This week Lauren welcomes Carla Britton, lead epidemiologist/deputy director of the Alaska Native Epidemiology Center in Anchorage and recipient of our 2023 Outstanding Alumni Award. They discuss Carla’s non-traditional path to her current career as well as her work with Alaska’s Native population and some of the challenges of public health work in Alaska. Carla received an MS degree in epidemiology in 2006 and a doctoral degree in epidemiology in 2010 from the University of Iowa College of Public Health, and a MS degree in environmental and public health from the University of Wisconsin.

Lauren Lavin:

Hey everybody, and welcome back to From the Front Row. This is Lauren, and I’m super excited to be sharing an episode, well, an interview that I did with Carla Britton back, oh, it was maybe September. So anyways, we’ve waited a while to release this episode, but I absolutely love talking with Carla. She is a PhD epidemiology graduate from the University of Iowa, and she now serves as the lead epidemiologist at the Alaska Native Tribal Health Consortium. It was awesome to talk to her. She’s a lot of really great practical advice for students, whether you’re an undergrad, master’s, or graduate student, and for individuals looking to work with Native populations or maybe populations farther away from our home state of Iowa. If it’s your first time with us, welcome. We’re so happy to have you listening. We’re a student run podcast that talks about major issues in public health and how they’re relevant to anyone, both in and outside of the field of public health.

Okay. Thank you so much for being on the podcast, Carla. I’m happy to have you here. To start off, could you just tell us a little bit about yourself, who you are, why you’re here, all of that?

Carla Britton:

So my name is Carla Britton. I am here as the Career Alumni Award recipient, which is-

Lauren Lavin:

That’s right.

Carla Britton:

… quite an honor. I am the lead epidemiologist at the Alaska Native Epidemiology Center located in Anchorage Alaska, which is not in Iowa.

Lauren Lavin:

It’s actually nowhere near Iowa.

Carla Britton:

No, it is not. It’s true. Your geography is great.

Lauren Lavin:

Well, I’ve got that going for me at least. So if that’s correct, you live in Anchorage Alaska?

Carla Britton:

I do.

Lauren Lavin:

Okay. Tell us a little bit about that, because I feel like everyone’s going to be like, wait, what?

Carla Britton:

So Anchorage is Alaska’s Urban Center. There’s almost 400,000 people that live in the urban area around-

Lauren Lavin:

Holy cow, 400,000.

Carla Britton:

Just about half the population, little actually over half the population of the state of Alaska in-

Lauren Lavin:

Whoa.

Carla Britton:

… in two parts of it, Anchorage proper, and then a couple suburbs that are relatively nearby.

Lauren Lavin:

Okay. So when I think of urban, I’m thinking big city, but also when I think of Alaska, I’m thinking like iceberg. So what is it?

Carla Britton:

It’s both. So Anchorage itself feels a little bit like a small city, but a complete city with all the things you would expect in cities including Costco.

Lauren Lavin:

I was literally going to ask, do you guys have Costco?

Carla Britton:

Two.

Lauren Lavin:

Two. Okay. Are you a Costco shopper?

Carla Britton:

Of course.

Lauren Lavin:

I am too.

Carla Britton:

Yeah. So it does have that urban feel. And by the way, Alaskans are big Costco shoppers. We should get-

Lauren Lavin:

Love to hear that.

Carla Britton:

…extra credit points for that. But within a really short space, really at the edge of town is a very, very large state park and national forest. So we back basically onto this huge wilderness area. And then of course, outside of the main metropolitan areas in Alaska, and a couple of them aren’t really all that big, we have a lot of really remote country that is accessible only by plane or boat.

Lauren Lavin:

Wow. And who lives out in that? Does anyone live out in the remote country? And if so, who?

Carla Britton:

Well, they do actually. There are a lot of villages that are primarily Alaska Native that are located in remote rural Alaska. And those villages range in size from anywhere from about 30 people to about a thousand. They’re accessible predominantly by plane or boat, and in the winter, sometimes by snow machine.

