January 19, 2021 • 41 mins
Did we not know that the big bug would hit? Or did we? Did our trusted officials just kick the can down the road? Or does the problem lie with the general public – and their unwillingness to listen to expert opinion and information? This week’s episode of Contakt World dives into the hot button issues of race, misinformation systems, pandemic plans and the politics of public health – specifically, through the lens of E. Oscar Alleyne, DrPH, MPH, epidemiologist and Chief of Programs and Services for NACCHO, The National Association of County and City Health Officials. Join our hosts Justin Beck, Catherine Delcin and Deepti Pahwa, as they speak with Alleyne, and discuss the challenges faced by public health organizations, epidemiologists and elected officials. As always, we’ll talk about how to help our local health departments – and encourage innovation and technology integration – all while remaining empathetic, plus keeping an eye toward health equity for all.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
As epidemiologists and public health planners for years, we've been
trilled into an exercises we've been talking about, you know,
a pandemic or the big one hitting for lack of
a better word. The plans, the the exercises and the
strategies that we had got thrown out the window. So
that was part of the initial frustration. Pandemic plans and
(00:21):
things that folks had essentially were not looked at. That's
Dr Oscar Allen, chief Program Officer for NATUO, the National
Association of County and City Health Officials. Dr. Allen undoubtedly
has one of the most important responsibilities in our public
health system today, overseeing and directing funding to more than
three thousand of our country's local health departments, serving more
(00:43):
than twenty five thousand health officials. In his leadership role,
he also leads to nacho's national response to emergent health threats,
including COVID nineteen, but also ZEKA and natural disasters. The
frustration of the anti science that we're seeing now in
the general public, and more specifically, just the lack of
desire to have that social responsibility of recognizing we're not
(01:06):
out of the woods yet, So it astounds us that
an altruistic group who are trying to save people's lives
are being targeted, have death threats, are being told that
they are lying, that they are part of a great scheme,
and in several cases are facing physical and online harm
when they're just trying to do their life's work. I'm
(01:32):
Justin Beck, founder and CEO of Contact World. I'm here
with my co host Katherine Nelson and DP Pava, and
over the coming months, we'll be talking to scientists, researchers, celebrities, experts,
anyone who has been affected by COVID and getting to
the bottom of how we can improve public health together.
We may not have all the answers, but you deserve
(01:53):
to understand what goes on in your neighborhood and the
decisions that will affect you and your family's health. Welcome
back everybody to Contact World. So even though this podcast
is centered around public health, we've identified racism and I'm
going to somehow add extremism as a public health issue
before we get into the heroic work of nature and
(02:14):
one of its leaders as a theme, I want to
start with here. I'm deeply concerned about where we are
as a country, just like we learned about how misinformation
could compromise the vaccine rollout. Misinformation from our political leaders
has now actually caused the insurrection of the United States
government through our capital, with planned armed protests throughout our
(02:37):
state capitals, and intelligence that we're just scratching the surface.
I'm curious to know what your thoughts are on how
you've seen all this play out deep in Catherine. Yeah,
I think it's kind of a weird divide. We want
to encourage people to share information, we don't want to suppress,
we don't want to stay answer, but at the same time,
we want to make sure that the information being shared
(02:59):
is accurate, that it is not something that's going to
be detrimental to our society, to our country. I think
it's also the responsibility also of the individual to fact check, Right,
where did you get this from before you hit that
retweet or share? But where did this come from? How
do I know this is accurate? Is it from CNN,
(03:19):
is it from ven S, NBC, whatever news you listen to,
or is it just some random guy posted it on
Facebook and it rings true somehow because of whatever you believe,
and then you just share it. So I think I
want some level of accountability from the individuals in the
information that they disseminate. Absolutely, But at the same time,
who are our role models? Right, We're actually kind of
(03:41):
leading our way into making us think like that. And
I was actually very impressed by Gabriel Sterling of Georgia
who responded to President Trump's false claims at a news
conference in Atlanta and he claimed it as an anti
disinformation Monday, I mean, which was amazing. And we need
more people like this to come out and counter misinformation
(04:01):
and facts and become rule models and make people in
public aware that there is a way to do the
fact checking and you should always fact check before you
share something. Yeah, And I think another scary thing is
that there's a distrust for the media. Growing up, you
want to know what's going on. You watch the news,
end of story. Now it's becoming well is it really
(04:22):
the news? Is it really the right information? We should
have some standards where we know if it's from this
reputable source, it is in fact what's happening. Yeah. I
think that we have a crisis on our hands and
politics because we celebrate our frontline healthcare workers as heroes,
but somehow our public health officials actually need security details
(04:47):
because people somehow blame our public health officials for trying
to save everyone's lives and make these recommendations to politicians.
The conservative media has almost been puppet for Donald Trump
for years now, and the misinformation we've seen has actually
(05:08):
been spread by the media. It's a scary time, it
really is. And I think that we've only seen, unfortunately,
the surface of extremism, and really racism and extremism are
a public health issue and it's something that we're going
to be dealing with for a long time unfortunately. Yeah,
and coming back to the topics that we usually talk about,
(05:28):
which is health equity and vaccination and COVID, you know,
all these things dying into the same team of misinformation.
For instance, you know the problem with public communication misinformation
for vaccines. The science is clear vaccines save lives, but
despite overwhelming evidence of the effectiveness, vaccines remain a very
contagious issue. You know, Like municipalities across the country are
(05:51):
receiving pushbacks in response to their efforts of humanization programs,
and this is all cause of misinformation. I mean, do
you guys have some thoughts on at as well. Yeah,
I think we start with fighting misinformation with proper information,
the right information getting out there. And I mean, we
need to give the numbers, who's taking those vaccines, what
(06:12):
are the results. So if allays see is the negative information,
then we tend to believe that it's true. Right. If
you encounter something two, three, or four times, your brain
just automatically accepts it as information that is valid and accurate.
So it's a tall order, but it is the responsibility
of the city's, the counties, the government officials, organizations like
(06:32):
nature to take this on and really put out the
information and let people know that this is safe. Right,
And I think maybe we need to dig deep a
little bit into our history as well. The ad Council
and nonprofit Advertising Group led a similar large scale effort
in nineteen fifties when they urged Americans to get vaccinated
against polio. When we talk about COVID nineteen, vaccination into
(06:55):
one of the biggest and the largest public education cruises
in history. And we have an opportunity here to bring
in the voice of public health in the right communication
framework that it speaks to people through our communities. You
will need to hear it from the people around you,
from your communities. You know, speaking of community engagement, I
(07:17):
Heart Media has been incredible and partnering with CDC, they
actually delivered over a billion impressions to help with COVID
nineteen campaigns. We're actually going to be launching a product
to help with community engagement through iHeart Media soon. But
I am really hopeful that under the new administration, we're
going to have a better federally coordinated response at the
(07:39):
local level. Okay, guys, we've had multiple conversations covering so
many different things, but this episode is focused on Nature.
Justin I know you spoke to Dr Allen. Can you
tell us a little bit about that interview. Yeah. Dr
Allen is the chief program officer for Nature. As I
think we've referenced before, show is a really important partnership
(08:02):
for Contact World. They actually serve the three thousand four
county and city health departments and over twenty health officials.
One of the things that we've learned at Contact World
is we have not made the commitments that we need
as a country to our public health infrastructure, and the
(08:22):
things that we're seeing play out here, whether it's problems
with contact tracing, testing vaccination, really point to the dearth
of resources that are provided to our local health agencies.
(08:48):
Dr Allen, thanks again for your time today. So can
you tell us about your role with the National Association
of County and City Health Officials or nature Sure. I'm
the Chief Program Officer at the nationals Asociation of County
and City Health Officials. That's the national organization that represents
the three thousand local health departments across the country. In
my role as Chief Program Officer, I am responsible for
(09:11):
the strategic program and the executive leadership at least on
program side of support in both technical assistance for local
jurisdictions capacity building, and I'm also as results of the pandemic,
I've been the incident Commander sorts that we've had associated
for the organization, representing ourselves in a national lends bow
(09:32):
for emergency preparedness as well as local interaction across the country.
