April 29, 2024 • 36 mins
PCA America is thrilled to bring you its first ever conversation series hosted by our very own President & CEO, Dr. Melissa Merrick.
Dr. Merrick explores the impacts of Adverse Childhood Experiences (ACEs) on children’s lives with a special guest, the esteemed Director of the CDC’s National Center for Injury Prevention and Control, Dr. Allison Arwady. This groundbreaking conversation marks a significant milestone in our mission to prevent child abuse and neglect.
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Episode Transcript
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SPEAKER_00 (00:12):
Hi everyone, we're joined today by Dr.
Allison Arwoody, the director ofthe National Center for Injury
Prevention and Control.
Dr.
Arwoody leads the CDC'sinnovative research and
science-based programs toprevent injuries and violence
and to reduce theirconsequences.
And she most recently servedfour years as the commissioner
(00:33):
of the Chicago Department ofPublic Health, leading the
health department of thenation's third largest city, and
of course, home to PCA America,including through the COVID-19
pandemic.
Dr.
Allison Arwoody, welcome to thePCA America's podcast in
celebration of this year's ChildAbuse Prevention Month.
SPEAKER_01 (00:52):
Yeah, thanks so much for having me.
I really am looking forward tothe conversation.
Obviously, PCA America lovespartnering with CDC and vice
versa.
I think there's a lot of thingsthat we have to talk about
because we care about a lot ofthe same work and uh really
looking forward to theconversation.
So thanks for that.
SPEAKER_00 (01:09):
I sure do.
Oh, thank you so much for beingwith us.
And obviously, such a specialplace in my heart for you, all
of the great work you did herein Chicago.
But then also, of course, Ispent uh numerous years at the
injury center doing such thatimportant public health work.
And I'm just so excited uh foryour new role.
So, first of all,congratulations on this
humongous role.
(01:29):
What an exciting opportunity andsuch a critical role at the CDC
for real prevention impact.
Tell us a little bit about yourvision on how that impacts
families.
SPEAKER_01 (01:40):
Absolutely.
So, you know, as you said, yes,this is a big role.
And just because everybody maynot know the injury center, uh,
it's the center at CDC that isfocused on preventing injuries.
But what does that mean?
That means overdose, that meanssuicide, that means violence in
all forms, which is wherethere's some overlap.
It also means other injuries,things like drowning, uh, things
(02:04):
like falls, uh, even some of theinjuries that come from car
crashes, for example.
Um, and so in all of theseapproaches, you know, the reason
I'm attracted to it is first ofall, these are preventable,
right?
And I'm a pediatrician and aninternal medicine doc by
training.
I really like taking care ofpatients.
(02:26):
I like helping them get wellafter they're sick.
But for me, the reason I'mattracted to the work of the
injury center and really topublic health overall is we have
the ability to think aboutbefore an injury happens, before
one of these reallylife-changing events uh comes
along.
Um, and we can use data and wecan use evidence and we can make
(02:49):
investments and we can trythings uh in partnership with
community to really say whatworks.
Um, and so when I think about,you know, a vision overall, we
like to have a vision in thepositive, right?
Not in the negative.
Um so, you know, thinking abouthaving a vision where we've got
healthy and safe childhoods forall kids, right?
(03:10):
Something as basic as that.
Um, thinking about the fact thatwhen we can create safe and
stable and nurturingrelationships and environments
for all children, that in turnleads to better development of
the brain and the endocrine andthe immune systems.
That in turn leads to healthierchildren, not just physically,
but emotionally and socially andbehaviorally.
(03:31):
And that in turn, healthychildren, leads to healthy
adults.
Um, and when I think about howhard this country is being hit
right now by the issues that theinjury center works on, we are
never gonna treat our way out ofthese crises, right?
Uh and so just to put a couplemore um out there, and then I'll
(03:53):
stop talking about it because Iwant to get into the prevention
piece.
But right now in this country,injuries related to firearms are
actually the number one cause ofdeath for kids one to 19 year
olds.
Overdoses are the number onecause of death for adults 18 to
45 year olds.
We see statistics that just takemy breath away when we're
(04:15):
interviewing young people.
The most recent survey for theyouth risk behavioral
surveillance, which is a surveythat's done in high schools, one
out of 10 high school kids toldus that they had not just
thought about, but attemptedsuicide.
We have to think about gettingupstream.
We have to think aboutpreventing these outcomes
(04:37):
because when they happen, youknow, it's it's it's a tragedy
for the person, but for theirfamily, for their community.
Um, and so I know we're gonnahave a chance to talk a little
bit more about adverse childhooduh experiences, um, but I think
that that the ability to thinkabout these really hard outcomes
that that are difficult foreverybody to talk about, but
(04:57):
then change the lens and sayit's not always just about
responding to these traumaticevents.
It's about doing theinvestments, doing the work to
prevent them in the first place.
As a society, uh, that that'swhy I do public health.
And so the vision is a really,you know, it's a positive one of
healthy and safe childhoods,which then lead to healthy and
(05:17):
safer adults.
Um, but there are real things inall of these complicated spaces
that we can do to prevent thatwork.
SPEAKER_00 (05:24):
Oh my gosh, I'm so it's just wonderful to hear you
say that and express that visionin such a clear way because
prevention is possible.
And I think that's what we learnand our science shows is true,
right?
When we make sure that familieshave what they need when they
need it, delivered in their owncommunities, you know, with love
and respect and trust withoutstigma before they're in crisis.
(05:48):
That's how we are reallyoperationalizing prevention and
how we operationalize equity forthat matter, right?
It's like, what can we all do toassure the conditions for
health, well-being, and thrivingand prevention of violence and
all of the adversities forchildren and families?
Such an important public healthlever that I'm so glad that you
(06:10):
highlighted there.
We can really meet our nation'shealth, well-being, and
prosperity goals when we havehealthier kids.