Lauren Lavin:

Oh my gosh.

Carla Britton:

On frozen rivers.

Lauren Lavin:

So do they live in traditional housing or?

Carla Britton:

Nope. They live in houses that are just houses that you and I would live in like anybody basically. But in some cases, some of the communities still don’t have running water.

Lauren Lavin:

Wow.

Carla Britton:

And so a big initiative within the Alaska Native Tribal Health Consortium, which is where I work, is to bring running water to some of the last communities within Alaska.

Lauren Lavin:

Wow. And how many are left?

Carla Britton:

There’s about 3000 people that are left.

Lauren Lavin:

Okay. And how do they get their water currently?

Carla Britton:

In a number of different ways, they sometimes get it directly from river, sometimes they’ll get it from rainwater. Most of the communities do have a central water point where there’s water and maybe a laundromat facility or a place for steam baths. It’s a little bit varied, but it is a variety of different ways, just depending on where you are and how close you are to other water sources.

Lauren Lavin:

Do these communities want running water in all of their houses, or are they not resistant? I don’t know.

Carla Britton:

So one of our communities, just the second half of it, just literally in the last week, got running water and everybody was very excited in part because probably the biggest change is moving from essentially a honey bucket to running water or bathroom. That’s a big switch people are pretty excited about-

Lauren Lavin:

I guess I didn’t even think about the bathroom part of that. That’s an important part of running water.

Carla Britton:

You don’t really think about it if you have running water. But yes, it’s a very big part of running water. The other big part of it is having running water to do dishes and wash hands. And there’s some pretty good evidence that suggests that access to running water affects your ability to reduce disease rates. So if you have running water, then respiratory infections and other infections are less. So it’s a big public health initiative.

Lauren Lavin:

Wow. And you’re working on that. Is that part of your current role?

Carla Britton:

I actually don’t spend a lot of time working directly on that. We have a division of engineering, and I guess it’s environmental health and engineering that is primarily, basically part of it is a really big construction operation and engineering operation.

Lauren Lavin:

Yeah, it’s lot of infrastructure.

Carla Britton:

Yep, big infrastructure.

Lauren Lavin:

Okay. Last question about Alaska related, or at least for now. So what does the Alaska Native population look like? Can you describe them for our audience? Not physically look, but what are they about?

Carla Britton:

So within Alaska, the Alaska Native population is about 20% of the overall population in the state, which makes it the highest proportion of Alaska Native or American Indian people within the states. There are about a 150,000 Alaska Native people. The population demographics are predominantly younger than the non-Native population in Alaska. And although a lot of Alaska Native people, of course, do live in the urban areas, that the remote population is predominantly Alaska Native. So the villages might have about 90% or so who are Alaska Native or American Indian.

Lauren Lavin:

Wow, okay. So it’s a large population.

Carla Britton:

About a 150,000. Yeah. And the Alaska Native Tribal Health Consortium for who I work actually has among other things a hospital and provides tertiary care as well as specialty medical care to the Alaska Native people and American Native people within Alaska.

Lauren Lavin:

Wow. Well, this is the perfect segue into what do you do now? Explain your role now and what that entails.

Carla Britton:

So I am technically the lead epidemiologist/deputy director of the Alaska Native Epidemiology Center, which is one of 12, what we call epicenters in the United States. There’s one for each of the Indian Health Service areas and one that serves the Urban Indian programs, and that one’s based in Seattle. So we support our tribal health organizations and tribal constituents through a lot of public health programs that are mainly centered around data, data dissemination, surveillance and training. So we do do some health promotion, but ANTHC is a really big organization and some of the other public health services that might sit within epicenters in other areas sits outside in its own division. So we focus a lot on data and data dissemination.

Lauren Lavin:

So do you have a lot of contact with Alaskan Native people or are you working more within your team at the center, at that center?