And when I was preparing for her discussion today, you
have an incredible resume spanning executive and advisor roles, thought leadership,
and a lot of publications. Can you share what inspired
you to take on a career in public health. It's
always a personal story in that regard. I became interested
(09:53):
in public health because of my grandmother, she had developed
multiple miloma, which is cancer the bone marrow, and I
could not understand why a woman who didn't drink, didn't
do anything that would have been deemed as high risk,
had developed this illness. I kind of always knew that
I wanted to be a doctor from a very tender age,
but that drive to figure out what was the cause
(10:14):
led me to pursue in both biology and public health,
and essentially I went into both environmental health and epidemiology.
And then while in grad school, I got an opportunity
to focus on local health departments, and when I graduated,
I went into working at the Rocklan County Health Department,
where I was the directive of epidemiology is for roughly
(10:35):
about fifteen sixteen years before coming too nature. You know,
our our listeners span public health experts, but also just
regular folks, because you explain to our listeners who aren't
really familiar more about what an epidemiologist does. Yeah, the
best way of describing epidemiologists your disease detective. Specifically, your
role is to identify what are the trends and diseases,
(10:56):
how are they caused, what are the reasons for are spread,
and more importantly, what can you do to prevent to
either stop and outbreak or develop policies or strategies to
help prevent them from happening in the future. So it's
a really robust way of describing and what disease detectives
do in epidemiology. You joined Nature, at least in executive capacity,
(11:17):
I think in March or April of two thousand nineteen.
I can imagine you've had a major learning curve. To
say the least, what have you learned about yourself in
the pandemic or everything. I would say what I've learned
has been the experience that have had at the ground
level has prepared me to at least have better insight
and better way of communicating at the national lens, because
(11:40):
oftentimes when you're sitting in these larger emergency centers, so
you're seeing these policies or suggestions come up, at times
you can tell that they weren't derived for individuals who
are at the ground level who need to take this
digested and make it available for the community members that
they serve. That's one of the things that I think
I really have learned and have really appreciated is that
(12:02):
experience that I had at the local ground level really
has prepared me and provided me with the ability to
communicate things at the national lens as well. What would
you say has frustrated you the most about and our
response to this pandemic? Two things. One of the first
things I would say, as epidemiologists and public health planners,
for years, we've been thrilled into and exercises we've been
(12:25):
talking about, you know, a pandemic or the big one
hitting for lack of a better word. And what one
of the initial frustrations the plans, the the exercises and
the strategies that we had weren't necessarily being utilized. And
part of that was as a result of changes in
the stance of where there's a nationalized effort, there's a federal,
(12:47):
state and local integration that's somewhat got thrown out the window, right,
That's somebody got a lot around the window. So that
was part of the initial frustration. Pandemic plans and things
that folks had essentially were uprooted or not looked at,
and you know, having to pivot and adjust to figure
out how to better integrating into this change in dynamic
did have a significant degree frustration. The second aspect of
(13:09):
My frustration, I would say, has been even though we
were able to experience that in the initial phases, and
as we've gone into this third quote unquote wave of diseases,
spread of the pandemic, both in the cases as well
as the deaths. It is the fact that no matter
what the science has done, the frustration of the anti
(13:29):
science realm that we're seeing now and in the general public,
and more specifically, just the lack of desire to have
that social responsibility of recognizing we're not out of the
woods yet and are still engaging in behavioral activities that
are significantly jeopardized and amplifying how this disease is continued
to wreak havoc on our lives. Right We were actually
(13:50):
speaking with Dr Peter Hotels recently about the threats of
misinformation from the anti vaxt Or movement. How do we
overcome the trust barriers to achieve broad back the nation
for COVID nineteen, especially in black and brown communities. You know,
it's not an easy answer because there's a significant structural
history that falls into play. So when we speak specifically
(14:11):
about the communities of color, they have had centuries of
disenfranchisement and medical apartheid and historical abuses by virtue of
how their interacted with medical community. We think about things
like Henrietta Lacks Right and her cells being taken and
not being told that she was being treated or being
examined for cancer, but yet her cells and her families
(14:33):
to that material use for decades. And we think about
the issues of Tuskegee and the syphilis, you know, the
looking at black men and not treating them for forty
plus years just to see how disease run through the population.
And I even use examples of even before that in
the eighteen hundreds, where the father of gynecology basically did
all his practice and his experiments on enslave black women
(14:56):
because they had this mentality that people of color didn't have.
Feel when you look at those historical context and it's
not just in the African American community, but also Native American,
Latino ets, etcetera. So this lack of trust over the
course of time, I think has really cemented a problem
of not only exacerbating the disparities that we're seeing and
(15:18):
how the public are looking at their being at risk,
but also their willingness to say, well, I want to
look at this vaccine in the new light versus one
of apprehension. So it's going to take a significant amount
of effort to one develop ambassadors within the communities. And
there are several that are in place right now doctors
who are signed up to be in the trial, participants, etcetera,
(15:39):
so that they can communicate what the effects are like
to their clients, etcetera, and their populations. So all of
that is really going to be important if we're really
going to turn the tide around how efficacy of vaccine
and safety is being communicated. We learned a lot about
the history of health equality in America from Daniel Dawes
recently executive director at satura Health Leadership Institute, and he
(16:03):
talked about how you know our system is you've just
highlighted not only from the trust standpoint, but also how
our system has just been fundamentally flawed. What role do
public health agencies play in improving health equity? The local
health departments are what we call the community health strategies.
They're the groups who are interfacing both with the health
(16:24):
care industry and the elected officials to community health, our organizations,
the schools, the business community. So the role that the
public health agencies. Play is not only trying to coalesce
the great collaborations to address issues of equity, but also
bring to point how these disparities are having an impact
on individuals lives. So it's not just the individual itself
(16:49):
who are to blame, but recognizing that there's all these
connected pieces what we call the social determines of health.
Right A quick example, let's say you want to stop
someone from smoking. You give them a patch. But if
they're in a household where smoking is approved, the smoking
is the norm, then that patch is not going to
be effective. If they're in a community where you go
(17:10):
into the stores, you go into the restaurants, who you
go into bodegas or whatever you name it, and you
see smoking materials right then and there in front of you,
then you're not going to be successful from an individual standpoint.
And then if you have policies that are in place
that really do not provide that clear alternative to those communities.
That's what we call these social determinants, these upstream issues
(17:33):
that have an impact on an individual decision point, and
they all are connected, it's not just one over the other.
So I think it's very important for health departments who
help amplify this message, who helps speak to the overall
population health of the community, to really bring these things
to bear and ensure that all of the partnerships and
the stakeholders are at the table to discuss them if
(17:54):
we are to be successful moving forward. One of the
things that really shocked me. You know, I don't come
from public health, but I've taken an interest in helping
improve the public health narrative. I was shocked to understand
that only two or three percent of the funding that
goes to provider care in this country goes to public health.
Despite you know, you guys being in the trenches and
(18:15):
being responsible for really protecting us and advancing health equity.
How do you think our country can improve the resources
for health agencies, especially the small ones that serve you know,
less than fifty thou people. So here's the thing. For
our three thousand counties city health departments, only six percent
of those are big cities, but yet they account for
(18:37):
more than half of the populations that are being served.
But the vast majority of these local jurisdictions are small
to medium size. So there are health departments that may
have a staff of six. Now, how are you going
to be able to ensure that such a small footprint
does have the workforce capacity to be able to address
all of these needs. You know, six people are not
(18:57):
going to solve the entire health cont strug for a population.
So that's where the benefit of collaboration and the team's
sport and public health is going to be important. Now
on top of that, the way we fund public health
is problematic. Oftentimes it's based on a disease specific issue,
so I'm just going to fund cancer and just go
to fund diabetes. So the real way we can address
(19:21):
better fund and local public health is to make sure
that the congressional side have an understanding that we can't
just look at categorical funding to do pet projects. It
has to be a universal way approaching support for health
agencies in the work that they do. And there is
also the need to address the private entities, you know,
(19:42):
the business communities. People say all the time, well, you know,
health is trying to shut people down and not address
the economy. You need healthy people in order to have
a healthy business. So those are all of the elements
of how I think we really need to shift Because
we've lost over fifty healthcare workers in the health World
within the last eight years, and there's even a sizeable
(20:04):
board that it being lost as a results of this
COVID response. You brought up something about communities and private
organizations working together. I was talking to Hannah Schultz last week,
who produces a podcast called Share public Health through the
Midwestern Public Health Training Center. She brought up something that
I think is really important to talk about, and I
think people need to mall this over. How do we
(20:24):
call our frontline workers heroes? Which I think is completely
commendable and understandable. But somehow our public health experts get
death threats and need security details. That is I should
have been my third frustration to your question. And I
say frustration because it's actually alarm and in the work
(20:46):
that public health practitioners get engaged in, they don't do
it for the sake of, well, we're going to make
a paycheck, and it is truly a sense of altruism.