And we know that our healthierkids live in healthier families,
healthier communities, andreally live in a country that
can better support children andfamilies to reach their maximum
health and life potential.
So, Dr.
Arwoody, just so excited thatyou're in this role at this
(06:33):
time.
And speaking of critical roles,you served as the leader of the
third largest city during anational, well, really a global
health crisis.
Um, so we have so much to learnfrom you about supporting
diverse communities.
And you've highlighted theimportance of partnerships and
communication in lots of venues,but we'd really love to hear
(06:55):
more about your perspective,especially through the lens of
diversity and equity.
SPEAKER_01 (07:01):
Yeah, absolutely.
I mean the COVID response wasjust such a fracturing of the
way that we normally do thingsin ways that were terrible, but
also I think had a lot ofpotential and a lot of ability
(07:21):
to really think differently andin ways that center diversity
and equity, not as sort of anice to have, but as essential
to really making a difference,you know, when it matters at the
heart of the issue.
And so, you know, as you noted,I was lucky enough to be in
(07:42):
Chicago at the ChicagoDepartment of Public Health for
about eight years before cominginto this role, and then the
last four as commissioner.
And that did that was almost theperfect overlap with COVID.
And I learned a lot during thatabout what it looks like to not
just say that you're engagingquote unquote community, but to
(08:07):
really start from a point oflistening and not talking and
bringing solutions, ofrecognizing that there is no
monolith community, that that ina city as diverse as Chicago,
but in a city as diverse asanywhere that you are, and in
this country of ours, there areby definition groups and
(08:29):
subgroups, no matter how youslice and dice the population,
that are gonna have differentneeds, that are gonna have
different um areas of strengthand areas of focus, and that are
going to need to be part of anyreal solution.
Because again, public health isnot so much about medical care.
(08:49):
There is work to do on themedical care side too, don't get
me wrong.
But in public health, whereyou're thinking about systems
and you're thinking aboutenvironments, if you start
having conversations thatassume, you know, as government,
for example, coming in or as apublic health department coming
in during COVID, that you knowwhat is needed for this
(09:11):
environment or this community.
Like you're never gonna have areal conversation.
And I was really, reallyappreciative in Chicago that we
saw a lot of really honestconversation um about where
things had not gone wellpreviously.
There's all kinds of reasons whyum different groups are not very
(09:32):
likely to, you know, trust thehealth department, honestly.
If you're a representative ofthe government and you're a
representative, you know,indirectly of the healthcare
system, and you're um, you know,a representative of long
histories of power and sort ofhow those have landed in
different ways and not always ofreally centering community
voice, you're starting from apoint where there's not always
(09:53):
that much trust at baseline.
Right.
But in a crisis um like COVID,but I would also argue in a
crisis like romantic childrenthe glass, like working on uh
suicide prevention, you've gotto make sure that we're not just
thinking about how to tailor ourmessage as public health, but to
(10:17):
make sure that the messages thatare we're even developing kind
of make sense in terms of uh thepeople we're listening to.
And then so much about who themessenger is, right?
And that and that trusted, um,that trusted messenger stance.
And so, you know, in in inChicago, for example, we we did
a lot of work to say equity isnot just a nice to have.
(10:40):
If you're in a crisis, you'vegot to make sure that resources
are getting to where they aremost needed to actually control
the outbreak, right?
It's not just a theoretical niceidea.
It's about saying, where inChicago is COVID hitting the
hardest?
Why is that where COVID ishitting the hardest?
Is that because of, you know,crowded housing and um, you
(11:02):
know, essential work that can'tbe done from home and food
insecurity where you, you know,are not able to just stock up
and stay home?
Uh, is that aboutintergenerational?
You know, it's about all ofthese things and so much more.
And if you don't design yourresponses um to be tailored to
those needs uh and recognizingthat those needs are going to be
(11:24):
different, even in differentparts of the city, you're not
gonna really make the progressthat you need to make, both on
building some of that trust sothat when we've got things like
a vaccine to offer, communitiesunderstand that that where that
is coming from, that that thisis something that is uh is is
(11:44):
going to be valuable everywhere,but it's going to be valuable in
their community specifically.
Um, but it's also about nothaving this be something that's
tacked on after the fact.
We really need to center a lotof the, you know, especially
racial and ethnic disparities,but you know, there were
disparities around age, therewere disparities around, you
know, neighborhood, all kinds ofother ways that you could look
(12:05):
at this.
Um, and and we we measured oursuccess in a lot of ways based
on whether we were seeing umimprovements and outcomes in the
neighborhoods, for example, orum the various subgroups um that
were furthest from where youwould want to be.
Are we making progress there?
Is in a lot of ways moreimportant.
(12:26):
And that's what's going to movethe lens overall, I think, when
you're wanting to make impact onthese huge societal programs.
And, you know, I think frankly,at the injury center at CDC, you
know, there is also a lot of,you know, prioritization, really
centering of health equity.
I think there's a lot still thatwe are all thinking about.
(12:47):
What does that really look like?
How do you make sure that thatresources are going where
they're most needed, that thevoices of people with lived and
living experience andcommunities are central to how
we are shaping and evaluatinginterventions?
Um, how are we really developingsome of that evidence base and
(13:08):
the partnerships?
Um, but I think when you look atit doesn't matter which of the
topics you look at within theinjury center, um, they don't
land in the same way on peoplein this country, broadly
speaking.
And again, there's differentways to think about diversity.
Um, but the ability to have thatkind of a focus and then to
(13:32):
recognize that diversity alsobrings the amazing strength,
right?
And the resilience.
And that anytime that you aremaking a decision, you've got to
have diverse voices in that roomto make the best decision
possible.
That you've got to reallyrecognize that there is such an
incredible amount of resilienceand um connectedness and sort of
(13:54):
culture building that again canlook different in different
subsets, but you don't you wantto be careful when you're
thinking about partners andyou're thinking about equity and
you're thinking about diversity,that you're not just thinking
about sort of the negativeoutcomes, but you're thinking
about the incredible positivework that can come.
