A Conversation with Dr. Denise Payán, Deputy Director of Cal-IHEA

September 20, 2020

I sat down with Dr. Denise Payán, a UC Merced professor, health policy researcher, and the newly appointed Deputy Director of Cal-IHEA. She told me about her work, our role as Cal-IHEA, and what she envisions for us moving forward.


Can you tell me a little bit about your research interests?

I'm really interested in policies, specifically obesity and nutrition policies at the state and federal levels, and have become increasingly interested in policy environments and the policymaking process itself. A key research question I think about is why are certain health policies successful in the legislative process? 

Another area I've been interested in is studying and examining advocacy coalitions here in California. We're a very large state, and we have a rich set of stakeholders involved in policy making, including nonprofits, industry groups, and individuals. I'm excited to connect with these stakeholders as part of Cal-IHEA with the hope of promoting evidence-based health policy for all Californians.

What role does Cal-IHEA play in the research-to-policy making pipeline, and how can we center equity in this process?

We're really fortunate that we have such a great public higher education system in California. We have the UC’s and the Cal States; we really do have a rich capacity to produce research that informs policy and practice. I envision Cal-IHEA as a vehicle to connect researchers in California in their respective fields to policy at state and local levels. 

One of the things we're starting to see, especially this year, is how specific communities and groups have been left out of the policy making process. Even though we're in a democracy, not all groups are represented in the policy process, or by elected officials as they make decisions. It's crucial to think about equity, and part of that is elevating community perspectives. We can’t expect individuals who have been left out to all of a sudden become involved in the policy process, because policymaking is a lot of different cogs. There are various phases, and it's really hard to figure out where you fit in and how to make a lasting impact. For some people, the topic is very personal if they're reacting to a tragedy or event. But it can be hard to sustain momentum or move the policy needle because of political inertia. We need vehicles like Cal-IHEA to promote research evidence and elevate community perspectives into the policymaking process itself. If these perspectives are integrated into the process, and they're valued and respected, hopefully the outcomes will narrow the gaps as opposed to what's happened in the past--some policies are effective and efficient, but they also widen inequalities and hurt certain groups, which is an unintended consequence we need to actively eliminate and address.

How can we collectively elevate those community perspectives and uplift individual voices into the policy process?

We need more partnerships between researchers, community organizations, and policy makers. For example, I think something you don't learn in a doctoral program--something I didn't learn in my research training--is how you actually impact policy and how your work fits within a broader policy environment. There are a lot of organizations in Sacramento or at local levels that are already embedded in the policy process. Connecting with them to identify research ideas and learning from one another can help bridge the gap between research and policy. Building strong relationships is also really important. I highly value community engaged research, and that means actually involving community members and organizations into the research process, including at early stages when they can provide input on the research questions. That's something we can strive to do more intentionally as researchers who would like to promote evidence-based policy. 

I know you intend to work on a telehealth project with Cal-IHEA. How have we seen telehealth transform during COVID-19? 

Some of the clinics that are providing care for the most underserved communities are struggling with the digital divide right now. Pre-COVID, there was low adoption and use of telehealth in many safety net settings due to operational, financial, technological, and patient readiness barriers. During COVID, we've seen all healthcare organizations experience a sharp increase in telehealth adoption and use because of the reduced risk of infection and reimbursement policy changes. But telehealth has been, and continues to be, a big challenge for safety net settings. We need implementation research on the experiences of these clinics and their patients to inform enduring policy changes.

What challenges or developments do you see for Cal-IHEA in the upcoming year? 

One of the challenges is promoting equitable health policy priorities. The COVID-19 pandemic really shifted the health policy agenda, and we've seen a flurry of policies that have focused on pandemic-related issues. There is a policy window, but the focus has also narrowed and seemingly unrelated issues have fallen by the wayside.

I think Cal IHEA can help connect the dots in this pandemic policy environment between the impact of COVID-19 and existing health inequities. For example, California’s healthcare workforce shortage was of huge concern during the pandemic, particularly for regions like the San Joaquin Valley. Farmworker health is another example. Cal-IHEA has done a great job so far toward promoting a comprehensive health policy perspective, but there are many uncertainties about what future policy priorities will be.

I highly value community engaged research, and that means actually involving community members and organizations into the research process, including at early stages when they can provide input on the research questions. That's something we can strive to do more intentionally as researchers who would like to promote evidence-based policy.
Dr. Denise Payan

What is your vision for Cal-IHEA moving forward? And how do you see us kind of developing as an organization?

I'm stepping into a new role in an organization that already has a really strong team and leadership as well as clear priority areas. What I hope to add is based off of my research on advocacy coalitions. How can we develop new partnerships with policy makers and advocates and sustain those relationships to promote evidence-based health policy? 

What I hope for in a few years time is, if a state legislator or legislative staff member has a question and it's related to health research, that they know they can turn to Cal-IHEA for research support. On the other side, [I hope for] greater visibility of Cal-IHEA in the UC and the Cal State systems, so researchers and practitioners are also familiar with the work that we do. In the long-term, I think Cal-IHEA can play a unique role in promoting processes that lead to equitable health policy for our state.

Cal-IHEA also provides a lot of opportunities for students and trainees to learn about the health policy field. Research can be slow so we need to make sure we are providing students with the opportunity to be exposed to these skills and ideas. That capacity building is really, really key. We need more providers, practitioners, researchers, and policymakers with strong analytical skills and an understanding of equity so they can make a difference in their own area. Down the line, [our students and trainees will] integrate equitable perspectives into work that they do and into these organizations and processes. That's what is really exciting in the intermediate and long term for Cal-IHEA.

Was there anything else that you might have wanted to touch on, either about your work or Cal-IHEA? 

Ah, just that I'm really happy that UC Merced is contributing. Part of the reason why I've been interested in supporting Cal-IHEA’s work is to integrate perspectives from the San Joaquin Valley, which is a very unique region that has been overlooked in the past. I'm really happy to be at UC Merced with wonderful colleagues and students who hope to get more involved in Cal-IHEA’s work.