The following is a transcript of an episode of From the Front Row: Student Voices in Public Health, the University of Iowa College of Public Health’s student podcast. Studying health policy during a pandemic presents many unique challenges. This week, Steve talks with PhD student Jason Semprini about his experiences and how COVID-19 and disparities in access and care are changing the future of health policy.

Steve Sonnier:

Hello all, and welcome back to From the Front Row. If this is your first time listening to us, welcome. We are a student-led podcast that explores issues across the field of public health.

Steve Sonnier:

Today, I am joined by Jason Semprini, a second-year PhD student in our Department of Health Management and Policy at the College of Public Health. Jason is a NIH pre-doctoral research fellow at the University of Iowa College of Public Health and College of Dentistry. Prior to beginning his PhD in the Department of Health Management and Policy, Jason was a cancer disparities research fellow as a master’s student at the University of Chicago. His policy research on health disparities has been published in peer-reviewed journals and presented at conferences across the country.

Steve Sonnier:

Jason, thanks for coming on the show today.

Jason Semprini:

Thanks for having me.

Steve Sonnier:

Let’s start off with your path into health policy. Was there a specific moment where you said, “I really want to be involved in this?” Or was it more of a gradual climb into the field as a whole?

Jason Semprini:

Yeah, it was definitely a gradual climb. I started my career working at the community level, really immersed, and seeing the poverty of people all across the State of Iowa, whether it was issues with housing and health and domestic violence and food insecurity. There were so many issues that I was exposed to as a young professional. And I didn’t really know what to do about it. I thought, “There’s social workers.” And I was working with doctors and lawyers. And I didn’t know how I could find a way for me to make an impact. But that’s when I started to see the connection to these policies that could either benefit these people or continue to exacerbate harm.

Steve Sonnier:

When you’re talking about the community involvement, what exact position led you to interact with that breadth of different health care professionals and folks involved with the social work aspect side of things?

Jason Semprini:

Yeah. Two early positions. One, I was an AmeriCorps member at a nonprofit law firm. So I was interviewing and doing community outreach at domestic violence shelters and homeless shelters and food sites and just seeing these people trying to get by, day to day, that were facing eviction or losing their Medicaid benefits or their social security income. And then, moving forward a few years, I was actually a caseworker myself, coordinating Medicaid home health services for people with disabilities.

Steve Sonnier:

And of those experiences, what really pushed you to go into the PhD side of things? You had mentioned you’d come along with a master’s already in terms of your work experience as well. Was there something specific that influenced your decision to take some time before going ahead? And why go and get a PhD specifically in this field of health services research?

Jason Semprini:

Yeah. Well, the reason I took my time is I wanted to make sure I knew exactly what I wanted to do. We all know, as graduate students, there’s definitely a cost, both financial and time. So I didn’t want to waste my time and resources on something that I wasn’t really passionate about. And when I finally started my master’s and knew that policy was the direction I wanted to go, I was really taken over by the idea of research and finding out some solutions and identifying those key problems that we can focus on through research. And that’s what led me to a PhD education. I guess I just wanted to get better at that part of the policy research.

Steve Sonnier:

Were there some skills specifically that you earned in your master’s degree that you thought “I really need to improve on this and a PhD will help me get there?” Was there a point of inflection there where you said, “This is where I want to learn more about?”

Jason Semprini:

Yeah. Yeah. I think that was the big step and the motivating piece from moving from a master’s where I learned a lot of data analysis skills and how to communicate effectively the findings of this research. But what I thought that the PhD, and what I’m learning, is that I can, to be an independent researcher and work more effectively with other individuals doing collaborative research is the motivation behind different policies, really understanding the mechanisms for how policies can actually impact people. Again, taking it back to the community and individual level. How can these policies, what are the links? And the PhD is helping me think through that, those processes.

Steve Sonnier:

Do you think that your experience at the ground level really augments your ability to understand how these policies impact folks in vulnerable, disadvantaged patient populations?

Jason Semprini:

Oh, absolutely. I think about some of these experiences all the time, some of the people that I’ve met, whether it’s the clients at this nonprofit law firm or some of the health care workers that I’ve collaborated with over the years. We think about policies and we think that they might have some intended effect. But without really thinking through how it’ll affect the people most impacted, those policies won’t lead to the outcomes that we’re hoping for.

