A group of protesters block a major highway in San Juan, Puerto Rico in June 2014.
Faculty Feature | 8/14/2023

Public Health Expert Sheds Light on a Worrying Cycle in Puerto Rico

By Jennifer Persons

A group of protesters block a major highway in San Juan, Puerto Rico in June 2014. They were protesting increasing healthcare costs and unemployment rates.

A group of protesters block a major highway in San Juan, Puerto Rico in June 2014.
A group of protesters block a major highway in San Juan, Puerto Rico in June 2014. They were protesting increasing healthcare costs and unemployment rates.

Dr. Shir Ginzburg has spent years speaking with the Puerto Rican community to understand and raise awareness about their major health concerns.

In June 2014, Dr. Shir Ginzburg watched protesters gather onto PR-1, blocking the biggest highway through San Juan, Puerto Rico. They were protesting increasing healthcare costs and unemployment rates. Dr. Ginzburg had heard these concerns from the people she interviewed as part of her public health research and had seen protests over the same issues. But this one was different.

“It was the first protest I’d seen where the police didn’t make an effort to stop the protest,” she remembered. Ginzburg, PhD, MPH, is an Assistant Professor of Public Health at Massachusetts College of Pharmacy and Health Sciences (MCPHS). “It wasn’t violent, but it was a visceral experience. I could feel how upset everyone was.”

Dr. Ginzburg spent a full year conducting research in Puerto Rico, during which she identified mental health, food insecurity, and diabetes as the three major interconnected public health issues facing the people of Puerto Rico. And, as the protest made clear to her, all three were entangled in the island’s political status as a territory of the United States.

“It became abundantly clear to me that we couldn’t just cover one of these issues because they all related to each other, and to leave one out would leave a hole,” Dr. Ginzburg said.

Uncovering Closely-Tied Concerns

Dr. Ginzburg’s first insight into health issues among Puerto Ricans happened in 2008 while she was a clinical interviewer for a national study about the Hispanic community. She had just earned her Master of Social Sciences and wanted work experience before pursuing an advanced degree. Dr. Ginzburg had studied Spanish for most of her education, and this job allowed her to practice her language and research skills.

Based in New York, Dr. Ginzburg mostly interviewed people from the Dominican Republic and Puerto Rico who had moved to the United States. It was an extensive health study with a specific piece about stress, and Dr. Ginzburg quickly noticed a trend.

“The Puerto Ricans I talked to were facing much higher rates of stress than other people in the study,” Dr. Ginzburg said. “Many of them felt stressed about their financial situation, a lack of good health insurance, and strained relationships with other Hispanic communities because of their status as American citizens.”

In 2012, Dr. Ginzburg visited Puerto Rico for the first time to better understand what was causing these stressors. She found all the concerns she heard about in New York were amplified in Puerto Rico and closely tied to other serious health concerns. In 2014, she returned for a whole year to expand her research.

“There was so much that came up that I hadn’t anticipated,” Dr. Ginzburg said, recalling her time conducting research at a diabetes clinic at the University of Puerto Rico School of Medicine. “I would ask about their diabetes, and they would share their struggles with finding and affording nutritious food. Then, they’d talk about their depression, stress, and anxiety, but they couldn’t afford mental health services or diabetes medication. And the cycle continued.”

Just as she witnessed on that summer day in 2014, political issues were a significant source of stress for the people Dr. Ginzburg met. Puerto Rico does not have representation in Congress, and its residents are not allowed to vote in presidential elections. These worries, along with their health and financial struggles, proved to Dr. Ginzburg that somebody should bring the public health issues affecting the people of Puerto Rico to light.

“They are doing more with less, and their health is affected,” she said.

After long days of interviews, Dr. Ginzburg needed a way to decompress. She discovered a coffee shop/art store in Viejo San Juan, owned by a woman named Lady Lee Andrews. Dr. Ginzburg would analyze her data while connecting with community members. Some nights, she’d stay late enough for poetry or music performances.

“It was a popular hangout spot for people to meet and discuss politics and other things happening in Puerto Rico,” she recalled. “Lady welcomed everyone regardless of nationality or political affiliation, which created a warm atmosphere.”

Research with Impact

Dr. Ginzburg’s research in Puerto Rico became the basis of her dissertation for her Doctor of Philosophy in Medical Anthropology. In 2019, she began turning that work into a book. It’s titled “Taking Health to the Streets in Puerto Rico: Resisting Gastronomic, Psychiatric and Diabetes Colonialism” and was published this summer.

“A wide range of things need to change, and many of them require government intervention and are much bigger than one person,” she said. “But changes are happening at the community level. Farming and agriculture are becoming more popular, so more people are growing food, which I think is fantastic.”

A return visit to Puerto Rico is always on Dr. Ginzburg’s mind, not just for continuing her research. She’s interested to see how the community that welcomed and integrated her has changed since she was last there, whether protests are still an empowering outlet for residents to voice their frustrations, and if Lady Lee Andrews is still hosting open mic nights.

“My philosophy is, how do I leave my little corner of the world a better place?” she said. “Whether it’s listening to somebody or raising awareness about what they’re going through, it has an impact.”

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