And I think when I think back tothe time in Chicago, I think we
(14:17):
we did not everybody goteverything perfect.
There's a million things, youknow, that everybody wishes we
would have been able to do moreof in COVID.
But I'm incredibly proud that wecentered equity not just as a
buzzword, but as a way to makedecisions about things like how
resources and vaccines weredistributed, how community voice
(14:37):
was involved in creatingmessaging campaigns, and how we
were pushed to really focus onthings like food insecurity,
even before we started thinkingabout PPE, because that is
frankly where the needs weregreatest.
And so I learned a whole lotkind of personally, um, and am
bringing that to the injurycenter, where there are
(14:59):
similarly so many people reallycommitted to thinking about how
do we do this work in a way thatthat moves the needle, um,
doesn't just move the needle forthe median, but kind of moves
the needle uh for both positive,kind of and negative in in ways
that that can impact on thesehuge problems.
(15:21):
And we're never gonna make theprogress we need to make, in my
opinion, um, on these issues ifwe're not thinking about those
issues from the beginning at theend and at all points in
between.
SPEAKER_00 (15:35):
Oh my gosh.
I so much that you said there isjust true to the work of public
health.
You know, I always refer back tothat um institutes of medicine,
like in 93, 1993 definition ofpublic health.
And it says it's what we as asociety do collectively to
assure the conditions in whichall people can be healthy and
(15:57):
can thrive.
And so it's that collectively,right?
It requires partnerships, itrequires a difference of
experience, the lived and livingexpertise, the centering of
families and of communities andof youth, right, into what those
prevention solutions are.
And I know that in our work, ourcollective work, you know, to
prevent adversity, you know,early adversity, child abuse and
(16:19):
neglect, other things before itoccurs.
Like we're all talking aboutco-design.
And I think it's exactly whatyou just described in this
beautiful way, right?
Until we actually celebratediversity and recognize that
we're going to be stronger withdiverse perspectives early and
often and throughout theprocess, we're not going to be
(16:39):
able to maximize the possibilityof prevention, right?
And we we already said and wesay again and again here that
prevention is possible.
So we want to maximize thatpossibility.
It's just really wonderful tohear you say it in such a clear
way.
And I'm glad that you feel proudof the work that you did in
Chicago because we are now aChicagoan and we feel proud of
(17:02):
the leadership that you providedto this city and still uh think
of you often and are so happythat now you have this platform
at our nation's you know publichealth agency to really elevate
um uh the different uh differentperspectives and different
approaches that are necessary toreally be in the business of
(17:23):
doing the work of public health.
So I just I just love everythingyou said, and I'm so um excited
um to be in partnership withyou.
One of our aspirations, as youknow from the PCA America, I
know that you share thisaspiration, is that for
children, you know, that thechildren and families have
(17:43):
mental and physical health andwell-being across the lifespan,
right?
And here in Chicago, you took aninnovative approach to the
promotion of mental health.
Tell us more about that and somekey lessons learned that could
be replicated as we build aprimary prevention ecosystem in
this country that doesn'tcurrently exist.
Like you said before, you know,we wait for families to be in
(18:06):
crisis before they can get theservices and supports that could
have kept them healthy andstrong in the beginning.
And yes, the preventioncontinuum has a real need always
for treatment andtrauma-informed responses, but
until we really move upstream,we're kind of kind of be like in
the position we're always at.
So tell us more about that, um,specifically in mental health
(18:29):
and some key lessons learnedthat could be replicated as we
build this primary preventionecosystem for our country.
SPEAKER_01 (18:35):
You know, you are correct that not just me, but my
incredible team at the ChicagoDepartment of Public Health
helped me think in newer andbigger ways about what does it
look like to take a publichealth approach to mental
health.
I think for a long time, publichealth has not been as focused,
frankly, on the mental healthside of things.
(18:57):
But you don't have to look anyfurther than COVID, right?
Uh to sort of recognize that,yes, it was physically, you
know, the the in terms of theillness and the deaths, I mean,
devastating.
But that physical illness hadreally consequential mental
health impacts.
Also just the changes, whetherit was just the isolation, that,
(19:20):
you know, so many, so manythings that upended connection
in ways that were critical earlyin the pandemic, especially when
we really didn't have the toolsto be able to help keep people
safer.
Um, and so in Chicago, we made adecision not to pull anybody
from our behavioral health team,which was our mental health
(19:42):
substance use and violenceprevention teams, into sort of
quote unquote COVID.
Everybody was working on COVID,of course.
But we said there's gonna beeven more need for mental health
resources as a result of COVID.
And so different than most otherfolks across the health
department, keep going, keepbuilding.
And just to kind of put this insome perspective, when I came in
(20:06):
as commissioner, again, most ofthis was not my work, it was a
citywide effort, my team, lotsand lots of advocates, support
from the mayor's office, etcetera, the health department,
we were um supporting the mentalhealth care for around three to
four thousand Chicagoans whootherwise would not have been
able to get that care.
(20:26):
And again, especially for peoplewith serious mental illness,
there are people who absolutelywe've got to make sure can get
into treatment.
But we were seeing such a gap interms of the number of people
who needed that care and whatwas available.
And importantly, people didn'tknow how to navigate it very
(20:46):
well, right?
For as complicated as ourphysical health system is, our
behavioral health system is evenharder to navigate, especially
if you are uninsured,underinsured, uh, you know,
perhaps undocumented, have otherissues going on in your life,
need substance use disordertreatment at the same time as
you need mental healthtreatment, you name it, it's
more complicated.
And so we did a whole host ofthings, um, really pulling
(21:10):
together.
Everybody working in the safetynet mental health care did a lot
of investments to make sure thatthere were mental health
resources outside of traditionalclinic settings.
