Health Affairs' Rob Lott interviews Thomas Dobbs of the University of Mississippi Medical Center to offer observations on the current state of public health funding, current career potential in the public health field, and reflections from being the namesake on the Dobbs v. Jackson Women's Health Organization Supreme Court Case.
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Episode Transcript
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Rob Lott (00:00):
Hello, and welcome to A Health Podicy. I'm your host,
(00:04):
Rob Lott. Friends, it's anotherone of A Health Podicy's very
special episodes. That's becausealthough we typically feature
the authors of some of the mostimportant recent health affairs
articles, we also set asideabout one episode a month to go
(00:26):
a little farther afield, to sitdown with various leading voices
in health, health care, andhealth policy. Today, it's
doctor Thomas Dobbs, dean of theJohn D.
Bauer School of PopulationHealth at the University of
Mississippi Medical Center.Doctor. Dobbs is an internal
medicine physician withexpertise in infectious disease
(00:49):
and epidemiology. He spentdecades treating patients and
caring for communities,including many of those living
with HIV during the nineties andearly two thousands, periods of
incredible transformation inboth the science and capacity
underpinning our systems relatedto HIV and AIDS. More recently,
(01:12):
doctor Dobbs served asMississippi State Health
Officer, leading the state'sDepartment of Health, including
its response to the COVIDnineteen pandemic.
In 2022, he returned to academiaat UMMC in Jackson, Mississippi.
And we're thrilled to have himhere today. Doctor. Thomas
Dobbs, welcome to A HealthOdyssey.
Thomas Dobbs (01:33):
Wonderful, I appreciate y'all having me.
Rob Lott (01:35):
So let's just jump in. I'm hoping maybe we can let our
listeners get a little bit of asense of your work and career
over the years. Tell us a littlebit, where are you from? Where'd
you grow up? How'd you get intothis business?
Thomas Dobbs (01:50):
So I'm initially from North Alabama. I was born
in a small town in NorthwestAlabama called Haleyville that
is of nestled up in sort of nearthe Sipsey Wilderness, really
beautiful part of the state.Then I went to college at Emory
in Atlanta and that was reallysort of a transformative time, I
think, for a lot of people. Andthen ended up going to medical
(02:11):
school at the University ofAlabama in Birmingham.
Rob Lott (02:14):
Okay, so when did you first think about pursuing a
career in medicine?
Thomas Dobbs (02:19):
Doctor. College, I always thought I was going to be
a theoretical physicist. And sothat's what I studied as an
undergraduate. But then, I had alot of health exposures, did
spend some summers doing,different work. Did some, I
spent some time in South AndCentral America and got to see
sort of the situations there,spent some time in the hospital
and surgery and had a goodexposure to the health
(02:42):
environment and then decided,you know, instead of doing or
trying to do physics, I wentinto medicine.
Rob Lott (02:49):
Do you miss the physics? Do you, dabble in
theoretical physics from time
Thomas Dobbs (02:54):
to Heavens no. But I do, you know, I do read like,
you know, news around, you know,exciting findings and, you know,
you know, just nerdy stuff likethat.
Rob Lott (03:06):
Cool. Well, tell us a little bit about your early
years as a practicing physicianin infectious disease. Where
were you practicing and what wasyour focus at that point?
Thomas Dobbs (03:17):
Through training, I realized pretty early that I
was interested in sort of a morepopulation based perspective of
health. And I think, when you'rein medical school and you're
idealistic and then you sort ofget into the hospitals and you
see that you're really takingcare of people at the end stage
manifestations of the disease,right? And understanding that a
lot of what we spend ourhealthcare dollar on in The
(03:39):
United States is really tryingto manage people who have severe
disease that could have beenprevented. And whether it's like
in the infectious disease realmor the chronic disease realm and
in the HIV world, certainlymakes a lot of sense. There's so
much that can be done upstream,so much that can be done from a
community or a state perspectiveof trying to improve the
(04:06):
possibilities for health forfolks.
Then so during my residency, Idid a master's in public health
at the UMB School of PublicHealth. I kind of, I did it
during my residency. I had sometime off to help, take care of
our youngest child, but thenalso too, I did it during
residency. I didn't, tell theresidency program and actually
had to sneak away to take mytablets. I still don't know that
they know that I was doing that,but anyways, fantastic
(04:28):
experience, and then, aftertraining, ended up working in
South Mississippi and did,worked in South Central Regional
Medical Center in Laurel,Mississippi, and also started
working, with the communityhealth center in Hattiesburg,
treating folks living with HIV.
Rob Lott (04:47):
What did you learn from those early experiences?
Thomas Dobbs (04:51):
Before that, I'd also been doing tuberculosis
work for a long time and got areally neat exposure to public
health. From that perspectiveworking with mentors at UAB,
specifically Doctor. MichaelKemerling. But then once I came
to Mississippi, it was reallykind of a remarkable experience
(05:16):
because I learned immediatelythat it's not the science of
medicine that's the challenge.Although it's beautiful what
we've invested in the science oftreating and preventing HIV,
it's really kind of remarkablewhat we've been able to do with
intention and investment.
But it wasn't the technology, itwas the challenges that people
had in their daily life, right?It was like, you know, I thought
(05:39):
I was going to go intohealthcare as a clinician
scientist, right? It was theintellectual part that I was
going to bring to the communitythat I'm working with. But
really, learned pretty quicklythat it was substance abuse,
transportation barriers, lack ofinsurance, all those things that
make it really hard to behealthy, that I spent the
majority of my time working on.And that really helped me get a
(06:02):
different viewpoint of what isreally driving health in our
country.
Rob Lott (06:05):
Okay, so over the years, in addition to practicing
direct patient care, you'vegotten more involved in
population health efforts,eventually becoming a public
health officer, a state healthofficer. Can you tell us a
little bit about that journeyand kind of how you went from
the bedside to the kind of theboardroom, if you will?
Thomas Dobbs (06:29):
Yeah, so there is no clear pathway into sort of
public health leadership. Earlyon when I was trying to meet
with people to understand how doyou get involved in public
health? There's a bunch ofdifferent pathways and I think
everybody has a different way ofgetting there. So I was a
clinician, I think working intuberculosis and HIV, there's a
(06:49):
natural overlap with publichealth because a lot of the work
that you do is, you know,working in communities, trying
to prevent transmission,identify people exposed, and
that sort of thing. I starteddoing the tuberculosis
consulting for the region in02/2005.
And I'm actually still doing itto this day. So it's still doing
(07:11):
that. And then from there, Itook over the local leadership
role, the regional healthofficer role, and practiced a
little bit. So I've kept my HIVpractice going pretty much
nonstop since early on, at leastin some way or another, and
really sort of learned how thepublic health system can work
(07:32):
effectively and sometimesineffectively at trying to
improve health for the localcommunities.
Rob Lott (07:38):
I want to circle back to the tuberculosis consulting
work. What does that job entailand sort of how has it changed
over the last few years?
