lot of this Food as Medicine work grew out of. To have that conference and since they’ve had that conference, they anticipate a lot of legislation and policy opportunities to support food as medicine, nutrition, and addressing issues around hunger.

[00:13:31] Dr. Estes White: So, there’s a bigger nut to crack here in how we increase access to food and actually improve health and wellbeing and moving those, moving it from prescriptions, and believe me, prescriptions are needed. They’re important, but how do we move it upstream and really address issues upfront?

[00:13:48] Amy: That’s amazing. And I know you said you had two… two initiatives you wanted to share with us. I can’t wait to hear what’s next because this is..

[00:13:56] Dr. Estes White: Yes!

[00:13:57] Amy: This is really pioneering work you’re doing. I think it’s incredible.

[00:14:00] Dr. Estes White: Yeah, and it’s– you have to do it in concert with others, and you have to do it across sector.

[00:14:05] Dr. Estes White: So, the second one is looking at guaranteed income, and I’ve supported really as a–in the background– looking at guaranteed income pilots and how they work and how they can be beneficial. And what does it mean to get an extra thousand dollars? For many of us in privilege that would be a great to have an extra thousand dollars, but for those who are low income, that extra a thousand dollars could be rent, it could be utilities.

[00:14:32] Dr. Estes White: It could actually allow them to start developing savings. And one of the initiatives that I mentioned Alameda County Supervisor Dave Brown, has also spearheaded is guaranteed income for foster youth. So, we are intentionally, as a county looking at foster youth transitioning out of the foster care system for, I believe it is, it’s either 18 to 24 months providing a $1,000 stipend.

[00:14:56] Dr. Estes White: And in the Bay Area $1,000 does not go very far. But in providing those funds, looking to see and additional wraparound services and supports, looking to see what are those outcomes that better support them in their transition into adulthood and out of like a system that has been there for them for a good time, a percentage of their lives.

[00:15:15] Dr. Estes White: And we’ve seen the data from the stocks and pilot with Mayor Tubbs, and the state itself has invested in guaranteed income by establishing a pilot for foster youth as well as for pregnant women. And so we actually have a community of practice in the state of California really looking at how does this extra money, just a little bit of extra money per month, really help transform lives of those who may not have boots or straps, we’re all expected to bootstrap it…

[00:15:45] Dr. Estes White: …and unfortunately, the inequity caused by racist policies and practices have taken those benefits away from folks. So, this is an opportunity to create a little bit more equity and push equity in, in, in income.

[00:15:59] Amy: I think about when we were in the middle of the pandemic and the federal government gave a childcare tax credit and they sent checks every month to people, and it was probably not as targeted as it needed to be, right?

[00:16:11] Amy: There were a lot of middle class families that got checks for their kids, and my family was one of those. Just that, that little bit extra that the federal government sent cut childhood poverty in half by 50% in this country.

[00:16:23] Dr. Estes White: Okay.

[00:16:24] Amy: And, it’s always astounding to me how simple the answers are. If you wanna cut homelessness, you put people in homes. If you wanna cut poverty, you give people money. If you wanna solve hunger problems, you give people food. And the problem goes away because you’ve given them the thing that they need to survive. And then everything else from there, that becomes a foundation from–for everything else they could accomplish and do.

[00:16:47] Amy: But without those things, they’re constantly struggling, trying to dig out of a pit…

[00:16:51] Dr. Estes White: Yeah.

[00:16:52] Amy: …of not having homes, not having money, not having food, and they can’t, you can’t really focus on anything else if your basic needs aren’t..

[00:17:00] Dr. Estes White: You can never catch up…

[00:17:02] Amy: …available.

[00:17:03] Dr. Estes White: …and for All In our focus are basic needs for food shelters, safety and access to care, quality education.

[00:17:09] Dr. Estes White: We’re really intentionally interested in children under five, ‘cause if a child enters kindergarten and they’re not ready, it’s very hard for them to catch up when it gets to third grade reading level. When it gets to graduation rates and them being prepared to then enter the workforce.

[00:17:23] Dr. Estes White: This is a– this is a human issue. This is a workforce issue. This is an economy issue in preparing our young people and our communities to grow as the US economy grows, and we don’t invest in these very, very basic needs. We’re going to see challenges down the line. And I will say that it’s all very attainable if you do it with intention…

[00:17:47] Dr. Estes White: …and one thing that I’ve learned in my own career when it comes to inclusion is if we can all work around a singular vision and we remind ourselves of what that vision is, we can work towards that vision. We all have different ways of getting there, and that’s where the dance of politics and policy and regulation happen but if we continue to zero in on that vision, amazing things can happen.