So making sure that schools andfood pantries and uh, you know,
service sites, libraries couldhave therapists, for example, in
a no-rong door approach, sort ofto thinking about mental health
(21:33):
on a continuum while reallyworking on that treatment.
We went from between three and4,000 people getting care that
year that I came in ascommissioner to while COVID was
going on, uh, up to over 70,000Chicagoans, you know, getting
care, getting treatment.
And that was through the work ofreally building collaborations,
(21:56):
helping to think about how younavigate and you know, this
system and making sure that whenwe were uh promoting any of
these resources, funding any ofit, pulling together, it was all
by definition for you, no matterwho you are.
This is not, we don't care ifyou're insured, we don't care
what language you speak, wedon't care, we don't care, but
(22:18):
it's again thinking about asystems-wide approach, which is
actually public health is prettygood at that.
Like, where what do we need todo kind of as a whole system?
And then getting upstream,saying for the people with the
most acute needs, yes, there'swork to do on treatment, and
we're gonna embed for the firsttime mental health professionals
into the 911 uh, you know, callresponse system.
(22:39):
Yes, we're gonna for the firsttime embed behavioral health
care in homeless shelters.
Yes, for the first, you know,there are these sort of pockets
you work on.
But when you think upstream fromthat, what does it look like?
First of all, to change theconversation around mental
health.
Mental health is health.
We had a campaign in Chicagothat was called Unspoken that
was really about trying to takeissues of mental health or
(23:00):
substance use disorder or, youknow, suicide prevention, things
that we frankly often don't talkabout, turning these into things
that we talk about.
What does it look like to reducestigma around that?
Again, working in very focusedways with a whole host of um
people from differentbackgrounds and communicators,
and thinking about things likewe're never gonna treat our way
(23:22):
out of this.
And so, what does it look likefor coaches?
What does it look like for uhfaith leaders?
What does it look like forpeople who interact with young
folks, especially sort of acrossthis city?
What does it look like for peersto feel like they have some
language to start thoseconversations and then know what
to do for more resources?
(23:42):
And this really for me, just totag into the work at CDC and the
injury center, I've been reallypleased in the way that the
center, and I know this is workthat we've shared with PCA
America, working on this adversechildhood experiences prevention
work.
Um and, you know, I think youraudience knows about adverse
childhood experiences, but butthe work of thinking about
(24:04):
things like child abuse orneglect as being something that
when it happens in childhood,first of all, it is preventable,
but then when it happens, umthere is the potential for
longer-term uh mental health,physical health, all kinds of
outcomes there.
And when I see data like that,if we were able to decrease the
(24:25):
amount of adverse childhoodexperiences that Americans were
having, we would cut adultdepression diagnoses by more
than 40%.
That's the kind of upstream workthat we need to do.
And so CDC has a website, forexample, um, it's veto violence,
uh, V-E-T-O-violence.cdc.gov,that puts together trainings
(24:45):
around ACEs prevention that aretailored for a whole host of
different groups.
It's not just about um pediatriccare providers, although they're
in there.
There's there are modules inthere for training educators,
uh, for training spiritual andreligious leaders.
Like again, this idea of how dowe broaden the conversation
(25:08):
beyond clinicians?
How do we think about creatingconnections uh in all of the
ways that we that we mean thatas communities?
And that work of buildingconnections, building networks,
making sure that young people inparticular know where to go,
have people to talk to, um, areable to sort of feel some more
(25:30):
support around that at a timewhen brains are developing and
there's a lot of impulsivebehavior, that is the kind of
work that you do to preventmental health crises, right?
To prevent some of that suicidalideation attempts work.
Um, and so that's just that, Imean, that's just one example.
But I really think that thiswork of thinking about what
(25:53):
happens early, how do we preventwhat happens early, and then how
do we promote the positivechildhood experiences that can
help mitigate some of thoseadverse childhood experiences?
That kind of work is prettyinvisible a lot of the time, or
it can be, but it is what setsyou up later in your life to
(26:15):
have fewer challenges in sort ofbeing able to lead that full and
healthy life from both a mentaland physical health standpoint.
SPEAKER_00 (26:22):
Yeah, no, I just love how you've underscored that
we all have a role to play inkeeping children and families
safe and healthy and thriving.
And like truly, the scienceshows that when we get it right
in the first place, it's lesscostly, it's more effective, it
has all of thesetransformational
(26:43):
intergenerational impacts aswell, right?
So when we really think about,you know, especially as it
relates to child abuse andneglect, I think still there's
this dominant narrative thatit's like that bad mom or that
poor family or whatever, andreally demystifying that for
people that it's like we're alljust trying to do the very best
(27:05):
we can do, but none of us doesthis job of parenting and and
and uh nurturing alone.
We all rely on each other.
And I mean, in some ways, I'mlike a perpetual optimist, but I
think a silver lining of COVIDwas that we kind of saw public
health in action, right?
We saw how my health wascompletely connected to my
(27:26):
neighbor's health, right?
Or the person next to me on theairplane.
And, you know, if I wore a mask,but my neighbor didn't, it's not
as effective, right?
I curbing, and the same is truein prevention evases, right?
It's like we all have a role toplay.
We want to get to those rootcauses, which are not bad
parents.
It is structural and socialdeterminants of health, you
(27:46):
know, all the isms, all the, youknow, uh uh things that we
challenges that we're allexperiencing and that some of us
have experienced forgenerations.
And it's like, yes, but evenwith all of that, we know and
the science show that thatprevention is possible if we
reduced ACEs, right, in thiscountry.
And I love that you quoted thevital science.
(28:07):
I was uh an author on that, andand just love the work that you
can find on veto violencebecause those are some of the
coolest, most interactive toolsthat CDC has, you know, those
trainings on ACEs, obviously,our website, other tools for
people who are listening whowant to get to that.