Thomas Dobbs (07:50):
You know, remarkably, job hasn't changed
much in the past thirty years. Istarted doing it with friends
and mentors in Alabama back inthe 90s. And a lot of it is
supporting the nurses and thepublic health professionals to
review cases and make sure thatthings are managed properly and
to help do outbreakinvestigations and prevent
(08:11):
transmission. A lot of it's thesame, technology is different
such that instead of having alight board on my wall to look
at the x rays, I look at them onthe computer. But, but, and
then, you know, electroniccommunications certainly make
things a lot more, moreefficient, but the work is, is
essentially the same.
The thing that we do have goingon and that's its whole
(08:32):
interesting sort of conversationwith tuberculosis. I think it's
a good sort of mirror on what'shappening in public health, you
know, but we've lost so muchexperience and so much
institutional knowledge intuberculosis, but in so many
other fields. I do aconsultation role with the
(08:54):
University of Florida for theSoutheastern Part Of The United
States for regional consultingfor all the states if they have
sort of complicated questions.And I'm seeing that public
health has really been decimatedwhen it comes to the number of
employees. And we've got a lotof young faces who are talented,
but the challenges are justreally overwhelming.
(09:16):
And I'm really worried about thepublic health future of our
country.
Rob Lott (09:19):
What do you attribute that change to that loss? I
mean, I know we certainly havehad cuts to investments
recently, but I presume thatthis was happening before
January of twenty twenty five.
Thomas Dobbs (09:36):
Yes, it has been. And I think what's going on now
is just a continuation of a longstanding narrative of our
underinvestment in public healthinfrastructure. It's something
that I've really been on thesoapbox about for a long time
and it's never gone anywhere,right? We've basically traded
public health for advancedbiomedical technology and so if
(10:00):
someone's really sick and whenthey need CAR T therapy and all
that kind of stuff, amazing, Ilove it, but we are way under
invested in the blocking andtackling that it takes to
protect the public at thefoundational level. And I think
that's one of the reasons why ifyou look at our life expectancy
and our excess avoidable deaths,we are an outlier for the world.
(10:22):
You know, I mean, we exist in aplane that's almost unimaginable
and if you really just step backand look at it and people don't
know it, I mean, people are sortof like the frog boiled in the
water, I mean, we've just gottenso used to it, you know, that,
you know, gun violence deaths,early deaths related to heart
disease, stroke, know, generalstatus of health is so poor
(10:45):
compared to, you know, otherdeveloped countries, even with a
lot lower income. It's, yeah, Ithink it really reflects our
lack of investment in a publicminded community approach to
health and well-being.
Rob Lott (11:00):
So let's say you had control over how we were
allocating funds and, or perhapsyou just have the ear of folks
in Congress who are doing theappropriations, besides simply
saying, spend more on publichealth, what are some of the
areas you think really couldbenefit from targeted investment
(11:21):
and that that investment wouldpay significant dividends?
Thomas Dobbs (11:25):
You know, this is going to sound kind of strange,
but the first thing I would dois not ask for more money, I
would ask for more flexibilityand stability, right? Because
what we end up doing is we havethese sort of like boluses of
money that come in targeted forsomething like Ebola, or Zika,
or whatever. And so it's reallykind of like a roller coaster.
(11:47):
And we build some specializedcapability that doesn't
translate into long term andthen the money gets pulled away,
right? We could spend a lot lessmoney and build a lot more
robust infrastructure if we justprovide some stability.
The other thing that we've seen,and I think it's particularly
bad in the South, is for a wholehost of reasons, we don't invest
(12:12):
in our people and we paypathetically low wages for our
experts in public health, ournurses, our disease
investigation specialists, allthese folks, and the world
outside of the government, thepay has increased pretty
substantially, but for publichealth and the government
(12:33):
health, and I think part of thatis intentional by folks trying
to cut costs or shrinkgovernment, it basically leaves
us with an inability to recruitsome of the best talent that
could really have major impactson the well-being of our state
and also in the populations thatneed us most.
Rob Lott (12:50):
You mentioned the particular challenges in the
South, and I know Mississippihas long placed on the sort of
lowest tier of states when itcomes to many population health
measures, things like prematuredeath, low birth rate,
cardiovascular disease. Howsignificant was that fact within
(13:11):
your own mindset when you tookon the role, Love leading the
state health department?
Thomas Dobbs (13:19):
You know, it's huge and I think there's a lot
of interest in sort of likegetting into that and trying to
figure out how we can makeprogress. It's a real challenge
because people don't really wantto address the core causes,
right? A lot of what we do is atthe surface, right? And some of
it's really good. I mean, cancertainly treat high blood
pressure and stuff like that,or, you know, try to open a
(13:41):
clinic here and there.
But if people don't grow up witha healthy environment and a
pathway to health, then the longterm trajectory is not going to
be great. And so I thinkthinking upstream is something
that really we've been trying todo. What I had sort of initially
hoped to do with the healthdepartment changed pretty
rapidly once COVID hit. And sothen it was all hands on deck.
(14:03):
Now, one of the things thathappened with COVID that I was
just shaking my head because Iknew it wasn't going to work out
well in the public health sortof, you know, space, there was
all this talk about, oh, werealize how important public
health is and oh, we're going toinvest.
Oh, we see how important youare. And I was just thinking to
myself, I have seen this before.I've seen this movie before. And
(14:26):
once the acute scare is over,the money gets pulled away and
we backslide and continue ourdisinvestment in one of our most
valuable institutional resourcesas a country.
Rob Lott (14:42):
Well, in a minute, I want to hear a little more about
your experience navigating theCOVID pandemic. But first, let's
take a quick break. And we'reback. I'm here with doctor
(15:10):
Thomas Dobbs, dean of the Schoolof Population Health at the
University of MississippiMedical Center and the former
state health officer for thestate of Mississippi. Just a
moment ago, you were talking alittle bit about the sort of
disappointment that camefollowing the high hopes for
perhaps some transformation toour public health system post
(15:31):
COVID and then the inevitablesort of backslide there.
In fact, you were the author ofa paper that we published in
Health Affairs, where youstudied non urgent elective
procedures, intensive care inMississippi. And I'm wondering
if you can just say a little bitabout that and kind of how your
(15:54):
work on that paper fit into yourbroader experience leading the
COVID fight in Mississippi.
Thomas Dobbs (16:00):
So I would like to say that I think we may be
missing a great opportunity tolearn from the last pandemic to
prepare for the next, because wedid so many things, right? We
did so many interventions, wedid the mask thing, we did the
social distancing thing, we dida lot of controls over hospital
admissions. There were a wholesequence of things we did to
(16:21):
society and we don't know whatworked and what didn't work.
Mean, to some extent we do knowsomewhat different things, but
we really haven't done the typeof investigations I think that
we could sort of hang our hat onwhere with the next pandemic we
can have a list of options. Say,okay, this works in this
(16:41):
scenario, this works.