Steve Sonnier:

When you’re reflecting on your decision, how did you end up choosing the University of Iowa? What really spoke to you about this program over others? I know you had mentioned your background, being in Iowa and seeing the health care disparities apparent in the region. Was that a combining factor into your decision as well?

Jason Semprini:

Yeah, it was. I guess, to be honest, growing up as an Iowan, I always wanted to go to the University of Iowa. I wanted to play football and be the quarterback. But I guess I settled to be a researcher, which I guess is, I prefer that now.

Jason Semprini:

But in all seriousness, when I interviewed at the University of Iowa and got to meet some of the faculty, they were just as committed to addressing social inequities and health disparities through their research as I was. Whether it was from a rural perspective or looking at people who earn low wages, racial and ethnic disparities, that was all here at the University of Iowa. And the level of rigor that some of these faculty use in their methods, I wanted to be exposed to that. So it was a very clear decision, a very easy decision, for me to make.

Steve Sonnier:

In these first two years, because you’re early into your program relatively to others, what are you most proud that you’ve been able to accomplish during your tenure here?

Jason Semprini:

That’s an interesting question. I can’t think of a specific event or a deliverable that happened. I think part of the PhD in any graduate’s education, it’s a grind. And I think just surviving over the past two years, especially over the past half year, since March of 2020, getting through, not missing out on some of the extracurricular experiences, still passing my exams and contributing to meaningful research at the University. I think just it’s a slow go. But I think just continuing to move forward is my favorite accomplishment.

Steve Sonnier:

How does the pandemic intersect with your academic life? Because we’ve all had this big shift right now. And especially when you’re going into something like a PhD, which I imagine is, it’s a very difficult burden to balance at times. How have you been able to adapt during the pandemic to ensure that you are academically successful?

Jason Semprini:

Yeah. I’ve tried to stick to a schedule. I still go to class. I still talk to my peers and colleagues. I don’t want that to fall to the wayside just because we have to do it over a different medium.

Jason Semprini:

I will say that this has opened some doors. I know we’ve talked, we’ve heard a lot on your podcast before about telehealth. I think tele-education or at least collaborative research using online tools, I think is going to proliferate. And I think it can help us include more people across, not just the country, but across the world, studying issues that we’re all interested in.

Steve Sonnier:

Have you had that experience where you’ve been able to collaborate through the tele-education medium, through the… We’ve had the Zoom meetings going on constantly with folks. Have you found that to be an effective way of communicating things or is it no replacement for in-person communication? Do you think there’s a happy medium in the middle? Where do you see that headed towards in the academic space?

Jason Semprini:

Yeah. I think there is. I guess I try to be an optimist when I can. But I guess the opportunities that present themselves from an online mode, I see them as outweighing the cost, especially for people in our career stage. Maybe for children, it’s much different. For example, some high school student down in Georgia reached out to me about a paper I wrote last year for a health policy class. And she’s doing an AP Capstone. And she was interested in telehealth for cancer. And I would have never been able to talk to this high school student. I wasn’t going to drive down to Georgia to give her a quick coffee chat. But I thought that was an interesting opportunity and wouldn’t have been able to happen without thinking of using online tools.

Steve Sonnier:

That was fantastic to see the proliferation of things.

Steve Sonnier:

Within that sphere of the pandemic as well, and on top of graduate school, you’re also balancing the family life side of things, also being a parent at this time. How do you ensure you can meet your scholastic and your familial obligations?

Jason Semprini:

Yeah. And I think they’re just, I have always known that my family is the most important thing. And it’s family and then work. But I wouldn’t be as successful in my studies and my work without my family. They help keep me grounded. They, my wife and daughter, give me so much support. But also, just a way to let go and step away from work for a minute. I’m lucky in a sense that I have these other duties and obligations. And I get to have fun playing with a cute little two-year-old daughter. They help keep me focused but also keep me balanced as well.

Steve Sonnier:

I think that balance is really critical when you’re talking about it. And then, I wonder, too. Do you feel like the University of Iowa helps you keep that balance with your family? Are they supportive of you having a family and going to school?