But I just feel like reallypreventing ACEs, preventing
(28:29):
early adversities, earlychallenges for families is
really such a critical publichealth lever that really the
primary prevention of, as yousaid, mental health problems
start with healthier children,right?
Of insert health outcome here.
There's been over 80, you know,that have been tied with ACEs in
(28:50):
the literature.
So I guess as we're wrapping uptoday, what do you see in your
really like just unique rolegiven the collection of
experience and leadershippositions that you've held?
Uh, what do you see as thefuture of primary prevention in
this country?
And what should we really befocusing our time on now so that
(29:11):
we were all prepared in thefuture?
SPEAKER_01 (29:14):
Yeah, you know, I really think, I mean, I think so
much about that.
I think one thing, and I thankyou for doing this, is
continuing to really help folksunderstand this space.
We talk about it in publichealth, but not everybody
outside public health evenunderstands the term primary
(29:36):
prevention, right?
And again, most Americans, whenthey think about health, they
think about when they go andseek health care.
It's very obvious when thathappens.
So much primary prevention workgoes unseen by definition, when
the outbreak doesn't happen,when the abuse doesn't occur,
(29:56):
when the overdose doesn'tresult.
And helping uh I think folks torecognize that this work is also
quantifiable, that this work isextraordinarily cost effective,
actually.
Um, and that it is we actuallywe have a lot of data on what
(30:19):
works.
And so when I think about thefuture, the future of primary
prevention, I think some of itis about just continuing that
education.
And I would hope, you know,folks who are listening uh into
this podcast, you know, are partof that, really thinking about
how do I, how do I help peoplewho maybe aren't in public
health all the time understandthis work, understand the
(30:41):
criticality of it.
I also think we've got to makesure that we are getting health
outcomes clearly inserted intoother investments.
So you take something like umensuring a strong start for
children through things likeaccess to high-quality
childcare, right?
We've got all kinds of evidence,you know, the conversation tends
(31:02):
to be on are the kids ready toread, right?
Like what's gonna happen, likesort of on the educational, and
those are amazing.
But those, those are also,there's good evidence, as you
know, that that that kind ofwork helps to prevent aces,
right?
Helps to lead to better healthoutcomes.
Similarly, you know, work ofthinking about, you know, skills
(31:23):
for both parents and kids aroundhealthy relationships and
resilience, like those kinds ofreally concrete investments,
they actually do pay off.
They're not just sort of nice,fluffy things to have.
Uh, there's evidence aroundthem.
And when you do them well andyou do them at scale, uh, you
are able to make an impact in away that is measurable.
(31:48):
Uh, and we're able to reallystart making progress on these
issues that we are we're nevergonna get ahead of, I fear, as a
country, if we can't get, if wecan't get upstream and if we
can't help sort of tell thisstory um in really concrete, uh,
in really concrete ways.
The theory of change, I knowthat PCA America has done a lot
of work on.
You know, I love that work.
(32:09):
I love that really thoughtfulpiece around, you know, how do
you create this?
How do you raise awareness ofthis?
How do we change thisconversation?
COVID did offer someopportunity, I think, to think
differently about that inconnectedness, in prevention,
um, in in being more sort ofprepared and thinking kind of as
(32:29):
a society ahead of a crisis thatmight come.
That is the entire bench ofpublic health.
And so, you know, I'm glad CDC'sdirector, uh, Mandy Cohen, Dr.
Mandy Cohen, you know, has madesupporting young families a
priority for this agency, um,just as she's made improving
mental health a priority forthis agency.
And the ability to do that withpartnership across the
(32:52):
government, across partners likeyou outside of government, but
also with people who don't arenot the most natural partners,
but can understand that we'vegot to, for these huge problems,
like it, like the injury centerfaces, like PCA America faces,
we just have to think aboutpreventing them from the
(33:14):
beginning uh and and make thecase for that with with one
concerted voice that is not justcoming from public health.
SPEAKER_00 (33:23):
I totally agree.
I am so honored um to be inpartnership with you, with the
CDC, um, you and and Dr.
Cohen, who you referenced, youknow, we are just coming on the
heels of Women's History Month,and I'm in awe of your uh
leadership.
Uh, and now we're in Child AbusePrevention Month, and prevention
(33:45):
is possible.
You've helped us understand um alittle bit better what a public
health approach to preventionlooks like.
Something that requires all ofus, there's a role for all of us
to play.
And we need to make preventionvisible, and you know, because
it can be really invisible, butprevention visible is joy,
(34:06):
health, well-being, thriving,prosperity.
It's all the good stuff.
It's all the stuff that's withinour reach.
And so not only is preventionpossible, we want to always be
maximizing that possibility.
Thank you so much for your greatleadership, Dr.
Rwoody, and for yourpartnership.
And um I hope soon friendship,because I want to talk more and
(34:26):
more to you every day.
And I want to, you know, learnabout your uh favorite hobbies
in Chicago.
And so we'll take that offline.
Um, and maybe we could have apart two that's like a more fun
conversation.
So thanks so much um foreverything you do and the way
you do it and for joining ustoday.
SPEAKER_01 (34:46):
Yeah, I mean, it's really, it's really been my
pleasure.
I, you know, I know from my mynew colleagues here at the
injury center, you know, howvalued your your work personally
was while you were here, butalso the work that you're doing
at PCA America.
And I just want all of us tothink about how we broaden this
conversation so that it is onethat is happening um in kind of
(35:09):
all corners of this country,because that's what we're gonna
need to get on top of theseissues.
So, yeah, looking forward, ofcourse.
Uh I love always, you know, Icould talk about this stuff
forever, as you can tell.
Um me too.
So um thanks.
Thanks for thanks for doingthis.
Thanks for having me on.
Um, and certainly moreconversations to come between
(35:29):
you and me, but also I thinkmore conversations, I hope, for
the folks who are, you know,listening in on this podcast.