And so that's what we wanted todo. One of the things that we
did in Mississippi and one ofthe things I think that really
challenged a lot of places, thatI do think it was worse here
because our baseline resourcesare so low, is that when COVID
got bad, our health systems wereoverwhelmed. And the inter
hospital transfers were blocked.It was basically concrete. And
(17:02):
we had people who were likehaving heart attacks in parking
lots and couldn't get to carebecause the ambulances were
backed up, their hospitals werefull and they wouldn't take
anybody.
And so we did a couple of thingsto try to like loosen up the
system a little bit. One of thethings is if you need a knee
replacement, it can wait a week,it can wait a couple of weeks,
right? But those are resourcesthat eat up hospital capacity.
(17:26):
And it's not just like, oh, andI had the doctors complaining
and saying, oh, it's a kneereplacement, it's an outpatient
thing, it's not going to use upany resources. But when we
looked at the data, we saw thatlike ten percent of knee
replacements end up hospitalizedunintentionally and about five
percent in ICU, at leasttemporarily.
And like, okay, those areresources that we're trying to
preserve. So that was thepremise we went into it with is
(17:48):
that we should delay these nonurgent elective procedures to
make space for criticalresources that we need in the
hospital. But after it's over,we said, okay, we did this,
right? Did it work? And sothat's what we did is we did a
study to see is, was this policyeffective in making more ICU
(18:10):
beds available?
And the answer was yes. And wedidn't get into the question,
did it make more general, youknow, medical surgical beds
available? But I think itprobably would bear out the same
way. And I was glad that we hadan opportunity to sort of try to
answer one of these questions ofwas something that we did, was
(18:30):
it worthwhile? And I think thatthis demonstrates pretty clearly
that yes, it was a worthwhilelogical intervention that we can
put on our list of things thatwe can do in the future when we
get in these sort of challenges.
Rob Lott (18:41):
So I'm so curious in that context, so many of the
papers that we publish at healthfairs are written by academic
researchers. That's their sortof almost their full time gig is
to connect these studies, writethe papers, submit the papers,
publish the papers. And oftenwhen we talk to folks who are
sort of either practicingphysicians or public health
(19:03):
professionals, what we hear is,Oh, I have this great thing. If
only I had the time to write itup, you know, or the resources
or the support. And I'm curioussort of if that kind of equation
was something that you grappledwith?
Did you set aside the time towork on this? Or was it the kind
(19:24):
of thing you had to do nightsand weekends just to make it a
priority?
Thomas Dobbs (19:28):
Yeah, gosh, it's such a good point because there
are so many smart people outthere who are too busy and under
resourced to do things. Youknow, fortunately, working for
the health department at thetime when we pulled this
together, And then shortlythereafter, my role was such
that I was able to put some timeinto it. And there was some, you
(19:49):
know, some after hours weekendsort of time on it. But I'm not
like a busy clinician, you know,trying to make money off RVUs,
right? And so I think in a waythat kind of speaks to the value
of having people whose job it isto figure this out.
I mean, that, you know, that'sto be some of the stuff like CDC
is doing. And I think, you know,CDC missed a bit of an
(20:12):
opportunity. I know they havetheir own challenges and have
ever since COVID and thereafterto look at some of these
questions, because even likeeven to this day, you know,
things that were sort of like alittle bit controversial, people
ask me like about the masks. Youknow, I'll give a talk and
people say, what's this nonsenseabout the masks? Or did they
work?
(20:33):
And so I have to give them whatI think is an evidence based
reasonable answer based on thecollective information that I
have. But I don't think we havea definitive science around, you
know, what is a proper publicmask policy in the setting of a
pandemic. I think that we havenot done a good job of
(20:55):
assembling the necessary data tobe unequivocal in this works,
this doesn't work, this makessense in these circumstances. I
think unfortunately, you know,we're not going to have that
information when the next needarises.
Rob Lott (21:08):
What would that look like to to be able to give an
unequivocal response? I knowthis is unlikely or or kind of
idealistic, but what would weneed to have in place in order
to be able to answer those kindsof questions in a timely
fashion?
Thomas Dobbs (21:27):
You know, you could probably do, you know,
almost like a quasi experimentalthing, looking at different
communities around transmission,whether or had like, know, mask
policies here and there, Ithink, you know, school settings
and those sorts of thingscertainly help to of do it and
there are some smaller things,but you know, think some other
(21:48):
countries who had sort of like abigger sort of perspective about
looking at their wholepopulation, England, Israel, you
know, they put out some reallygood stuff that sort of answered
some questions. And, know, Idon't think that we had that
sort of foresight. We werealways sort of like, you know,
running behind the truck, right?We're always trying to catch up
instead of thinking ahead say,Oh, you know, we have this
(22:10):
really important question, wecan sort of do some stuff ahead
of time. But I think, you know,not to be too critical, because
we were just trying to getthrough everything.
But, you know, the data couldhave been out there. But, you
know, we wasted a lot of timewith other stuff that was
probably a little bitunimportant. Duplicated data
reporting and all kinds ofstuff, outmoded reporting
(22:33):
systems, you know, that's one ofthe things too, that I think
that I'm sad that with our, youknow, reportable disease
reporting, had to build aninfrastructure that because it
was bought with emergencyfunding has been actually
dismantled because now it sgoing through a procurement
process, the whole sort anyway.
Rob Lott (22:51):
Yeah. It's a little bit of a Jenga tower or
something like that where you'retrying to adjust in the middle
of building at the same time.And I can imagine that without a
sort of someone taking a stepback, it's hard to know exactly
(23:12):
where to push and where to pull.That's a great analogy. I do
want to shift gears just for amoment and just acknowledge your
name is attached to one of themost divisive Supreme Court
cases of recent years.
And I'm curious if you can tellus a little bit about how that
(23:34):
happened and sort of what thatexperience has been like for
you.
Thomas Dobbs (23:38):
It's not universal knowledge, And it's not even
common knowledge that there's asovereign immunity clause, in
the constitution where you can'tsue the government, at least I
think that's the best way toexplain it, and I'm not a
lawyer. And so what happens isthat if you sue an entity, a
regulatory entity, a person'sname has to be put on it, Right?
(24:04):
And so what happened was theclinic here in Jackson, sued the
government, but the regulatoryauthority was the health
department who was theinspector, as under sort of like
the the inspection panel thatthey would do for an ambulatory
surgery center.
Rob Lott (24:22):
And this was a dedicated reproductive health
care clinic in Jackson, is thatright?
Thomas Dobbs (24:28):
It was, yeah, yeah, yeah. And so, so the
initial lawsuit was Jackson,women's health, or I can't
remember exactly the name versusCourier, Doctor. Courier,
because she was the healthofficer at the time. And she had
nothing to do with it. Right?