As I told you, I joined public health because I
wanted to find out want my grandmother got sick, and
by doing that, I found that there's more to it
than just a single point source of cause of illness.
That yes, there's environmental factors, there are all these other
(21:06):
factors that come into play, and that's why I ended
up going too epidemiology. So my going into epidemiology of
public health, similar to many of the staff across the country,
has really been trying to do their life's work of
helping people. So it astounds us that an altruistic group
who are trying to save people's lives are being targeted,
(21:28):
have death threats, are being told that they are lying
that they are part of a great scheme, and in
several cases are facing physical and online harm when they're
just trying to do their life's work. So that does
not compute to me. As many times as I've heard it,
and even listening to the messages and seeing what our
members have been sharing with us, there are some very
(21:50):
horrific scenarios that are coming into play where people are
being enforced out of the jobs because they're simple trying
to follow our way of doing things in protection of life,
safety and wellness. So it is a frustrating and unimaginable
scenario that we now find ourselves. And I've gained an
immense respect for the work of public health, and I
(22:11):
think it's unfortunate that because of the altruism I think
that it's almost like our system and our politicians have
taken advantage of that and thought, well, maybe they don't
need that many resources. But I really hope that, you know,
especially going into the next four years, that our country
can really take a hard look at itself and change
the narrative and stop harassing public health workers. One of
(22:33):
the things we've always realized that health, public health doesn't
really do a good job of selling itself because we
operate into shadows. Right. You only hear about public health
when there's something big. You know, for example, there's an
outbreaking a restaurant, Oh, where's the health department? You know,
where's the inspectors. People are thinking things only in those
boxed approaches, but no one really pays attention at their
(22:57):
Public health departments are engaged in safe moms and babies,
teaching breastfeeding, ensuring that you have your foreign travel vaccines
as well as your regular adult or childhood level vaccines,
or teaching how to have better prevention techniques around diabetes
case management, and of course what the infectious disease world
and indoor outdoor air water quality, you name it. There's
(23:17):
so much that public health does, but they just put
their heads down, do it and move on to the
next thing, and don't sit back and say, hey, look
what we're doing. And as results, I think that somewhat
has been a problem and really to your point, really
articulating that folks the value of what public health departments
do and how their innovation, even in light of not
having great resources, allows them to be nimble and hopefully
(23:41):
be successful. I noticed that there's a lot of I
guess buckets or almost silos where public health, like you said,
works in the shadows, and we're really trying to with
tons tech world, bring attention to the unsung heroes of
(24:03):
our system. So we certainly appreciate all that you do
with Dr Allen. So you mentioned about innovation, so I
understand that Nature is launching an Innovative Practice Award to
highlight the creativity and COVID nineteen response, what sort of
innovation have you seen from local health agencies who we've
already talked about are under resource and underappreciated. Health departments
(24:23):
have really stepped up to the plate when it comes
to looking at ways to innovate both messaging as well
as access to for example testing. Even the role that
they have had to rapidly deploy in how they can
do contact tracing, as well as addressing several of the
needs that they're seen in communities. For example, ensuring that
we have one health department that just mentioned that folks
(24:46):
who do not have the capacity to isolating quarantine, they
set up a system where you could actually have a
hotel state. So they worked with a local hotel where
individuals who need to isolate for that fourteen days are
able to do so in a safe manner. That of
course allows them both the security and the privacy and
the ability to ensure that they are probably being cared for. Secondly,
(25:08):
we saw in the early phases of the pandemic, recognizing
that there's a need for improved community based testing, working
with several community agencies to ensure that testing can be
done at at risk populations like homeless shelters, where you know,
at times people forget about because well, you know, we
just have to hunker down. So these local jurisdictions have
(25:29):
really tried to find ways to even communicate. Oftentimes information
comes out from an English or maybe one or two languages,
but recognizing that some communities have multiple centers of cultures
and working with those communities to ensure that the messages
being done and the ambassadors and the community health workers
(25:49):
are on the ground interface and so that you are
hearing the message from someone that looks like you, speaks
your language, and they're able to address your questions in
a way that makes sense versus you know, as we
would say, the talking heads on TV. So there's so
many different areas around both integration of community interaction, looking
at what technology tools can be used, you know, how
(26:10):
rapidly they can really adapt and really amplifying their reaching
that effort to really ensure that they put their best
foot forward in how they want to tackle this particular
pandemic response. How do you see the role of health
agencies evolving over the next five years. You mentioned a
couple of things with messaging, improving their communications tools. How
do you see the evolution of the health agency, especially
(26:32):
after the disaster we've been through in twenty so we
have seen even prior to this, this whole concept of
public health transformation kind of call public Health three point oh,
which was an effort to look at how our health
departments going to change in both delivery of services as
well as the interaction with the community and one thing
I can say when the initial transformations began, a lot
(26:54):
of the thought was that well, health departments are no
longer going to be the go to or as we
call them, the safety now providers. So a lot of
this will be go into the affordable care organization and
other entities you know, health clinics, health centers. But what
we've seen in several cases, the health departments still remain
as that key deliverer of health and clinical health practices
(27:15):
in addition to the prevention piece. So I think moving
forward and recognizing the role that we have to play
in both the administration of programs and intervention strategies prevention messages,
I think there's an opportunity for us to take another
look at how we fashion our health department's role in
the community, both from the way it's funded and the
(27:38):
way it provides a cross matrix approach to addressing diseases,
so that we're not just looking at one disease independent
of others, but truly are embracing this cross matrix approach
that hopefully addresses as many points as possible while still
maintaining the focus on the wellness and safety in the
lungevity of individual's life. So is there a spot in
(28:00):
side of the Affordable Care Act or the kind of
the funding mechanism that is provider care where public health
is inserted ever, or is it just that public health
agencies have to just manage everything on the budgets that
they're handed and then hope for the best. Part of
the goal of the Affordable Care Act was to develop,
as we would say, the medical village that you were
(28:22):
not just going to one doctor's office, or you're not
just crowd in the hospitals, but that there's this approach
to really try to get things upscreen before become a
problem for hospitalization. Now, what that really tells you is
that the primary focus was on addressing things from a clinical,
hospital based care perspective, whereas all these upstream issues are
(28:43):
issues that public health departments have always been engaged in,
but they weren't necessarily funded to support in that strategy
because of a heavy reliance on a hospital based approach.
So we've had scenarios where health departments were not involved
and not at the table when several of these policies
or strategies were put into play. So where I would say,
(29:03):
moving forward and recognizing the role that these communities have
now realized, especially when it comes to the COVID response.
They're the ones responsible for about eighty percent of vaccinations.