Um, because we've we've got toget this conversation happening
uh across the country.
SPEAKER_00 (35:40):
Absolutely thanks for tuning in to this exclusive
episode.
The 2024 Cat Month series can bestreamed on our Cat Month page,
preventchildabuse.org backslashcatmonth 2024, and wherever you
listen to your podcasts.
You can find more information atpreventchildause.org and on our
(36:03):
social media channels.
Remember, prevention ispossible, and together we can
prevent child abuse, America,because childhood lasts a
lifetime.
Hi everyone, we're joined today by Dr.
Allison Arwoody, the director ofthe National Center for Injury
Prevention and Control.
Dr.
Arwoody leads the CDC'sinnovative research and
science-based programs toprevent injuries and violence
and to reduce theirconsequences.
And she most recently servedfour years as the commissioner
(00:33):
of the Chicago Department ofPublic Health, leading the
health department of thenation's third largest city, and
of course, home to PCA America,including through the COVID-19
pandemic.
Dr.
Allison Arwoody, welcome to thePCA America's podcast in
celebration of this year's ChildAbuse Prevention Month.
SPEAKER_01 (00:52):
Yeah, thanks so much for having me.
I really am looking forward tothe conversation.
Obviously, PCA America lovespartnering with CDC and vice
versa.
I think there's a lot of thingsthat we have to talk about
because we care about a lot ofthe same work and uh really
looking forward to theconversation.
So thanks for that.
SPEAKER_00 (01:09):
I sure do.
Oh, thank you so much for beingwith us.
And obviously, such a specialplace in my heart for you, all
of the great work you did herein Chicago.
But then also, of course, Ispent uh numerous years at the
injury center doing such thatimportant public health work.
And I'm just so excited uh foryour new role.
So, first of all,congratulations on this
humongous role.
(01:29):
What an exciting opportunity andsuch a critical role at the CDC
for real prevention impact.
Tell us a little bit about yourvision on how that impacts
families.
SPEAKER_01 (01:40):
Absolutely.
So, you know, as you said, yes,this is a big role.
And just because everybody maynot know the injury center, uh,
it's the center at CDC that isfocused on preventing injuries.
But what does that mean?
That means overdose, that meanssuicide, that means violence in
all forms, which is wherethere's some overlap.
It also means other injuries,things like drowning, uh, things
(02:04):
like falls, uh, even some of theinjuries that come from car
crashes, for example.
Um, and so in all of theseapproaches, you know, the reason
I'm attracted to it is first ofall, these are preventable,
right?
And I'm a pediatrician and aninternal medicine doc by
training.
I really like taking care ofpatients.
(02:26):
I like helping them get wellafter they're sick.
But for me, the reason I'mattracted to the work of the
injury center and really topublic health overall is we have
the ability to think aboutbefore an injury happens, before
one of these reallylife-changing events uh comes
along.
Um, and we can use data and wecan use evidence and we can make
(02:49):
investments and we can trythings uh in partnership with
community to really say whatworks.
Um, and so when I think about,you know, a vision overall, we
like to have a vision in thepositive, right?
Not in the negative.
Um so, you know, thinking abouthaving a vision where we've got
healthy and safe childhoods forall kids, right?
(03:10):
Something as basic as that.
Um, thinking about the fact thatwhen we can create safe and
stable and nurturingrelationships and environments
for all children, that in turnleads to better development of
the brain and the endocrine andthe immune systems.
That in turn leads to healthierchildren, not just physically,
but emotionally and socially andbehaviorally.
(03:31):
And that in turn, healthychildren, leads to healthy
adults.
Um, and when I think about howhard this country is being hit
right now by the issues that theinjury center works on, we are
never gonna treat our way out ofthese crises, right?
Uh and so just to put a couplemore um out there, and then I'll
(03:53):
stop talking about it because Iwant to get into the prevention
piece.
But right now in this country,injuries related to firearms are
actually the number one cause ofdeath for kids one to 19 year
olds.
Overdoses are the number onecause of death for adults 18 to
45 year olds.
We see statistics that just takemy breath away when we're
(04:15):
interviewing young people.
The most recent survey for theyouth risk behavioral
surveillance, which is a surveythat's done in high schools, one
out of 10 high school kids toldus that they had not just
thought about, but attemptedsuicide.
We have to think about gettingupstream.
We have to think aboutpreventing these outcomes
(04:37):
because when they happen, youknow, it's it's it's a tragedy
for the person, but for theirfamily, for their community.
Um, and so I know we're gonnahave a chance to talk a little
bit more about adverse childhooduh experiences, um, but I think
that that the ability to thinkabout these really hard outcomes
that that are difficult foreverybody to talk about, but
(04:57):
then change the lens and sayit's not always just about
responding to these traumaticevents.
It's about doing theinvestments, doing the work to
prevent them in the first place.
As a society, uh, that that'swhy I do public health.
And so the vision is a really,you know, it's a positive one of
healthy and safe childhoods,which then lead to healthy and
(05:17):
safer adults.
Um, but there are real things inall of these complicated spaces
that we can do to prevent thatwork.
SPEAKER_00 (05:24):
Oh my gosh, I'm so it's just wonderful to hear you
say that and express that visionin such a clear way because
prevention is possible.
And I think that's what we learnand our science shows is true,
right?
When we make sure that familieshave what they need when they
need it, delivered in their owncommunities, you know, with love
and respect and trust withoutstigma before they're in crisis.
(05:48):
That's how we are reallyoperationalizing prevention and
how we operationalize equity forthat matter, right?
It's like, what can we all do toassure the conditions for
health, well-being, and thrivingand prevention of violence and
all of the adversities forchildren and families?
Such an important public healthlever that I'm so glad that you
(06:10):
highlighted there.
We can really meet our nation'shealth, well-being, and
prosperity goals when we havehealthier kids.
And we know that our healthierkids live in healthier families,
healthier communities, andreally live in a country that
can better support children andfamilies to reach their maximum
health and life potential.