And so when I took the job aftershe left, the naming convention
(24:54):
automatically replaced her namewith my name. I had nothing to
do with that case at all. Ididn't testify, I didn't try to
do anything, I didn't want tohave any part of it. And it
just, you know, it's just one ofthose things. If you're a public
official, you have these sort ofvulnerabilities as far as like,
you know, the stuff that's gonnahappen, and so it went through,
(25:17):
and you know in December, whichwas right during the explosion
of the Omicron, the SupremeCourt chose the Mississippi
case, which I didn't have anyforesight into that.
And so from there on it happenedand I tried to see if there was
a way to pull my name off of itand they said nope, too late.
And that was it. That's how ithappened.
Rob Lott (25:38):
How has that affected your your day to day work if if
it has at all?
Thomas Dobbs (25:43):
It mostly hasn't been too impactful for the most
part because, most people day today don't even realize it,
right, because they don'treally, you know, know about
that and certainly because Ihaven't been, you know, active
in that world at all. I did getsome good advice early on and
basically someone told me to,you know, lay low, just stay out
(26:06):
of the fray, and if people askme I just explain it. I get hate
mail and love mail and I respondthe same way, thank you for your
communication, and I send theman article from the New York
Times that says, hey, this guyhad nothing to do with it. It's
just kind of one of those quirkythings. Just try not to think
(26:29):
about it as well.
I mean, it's kind of I don'tknow, just kind of a strange
thing.
Rob Lott (26:34):
Well, in July of twenty twenty two, you stepped
back from your role as a statehealth officer and have since
become the Dean of the School ofPopulation Health at the
University of MississippiMedical Center. What have you
been able to focus on in thisrole that perhaps you couldn't,
(26:54):
in your previous roles?
Thomas Dobbs (26:55):
I have been hopeful and am still hopeful to
engage the clinical academiccommunity to fill some of the
gaps that exist within thepublic health world. Part of
that is, you know, there aren'tthat many public health
clinicians anymore. And so I'mstill very active in TB control
(27:18):
and in STD prevention, HIVtreatment and prevention. And so
we've had some pretty goodheadway in those areas, But it's
also given us an opportunity todo some sort of research, some
landscape analysis, educationalwork, and we have some cool
(27:38):
things going on that think aregoing to be important for our
future. Based on my lifeexperience, at least as long as
I'm alive, we're never going togive public health a reasonable
investment.
But where do we spend trillionsof dollars, trillions of dollars
(28:00):
to low impact every year? In thehealth care, right? I mean, you
spend so much money and so partof my dream is to figure out how
do you incorporate public healthpractice, at least the elements
that can be done as part of thehealthcare system, into the
clinical environment. And partof that's going to be training
(28:21):
the next generation of clinicianleaders. You know, we have some
interesting things going on withCMS right now around social
determinants of health, I thinkthey're important and that I
hope will stay.
We're looking at some innovativeapproaches toward our maternal
health crisis and infant healthcrisis here around group based
prenatal care and integrating itwith helping women with their
(28:42):
health related social needs. SoI think a tighter marriage
between the clinical resourcesand also with community health
centers. I think that's ourfuture. We still need public
health desperately and there'ssome things that public health
only can do like contactinvestigation or intervening,
you know, testing contacts toSTDs. I mean, private doctor
(29:03):
can't go to your boyfriend'shouse and test him for so forth,
right?
That'd be interesting. Soanyway, I think there's some
neat roles we need to thinkabout. We need to be innovative
because my hopes of the pasthave been repeatedly dashed and
I'm going to change myperspective.
Rob Lott (29:19):
Well, that's a great segue. As you're saying here,
the outlook for public healthdepartments at the state and
local level has gotten sort ofcloudier in recent months after
having long been stretched thinfor for many years. What advice
(29:42):
do you give to your students whomight come to you and express
sort of doubt about the futureof the field and whether or not
they should even pursue publichealth and population health as
a career?
Thomas Dobbs (29:55):
You know, now is kind of a challenging time and
so it depends on who's askingme. So if you have something
else you do, right? So if you'rea physician, if you're a nurse,
if you're a healthcareexecutive, if you do something
else, I strongly encourage andrecruit them to get a public
(30:18):
health degree because it reallyelevates their capabilities, not
only to advocate and improvehealth from a community level,
but also to be better sort ofscientists, right? I mean, we
saw some of the most egregiousthings happen during COVID, even
(30:39):
among sort of clinicians whowere kind of didn't really
understand science, right? Andso would make these wild,
assumptions, right?
So it's important to understandthe framework. I mean, the kind
of analogy I get is likeeverybody thinks they're a
public health expert, right? Butyou know, I don't know how to
fix the transmission justbecause I saw a scary YouTube
video about transmissions, I'mnot going to go try to fix my
(31:00):
transmission, right? And I thinkpeople, I don't know, it's
important to understand thatthere is a very precise science
around all this stuff, I want totrain better public health
scientists. Now someone who justwants to get an Miles hour to go
work at the health department, Ithink it's a tough time.
I just don't think those jobsare going be there, I'm just
being honest. You know,eventually, you know, we'll have
to rethink how we're doing this,but you know, right now we're
(31:23):
seeing layoffs, not hiring.
Rob Lott (31:24):
Wow, well, so a realistic take on the current
state of the world. Any otherfinal thoughts for listeners
about your experience and whatyou might want to share with
them?
Thomas Dobbs (31:40):
You know, the only thing I just want to just
reiterate is how importantpublic health is. If we think
about our gains in prosperity,expectancy over our entire
nation's history, it was rootedin disease prevention and having
healthy communities, healthywater, healthy food systems,
those sorts of things. And we donot need to abandon those
(32:03):
foundations, right? It's why dothey have cholera and typhoid in
certain undeveloped countries?It's because they have abandoned
those systems or they never hadthem, right?
And I worry about our mad rushto health individualism, right?
(32:24):
Where everybody's responsiblefor their own health. Everybody
can't be responsible for a sewerworking, right? Everybody can't
be personally responsible formaking sure they're not lead in
their water. There are somecommunity responsibilities that
are critically important.
It's okay to have a publicconversation about what those
are, but we cannot abandon them.We not only need to recognize
(32:45):
them, we need to fortify them.America's health is bad. We
perform very poorly. Women'shealth in Mississippi and infant
mortality ranks somewherebetween Algeria and Turkey,
right?
So that's not something to beproud of. We need to invest in
(33:06):
the foundation that allowspeople to be healthy, allow
people to make the individualdecisions that they can to
achieve maximum prosperity andhealth.
Rob Lott (33:15):
Well, that's a great place to wrap up. Think Doctor.
Thomas Stubbs, thank you so muchfor those thoughts and for
taking the time to chat with ustoday.
Thomas Dobbs (33:24):
Thanks so much for having me. It's great to talk to
you guys.