But here's the funny thing. Their staff it's been pulled
off doing vaccines to do the COVID response, and they're
supposed to do contact tracing. Contact tracing. So, how do
(29:25):
we then pivot to ensure that in the future we're
rebuilding this framework for a nimble workforce. How are we
restocking the skills and integrating technology so that we can
make our lives easier, and how the work is engaged
and deployed. And then finally, how we also funded it
to ensure that is sustainable, that is not just based
(29:46):
on COVID dollars, but that we look at it as
a public health prevention fund that we can at least
apply for years to come. That makes sense. One of
the things that I'm a little bit fearful of, and
now all of that I've learned because of experts like you,
is the equitable distribution of vaccines. And one of the
things that I worry about. We're looking at how we're
(30:07):
gonna have these vaccination cards that are saying that yes,
I've been vaccinated, and you already have companies like Ticketmaster
talking about how they're going to have like a digital
verification of vaccination prior to entering events like that. How
do we prevent the vaccines or validation of vaccines from
advancing or creating more disparities in our system? Like what
(30:30):
is the fine line between ensuring people are healthy when
they enter places and also making sure that we're not
creating more disparities. So it's a slipper slope. I'll actually
first start with just the public sentiment around vaccines. That
we know that Americans want vaccines above anything else, but
they don't want one that's rush and that seems to
be some of the prevailing point. So the real goal
(30:52):
is to focus on ensuring that the messages around effectiveness
and how the vaccines were developed in that way, shape
or form to cut at this issue of hesitancy. The
other piece to that, to the point that you just raise,
is that of equity. We recognize that acuable allocation distribution
is going to be an issue not only with respect
to who gets it but where. So, for example, how
(31:15):
many vaccines are going to be available to the remote
and rule errors of the country when they may not
have the infrastructure to really address the cold storage and
handling for one. And then in addition, how do we
ensure that the populations that are most impacted can get
a vaccine and not necessarily be left out in the cold. So,
for example, one of the strategies have been let's focus
(31:37):
on the local pharmacies or the big ticket pharmacies. Now,
technically speaking, if the vaccines are supposed to be delivered
free for lack of better word, you still would have
to be able to pay an administrative fee for that
kind of distribution at a site like that. So are
we adding to the equity issue by saying that you
need to still pay an administration fee that individuals may
(31:58):
or may not have out. The other piece, which I
think is very important, is very talent as we look
at what lies ahead. I'll use the example of Washington
d C. Right now, and we have heard the news
that even with the initial deployments of vaccines that have
come into play, the numbers that were anticipated are gonna
be much less than what's going to be delivered. Washington
d C. Their health department came out with a message
(32:20):
that talked about their first allocation was only going to
be six thousand doses. Now in that first phase of
both the health care as well as the long term care,
they've identified about eighty five thou individuals. So automatically, we
already walked into an area of inequitable allocation, not even
talking about the general public and getting the other access
(32:43):
points for those hard to reach communities, those resource efficient areas,
et cetera. So it is a significant uphill climb that
we have ahead of us the goal and the hope
of courses as more vaccines become available and then we
get through this initial phase that hopefully we can reconcile
these particular issues. But I would dare say that we
can't go in it blind or thinking oh, there's a vaccine,
(33:04):
all's good and all's well done. There's still a lot
of work to go through. I mean, you're already seeing
the combination of the fatigue of lockdown combining with people's
false sense of security that just because of vaccine is
on the way that they can do away with public
health measures. I'd like to remind people that the countries
that have done a good job with this have actually
been the ones that just listened to public health measures
(33:26):
and not they didn't have a vaccine, yet they were
able to manage this because they listen to people like you.
So I know that this is difficult. But if you
were to remove the COVID nineteen pandemic from your radar
right now, what are the other threats to public health
that keep you up at night? The last time someone
asked me that question, I told them about pandemic and
they found me and reminded me that I said that
(33:48):
about five years ago. So previous to COVID, the primary
causes of death and illness in our population really shifted
from the infectious diseases to the chronic conditions, the heart
disease and diabetes in the etcetera. But to answer your question,
what's keeping me up at night is the issues of
(34:10):
mental health and addressing the concerns about how much this
pandemic has both amplified the spotlight on how disparities and
racimicity and also the total impacts on social behavioral and
mental health and the capacity to address those that's alarmment.
You know, there's a graph that I tend to use
(34:31):
when speaking to communities and schools, et cetera, where we
talk about that first wave of COVID being the initial
acute phase, meaning the initial infections that you're getting. Then
you're gonna have the secondary concerns about those illnesses that
are not COVID but the emergent and how do folks
excess their healthcare system because of addressing heart attacks and
(34:51):
other concerns. Then you have the chronic conditions that kind
of got suppressed a bit, but you expect that's rise.
But the biggest curve of the concern is the pact
of the financial constraints, the mental health, these psychological impacts
that are going to be long lasting, and we're seeing
them now. May we talk about it as COVID fatigue
and everything else, but we recognize that even from the
(35:14):
school based education, these are generations of students that have
had impact. The social isolation, the loss of loved ones
without the ability to go to their funerals or be
there when they pass as a result of being hospitalized
of COVID and not having a capacity to have visitors,
et cetera. You know, the financial difficulties and the uncertainty
and just the general tenor in our culture at this
(35:36):
present moment. I think that compounding is probably one of
the greatest bears that I have as far as the
overall what we will see coming down the pipeline as
a result of what's growing underneath. You're right. I mean,
I think I'm fortunate just to live in a really
stable environment and I can't even imagine the impact that
this has had on some people. And think about it
(35:57):
from my experience, as I mentioned, being a local health official,
local health epidemiologists, I used to write the community health plans,
and I remember writing plans upwards of even where we
talked about the lack of having mental health professionals in
a and this was an affriluent community through entr thousand people,
(36:19):
for lack of a better word, there was one child
psychologist in the entire county, one one. So think about
that now extrapolated to where we are that even back
then where there was a scarcity of having the requisite
resources for mental health and addressing clinical mental health, where
are we now and how we supporting that both from
(36:40):
the adult, the adolescent and the pediatric lends. So it's
really concerned if you had a blank checkbook to resource
health agencies, what would your top three priorities be? Top
three priorities would be on the workforce, both sustaining and
rebuilding it. I think we have a good opportunity to
onboard folks onto the workforce that really has been decimated
(37:03):
as results of this pandemic. The second bolus would be
on the technology. You know, we still have health departments
that are receiving reports on facts now. That may have
been a goal standard, you know, back in my time,
but you know, it just tells us that in the
age of the Superformation Highway, many health departments sitting on
that highway carrying a bus bass even Harris County they
(37:25):
had like a stack of facts is coming in the
five million people? Yes, and the facts machine broke a
couple of times in the pandemic. And the third, I
would say, would be on addressing both the community integration,
ensuring that the community ambassadors understand the role of public
health and player part because as I mentioned, you're not
going to solve it with five or six people or
even three people in one health department. It is going
(37:48):
to be a community based approach that can only be
successful when everyone takes takes a role, takes apart, and
takes ownership in how their health safety and the strata
gs that are in place and the support for public
health is imagine and realized on a day to day basis.
That's great. Is there anything else our listeners can do
(38:09):
to support the public health narrative and your profession in general?
I would say, honestly, reach out to your local health departments,
whether it's on their social media page or you know,
dropping an email and just thank them. I think they
have been beat up so much for this past you know,
twelve months and are still waking up every morning, just
(38:30):
as people talk about, you know, the immerged room docs
that get up and they go, the nurse practitioners, the anesthesiologists,
the even the bus drivers. Just thank folks. I think
if we get into that mentality of just finding a
moment of time to appreciate those who have put theirselves
at risk for the health and safety of others, I
(38:51):
think a simple thank you goes a long way. But
you can't hug them because of social distancing. Giving electronic
hug and thank you that's really powerful. Dr Allen, Thank
you so much again for your time today. I know
how busy you are with all of this and very
insightful discussion today. Thank you appreciate it. Justin appreciate it law.
We really appreciate Dr Allen taking time to speak with
(39:13):
us and sharing more about our public health infrastructure with you.
Before you start raising hell about local restrictions that might
be influenced by your local health officials, Please don't forget
that these heroes are only doing their job and that
they care about you. How would you feel if you
or your family's life was threatened just for doing your job.
(39:35):
COVID nineteen doesn't affect you in a vacuum. We're getting
closer to normalcy, but please remain diligent with public health measures,
including phase coverings, physical distancing, and hygiene. I know it's hard.
I'd like to close today's show with another challenge. Look
up your local health department and send them a thank
you message. Just as Dr Allen suggested, you can go
(39:58):
to Contact World Social Annals, where we'll be posting ideas
on what to do Again, I challenge you to thank
your local health department who are helping to manage pandemic response.
They are overtaxed, overworked, and often under resourced, and we're
really forgetting their role in all of this. We rightly
(40:19):
celebrate the heroes in our frontline workers, but we really
don't do enough to thank our local health agencies and
the valuable work that they do. Now, I want to
connect Dr Allen's call to action to be kind to
our public health servants to our upcoming guests who are
both in healthcare and e er doctor and a nurse.
Oftentimes we become desensitized to the problems that exist in
(40:42):
our society, especially when we ourselves are not directly affected
or suffer the deadly consequences of novel coronavirus or COVID nineteen.
So call it information fatigue, distrust in the system, confusion
over how to help, or even a desire to help well.
On this podcast, our goal is always to present the
human truths behind the words, behind the science and the theories.