Carla Britton:

We have a lot of tribal health partners. So for example, last week, was it just last week, I was in Kotzebue, Alaska, which is the home of the Maniilaq Association, which is one of our regional tribal health organizations to work with them on a couple projects. So we do have a fair… We do a lot of technical assistance directly for the tribal health organizations,

Lauren Lavin:

And that’s what the data dissemination looks like.

Carla Britton:

Some of it is data dissemination, some of it is epi-studies, some of it is special demography requests, some of it is training. We do a little bit of all of these things at any given moment.

Lauren Lavin:

Yeah. That’s, I feel like most jobs, especially when you get up to the level that you’re at, require a lot of different hats. So then how did you get to where you’re at? Can you speak to your educational path?

Carla Britton:

So I have a little bit of a nontraditional pathway to getting here. I found out about public health, I think I probably already always knew about it, but when I was an undergraduate, I took a class in variously titled Introduction to Community Health or Introduction to Environmental Health, depending on which pathway you took, the same class. And then ended up working for the National Park Service through an internship. So remember, take an internship for almost 18 years in a variety of different positions, but the last few years predominantly in law enforcement.

Lauren Lavin:

Okay. Explain what that is.

Carla Britton:

It’s like being a wildlife cop, except the wildlife all has two legs.

Lauren Lavin:

That’s probably really accurate. So where did you work doing that stuff?

Carla Britton:

I started in Yosemite National Park as maybe a sophomore in college. And then when I finished up that part of my career, I was in a park in Northern Wisconsin, and then I segued actually directly from there into a public health job or public health internship. Actually, I was by that time also a grad student at the University of Wisconsin-Eau Claire where I was commuting back and forth.

Lauren Lavin:

Oh dang.

Carla Britton:

But it actually worked out really well. I worked four 10-hour days and had three days off and they were split, and so I could make it actually work pretty efficiently. So then I ended up working, doing a junior post-op internship with the Indian Health Service at the local tribal health clinic, which was very conveniently located to my house.

Lauren Lavin:

Well, sometimes it’s the little things.

Carla Britton:

Although I will say that if you don’t have as many dependents in terms of houses and pets that it might be more exciting to do something that’s not right at home and experience some little broader, more excitement. There were some folks in Alaska that basically told me that my strategy should be just to quit grad school and come work for them. I’m like, yeah, I don’t think so, but nice try.

Lauren Lavin:

They gave it a shot.

Carla Britton:

Good shot. They gave it their best shot. So from that point then I had to make a decision about whether I was going to look for a job or what the next step was going to be. I ended up actually applying for a job, which I was offered, and then subsequently decided to go back to grad school and get a PhD because then you can be a CDC Epidemic Intelligence service officer, which is the second coolest job on the planet after being a park ranger. And I ended up at the state of Idaho and there were some pathways in between. I worked for UI Sports Medicine for several years while getting my degree here, which was also super fun. And then finally finished up in Idaho and made my way to Alaska, which was not a shocker as I’ve known about the Tribal Epi Centers for a really long time and expected that I would at some point in time work in Alaska.

Lauren Lavin:

So how long have you been in Alaska?

Carla Britton:

I have been in Alaska 10 years.

Lauren Lavin:

Okay. So yeah, you were well acquainted. So looking back on your path, what part of your schooling do you think was most formative in what you’re doing now?

Carla Britton:

All of the public health pieces, and actually quite a lot of the pieces even before have been really useful. I was a wildlife biology major as an undergrad, but I also spent my summers interning with the National Park Service. So there’s this really big communications piece, and I think we discount in public health how important communications is. Especially I think we all learned that during COVID

Lauren Lavin:

Now we might know it, but before that might have been a lesser known fact.

Carla Britton:

It’s a little clearer and a little sharper focused now than it was how important communications is and being strategic. And so I think we learned that. I brought that piece from the park service with me since it’s a big part of what you do in the park service is really public communications. And then I got really good grounding here and just for public health principles here. Epi, of course, is your first love because why would you not want to use it as the puzzle solving skill that it is? It’s really about puzzle solving. I also really liked the science of ecology, and to be honest, Epi is just the ecology of disease. So it was an excellent transition for me. So I use a lot of it really on a day-to-day basis.