Jason Semprini:

Yeah. I have been supported personally from my faculty that I work with, my supervisors, as well as I’ve been able to benefit from some of the resources that the University provides. However, I will say, though, that those resources aren’t always easily accessible. So it’s not that the University of Iowa doesn’t provide the resources. There just might be some gaps in making sure that they’re equitably distributed to all families who are studying and working at the University. And I think there’s steps being made. I’m actually on a Family Issues Charter Committee with the University and I think there is definitely some progress. And I think we’re all very aware that there are still some gaps to address as far as getting those resources out.

Steve Sonnier:

What are some of the steps that you want to see taken to address those gaps? You mentioned the health equity piece of it. And I’m sure that’s completely blown apart by the pandemic right now, too. Where do you see those gaps being taken care of?

Jason Semprini:

I guess, for one example, is just rethinking what it means to be a family member as a student or a worker for the University of Iowa. Thinking from a very traditional sense, if we only look at providing childcare subsidies for someone who goes to a daycare, you could really be missing some students and workers who have informal care or have obligations outside of the typical 9-to-5 workday, as well as you’ll miss some people who take care of non children, whether it’s older adults or partners who have special health care needs.

Steve Sonnier:

Do you see those voices represented a lot at those meetings? Or do you get that feedback and commentary when you’re there?

Jason Semprini:

That’s part of the question is how to get more people involved. And I think, bringing it back to having some of these meetings online, I think we’re going to see more voices represented, especially family members who can’t afford to spend two hours traveling back and forth to a meeting at 7:00 at night. But you can get the meeting done over a half hour from the comfort of your home, with your family needs taken care of. Easier, not completely.

Steve Sonnier:

Right.

Jason Semprini:

But more accessible there.

Steve Sonnier:

We’re reflecting on these opportunities that you’ve been a part of. And they all revolve around the focus of health equity as a whole. When you’re looking at these issues that you’ve been able to take part of so far in your career, what do you think is the biggest health policy issue you’d like to focus on in your career that the general public needs to know more about?

Jason Semprini:

I think health policy, it’s been, not overtaken. But the big focus is on coverage and access. And I think that’s critical. But I think, moving forward, eventually, we’re going to have, at least I hope, we’re going to have universal coverage of all people living in this country. But what do we do from there? And even right now, we have people who receive health insurance. It’s not always equitable and it doesn’t always lead to improved health. So how can we design the health system in a way that, once people are in that system, they can realize some of these benefits that the rest of us have been experiencing?

Steve Sonnier:

It’s interesting. Because we have seen a lot of that, thinking back to the Affordable Care Act approach, right? We were trying to aim for the coverage side of things. There’s been considerable concern about the quality of care and making sure that access doesn’t necessarily equal good outcomes on those side of things.

Steve Sonnier:

Within that big sphere, right? Of the quality of care or the timeliness of care or the affordable cost actually within it, which of those points do you think is most critical to emphasize for us going forward, beyond the ability to even have coverage as a whole, as you talked about with access?

Jason Semprini:

Yeah. And I guess I would add one more. And I think this is becoming more obvious that this is the duty and an obligation of the health system and health policy. It’s addressing those social determinants of health. And whether that is through health care interventions or if it’s just the health system and health policymakers saying, “Look. We’re seeing all of these negative consequences and inequalities on the back end that are caused not by anything that we’re doing at the hospital or at the clinic. But it’s happening well before they ever enter the system.” So we’re giving these people coverage. And that’s necessary for their health and their financial security. But what are we doing to address some of these more structural issues?

Jason Semprini:

And one that I think is probably the most prominent right now is racism. I used to think that race was a social determinant of health. Where really, it’s just, it’s racism, is the determinant of health. And I think that is where we can really move forward. And I think we’re starting to see more health systems get involved in that pursuit.

Steve Sonnier:

On top of being anti-racist and going forward with the acknowledgement of this situation here, how do you see health systems? What’s going to be… There’s the carrot and the stick model. What do you think is going to entice health systems or push health systems to move on this really difficult issue that needs to be addressed to ensure that these health care disparity gaps get closed?

Jason Semprini:

I’m really interested in some of the innovation happening where health systems are investing in affordable housing or they’re increasing the wages of their workers at their hospital. And these are workers who live near major clinics or large academic institutions and they haven’t historically benefited from the presence of such a great institution. So I think, I’m hopeful about some of those initiatives and I think there’s more to come. And I’m going to stay tuned and hopefully try to be involved as I can.