(41:05):
So in our next episode, we're going to sit with
Melizza Wrangel, mother, loving daughter and practicing nurse, speaks on
behalf of yet another grieving family. She shares the devastating
story of how her father paid the ultimate price while
protecting her from the disease, and all because of an
overwhelmed and broken system. After multiple failed attempts at trying
(41:28):
to secure an ambulance to transport her father to the hospital,
the Wrangel family are left with an empty seat at
the kitchen table and so many unanswered questions. We're gonna
try and get to the bottom of it. Listen to
Contact World the podcast on the I Heart Radio app,
(41:49):
or wherever you get your podcast
As epidemiologists and public health planners for years, we've been
trilled into an exercises we've been talking about, you know,
a pandemic or the big one hitting for lack of
a better word. The plans, the the exercises and the
strategies that we had got thrown out the window. So
that was part of the initial frustration. Pandemic plans and
(00:21):
things that folks had essentially were not looked at. That's
Dr Oscar Allen, chief Program Officer for NATUO, the National
Association of County and City Health Officials. Dr. Allen undoubtedly
has one of the most important responsibilities in our public
health system today, overseeing and directing funding to more than
three thousand of our country's local health departments, serving more
(00:43):
than twenty five thousand health officials. In his leadership role,
he also leads to nacho's national response to emergent health threats,
including COVID nineteen, but also ZEKA and natural disasters. The
frustration of the anti science that we're seeing now in
the general public, and more specifically, just the lack of
desire to have that social responsibility of recognizing we're not
(01:06):
out of the woods yet, So it astounds us that
an altruistic group who are trying to save people's lives
are being targeted, have death threats, are being told that
they are lying, that they are part of a great scheme,
and in several cases are facing physical and online harm
when they're just trying to do their life's work. I'm
(01:32):
Justin Beck, founder and CEO of Contact World. I'm here
with my co host Katherine Nelson and DP Pava, and
over the coming months, we'll be talking to scientists, researchers, celebrities, experts,
anyone who has been affected by COVID and getting to
the bottom of how we can improve public health together.
We may not have all the answers, but you deserve
(01:53):
to understand what goes on in your neighborhood and the
decisions that will affect you and your family's health. Welcome
back everybody to Contact World. So even though this podcast
is centered around public health, we've identified racism and I'm
going to somehow add extremism as a public health issue
before we get into the heroic work of nature and
(02:14):
one of its leaders as a theme, I want to
start with here. I'm deeply concerned about where we are
as a country, just like we learned about how misinformation
could compromise the vaccine rollout. Misinformation from our political leaders
has now actually caused the insurrection of the United States
government through our capital, with planned armed protests throughout our
(02:37):
state capitals, and intelligence that we're just scratching the surface.
I'm curious to know what your thoughts are on how
you've seen all this play out deep in Catherine. Yeah,
I think it's kind of a weird divide. We want
to encourage people to share information, we don't want to suppress,
we don't want to stay answer, but at the same time,
we want to make sure that the information being shared
(02:59):
is accurate, that it is not something that's going to
be detrimental to our society, to our country. I think
it's also the responsibility also of the individual to fact check, Right,
where did you get this from before you hit that
retweet or share? But where did this come from? How
do I know this is accurate? Is it from CNN,
(03:19):
is it from ven S, NBC, whatever news you listen to,
or is it just some random guy posted it on
Facebook and it rings true somehow because of whatever you believe,
and then you just share it. So I think I
want some level of accountability from the individuals in the
information that they disseminate. Absolutely, But at the same time,
who are our role models? Right, We're actually kind of
(03:41):
leading our way into making us think like that. And
I was actually very impressed by Gabriel Sterling of Georgia
who responded to President Trump's false claims at a news
conference in Atlanta and he claimed it as an anti
disinformation Monday, I mean, which was amazing. And we need
more people like this to come out and counter misinformation
(04:01):
and facts and become rule models and make people in
public aware that there is a way to do the
fact checking and you should always fact check before you
share something. Yeah, And I think another scary thing is
that there's a distrust for the media. Growing up, you
want to know what's going on. You watch the news,
end of story. Now it's becoming well is it really
(04:22):
the news? Is it really the right information? We should
have some standards where we know if it's from this
reputable source, it is in fact what's happening. Yeah. I
think that we have a crisis on our hands and
politics because we celebrate our frontline healthcare workers as heroes,
but somehow our public health officials actually need security details
(04:47):
because people somehow blame our public health officials for trying
to save everyone's lives and make these recommendations to politicians.
The conservative media has almost been puppet for Donald Trump
for years now, and the misinformation we've seen has actually
(05:08):
been spread by the media. It's a scary time, it
really is. And I think that we've only seen, unfortunately,
the surface of extremism, and really racism and extremism are
a public health issue and it's something that we're going
to be dealing with for a long time unfortunately. Yeah,
and coming back to the topics that we usually talk about,
(05:28):
which is health equity and vaccination and COVID, you know,
all these things dying into the same team of misinformation.
For instance, you know the problem with public communication misinformation
for vaccines. The science is clear vaccines save lives, but
despite overwhelming evidence of the effectiveness, vaccines remain a very
contagious issue. You know, Like municipalities across the country are
(05:51):
receiving pushbacks in response to their efforts of humanization programs,
and this is all cause of misinformation. I mean, do
you guys have some thoughts on at as well. Yeah,
I think we start with fighting misinformation with proper information,
the right information getting out there. And I mean, we
need to give the numbers, who's taking those vaccines, what
(06:12):
are the results. So if allays see is the negative information,
then we tend to believe that it's true. Right. If
you encounter something two, three, or four times, your brain
just automatically accepts it as information that is valid and accurate.
So it's a tall order, but it is the responsibility
of the city's, the counties, the government officials, organizations like
(06:32):
nature to take this on and really put out the
information and let people know that this is safe. Right,
And I think maybe we need to dig deep a
little bit into our history as well. The ad Council
and nonprofit Advertising Group led a similar large scale effort
in nineteen fifties when they urged Americans to get vaccinated
against polio. When we talk about COVID nineteen, vaccination into
(06:55):
one of the biggest and the largest public education cruises
in history. And we have an opportunity here to bring
in the voice of public health in the right communication
framework that it speaks to people through our communities. You
will need to hear it from the people around you,
from your communities. You know, speaking of community engagement, I
(07:17):
Heart Media has been incredible and partnering with CDC, they
actually delivered over a billion impressions to help with COVID
nineteen campaigns. We're actually going to be launching a product
to help with community engagement through iHeart Media soon. But
I am really hopeful that under the new administration, we're
going to have a better federally coordinated response at the
(07:39):
local level. Okay, guys, we've had multiple conversations covering so
many different things, but this episode is focused on Nature.
Justin I know you spoke to Dr Allen. Can you
tell us a little bit about that interview. Yeah. Dr
Allen is the chief program officer for Nature. As I
think we've referenced before, show is a really important partnership
(08:02):
for Contact World. They actually serve the three thousand four
county and city health departments and over twenty health officials.
One of the things that we've learned at Contact World
is we have not made the commitments that we need
as a country to our public health infrastructure, and the
(08:22):
things that we're seeing play out here, whether it's problems
with contact tracing, testing vaccination, really point to the dearth
of resources that are provided to our local health agencies.
(08:48):
Dr Allen, thanks again for your time today. So can
you tell us about your role with the National Association
of County and City Health Officials or nature Sure. I'm
the Chief Program Officer at the nationals Asociation of County
and City Health Officials. That's the national organization that represents
the three thousand local health departments across the country. In
my role as Chief Program Officer, I am responsible for
(09:11):
the strategic program and the executive leadership at least on
program side of support in both technical assistance for local
jurisdictions capacity building, and I'm also as results of the pandemic,
I've been the incident Commander sorts that we've had associated
for the organization, representing ourselves in a national lends bow
(09:32):
for emergency preparedness as well as local interaction across the country.
And when I was preparing for her discussion today, you
have an incredible resume spanning executive and advisor roles, thought leadership,
and a lot of publications. Can you share what inspired
you to take on a career in public health. It's
always a personal story in that regard. I became interested
(09:53):
in public health because of my grandmother, she had developed
multiple miloma, which is cancer the bone marrow, and I
could not understand why a woman who didn't drink, didn't
do anything that would have been deemed as high risk,
had developed this illness. I kind of always knew that
I wanted to be a doctor from a very tender age,
but that drive to figure out what was the cause
(10:14):
led me to pursue in both biology and public health,
and essentially I went into both environmental health and epidemiology.