Rob Lott (33:27):
And to our listeners, thanks for tuning in. If you
enjoyed this episode, share itwith a friend, leave a review
and subscribe. Thanks so much.Thanks for listening. If you
enjoyed today's episode, I hopeyou'll tell a friend about a
healthy podcast.
Hello, and welcome to A Health Podicy. I'm your host,
(00:04):
Rob Lott. Friends, it's anotherone of A Health Podicy's very
special episodes. That's becausealthough we typically feature
the authors of some of the mostimportant recent health affairs
articles, we also set asideabout one episode a month to go
(00:26):
a little farther afield, to sitdown with various leading voices
in health, health care, andhealth policy. Today, it's
doctor Thomas Dobbs, dean of theJohn D.
Bauer School of PopulationHealth at the University of
Mississippi Medical Center.Doctor. Dobbs is an internal
medicine physician withexpertise in infectious disease
(00:49):
and epidemiology. He spentdecades treating patients and
caring for communities,including many of those living
with HIV during the nineties andearly two thousands, periods of
incredible transformation inboth the science and capacity
underpinning our systems relatedto HIV and AIDS. More recently,
(01:12):
doctor Dobbs served asMississippi State Health
Officer, leading the state'sDepartment of Health, including
its response to the COVIDnineteen pandemic.
In 2022, he returned to academiaat UMMC in Jackson, Mississippi.
And we're thrilled to have himhere today. Doctor. Thomas
Dobbs, welcome to A HealthOdyssey.
Thomas Dobbs (01:33):
Wonderful, I appreciate y'all having me.
Rob Lott (01:35):
So let's just jump in. I'm hoping maybe we can let our
listeners get a little bit of asense of your work and career
over the years. Tell us a littlebit, where are you from? Where'd
you grow up? How'd you get intothis business?
Thomas Dobbs (01:50):
So I'm initially from North Alabama. I was born
in a small town in NorthwestAlabama called Haleyville that
is of nestled up in sort of nearthe Sipsey Wilderness, really
beautiful part of the state.Then I went to college at Emory
in Atlanta and that was reallysort of a transformative time, I
think, for a lot of people. Andthen ended up going to medical
(02:11):
school at the University ofAlabama in Birmingham.
Rob Lott (02:14):
Okay, so when did you first think about pursuing a
career in medicine?
Thomas Dobbs (02:19):
Doctor. College, I always thought I was going to be
a theoretical physicist. And sothat's what I studied as an
undergraduate. But then, I had alot of health exposures, did
spend some summers doing,different work. Did some, I
spent some time in South AndCentral America and got to see
sort of the situations there,spent some time in the hospital
and surgery and had a goodexposure to the health
(02:42):
environment and then decided,you know, instead of doing or
trying to do physics, I wentinto medicine.
Rob Lott (02:49):
Do you miss the physics? Do you, dabble in
theoretical physics from time
Thomas Dobbs (02:54):
to Heavens no. But I do, you know, I do read like,
you know, news around, you know,exciting findings and, you know,
you know, just nerdy stuff likethat.
Rob Lott (03:06):
Cool. Well, tell us a little bit about your early
years as a practicing physicianin infectious disease. Where
were you practicing and what wasyour focus at that point?
Thomas Dobbs (03:17):
Through training, I realized pretty early that I
was interested in sort of a morepopulation based perspective of
health. And I think, when you'rein medical school and you're
idealistic and then you sort ofget into the hospitals and you
see that you're really takingcare of people at the end stage
manifestations of the disease,right? And understanding that a
lot of what we spend ourhealthcare dollar on in The
(03:39):
United States is really tryingto manage people who have severe
disease that could have beenprevented. And whether it's like
in the infectious disease realmor the chronic disease realm and
in the HIV world, certainlymakes a lot of sense. There's so
much that can be done upstream,so much that can be done from a
community or a state perspectiveof trying to improve the
(04:06):
possibilities for health forfolks.
Then so during my residency, Idid a master's in public health
at the UMB School of PublicHealth. I kind of, I did it
during my residency. I had sometime off to help, take care of
our youngest child, but thenalso too, I did it during
residency. I didn't, tell theresidency program and actually
had to sneak away to take mytablets. I still don't know that
they know that I was doing that,but anyways, fantastic
(04:28):
experience, and then, aftertraining, ended up working in
South Mississippi and did,worked in South Central Regional
Medical Center in Laurel,Mississippi, and also started
working, with the communityhealth center in Hattiesburg,
treating folks living with HIV.
Rob Lott (04:47):
What did you learn from those early experiences?
Thomas Dobbs (04:51):
Before that, I'd also been doing tuberculosis
work for a long time and got areally neat exposure to public
health. From that perspectiveworking with mentors at UAB,
specifically Doctor. MichaelKemerling. But then once I came
to Mississippi, it was reallykind of a remarkable experience
(05:16):
because I learned immediatelythat it's not the science of
medicine that's the challenge.Although it's beautiful what
we've invested in the science oftreating and preventing HIV,
it's really kind of remarkablewhat we've been able to do with
intention and investment.
But it wasn't the technology, itwas the challenges that people
had in their daily life, right?It was like, you know, I thought
(05:39):
I was going to go intohealthcare as a clinician
scientist, right? It was theintellectual part that I was
going to bring to the communitythat I'm working with. But
really, learned pretty quicklythat it was substance abuse,
transportation barriers, lack ofinsurance, all those things that
make it really hard to behealthy, that I spent the
majority of my time working on.And that really helped me get a
(06:02):
different viewpoint of what isreally driving health in our
country.
Rob Lott (06:05):
Okay, so over the years, in addition to practicing
direct patient care, you'vegotten more involved in
population health efforts,eventually becoming a public
health officer, a state healthofficer. Can you tell us a
little bit about that journeyand kind of how you went from
the bedside to the kind of theboardroom, if you will?
Thomas Dobbs (06:29):
Yeah, so there is no clear pathway into sort of
public health leadership. Earlyon when I was trying to meet
with people to understand how doyou get involved in public
health? There's a bunch ofdifferent pathways and I think
everybody has a different way ofgetting there. So I was a
clinician, I think working intuberculosis and HIV, there's a
(06:49):
natural overlap with publichealth because a lot of the work
that you do is, you know,working in communities, trying
to prevent transmission,identify people exposed, and
that sort of thing. I starteddoing the tuberculosis
consulting for the region in02/2005.
And I'm actually still doing itto this day. So it's still doing
(07:11):
that. And then from there, Itook over the local leadership
role, the regional healthofficer role, and practiced a
little bit. So I've kept my HIVpractice going pretty much
nonstop since early on, at leastin some way or another, and
really sort of learned how thepublic health system can work
(07:32):
effectively and sometimesineffectively at trying to
improve health for the localcommunities.
Rob Lott (07:38):
I want to circle back to the tuberculosis consulting
work. What does that job entailand sort of how has it changed
over the last few years?
