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Della Au Belatti
In conversation with Milbank Memorial Fund former program officer Kate McEvoy, Della Au Belatti, Hawaii State Representative, and Vincent Pinkney, Deputy Director of Managed Care Operations for Tennessee’s state Medicaid agency, reflect on how their backgrounds have influenced and inspired their public service. The two members of the 2021–22 Milbank Fellows cohort discuss the communities where they grew up, how they work with people with different origin stories, and mentors who have shaped their leadership styles. This Q&A is the second in a series on policymaker “origin stories.”
Kate: How would you describe your origin story, or where you came from and what influenced and inspired you in public service?
Della: I am the great-granddaughter of Chinese–Filipino immigrants to Hawaii. Hawaii has very rich cultural, racial, and ethnic diversity. I am a descendant of working families, and that’s really been what’s informed my work in public health and health care.
Kate: Thank you so much. And, Vincent, to you for the same question.
Vincent: I come from Southwestern Virginia, a town called Roanoke, Virginia, which is not that different from Tennessee. It’s rural and that shaped me growing up — seeing how state resources are distributed unevenly within that state.
Another thing that shaped me were my mother and father’s clinical experiences. They both have experienced various chronic diseases. I went in and out of hospitals all the time, so I saw how the delivery of care, and being a working family, had an impact not only on household finances but also the opportunity for work for persons who have a partial-disability or full disability. Having this exposure led me to want to become involved in health care. Ultimately, I’m a systems thinker, and I felt that public health was where I could make a better impact.
Kate: I’m so grateful that both of you would share in that personal way. Della, the aspect of heritage, and Vincent, the specifics of lived experiences. How do you think about connecting with people who have origin stories that are very different than your own?
Vincent: I find myself working within a government system that has a Republican super majority within state legislature and similar appointees within the executive and judicial branches. Ironically, I don’t see that as a barrier. I see that as an opportunity. I try to lead in a way that encourages difference because I think that there is strength within a diversity of perspective. I’ve learned over time that the more you are willing to listen to other people’s experiences and perspectives, the more that you see there is neither a right way nor one particular way to accomplish something. Often, you can share strategies, combine approaches, and arrive at the most optimal outcome.
Having years of experience serving as a facilitator, I’ve learned that it is sometimes more important to ask the right questions than to try to deliver a solution because those closest to the problem usually have the best solution.
Kate: Della, connecting with people across differences is a great talent of yours. Can you say more about how you think about that?
Della: I’m going to go back into my origin story. I’ve lived in a place that’s really a minority-majority culture. In Hawaii, collaboration is baked into the DNA because we’ve had to work with such multicultural diverse populations for so long.
The thing that has driven me, and I think you see it in the way we developed policy in Hawaii at the start of the pandemic, is convening large groups of people. We pull in community systems, advocacy groups, faith groups, community representatives from the health sector and the social services sector, and that’s how we get things done. Our approach involves listening with empathy, finding those solutions, and then working through issues to deliver results.
Kate: Was there a particular example of legislation or policy action that benefited from that intentionality around connecting across difference?
Della: The experience of rolling out our vaccination policies and our mass vaccination clinics was very much built upon making sure we listened to community and reached across to community. Getting that message out meant approaching it differently for certain groups and being attentive to language barriers and understanding who the trusted folks were in the community. Finding those people depended on connections through community health clinics, schools, and faith communities.
Kate: Are there strategies that you have evolved over time to support your work in population health?
Vincent: Empathy is a valuable strategy. People want to feel heard and be seen and we can do that by trying to think through others’ experiences. When you are accomplishing work between teams or even between organizations, you must recognize that everyone has a position or an agenda. Everyone has baggage, even organizations. To be effective, you must seek alignment.
Della: In Hawaii, we drew down a lot of the federal assistance for rent toward the end of 2020 for our landlord-renter mediation relief program. What made that program so successful is we brought in the third branch of government, the judiciary. It’s not just about working across community sectors, we also have to think about government sectors. Bringing the judiciary to the table to design that piece of legislation made mediation a key part of connecting people who have adverse interests and giving them the space to work out their differences. That is a part of empathy, alignment, and coordination. Not all the problems were solved, but in the vast majority of cases, we were able to keep people housed.
Kate: What an amazingly powerful example. I am struck by how often when we talk about cross-branch, we are talking only about the legislature and the executive branch. We have a real myopia around the third branch, which can have powerful inhibiting or enabling influences, depending on how you establish the levers. Vincent is there anything you would like to add?
Vincent: In Medicaid managed care, that’s exactly what we do with our three health plans. We challenge the three health insurance plans to work together. Traditionally, Medicaid agencies as a regulator, may want to come in with a top-down approach and say this is what you should do. In reality, the health insurance plans have the subject matter expertise across their competing organizations. If you create a safe space, like Representative Della said, they’ll be able to come up with an even better solution.
Kate: I love hearing that, and that’s even expanding that lens. Obviously state government is not the seed of all solutions, and we can think about private partners and communities being an origin point. I’d also like to ask if there a person you’d like to mention who was very influential on your development and as you entered this work and progressed?
Vincent: Annette Haley, who previously worked as the Mid-Cumberland Regional Director of the Tennessee Department of Health. She exemplified how to create a healthy operating environment where people not only felt personally supported but also professionally developed and challenged. She was confident in the capacity of her team to identify the right solution. She didn’t try to do it all herself. She showed me a leadership style that was rooted in servant-leadership. Her level of humility allowed her to be even more effective in her role because she gave us space to innovate in a safe environment and to tackle conflict in a healthy manner.
Kate: That’s fantastic to hear. Della, how about you?
Della: I’m not particularly religious, but faith played an important part in my formative years. I’m a proud graduate of Maryknoll School here in Hawaii, and it’s the Maryknoll Sisters who have shaped me. The Maryknoll Sisters have a rich tradition of empowering the communities that they go to, and then leaving. Their legacy is about growing leaders. I think that showed me how, as a leader, it’s about building the community and the capacity around you and passing the torch on. There’s this great ceremony that the Maryknoll Sisters do as part of graduation where you light a candle, and you pass that light on because you want to share it with other people. As a woman of color, and as a beneficiary of that kind of education, that instills servant-leadership that Vincent talked about.
Kate: Thank you so much for sharing that. I’m so taken by the image of passing light. It’s a beautiful metaphor to wind up our discussion.
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