And then while in grad school, I got an opportunity
to focus on local health departments, and when I graduated,
I went into working at the Rocklan County Health Department,
where I was the directive of epidemiology is for roughly
(10:35):
about fifteen sixteen years before coming too nature. You know,
our our listeners span public health experts, but also just
regular folks, because you explain to our listeners who aren't
really familiar more about what an epidemiologist does. Yeah, the
best way of describing epidemiologists your disease detective. Specifically, your
role is to identify what are the trends and diseases,
(10:56):
how are they caused, what are the reasons for are spread,
and more importantly, what can you do to prevent to
either stop and outbreak or develop policies or strategies to
help prevent them from happening in the future. So it's
a really robust way of describing and what disease detectives
do in epidemiology. You joined Nature, at least in executive capacity,
(11:17):
I think in March or April of two thousand nineteen.
I can imagine you've had a major learning curve. To
say the least, what have you learned about yourself in
the pandemic or everything. I would say what I've learned
has been the experience that have had at the ground
level has prepared me to at least have better insight
and better way of communicating at the national lens, because
(11:40):
oftentimes when you're sitting in these larger emergency centers, so
you're seeing these policies or suggestions come up, at times
you can tell that they weren't derived for individuals who
are at the ground level who need to take this
digested and make it available for the community members that
they serve. That's one of the things that I think
I really have learned and have really appreciated is that
(12:02):
experience that I had at the local ground level really
has prepared me and provided me with the ability to
communicate things at the national lens as well. What would
you say has frustrated you the most about and our
response to this pandemic? Two things. One of the first
things I would say, as epidemiologists and public health planners,
for years, we've been thrilled into and exercises we've been
(12:25):
talking about, you know, a pandemic or the big one
hitting for lack of a better word. And what one
of the initial frustrations the plans, the the exercises and
the strategies that we had weren't necessarily being utilized. And
part of that was as a result of changes in
the stance of where there's a nationalized effort, there's a federal,
(12:47):
state and local integration that's somewhat got thrown out the window, right,
That's somebody got a lot around the window. So that
was part of the initial frustration. Pandemic plans and things
that folks had essentially were uprooted or not looked at,
and you know, having to pivot and adjust to figure
out how to better integrating into this change in dynamic
did have a significant degree frustration. The second aspect of
(13:09):
My frustration, I would say, has been even though we
were able to experience that in the initial phases, and
as we've gone into this third quote unquote wave of diseases,
spread of the pandemic, both in the cases as well
as the deaths. It is the fact that no matter
what the science has done, the frustration of the anti
(13:29):
science realm that we're seeing now and in the general public,
and more specifically, just the lack of desire to have
that social responsibility of recognizing we're not out of the
woods yet and are still engaging in behavioral activities that
are significantly jeopardized and amplifying how this disease is continued
to wreak havoc on our lives. Right We were actually
(13:50):
speaking with Dr Peter Hotels recently about the threats of
misinformation from the anti vaxt Or movement. How do we
overcome the trust barriers to achieve broad back the nation
for COVID nineteen, especially in black and brown communities. You know,
it's not an easy answer because there's a significant structural
history that falls into play. So when we speak specifically
(14:11):
about the communities of color, they have had centuries of
disenfranchisement and medical apartheid and historical abuses by virtue of
how their interacted with medical community. We think about things
like Henrietta Lacks Right and her cells being taken and
not being told that she was being treated or being
examined for cancer, but yet her cells and her families
(14:33):
to that material use for decades. And we think about
the issues of Tuskegee and the syphilis, you know, the
looking at black men and not treating them for forty
plus years just to see how disease run through the population.
And I even use examples of even before that in
the eighteen hundreds, where the father of gynecology basically did
all his practice and his experiments on enslave black women
(14:56):
because they had this mentality that people of color didn't have.
Feel when you look at those historical context and it's
not just in the African American community, but also Native American,
Latino ets, etcetera. So this lack of trust over the
course of time, I think has really cemented a problem
of not only exacerbating the disparities that we're seeing and
(15:18):
how the public are looking at their being at risk,
but also their willingness to say, well, I want to
look at this vaccine in the new light versus one
of apprehension. So it's going to take a significant amount
of effort to one develop ambassadors within the communities. And
there are several that are in place right now doctors
who are signed up to be in the trial, participants, etcetera,
(15:39):
so that they can communicate what the effects are like
to their clients, etcetera, and their populations. So all of
that is really going to be important if we're really
going to turn the tide around how efficacy of vaccine
and safety is being communicated. We learned a lot about
the history of health equality in America from Daniel Dawes
recently executive director at satura Health Leadership Institute, and he
(16:03):
talked about how you know our system is you've just
highlighted not only from the trust standpoint, but also how
our system has just been fundamentally flawed. What role do
public health agencies play in improving health equity? The local
health departments are what we call the community health strategies.
They're the groups who are interfacing both with the health
(16:24):
care industry and the elected officials to community health, our organizations,
the schools, the business community. So the role that the
public health agencies. Play is not only trying to coalesce
the great collaborations to address issues of equity, but also
bring to point how these disparities are having an impact
on individuals lives. So it's not just the individual itself
(16:49):
who are to blame, but recognizing that there's all these
connected pieces what we call the social determines of health.
Right A quick example, let's say you want to stop
someone from smoking. You give them a patch. But if
they're in a household where smoking is approved, the smoking
is the norm, then that patch is not going to
be effective. If they're in a community where you go
(17:10):
into the stores, you go into the restaurants, who you
go into bodegas or whatever you name it, and you
see smoking materials right then and there in front of you,
then you're not going to be successful from an individual standpoint.
And then if you have policies that are in place
that really do not provide that clear alternative to those communities.
That's what we call these social determinants, these upstream issues
(17:33):
that have an impact on an individual decision point, and
they all are connected, it's not just one over the other.
So I think it's very important for health departments who
help amplify this message, who helps speak to the overall
population health of the community, to really bring these things
to bear and ensure that all of the partnerships and
the stakeholders are at the table to discuss them if
(17:54):
we are to be successful moving forward. One of the
things that really shocked me. You know, I don't come
from public health, but I've taken an interest in helping
improve the public health narrative. I was shocked to understand
that only two or three percent of the funding that
goes to provider care in this country goes to public health.
Despite you know, you guys being in the trenches and
(18:15):
being responsible for really protecting us and advancing health equity.
How do you think our country can improve the resources
for health agencies, especially the small ones that serve you know,
less than fifty thou people. So here's the thing. For
our three thousand counties city health departments, only six percent
of those are big cities, but yet they account for
(18:37):
more than half of the populations that are being served.
But the vast majority of these local jurisdictions are small
to medium size. So there are health departments that may
have a staff of six. Now, how are you going
to be able to ensure that such a small footprint
does have the workforce capacity to be able to address
all of these needs. You know, six people are not
(18:57):
going to solve the entire health cont strug for a population.
So that's where the benefit of collaboration and the team's
sport and public health is going to be important. Now
on top of that, the way we fund public health
is problematic. Oftentimes it's based on a disease specific issue,
so I'm just going to fund cancer and just go
to fund diabetes. So the real way we can address
(19:21):
better fund and local public health is to make sure
that the congressional side have an understanding that we can't
just look at categorical funding to do pet projects. It
has to be a universal way approaching support for health
agencies in the work that they do. And there is
also the need to address the private entities, you know,
(19:42):
the business communities. People say all the time, well, you know,
health is trying to shut people down and not address
the economy. You need healthy people in order to have
a healthy business. So those are all of the elements
of how I think we really need to shift Because
we've lost over fifty healthcare workers in the health World
within the last eight years, and there's even a sizeable
(20:04):
board that it being lost as a results of this
COVID response. You brought up something about communities and private
organizations working together. I was talking to Hannah Schultz last week,
who produces a podcast called Share public Health through the
Midwestern Public Health Training Center. She brought up something that
I think is really important to talk about, and I
think people need to mall this over. How do we
(20:24):
call our frontline workers heroes? Which I think is completely
commendable and understandable. But somehow our public health experts get
death threats and need security details. That is I should
have been my third frustration to your question. And I
say frustration because it's actually alarm and in the work
(20:46):
that public health practitioners get engaged in, they don't do
it for the sake of, well, we're going to make
a paycheck, and it is truly a sense of altruism.