Lauren Lavin:

What made you decide that you wanted to get your PhD and then or why in Epi specifically?

Carla Britton:

So the PhD was in part driven by the whole EIS focus because you actually can’t be an EIS officer unless you have some sort of terminal degree.

Lauren Lavin:

Can you explain what that is?

Carla Britton:

So that’s the Epidemic Intelligence Service. It’s a CDC two-year fellowship, only one of many CDC fellowships. I’m going to put a little plug in here for public health fellowships that you might consider as you move toward graduation from either your undergraduate program or your MPH or your MS or anything else that you have. And it’s intended to be a really applied fellowship. About 70% of the class will end up at the CDC in Atlanta and, or other CDC programs, and then about 30% will end up at states or tribes or other affiliated programs. I chose to go to a state, I wanted to see how local public health worked, which was very informative. Of course, the one really important thing is if you know about one state, you know about one state and nothing more.

Lauren Lavin:

We say that all the time, especially about Medicaid.

Carla Britton:

It’s about Medicaid. It’s really every state program runs exactly the way it does in that state and in no other state. So it was a really good entree into seeing how one state thinks about and does public health. I chose Epi in part just because I love puzzles and Epi is really the puzzle-solving piece of public health. And it’s got some great skills, lots of data skills and all those things that, because mostly I manage people. I’ve completely forgotten, but I-

Lauren Lavin:

But you had them to start.

Carla Britton:

And I have people to do those.

Lauren Lavin:

Yeah, exactly. So do you think that your time as a, well with the National Park Service impacts what you do now?

Carla Britton:

Sure. Those communication pieces of it are a big piece of what I do now.

Lauren Lavin:

Yeah. I think that’s the beautiful thing about public health is that there’s so many intersections with other disciplines, and I think the broad variety that people bring to it is what makes it such a unique field.

Carla Britton:

And I do think it’s also one of the reasons that people are attracted to it is that there is this really broad spectrum of interests and this really broad spectrum of skills, this skillset that people use. If you work in really, especially if you work in local public health, I would say it’s less true if you work on a national level than it is really if you work in local public health where you’re dependent on using all your skills to get your job done.

Lauren Lavin:

Yeah, yeah, that’s a really good point. So what research are you involved in right now?

Carla Britton:

So we do a lot of non-research, public health surveillance and data dissemination projects. And then we do some quality improvement projects. One of which is that I’m working on right now, we’re just getting off the ground, is around hepatitis C screening within the tribal health system. And then I also have worked with someone who’s doing a project around clinical decision-making in Medivacs, because we do a lot of rural Medivacs in Alaska more than anywhere else.

Lauren Lavin:

What is a Medivacs?

Carla Britton:

So those are medical flights to higher level facilities. And so we do a lot of that in Alaska, obviously, since a lot of our villages in particular are accessible by air only. And so, one of the projects has to do with some of the decision-making around how we decide how a patient’s going to get from a village to higher medical care, whether they are metaflighted out of there or whether they are going to go on the next commercial flight or whether they’re going to stay in the village.

Lauren Lavin:

Okay. Yeah, that’s really interesting.

Carla Britton:

So that’s a pretty exciting project.

Lauren Lavin:

When you say public health surveillance, what type of things are you looking at?

Carla Britton:

So we do a lot of work with some of the national data sets that are collected. So obviously BRFSS, we have a huge partnership with the state of Alaska around BRFSS. In fact, we’ve done with the state partnership, a really nice data sharing app.

Lauren Lavin:

Really?