[00:18:18] Amy: And I think one of the keys to your success in this role is something you told me when we had our prep call for this, which is, you don’t ask for what you think you can get. You ask for what you actually need.

[00:18:28] Dr. Estes White: Yeah.

[00:18:28] Amy:And can you expand upon that? ‘Cause I know that’s something that, that you are fond of saying in the work that you do, to really push people to think bigger in terms of how they can actually solve problems, not just kick the can a couple of feet at a time.

[00:18:45] Dr. Estes White: We are powerful people and if you get some really powerful people in a room, a lot of things can happen.

[00:18:53] Dr. Estes White: And I think it’s the blue sky thinking and allowing yourself to dream and allowing yourself to dream big. And I think we often work from places of deficit and the anti-poverty narratives, and when I say anti: against people trying just to survive that came out of the eighties and the Reagan area, or not even the eighties, the seventies and the eighties, and perpetuated on through has really hurt the narrative of what people are—

[00:19:22] Dr. Estes White: People just wanna stop. Every single one of us out here just wants to be able to live our lives, take care of our families, and be able to thrive. That’s pretty basic. That is very basic. And so, when dreaming big, it’s not about what you think you can get, it’s about what you actually need.

[00:19:40] Dr. Estes White: And I think for many of our community organizations even as residents that are challenged and struggling, I’m only ask for this because I know that’s all they might give me instead of no, I actually need this, and this. I need a little bit more for food, for food this month. I need help with paying my bills and this is why.

[00:20:04] Dr. Estes White: You gotta be able to articulate it. And that’s where it’s important to be advocates. And that’s where the, our community organizations really do come into play in being able to translate the needs of the community to larger, powerful, bureaucratic institutions. But when we all come together and we actually lead with listening first, that is the, that is where the power lies in really listening and intentionally understanding what people need.

[00:20:32] Dr. Estes White: Not what you can and cannot do, but really what do people need and how do we work to get that and meet that need, not this says, I can’t do this. This says I can’t do that. We always go back to the can’t. And I encourage people to think about can.

[00:20:48] Amy: you are such a great example of that and the work that you do. I appreciate it so much. What is next for you? What’s the next initiative? What’s the, what are you looking for in the future in terms of, milestones or issues that you wanna address?

[00:21:03] Dr. Estes White: Yeah. So what’s beautiful about the work of All In is we’re really an incubation hub. We’re– we have three staff, and we’re not meant to…

[00:21:13] Dr. Estes White: …carry a project long term, and we were actually a larger group and because of our success of our recipe for health work as well as some youth homelessness work, those programs actually graduated into more operational agencies where they could be sustained long term. So, it wasn’t actually a bad thing to go from eight and nine to down to three.

[00:21:32] Dr. Estes White: We’re just at a rebuilding space right now and that’s actually an exciting time for me ‘cause it’s what can we tackle next over the next three years? Iterate and move it with in partnership with community and our agency and non-profit partners. And think with equity instead of sustainability in mind. So, a couple of the areas that we’re looking at now, we’re looking at the role of family resource centers which we’ve worked with in the past in supporting kindergarten readiness from a community driven lens…

[00:22:01] Dr. Estes White: …and looking at expanding those across Alameda County into other regions of the county. We are looking at supporting workforce development, and working with agencies and entities that are already doing workforce development strategies, and how do we better align and support people with lived experience, getting access to employment opportunities that are not living wage, ‘cause living wage is not even enough…

[00:22:25] Dr. Estes White: …it’s actually about building wealth and supporting wealth building. Other areas that we’re looking at is continuing to build upon this idea of a circular food economy and how do we support smaller community-based organizations that are in the food economy, whether they be entrepreneurs, food, recoverers, growers and how do we connect them into the system where they’re just as much empowered as any other larger, mega farm.

[00:22:50] Dr. Estes White: So, there’s a lot of opportunity in this and we are continuing to iterate and refine, but I’m excited that– come and talk to me in three years and we can see what is evolved and what has changed because what I believe is we are actually in a space of transformation because of the pandemic. We’re looking for ways to step up and come out better than we were before we went into the pandemic on how we better serve people. Dr. Estes

[00:23:13] Amy: Dr. Estes White, I would love to catch up with you. I don’t wanna wait three years to do it. I have a feeling that the impact that you’re gonna have is going to be sustained, constant, and large in the short term and the long term, So I’d love to catch up with you before then.

[00:23:28] Dr. Estes White: Absolutely.

[00:23:28] Amy: Thank you so much for being on the show and for sharing with us just the amazing work that you’re doing.

[00:23:34] Dr. Estes White: Thank you for having me, Amy. This was great.

[00:24:00]

[00:24:24] Amy: That’s it for this week’s episode of Including You. Join me next week when my guest will be, Tricia Montalvo Timm from Salsify.