As I told you, I joined public health because I
wanted to find out want my grandmother got sick, and
by doing that, I found that there's more to it
than just a single point source of cause of illness.
That yes, there's environmental factors, there are all these other
(21:06):
factors that come into play, and that's why I ended
up going too epidemiology. So my going into epidemiology of
public health, similar to many of the staff across the country,
has really been trying to do their life's work of
helping people. So it astounds us that an altruistic group
who are trying to save people's lives are being targeted,
(21:28):
have death threats, are being told that they are lying
that they are part of a great scheme, and in
several cases are facing physical and online harm when they're
just trying to do their life's work. So that does
not compute to me. As many times as I've heard it,
and even listening to the messages and seeing what our
members have been sharing with us, there are some very
(21:50):
horrific scenarios that are coming into play where people are
being enforced out of the jobs because they're simple trying
to follow our way of doing things in protection of life,
safety and wellness. So it is a frustrating and unimaginable
scenario that we now find ourselves. And I've gained an
immense respect for the work of public health, and I
(22:11):
think it's unfortunate that because of the altruism I think
that it's almost like our system and our politicians have
taken advantage of that and thought, well, maybe they don't
need that many resources. But I really hope that, you know,
especially going into the next four years, that our country
can really take a hard look at itself and change
the narrative and stop harassing public health workers. One of
(22:33):
the things we've always realized that health, public health doesn't
really do a good job of selling itself because we
operate into shadows. Right. You only hear about public health
when there's something big. You know, for example, there's an
outbreaking a restaurant, Oh, where's the health department? You know,
where's the inspectors. People are thinking things only in those
boxed approaches, but no one really pays attention at their
(22:57):
Public health departments are engaged in safe moms and babies,
teaching breastfeeding, ensuring that you have your foreign travel vaccines
as well as your regular adult or childhood level vaccines,
or teaching how to have better prevention techniques around diabetes
case management, and of course what the infectious disease world
and indoor outdoor air water quality, you name it. There's
(23:17):
so much that public health does, but they just put
their heads down, do it and move on to the
next thing, and don't sit back and say, hey, look
what we're doing. And as results, I think that somewhat
has been a problem and really to your point, really
articulating that folks the value of what public health departments
do and how their innovation, even in light of not
having great resources, allows them to be nimble and hopefully
(23:41):
be successful. I noticed that there's a lot of I
guess buckets or almost silos where public health, like you said,
works in the shadows, and we're really trying to with
tons tech world, bring attention to the unsung heroes of
(24:03):
our system. So we certainly appreciate all that you do
with Dr Allen. So you mentioned about innovation, so I
understand that Nature is launching an Innovative Practice Award to
highlight the creativity and COVID nineteen response, what sort of
innovation have you seen from local health agencies who we've
already talked about are under resource and underappreciated. Health departments
(24:23):
have really stepped up to the plate when it comes
to looking at ways to innovate both messaging as well
as access to for example testing. Even the role that
they have had to rapidly deploy in how they can
do contact tracing, as well as addressing several of the
needs that they're seen in communities. For example, ensuring that
we have one health department that just mentioned that folks
(24:46):
who do not have the capacity to isolating quarantine, they
set up a system where you could actually have a
hotel state. So they worked with a local hotel where
individuals who need to isolate for that fourteen days are
able to do so in a safe manner. That of
course allows them both the security and the privacy and
the ability to ensure that they are probably being cared for. Secondly,
(25:08):
we saw in the early phases of the pandemic, recognizing
that there's a need for improved community based testing, working
with several community agencies to ensure that testing can be
done at at risk populations like homeless shelters, where you know,
at times people forget about because well, you know, we
just have to hunker down. So these local jurisdictions have
(25:29):
really tried to find ways to even communicate. Oftentimes information
comes out from an English or maybe one or two languages,
but recognizing that some communities have multiple centers of cultures
and working with those communities to ensure that the messages
being done and the ambassadors and the community health workers
(25:49):
are on the ground interface and so that you are
hearing the message from someone that looks like you, speaks
your language, and they're able to address your questions in
a way that makes sense versus you know, as we
would say, the talking heads on TV. So there's so
many different areas around both integration of community interaction, looking
at what technology tools can be used, you know, how
(26:10):
rapidly they can really adapt and really amplifying their reaching
that effort to really ensure that they put their best
foot forward in how they want to tackle this particular
pandemic response. How do you see the role of health
agencies evolving over the next five years. You mentioned a
couple of things with messaging, improving their communications tools. How
do you see the evolution of the health agency, especially
(26:32):
after the disaster we've been through in twenty so we
have seen even prior to this, this whole concept of
public health transformation kind of call public Health three point oh,
which was an effort to look at how our health
departments going to change in both delivery of services as
well as the interaction with the community and one thing
I can say when the initial transformations began, a lot
(26:54):
of the thought was that well, health departments are no
longer going to be the go to or as we
call them, the safety now providers. So a lot of
this will be go into the affordable care organization and
other entities you know, health clinics, health centers. But what
we've seen in several cases, the health departments still remain
as that key deliverer of health and clinical health practices
(27:15):
in addition to the prevention piece. So I think moving
forward and recognizing the role that we have to play
in both the administration of programs and intervention strategies prevention messages,
I think there's an opportunity for us to take another
look at how we fashion our health department's role in
the community, both from the way it's funded and the
(27:38):
way it provides a cross matrix approach to addressing diseases,
so that we're not just looking at one disease independent
of others, but truly are embracing this cross matrix approach
that hopefully addresses as many points as possible while still
maintaining the focus on the wellness and safety in the
lungevity of individual's life. So is there a spot in
(28:00):
side of the Affordable Care Act or the kind of
the funding mechanism that is provider care where public health
is inserted ever, or is it just that public health
agencies have to just manage everything on the budgets that
they're handed and then hope for the best. Part of
the goal of the Affordable Care Act was to develop,
as we would say, the medical village that you were
(28:22):
not just going to one doctor's office, or you're not
just crowd in the hospitals, but that there's this approach
to really try to get things upscreen before become a
problem for hospitalization. Now, what that really tells you is
that the primary focus was on addressing things from a clinical,
hospital based care perspective, whereas all these upstream issues are
(28:43):
issues that public health departments have always been engaged in,
but they weren't necessarily funded to support in that strategy
because of a heavy reliance on a hospital based approach.
So we've had scenarios where health departments were not involved
and not at the table when several of these policies
or strategies were put into play. So where I would say,
(29:03):
moving forward and recognizing the role that these communities have
now realized, especially when it comes to the COVID response.
They're the ones responsible for about eighty percent of vaccinations.