Thomas Dobbs (07:50):
You know, remarkably, job hasn't changed
much in the past thirty years. Istarted doing it with friends
and mentors in Alabama back inthe 90s. And a lot of it is
supporting the nurses and thepublic health professionals to
review cases and make sure thatthings are managed properly and
to help do outbreakinvestigations and prevent
(08:11):
transmission. A lot of it's thesame, technology is different
such that instead of having alight board on my wall to look
at the x rays, I look at them onthe computer. But, but, and
then, you know, electroniccommunications certainly make
things a lot more, moreefficient, but the work is, is
essentially the same.
The thing that we do have goingon and that's its whole
(08:32):
interesting sort of conversationwith tuberculosis. I think it's
a good sort of mirror on what'shappening in public health, you
know, but we've lost so muchexperience and so much
institutional knowledge intuberculosis, but in so many
other fields. I do aconsultation role with the
(08:54):
University of Florida for theSoutheastern Part Of The United
States for regional consultingfor all the states if they have
sort of complicated questions.And I'm seeing that public
health has really been decimatedwhen it comes to the number of
employees. And we've got a lotof young faces who are talented,
but the challenges are justreally overwhelming.
(09:16):
And I'm really worried about thepublic health future of our
country.
Rob Lott (09:19):
What do you attribute that change to that loss? I
mean, I know we certainly havehad cuts to investments
recently, but I presume thatthis was happening before
January of twenty twenty five.
Thomas Dobbs (09:36):
Yes, it has been. And I think what's going on now
is just a continuation of a longstanding narrative of our
underinvestment in public healthinfrastructure. It's something
that I've really been on thesoapbox about for a long time
and it's never gone anywhere,right? We've basically traded
public health for advancedbiomedical technology and so if
(10:00):
someone's really sick and whenthey need CAR T therapy and all
that kind of stuff, amazing, Ilove it, but we are way under
invested in the blocking andtackling that it takes to
protect the public at thefoundational level. And I think
that's one of the reasons why ifyou look at our life expectancy
and our excess avoidable deaths,we are an outlier for the world.
(10:22):
You know, I mean, we exist in aplane that's almost unimaginable
and if you really just step backand look at it and people don't
know it, I mean, people are sortof like the frog boiled in the
water, I mean, we've just gottenso used to it, you know, that,
you know, gun violence deaths,early deaths related to heart
disease, stroke, know, generalstatus of health is so poor
(10:45):
compared to, you know, otherdeveloped countries, even with a
lot lower income. It's, yeah, Ithink it really reflects our
lack of investment in a publicminded community approach to
health and well-being.
Rob Lott (11:00):
So let's say you had control over how we were
allocating funds and, or perhapsyou just have the ear of folks
in Congress who are doing theappropriations, besides simply
saying, spend more on publichealth, what are some of the
areas you think really couldbenefit from targeted investment
(11:21):
and that that investment wouldpay significant dividends?
Thomas Dobbs (11:25):
You know, this is going to sound kind of strange,
but the first thing I would dois not ask for more money, I
would ask for more flexibilityand stability, right? Because
what we end up doing is we havethese sort of like boluses of
money that come in targeted forsomething like Ebola, or Zika,
or whatever. And so it's reallykind of like a roller coaster.
(11:47):
And we build some specializedcapability that doesn't
translate into long term andthen the money gets pulled away,
right? We could spend a lot lessmoney and build a lot more
robust infrastructure if we justprovide some stability.
The other thing that we've seen,and I think it's particularly
bad in the South, is for a wholehost of reasons, we don't invest
(12:12):
in our people and we paypathetically low wages for our
experts in public health, ournurses, our disease
investigation specialists, allthese folks, and the world
outside of the government, thepay has increased pretty
substantially, but for publichealth and the government
(12:33):
health, and I think part of thatis intentional by folks trying
to cut costs or shrinkgovernment, it basically leaves
us with an inability to recruitsome of the best talent that
could really have major impactson the well-being of our state
and also in the populations thatneed us most.
Rob Lott (12:50):
You mentioned the particular challenges in the
South, and I know Mississippihas long placed on the sort of
lowest tier of states when itcomes to many population health
measures, things like prematuredeath, low birth rate,
cardiovascular disease. Howsignificant was that fact within
(13:11):
your own mindset when you tookon the role, Love leading the
state health department?
Thomas Dobbs (13:19):
You know, it's huge and I think there's a lot
of interest in sort of likegetting into that and trying to
figure out how we can makeprogress. It's a real challenge
because people don't really wantto address the core causes,
right? A lot of what we do is atthe surface, right? And some of
it's really good. I mean, cancertainly treat high blood
pressure and stuff like that,or, you know, try to open a
(13:41):
clinic here and there.
But if people don't grow up witha healthy environment and a
pathway to health, then the longterm trajectory is not going to
be great. And so I thinkthinking upstream is something
that really we've been trying todo. What I had sort of initially
hoped to do with the healthdepartment changed pretty
rapidly once COVID hit. And sothen it was all hands on deck.
(14:03):
Now, one of the things thathappened with COVID that I was
just shaking my head because Iknew it wasn't going to work out
well in the public health sortof, you know, space, there was
all this talk about, oh, werealize how important public
health is and oh, we're going toinvest.
Oh, we see how important youare. And I was just thinking to
myself, I have seen this before.I've seen this movie before. And
(14:26):
once the acute scare is over,the money gets pulled away and
we backslide and continue ourdisinvestment in one of our most
valuable institutional resourcesas a country.
Rob Lott (14:42):
Well, in a minute, I want to hear a little more about
your experience navigating theCOVID pandemic. But first, let's
take a quick break. And we'reback. I'm here with doctor
(15:10):
Thomas Dobbs, dean of the Schoolof Population Health at the
University of MississippiMedical Center and the former
state health officer for thestate of Mississippi. Just a
moment ago, you were talking alittle bit about the sort of
disappointment that camefollowing the high hopes for
perhaps some transformation toour public health system post
(15:31):
COVID and then the inevitablesort of backslide there.
In fact, you were the author ofa paper that we published in
Health Affairs, where youstudied non urgent elective
procedures, intensive care inMississippi. And I'm wondering
if you can just say a little bitabout that and kind of how your
(15:54):
work on that paper fit into yourbroader experience leading the
COVID fight in Mississippi.
Thomas Dobbs (16:00):
So I would like to say that I think we may be
missing a great opportunity tolearn from the last pandemic to
prepare for the next, because wedid so many things, right? We
did so many interventions, wedid the mask thing, we did the
social distancing thing, we dida lot of controls over hospital
admissions. There were a wholesequence of things we did to
(16:21):
society and we don't know whatworked and what didn't work.
Mean, to some extent we do knowsomewhat different things, but
we really haven't done the typeof investigations I think that
we could sort of hang our hat onwhere with the next pandemic we
can have a list of options. Say,okay, this works in this
(16:41):
scenario, this works.