So, Dr.
Arwoody, just so excited thatyou're in this role at this
(06:33):
time.
And speaking of critical roles,you served as the leader of the
third largest city during anational, well, really a global
health crisis.
Um, so we have so much to learnfrom you about supporting
diverse communities.
And you've highlighted theimportance of partnerships and
communication in lots of venues,but we'd really love to hear
(06:55):
more about your perspective,especially through the lens of
diversity and equity.
SPEAKER_01 (07:01):
Yeah, absolutely.
I mean the COVID response wasjust such a fracturing of the
way that we normally do thingsin ways that were terrible, but
also I think had a lot ofpotential and a lot of ability
(07:21):
to really think differently andin ways that center diversity
and equity, not as sort of anice to have, but as essential
to really making a difference,you know, when it matters at the
heart of the issue.
And so, you know, as you noted,I was lucky enough to be in
(07:42):
Chicago at the ChicagoDepartment of Public Health for
about eight years before cominginto this role, and then the
last four as commissioner.
And that did that was almost theperfect overlap with COVID.
And I learned a lot during thatabout what it looks like to not
just say that you're engagingquote unquote community, but to
(08:07):
really start from a point oflistening and not talking and
bringing solutions, ofrecognizing that there is no
monolith community, that that ina city as diverse as Chicago,
but in a city as diverse asanywhere that you are, and in
this country of ours, there areby definition groups and
(08:29):
subgroups, no matter how youslice and dice the population,
that are gonna have differentneeds, that are gonna have
different um areas of strengthand areas of focus, and that are
going to need to be part of anyreal solution.
Because again, public health isnot so much about medical care.
(08:49):
There is work to do on themedical care side too, don't get
me wrong.
But in public health, whereyou're thinking about systems
and you're thinking aboutenvironments, if you start
having conversations thatassume, you know, as government,
for example, coming in or as apublic health department coming
in during COVID, that you knowwhat is needed for this
(09:11):
environment or this community.
Like you're never gonna have areal conversation.
And I was really, reallyappreciative in Chicago that we
saw a lot of really honestconversation um about where
things had not gone wellpreviously.
There's all kinds of reasons whyum different groups are not very
(09:32):
likely to, you know, trust thehealth department, honestly.
If you're a representative ofthe government and you're a
representative, you know,indirectly of the healthcare
system, and you're um, you know,a representative of long
histories of power and sort ofhow those have landed in
different ways and not always ofreally centering community
voice, you're starting from apoint where there's not always
(09:53):
that much trust at baseline.
Right.
But in a crisis um like COVID,but I would also argue in a
crisis like romantic childrenthe glass, like working on uh
suicide prevention, you've gotto make sure that we're not just
thinking about how to tailor ourmessage as public health, but to
(10:17):
make sure that the messages thatare we're even developing kind
of make sense in terms of uh thepeople we're listening to.
And then so much about who themessenger is, right?
And that and that trusted, um,that trusted messenger stance.
And so, you know, in in inChicago, for example, we we did
a lot of work to say equity isnot just a nice to have.
(10:40):
If you're in a crisis, you'vegot to make sure that resources
are getting to where they aremost needed to actually control
the outbreak, right?
It's not just a theoretical niceidea.
It's about saying, where inChicago is COVID hitting the
hardest?
Why is that where COVID ishitting the hardest?
Is that because of, you know,crowded housing and um, you
(11:02):
know, essential work that can'tbe done from home and food
insecurity where you, you know,are not able to just stock up
and stay home?
Uh, is that aboutintergenerational?
You know, it's about all ofthese things and so much more.
And if you don't design yourresponses um to be tailored to
those needs uh and recognizingthat those needs are going to be
(11:24):
different, even in differentparts of the city, you're not
gonna really make the progressthat you need to make, both on
building some of that trust sothat when we've got things like
a vaccine to offer, communitiesunderstand that that where that
is coming from, that that thisis something that is uh is is
(11:44):
going to be valuable everywhere,but it's going to be valuable in
their community specifically.
Um, but it's also about nothaving this be something that's
tacked on after the fact.
We really need to center a lotof the, you know, especially
racial and ethnic disparities,but you know, there were
disparities around age, therewere disparities around, you
know, neighborhood, all kinds ofother ways that you could look
(12:05):
at this.
Um, and and we we measured oursuccess in a lot of ways based
on whether we were seeing umimprovements and outcomes in the
neighborhoods, for example, orum the various subgroups um that
were furthest from where youwould want to be.
Are we making progress there?
Is in a lot of ways moreimportant.
(12:26):
And that's what's going to movethe lens overall, I think, when
you're wanting to make impact onthese huge societal programs.
And, you know, I think frankly,at the injury center at CDC, you
know, there is also a lot of,you know, prioritization, really
centering of health equity.
I think there's a lot still thatwe are all thinking about.
(12:47):
What does that really look like?
How do you make sure that thatresources are going where
they're most needed, that thevoices of people with lived and
living experience andcommunities are central to how
we are shaping and evaluatinginterventions?
Um, how are we really developingsome of that evidence base and
(13:08):
the partnerships?
Um, but I think when you look atit doesn't matter which of the
topics you look at within theinjury center, um, they don't
land in the same way on peoplein this country, broadly
speaking.
And again, there's differentways to think about diversity.
Um, but the ability to have thatkind of a focus and then to
(13:32):
recognize that diversity alsobrings the amazing strength,
right?
And the resilience.
And that anytime that you aremaking a decision, you've got to
have diverse voices in that roomto make the best decision
possible.
That you've got to reallyrecognize that there is such an
incredible amount of resilienceand um connectedness and sort of
(13:54):
culture building that again canlook different in different
subsets, but you don't you wantto be careful when you're
thinking about partners andyou're thinking about equity and
you're thinking about diversity,that you're not just thinking
about sort of the negativeoutcomes, but you're thinking
about the incredible positivework that can come.