But here's the funny thing. Their staff it's been pulled
off doing vaccines to do the COVID response, and they're
supposed to do contact tracing. Contact tracing. So, how do
(29:25):
we then pivot to ensure that in the future we're
rebuilding this framework for a nimble workforce. How are we
restocking the skills and integrating technology so that we can
make our lives easier, and how the work is engaged
and deployed. And then finally, how we also funded it
to ensure that is sustainable, that is not just based
(29:46):
on COVID dollars, but that we look at it as
a public health prevention fund that we can at least
apply for years to come. That makes sense. One of
the things that I'm a little bit fearful of, and
now all of that I've learned because of experts like you,
is the equitable distribution of vaccines. And one of the
things that I worry about. We're looking at how we're
(30:07):
gonna have these vaccination cards that are saying that yes,
I've been vaccinated, and you already have companies like Ticketmaster
talking about how they're going to have like a digital
verification of vaccination prior to entering events like that. How
do we prevent the vaccines or validation of vaccines from
advancing or creating more disparities in our system? Like what
(30:30):
is the fine line between ensuring people are healthy when
they enter places and also making sure that we're not
creating more disparities. So it's a slipper slope. I'll actually
first start with just the public sentiment around vaccines. That
we know that Americans want vaccines above anything else, but
they don't want one that's rush and that seems to
be some of the prevailing point. So the real goal
(30:52):
is to focus on ensuring that the messages around effectiveness
and how the vaccines were developed in that way, shape
or form to cut at this issue of hesitancy. The
other piece to that, to the point that you just raise,
is that of equity. We recognize that acuable allocation distribution
is going to be an issue not only with respect
to who gets it but where. So, for example, how
(31:15):
many vaccines are going to be available to the remote
and rule errors of the country when they may not
have the infrastructure to really address the cold storage and
handling for one. And then in addition, how do we
ensure that the populations that are most impacted can get
a vaccine and not necessarily be left out in the cold. So,
for example, one of the strategies have been let's focus
(31:37):
on the local pharmacies or the big ticket pharmacies. Now,
technically speaking, if the vaccines are supposed to be delivered
free for lack of better word, you still would have
to be able to pay an administrative fee for that
kind of distribution at a site like that. So are
we adding to the equity issue by saying that you
need to still pay an administration fee that individuals may
(31:58):
or may not have out. The other piece, which I
think is very important, is very talent as we look
at what lies ahead. I'll use the example of Washington
d C. Right now, and we have heard the news
that even with the initial deployments of vaccines that have
come into play, the numbers that were anticipated are gonna
be much less than what's going to be delivered. Washington
d C. Their health department came out with a message
(32:20):
that talked about their first allocation was only going to
be six thousand doses. Now in that first phase of
both the health care as well as the long term care,
they've identified about eighty five thou individuals. So automatically, we
already walked into an area of inequitable allocation, not even
talking about the general public and getting the other access
(32:43):
points for those hard to reach communities, those resource efficient areas,
et cetera. So it is a significant uphill climb that
we have ahead of us the goal and the hope
of courses as more vaccines become available and then we
get through this initial phase that hopefully we can reconcile
these particular issues. But I would dare say that we
can't go in it blind or thinking oh, there's a vaccine,
(33:04):
all's good and all's well done. There's still a lot
of work to go through. I mean, you're already seeing
the combination of the fatigue of lockdown combining with people's
false sense of security that just because of vaccine is
on the way that they can do away with public
health measures. I'd like to remind people that the countries
that have done a good job with this have actually
been the ones that just listened to public health measures
(33:26):
and not they didn't have a vaccine, yet they were
able to manage this because they listen to people like you.
So I know that this is difficult. But if you
were to remove the COVID nineteen pandemic from your radar
right now, what are the other threats to public health
that keep you up at night? The last time someone
asked me that question, I told them about pandemic and
they found me and reminded me that I said that
(33:48):
about five years ago. So previous to COVID, the primary
causes of death and illness in our population really shifted
from the infectious diseases to the chronic conditions, the heart
disease and diabetes in the etcetera. But to answer your question,
what's keeping me up at night is the issues of
(34:10):
mental health and addressing the concerns about how much this
pandemic has both amplified the spotlight on how disparities and
racimicity and also the total impacts on social behavioral and
mental health and the capacity to address those that's alarmment.
You know, there's a graph that I tend to use
(34:31):
when speaking to communities and schools, et cetera, where we
talk about that first wave of COVID being the initial
acute phase, meaning the initial infections that you're getting. Then
you're gonna have the secondary concerns about those illnesses that
are not COVID but the emergent and how do folks
excess their healthcare system because of addressing heart attacks and
(34:51):
other concerns. Then you have the chronic conditions that kind
of got suppressed a bit, but you expect that's rise.
But the biggest curve of the concern is the pact
of the financial constraints, the mental health, these psychological impacts
that are going to be long lasting, and we're seeing
them now. May we talk about it as COVID fatigue
and everything else, but we recognize that even from the
(35:14):
school based education, these are generations of students that have
had impact. The social isolation, the loss of loved ones
without the ability to go to their funerals or be
there when they pass as a result of being hospitalized
of COVID and not having a capacity to have visitors,
et cetera. You know, the financial difficulties and the uncertainty
and just the general tenor in our culture at this
(35:36):
present moment. I think that compounding is probably one of
the greatest bears that I have as far as the
overall what we will see coming down the pipeline as
a result of what's growing underneath. You're right. I mean,
I think I'm fortunate just to live in a really
stable environment and I can't even imagine the impact that
this has had on some people. And think about it
(35:57):
from my experience, as I mentioned, being a local health official,
local health epidemiologists, I used to write the community health plans,
and I remember writing plans upwards of even where we
talked about the lack of having mental health professionals in
a and this was an affriluent community through entr thousand people,
(36:19):
for lack of a better word, there was one child
psychologist in the entire county, one one. So think about
that now extrapolated to where we are that even back
then where there was a scarcity of having the requisite
resources for mental health and addressing clinical mental health, where
are we now and how we supporting that both from
(36:40):
the adult, the adolescent and the pediatric lends. So it's
really concerned if you had a blank checkbook to resource
health agencies, what would your top three priorities be? Top
three priorities would be on the workforce, both sustaining and
rebuilding it. I think we have a good opportunity to
onboard folks onto the workforce that really has been decimated
(37:03):
as results of this pandemic. The second bolus would be
on the technology. You know, we still have health departments
that are receiving reports on facts now. That may have
been a goal standard, you know, back in my time,
but you know, it just tells us that in the
age of the Superformation Highway, many health departments sitting on
that highway carrying a bus bass even Harris County they
(37:25):
had like a stack of facts is coming in the
five million people? Yes, and the facts machine broke a
couple of times in the pandemic. And the third, I
would say, would be on addressing both the community integration,
ensuring that the community ambassadors understand the role of public
health and player part because as I mentioned, you're not
going to solve it with five or six people or
even three people in one health department. It is going
(37:48):
to be a community based approach that can only be
successful when everyone takes takes a role, takes apart, and
takes ownership in how their health safety and the strata
gs that are in place and the support for public
health is imagine and realized on a day to day basis.
That's great. Is there anything else our listeners can do
(38:09):
to support the public health narrative and your profession in general?
I would say, honestly, reach out to your local health departments,
whether it's on their social media page or you know,
dropping an email and just thank them. I think they
have been beat up so much for this past you know,
twelve months and are still waking up every morning, just
(38:30):
as people talk about, you know, the immerged room docs
that get up and they go, the nurse practitioners, the anesthesiologists,
the even the bus drivers. Just thank folks. I think
if we get into that mentality of just finding a
moment of time to appreciate those who have put theirselves
at risk for the health and safety of others, I
(38:51):
think a simple thank you goes a long way. But
you can't hug them because of social distancing. Giving electronic
hug and thank you that's really powerful. Dr Allen, Thank
you so much again for your time today. I know
how busy you are with all of this and very
insightful discussion today. Thank you appreciate it. Justin appreciate it law.
We really appreciate Dr Allen taking time to speak with
(39:13):
us and sharing more about our public health infrastructure with you.
Before you start raising hell about local restrictions that might
be influenced by your local health officials, Please don't forget
that these heroes are only doing their job and that
they care about you. How would you feel if you
or your family's life was threatened just for doing your job.
(39:35):
COVID nineteen doesn't affect you in a vacuum. We're getting
closer to normalcy, but please remain diligent with public health measures,
including phase coverings, physical distancing, and hygiene. I know it's hard.
I'd like to close today's show with another challenge. Look
up your local health department and send them a thank
you message. Just as Dr Allen suggested, you can go
(39:58):
to Contact World Social Annals, where we'll be posting ideas
on what to do Again, I challenge you to thank
your local health department who are helping to manage pandemic response.
They are overtaxed, overworked, and often under resourced, and we're
really forgetting their role in all of this. We rightly
(40:19):
celebrate the heroes in our frontline workers, but we really
don't do enough to thank our local health agencies and
the valuable work that they do. Now, I want to
connect Dr Allen's call to action to be kind to
our public health servants to our upcoming guests who are
both in healthcare and e er doctor and a nurse.
Oftentimes we become desensitized to the problems that exist in
(40:42):
our society, especially when we ourselves are not directly affected
or suffer the deadly consequences of novel coronavirus or COVID nineteen.
So call it information fatigue, distrust in the system, confusion
over how to help, or even a desire to help well.
On this podcast, our goal is always to present the
human truths behind the words, behind the science and the theories.
(41:05):
So in our next episode, we're going to sit with
Melizza Wrangel, mother, loving daughter and practicing nurse, speaks on
behalf of yet another grieving family. She shares the devastating
story of how her father paid the ultimate price while
protecting her from the disease, and all because of an
overwhelmed and broken system. After multiple failed attempts at trying
(41:28):
to secure an ambulance to transport her father to the hospital,
the Wrangel family are left with an empty seat at
the kitchen table and so many unanswered questions. We're gonna
try and get to the bottom of it. Listen to
Contact World the podcast on the I Heart Radio app,
(41:49):
or wherever you get your podcast
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