Carla Britton:

If you show up tomorrow, you can have a look at. Yeah, and that was really important because of a cyber tech that the state experienced, and we lost the ability to do that. But this provides more accessible data to the state partners in a way that reduces burden in terms of special data requests and everything else. We also do a lot with really basically any public data set and, or data set that we can acquire from the state that we share specifically within Alaska Native focus. We’re big partners also in the state’s state health improvement plan, which is Healthy Alaskans 2030. And the Epicenter provides data support to the Healthy Alaskans program. And that, again, is a really big state of Alaska, Alaska Native Tribal Health Consortium partnership where both organizations provide some resources to the partnership. So that’s been, and it’s multi-year partnership, it’s been really exciting.

Lauren Lavin:

Wow. Okay. Can you explain some of the challenges and triumphs you have seen while working in the area of Alaskan Native Health?

Carla Britton:

Obviously, from a data standpoint, our challenges are always small numbers from improving public health. There’s obviously a couple big pieces. One of is that when you have these really remote and rural populations, they’re at just a general disadvantage in terms of both economic resources, but also just healthcare access. So there are lots of initiatives to address some of those things. And on the AMTHC level, we have a dental health aid therapist program, which is intended to basically improve access to oral healthcare, which is really exciting because that’s a huge, big burden and certainly impacts people’s health across our lifetime.

Lauren Lavin:

Absolutely.

Carla Britton:

We also have a community health aid program, and the community health aids in our smaller villages provide almost all emergency and preventive healthcare.

Lauren Lavin:

Wow.

Carla Britton:

So that’s a really big program. We have a similar program for behavioral health aids, which is intended to focus on behavioral health challenges. At the epicenter we are a big focus in the last couple, well, last year, so really has been around data access and data sharing and working with state and federal agencies to improve tribal and tribal organization access to surveillance data. So that’s been a big initiative.

Lauren Lavin:

Do tribal organizations want access to this data for their own use?

Carla Britton:

The epicenters do, and we’re a central point for data sharing, and we’ll provide a lot of technical assistance around data for the tribal health organization. So for us, it’s not as much specifically tribal access as it is access for the epicenter. For some of our other epicenter partners, the data access is even really more local, and there’s a lot of some more interest in tribal access.

Lauren Lavin:

Many people have praised you for your incredible mentorship. What advice do you have for students looking for a mentor? And if there are people listening who are looking to mentor others, do you have any advice for them?

Carla Britton:

For looking for a mentor, I think a lot of it is finding somebody that you first admire and two has interests that are aligned with the things that you think you might be interested in doing, and then developing those relationships. And then from the standpoint of being a mentor, I think it’s being there to be a sounding board and both to provide, I’ve always just thought of it as a way of bouncing ideas back and forth and providing insight into whether it’s possible or just even providing advice on where you could or could not go.

Lauren Lavin:

Yeah, there’s a practicality to it.

Carla Britton:

There’s a practicality. It’s like, okay-

Lauren Lavin:

That students don’t get.

Carla Britton:

… it’s a great idea, but it just might not be your best idea. You don’t want to squash anybody’s ideas. But I think it’s just a lot of it is just being a sounding board. People have amazing ideas, and to some degree, being a mentor is helping people get those ideas out in the world and moving them to fruition.

Lauren Lavin:

Yeah, facilitation.

Carla Britton:

Exactly. Facilitation.

Lauren Lavin:

So what suggestions do you have for students who are looking to have a job like yours? So a little bit more specifically to work with maybe Native populations or to work in the type of federal, what would you call it? Federal, I don’t know, research group essentially, or consortium.

Carla Britton:

Yeah. If you’re interested, I think this is probably true of working in any population that experiences health disparities. If you’re not of that community, then you need to be humble and it’s not about you. And I think it’s really helpful to be open and honest about that. I’ve never been less than honest about the fact that it’s clear that I am not Alaska Native or American Indian, and that there are certain things I absolutely have no experience with and cannot understand, and I can hear and I can listen, but I don’t have that experience. And I think too, that just in general, being innovative and flexible and open and inviting and realizing too that it’s really about the communities and that there’s no top-down solution that has ever worked at any time.