And so that's what we wanted todo. One of the things that we
did in Mississippi and one ofthe things I think that really
challenged a lot of places, thatI do think it was worse here
because our baseline resourcesare so low, is that when COVID
got bad, our health systems wereoverwhelmed. And the inter
hospital transfers were blocked.It was basically concrete. And
(17:02):
we had people who were likehaving heart attacks in parking
lots and couldn't get to carebecause the ambulances were
backed up, their hospitals werefull and they wouldn't take
anybody.
And so we did a couple of thingsto try to like loosen up the
system a little bit. One of thethings is if you need a knee
replacement, it can wait a week,it can wait a couple of weeks,
right? But those are resourcesthat eat up hospital capacity.
(17:26):
And it's not just like, oh, andI had the doctors complaining
and saying, oh, it's a kneereplacement, it's an outpatient
thing, it's not going to use upany resources. But when we
looked at the data, we saw thatlike ten percent of knee
replacements end up hospitalizedunintentionally and about five
percent in ICU, at leasttemporarily.
And like, okay, those areresources that we're trying to
preserve. So that was thepremise we went into it with is
(17:48):
that we should delay these nonurgent elective procedures to
make space for criticalresources that we need in the
hospital. But after it's over,we said, okay, we did this,
right? Did it work? And sothat's what we did is we did a
study to see is, was this policyeffective in making more ICU
(18:10):
beds available?
And the answer was yes. And wedidn't get into the question,
did it make more general, youknow, medical surgical beds
available? But I think itprobably would bear out the same
way. And I was glad that we hadan opportunity to sort of try to
answer one of these questions ofwas something that we did, was
(18:30):
it worthwhile? And I think thatthis demonstrates pretty clearly
that yes, it was a worthwhilelogical intervention that we can
put on our list of things thatwe can do in the future when we
get in these sort of challenges.
Rob Lott (18:41):
So I'm so curious in that context, so many of the
papers that we publish at healthfairs are written by academic
researchers. That's their sortof almost their full time gig is
to connect these studies, writethe papers, submit the papers,
publish the papers. And oftenwhen we talk to folks who are
sort of either practicingphysicians or public health
(19:03):
professionals, what we hear is,Oh, I have this great thing. If
only I had the time to write itup, you know, or the resources
or the support. And I'm curioussort of if that kind of equation
was something that you grappledwith?
Did you set aside the time towork on this? Or was it the kind
(19:24):
of thing you had to do nightsand weekends just to make it a
priority?
Thomas Dobbs (19:28):
Yeah, gosh, it's such a good point because there
are so many smart people outthere who are too busy and under
resourced to do things. Youknow, fortunately, working for
the health department at thetime when we pulled this
together, And then shortlythereafter, my role was such
that I was able to put some timeinto it. And there was some, you
(19:49):
know, some after hours weekendsort of time on it. But I'm not
like a busy clinician, you know,trying to make money off RVUs,
right? And so I think in a waythat kind of speaks to the value
of having people whose job it isto figure this out.
I mean, that, you know, that'sto be some of the stuff like CDC
is doing. And I think, you know,CDC missed a bit of an
(20:12):
opportunity. I know they havetheir own challenges and have
ever since COVID and thereafterto look at some of these
questions, because even likeeven to this day, you know,
things that were sort of like alittle bit controversial, people
ask me like about the masks. Youknow, I'll give a talk and
people say, what's this nonsenseabout the masks? Or did they
work?
(20:33):
And so I have to give them whatI think is an evidence based
reasonable answer based on thecollective information that I
have. But I don't think we havea definitive science around, you
know, what is a proper publicmask policy in the setting of a
pandemic. I think that we havenot done a good job of
(20:55):
assembling the necessary data tobe unequivocal in this works,
this doesn't work, this makessense in these circumstances. I
think unfortunately, you know,we're not going to have that
information when the next needarises.
Rob Lott (21:08):
What would that look like to to be able to give an
unequivocal response? I knowthis is unlikely or or kind of
idealistic, but what would weneed to have in place in order
to be able to answer those kindsof questions in a timely
fashion?
Thomas Dobbs (21:27):
You know, you could probably do, you know,
almost like a quasi experimentalthing, looking at different
communities around transmission,whether or had like, know, mask
policies here and there, Ithink, you know, school settings
and those sorts of thingscertainly help to of do it and
there are some smaller things,but you know, think some other
(21:48):
countries who had sort of like abigger sort of perspective about
looking at their wholepopulation, England, Israel, you
know, they put out some reallygood stuff that sort of answered
some questions. And, know, Idon't think that we had that
sort of foresight. We werealways sort of like, you know,
running behind the truck, right?We're always trying to catch up
instead of thinking ahead say,Oh, you know, we have this
(22:10):
really important question, wecan sort of do some stuff ahead
of time. But I think, you know,not to be too critical, because
we were just trying to getthrough everything.
But, you know, the data couldhave been out there. But, you
know, we wasted a lot of timewith other stuff that was
probably a little bitunimportant. Duplicated data
reporting and all kinds ofstuff, outmoded reporting
(22:33):
systems, you know, that's one ofthe things too, that I think
that I'm sad that with our, youknow, reportable disease
reporting, had to build aninfrastructure that because it
was bought with emergencyfunding has been actually
dismantled because now it sgoing through a procurement
process, the whole sort anyway.
Rob Lott (22:51):
Yeah. It's a little bit of a Jenga tower or
something like that where you'retrying to adjust in the middle
of building at the same time.And I can imagine that without a
sort of someone taking a stepback, it's hard to know exactly
(23:12):
where to push and where to pull.That's a great analogy. I do
want to shift gears just for amoment and just acknowledge your
name is attached to one of themost divisive Supreme Court
cases of recent years.
And I'm curious if you can tellus a little bit about how that
(23:34):
happened and sort of what thatexperience has been like for
you.
Thomas Dobbs (23:38):
It's not universal knowledge, And it's not even
common knowledge that there's asovereign immunity clause, in
the constitution where you can'tsue the government, at least I
think that's the best way toexplain it, and I'm not a
lawyer. And so what happens isthat if you sue an entity, a
regulatory entity, a person'sname has to be put on it, Right?
(24:04):
And so what happened was theclinic here in Jackson, sued the
government, but the regulatoryauthority was the health
department who was theinspector, as under sort of like
the the inspection panel thatthey would do for an ambulatory
surgery center.
Rob Lott (24:22):
And this was a dedicated reproductive health
care clinic in Jackson, is thatright?
Thomas Dobbs (24:28):
It was, yeah, yeah, yeah. And so, so the
initial lawsuit was Jackson,women's health, or I can't
remember exactly the name versusCourier, Doctor. Courier,
because she was the healthofficer at the time. And she had
nothing to do with it. Right?