Steve Sonnier:

That’s great to hear. I’m thinking back on this, too. You mentioned a subsequent amount of opportunities to get involved, the path that’s led you here as a whole. And when folks are reflecting on, “Do I go out and consider getting a PhD?” Whether it’s in health services research or other areas of health policy or public health, what do you think is the best advice that you can give, reflecting on your experiences, to say, “This might be an area you want to consider. This might be an area that you should think about going into?”

Jason Semprini:

That’s a great question. I would say the advice to someone considering a PhD, especially in health policy or health services research, is if you have a strong desire, not just a passion about a topic but a strong desire to learn more about a topic, and you enjoy learning, both in workshops and in the classroom and reading, there’s no lack of reading in the PhD pursuit. But if you really have a desire to learn more about the topic that you’re passionate in, I think that should serve as a signal to, that you should consider a PhD. Because it’s a protected time in our lives where we can really focus on learning, and learning how to learn more about a topic. That is not really available in the professional world, where we’re expected to get a lot more done.

Steve Sonnier:

I appreciate that. Because we started out talking about how this time was important to take off, right? Before you go into, to make sure that you are prepared to commit three-plus years of your life to studying something and learning how to learn. I really appreciate that. Because it’s that continual process that we really want to emphasize with folks, is that idea of lifelong learning, right?

Jason Semprini:

Mm-hmm (affirmative).

Steve Sonnier:

As a whole.

Jason Semprini:

Exactly.

Steve Sonnier:

Is so critical.

Steve Sonnier:

When we’re reflecting on things for you. I mean, we ask folks always just one question at the end. It’s the idea of, what is one thing that you thought you knew but were later wrong about?

Jason Semprini:

Sure. Yeah. That’s a good question. I like that segment.

Jason Semprini:

So what I would say here, from what I’ve seen at the community level and beginning work, getting interested in health policy, I saw all these problems. And I thought, “Wow! If we just knew the answer to these problems, if we knew what these policies were doing, then it would be so easy to just change that policy or adapt a new policy.” So talking like a PhD, if we just find the evidence, we show it to the people in charge, they’ll just listen to us and that will be that. And at my master’s and here, during my PhD, the people that I’ve gotten to learn from are very well aware and have reiterated that that is just not the case, that people have competing agendas, implicit or explicit.

Jason Semprini:

And again, I was quite upset about that. And then, you go through periods where you’re disgruntled. But I think that itself is an opportunity where, while it’s not as easy as just presenting the evidence or presenting the research, knowing that some people have competing agendas, we can try to find some levers to find compromise or at least incrementally try to make things better.

Steve Sonnier:

I think that’s a really important answer. Especially now, during the pandemic where, in the field of public health, there are a lot of frustrating things going on. There’s a concern for our fellow Iowans. There’s the concern for our fellow Americans and how the pandemic has affected people in many, many different ways and trying to navigate those areas. And also, to recognize that, truly, right? The evidence does not always lead to the best outcome. There are those other forces at play.

Steve Sonnier:

And then, being able to emotionally navigate that too, as a professional, too. I think about, right? That saying, “You can lead a horse to water but you can’t make them drink.”

Jason Semprini:

Mm-hmm (affirmative).

Steve Sonnier:

There’s a lot of that in health policy. And beyond, too, in public health. But staying optimistic, too. And pressing on and being excited about learning and being passionate about understanding more for yourself as a whole, how you can make the lives of other folks better.

Steve Sonnier:

So I want to thank you for your insights today and for coming on our podcast and sharing more about your life with us.

Jason Semprini:

Yeah. Thanks for having me. I appreciate it.

Steve Sonnier:

That’s it for our episode this week. A major thanks to Jason Semprini for coming on today with us.

Steve Sonnier:

This episode was hosted, written, edited, and produced by Steve Sonnier. You can find more about the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple Podcasts, and SoundCloud. If you enjoyed this episode, please share it with your colleagues. Our team can be reached at cph-gradambassador@uiowa.edu. This episode was brought to you by the University of Iowa College of Public Health. Keep on keeping on out there.