Lauren Lavin:

I think that’s a really good point.

Carla Britton:

And so it’s like how do you engage communities to have, in some cases, probably really hard discussions?

Lauren Lavin:

Have you ever had a hard time or have you thought that it’s been harder since you aren’t one of their population? Or do you think it gives you an outside in?

Carla Britton:

I think it certainly is a different perspective. You bring to whatever job you’re doing, the perspective from where you came from and who you are. I can’t change that at all. And I did not grow up in Alaska, and I grew up in California. And so what I experienced and the perspective I bring is maybe helpful, but is certainly just one perspective. And when I talk to friends and we talk about some of the experiences that they had, they’re just extremely different. And I’m more interested particularly in this environment and nurturing community members, because again, it’s not going to come, no change is going to come from outside. So nurturing community members to engage in public health and just encouraging an interest in public health and the fact that it’s this incredibly broad thing.

I do think that one thing, there’s a lot of discussion right now about the social determinants of health, and I think as public health practitioners, one thing we do need to recognize is that there are a lot of social determinants of health over which public health has no influence. So I think that this is an opportunity for public health to maybe step outside the box and think about where partners might come from and what those partnerships might look like.

Lauren Lavin:

Explain that further. So which social determinants of health do you think that applies to?

Carla Britton:

So I think if you really think about things like education and poverty and economic opportunities, those are areas in particular that public health does not have any direct influence over, but they’re big determinants of health.

Lauren Lavin:

Absolutely.

Carla Britton:

Of both the community and individual health. So I think those in particular are going to require some unique thinking and some unique partnerships.

Lauren Lavin:

Yeah. Collaboration with those organizations as well. That’s some good food for thought for students listening to this. Okay. Two last questions. So going a little bit more broadly, what suggestions do you have for future public health students in general? Undergrad, grad, just in general going forward?

Carla Britton:

I think that from the standpoint of as you move forward into your new career, think a little bit about what is it that you’re interested in, where do you want to live? Because if there are places that you specifically want to live and places you specifically don’t, then just don’t look in the areas that you’re not interested in, but also realize that no matter what it is that you do, I can guarantee that there’ll be something you can learn from it. And so be flexible and try not to be completely focused on just one goal. Realize that there could be some pathways that maybe don’t look like the most obvious pathway to where you’re headed, but that you can gain some valuable mileage on.

Lauren Lavin:

Absolutely. I think that’s great advice. Okay. Last question. What was one thing that you thought you knew, but you were later wrong about?

Carla Britton:

Every day. Things that I thought I knew. In my head some of these things have really simple solutions. I was thinking about, I was talking to somebody the other day about some data access to our EHR data and some linkages, and I’m thinking, Oh, this really shouldn’t be a big deal. It should be just an easy thing to do. And the reality of it is there’s probably all sorts of barriers that I just haven’t seen yet, but in my head, it’s really easy. This really shouldn’t be a problem.

Lauren Lavin:

So it’s an everyday occurrence.

Carla Britton:

Everyday occurrence, every day there’s something that I thought I think should be really easy that isn’t as easy as I perceive it. I always see these really simple paths to where we’re going, and the path is really as straightforward as I think.

Lauren Lavin:

Yeah, I think we can all relate to that a little bit. Well, thank you so much, Carla. We were honored to have you on the podcast, and congratulations on your Distinguished Alumni Award. And well, yeah, just thank you so much for being here.

Carla Britton:

Well, thanks for having me. It’s been a pleasure.

Lauren Lavin:

That’s all for our episode this week. Big thank you to Carla for joining us today. This episode was hosted and written by Lauren Lavin and edited and produced by Lauren Lavin. You can learn 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 and would like to help support the podcast, please share it with your colleagues, friends, or anyone interested in public health. Have a suggestion for our team? You can reach us at CPH-gradambassador@uiowa.edu. This episode is brought to you by the University of Iowa College of Public Health. Until next week, stay healthy, stay curious, and take care.