And so when I took the job aftershe left, the naming convention
(24:54):
automatically replaced her namewith my name. I had nothing to
do with that case at all. Ididn't testify, I didn't try to
do anything, I didn't want tohave any part of it. And it
just, you know, it's just one ofthose things. If you're a public
official, you have these sort ofvulnerabilities as far as like,
you know, the stuff that's gonnahappen, and so it went through,
(25:17):
and you know in December, whichwas right during the explosion
of the Omicron, the SupremeCourt chose the Mississippi
case, which I didn't have anyforesight into that.
And so from there on it happenedand I tried to see if there was
a way to pull my name off of itand they said nope, too late.
And that was it. That's how ithappened.
Rob Lott (25:38):
How has that affected your your day to day work if if
it has at all?
Thomas Dobbs (25:43):
It mostly hasn't been too impactful for the most
part because, most people day today don't even realize it,
right, because they don'treally, you know, know about
that and certainly because Ihaven't been, you know, active
in that world at all. I did getsome good advice early on and
basically someone told me to,you know, lay low, just stay out
(26:06):
of the fray, and if people askme I just explain it. I get hate
mail and love mail and I respondthe same way, thank you for your
communication, and I send theman article from the New York
Times that says, hey, this guyhad nothing to do with it. It's
just kind of one of those quirkythings. Just try not to think
(26:29):
about it as well.
I mean, it's kind of I don'tknow, just kind of a strange
thing.
Rob Lott (26:34):
Well, in July of twenty twenty two, you stepped
back from your role as a statehealth officer and have since
become the Dean of the School ofPopulation Health at the
University of MississippiMedical Center. What have you
been able to focus on in thisrole that perhaps you couldn't,
(26:54):
in your previous roles?
Thomas Dobbs (26:55):
I have been hopeful and am still hopeful to
engage the clinical academiccommunity to fill some of the
gaps that exist within thepublic health world. Part of
that is, you know, there aren'tthat many public health
clinicians anymore. And so I'mstill very active in TB control
(27:18):
and in STD prevention, HIVtreatment and prevention. And so
we've had some pretty goodheadway in those areas, But it's
also given us an opportunity todo some sort of research, some
landscape analysis, educationalwork, and we have some cool
(27:38):
things going on that think aregoing to be important for our
future. Based on my lifeexperience, at least as long as
I'm alive, we're never going togive public health a reasonable
investment.
But where do we spend trillionsof dollars, trillions of dollars
(28:00):
to low impact every year? In thehealth care, right? I mean, you
spend so much money and so partof my dream is to figure out how
do you incorporate public healthpractice, at least the elements
that can be done as part of thehealthcare system, into the
clinical environment. And partof that's going to be training
(28:21):
the next generation of clinicianleaders. You know, we have some
interesting things going on withCMS right now around social
determinants of health, I thinkthey're important and that I
hope will stay.
We're looking at some innovativeapproaches toward our maternal
health crisis and infant healthcrisis here around group based
prenatal care and integrating itwith helping women with their
(28:42):
health related social needs. SoI think a tighter marriage
between the clinical resourcesand also with community health
centers. I think that's ourfuture. We still need public
health desperately and there'ssome things that public health
only can do like contactinvestigation or intervening,
you know, testing contacts toSTDs. I mean, private doctor
(29:03):
can't go to your boyfriend'shouse and test him for so forth,
right?
That'd be interesting. Soanyway, I think there's some
neat roles we need to thinkabout. We need to be innovative
because my hopes of the pasthave been repeatedly dashed and
I'm going to change myperspective.
Rob Lott (29:19):
Well, that's a great segue. As you're saying here,
the outlook for public healthdepartments at the state and
local level has gotten sort ofcloudier in recent months after
having long been stretched thinfor for many years. What advice
(29:42):
do you give to your students whomight come to you and express
sort of doubt about the futureof the field and whether or not
they should even pursue publichealth and population health as
a career?
Thomas Dobbs (29:55):
You know, now is kind of a challenging time and
so it depends on who's askingme. So if you have something
else you do, right? So if you'rea physician, if you're a nurse,
if you're a healthcareexecutive, if you do something
else, I strongly encourage andrecruit them to get a public
(30:18):
health degree because it reallyelevates their capabilities, not
only to advocate and improvehealth from a community level,
but also to be better sort ofscientists, right? I mean, we
saw some of the most egregiousthings happen during COVID, even
(30:39):
among sort of clinicians whowere kind of didn't really
understand science, right? Andso would make these wild,
assumptions, right?
So it's important to understandthe framework. I mean, the kind
of analogy I get is likeeverybody thinks they're a
public health expert, right? Butyou know, I don't know how to
fix the transmission justbecause I saw a scary YouTube
video about transmissions, I'mnot going to go try to fix my
(31:00):
transmission, right? And I thinkpeople, I don't know, it's
important to understand thatthere is a very precise science
around all this stuff, I want totrain better public health
scientists. Now someone who justwants to get an Miles hour to go
work at the health department, Ithink it's a tough time.
I just don't think those jobsare going be there, I'm just
being honest. You know,eventually, you know, we'll have
to rethink how we're doing this,but you know, right now we're
(31:23):
seeing layoffs, not hiring.
Rob Lott (31:24):
Wow, well, so a realistic take on the current
state of the world. Any otherfinal thoughts for listeners
about your experience and whatyou might want to share with
them?
Thomas Dobbs (31:40):
You know, the only thing I just want to just
reiterate is how importantpublic health is. If we think
about our gains in prosperity,expectancy over our entire
nation's history, it was rootedin disease prevention and having
healthy communities, healthywater, healthy food systems,
those sorts of things. And we donot need to abandon those
(32:03):
foundations, right? It's why dothey have cholera and typhoid in
certain undeveloped countries?It's because they have abandoned
those systems or they never hadthem, right?
And I worry about our mad rushto health individualism, right?
(32:24):
Where everybody's responsiblefor their own health. Everybody
can't be responsible for a sewerworking, right? Everybody can't
be personally responsible formaking sure they're not lead in
their water. There are somecommunity responsibilities that
are critically important.
It's okay to have a publicconversation about what those
are, but we cannot abandon them.We not only need to recognize
(32:45):
them, we need to fortify them.America's health is bad. We
perform very poorly. Women'shealth in Mississippi and infant
mortality ranks somewherebetween Algeria and Turkey,
right?
So that's not something to beproud of. We need to invest in
(33:06):
the foundation that allowspeople to be healthy, allow
people to make the individualdecisions that they can to
achieve maximum prosperity andhealth.
Rob Lott (33:15):
Well, that's a great place to wrap up. Think Doctor.
Thomas Stubbs, thank you so muchfor those thoughts and for
taking the time to chat with ustoday.
Thomas Dobbs (33:24):
Thanks so much for having me. It's great to talk to
you guys.
Rob Lott (33:27):
And to our listeners, thanks for tuning in. If you
enjoyed this episode, share itwith a friend, leave a review
and subscribe. Thanks so much.Thanks for listening. If you
enjoyed today's episode, I hopeyou'll tell a friend about a
healthy podcast.
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