And I think when I think back tothe time in Chicago, I think we
(14:17):
we did not everybody goteverything perfect.
There's a million things, youknow, that everybody wishes we
would have been able to do moreof in COVID.
But I'm incredibly proud that wecentered equity not just as a
buzzword, but as a way to makedecisions about things like how
resources and vaccines weredistributed, how community voice
(14:37):
was involved in creatingmessaging campaigns, and how we
were pushed to really focus onthings like food insecurity,
even before we started thinkingabout PPE, because that is
frankly where the needs weregreatest.
And so I learned a whole lotkind of personally, um, and am
bringing that to the injurycenter, where there are
(14:59):
similarly so many people reallycommitted to thinking about how
do we do this work in a way thatthat moves the needle, um,
doesn't just move the needle forthe median, but kind of moves
the needle uh for both positive,kind of and negative in in ways
that that can impact on thesehuge problems.
(15:21):
And we're never gonna make theprogress we need to make, in my
opinion, um, on these issues ifwe're not thinking about those
issues from the beginning at theend and at all points in
between.
SPEAKER_00 (15:35):
Oh my gosh.
I so much that you said there isjust true to the work of public
health.
You know, I always refer back tothat um institutes of medicine,
like in 93, 1993 definition ofpublic health.
And it says it's what we as asociety do collectively to
assure the conditions in whichall people can be healthy and
(15:57):
can thrive.
And so it's that collectively,right?
It requires partnerships, itrequires a difference of
experience, the lived and livingexpertise, the centering of
families and of communities andof youth, right, into what those
prevention solutions are.
And I know that in our work, ourcollective work, you know, to
prevent adversity, you know,early adversity, child abuse and
(16:19):
neglect, other things before itoccurs.
Like we're all talking aboutco-design.
And I think it's exactly whatyou just described in this
beautiful way, right?
Until we actually celebratediversity and recognize that
we're going to be stronger withdiverse perspectives early and
often and throughout theprocess, we're not going to be
(16:39):
able to maximize the possibilityof prevention, right?
And we we already said and wesay again and again here that
prevention is possible.
So we want to maximize thatpossibility.
It's just really wonderful tohear you say it in such a clear
way.
And I'm glad that you feel proudof the work that you did in
Chicago because we are now aChicagoan and we feel proud of
(17:02):
the leadership that you providedto this city and still uh think
of you often and are so happythat now you have this platform
at our nation's you know publichealth agency to really elevate
um uh the different uh differentperspectives and different
approaches that are necessary toreally be in the business of
(17:23):
doing the work of public health.
So I just I just love everythingyou said, and I'm so um excited
um to be in partnership withyou.
One of our aspirations, as youknow from the PCA America, I
know that you share thisaspiration, is that for
children, you know, that thechildren and families have
(17:43):
mental and physical health andwell-being across the lifespan,
right?
And here in Chicago, you took aninnovative approach to the
promotion of mental health.
Tell us more about that and somekey lessons learned that could
be replicated as we build aprimary prevention ecosystem in
this country that doesn'tcurrently exist.
Like you said before, you know,we wait for families to be in
(18:06):
crisis before they can get theservices and supports that could
have kept them healthy andstrong in the beginning.
And yes, the preventioncontinuum has a real need always
for treatment andtrauma-informed responses, but
until we really move upstream,we're kind of kind of be like in
the position we're always at.
So tell us more about that, um,specifically in mental health
(18:29):
and some key lessons learnedthat could be replicated as we
build this primary preventionecosystem for our country.
SPEAKER_01 (18:35):
You know, you are correct that not just me, but my
incredible team at the ChicagoDepartment of Public Health
helped me think in newer andbigger ways about what does it
look like to take a publichealth approach to mental
health.
I think for a long time, publichealth has not been as focused,
frankly, on the mental healthside of things.
(18:57):
But you don't have to look anyfurther than COVID, right?
Uh to sort of recognize that,yes, it was physically, you
know, the the in terms of theillness and the deaths, I mean,
devastating.
But that physical illness hadreally consequential mental
health impacts.
Also just the changes, whetherit was just the isolation, that,
(19:20):
you know, so many, so manythings that upended connection
in ways that were critical earlyin the pandemic, especially when
we really didn't have the toolsto be able to help keep people
safer.
Um, and so in Chicago, we made adecision not to pull anybody
from our behavioral health team,which was our mental health
(19:42):
substance use and violenceprevention teams, into sort of
quote unquote COVID.
Everybody was working on COVID,of course.
But we said there's gonna beeven more need for mental health
resources as a result of COVID.
And so different than most otherfolks across the health
department, keep going, keepbuilding.
And just to kind of put this insome perspective, when I came in
(20:06):
as commissioner, again, most ofthis was not my work, it was a
citywide effort, my team, lotsand lots of advocates, support
from the mayor's office, etcetera, the health department,
we were um supporting the mentalhealth care for around three to
four thousand Chicagoans whootherwise would not have been
able to get that care.
(20:26):
And again, especially for peoplewith serious mental illness,
there are people who absolutelywe've got to make sure can get
into treatment.
But we were seeing such a gap interms of the number of people
who needed that care and whatwas available.
And importantly, people didn'tknow how to navigate it very
(20:46):
well, right?
For as complicated as ourphysical health system is, our
behavioral health system is evenharder to navigate, especially
if you are uninsured,underinsured, uh, you know,
perhaps undocumented, have otherissues going on in your life,
need substance use disordertreatment at the same time as
you need mental healthtreatment, you name it, it's
more complicated.
And so we did a whole host ofthings, um, really pulling
(21:10):
together.
Everybody working in the safetynet mental health care did a lot
of investments to make sure thatthere were mental health
resources outside of traditionalclinic settings.
So making sure that schools andfood pantries and uh, you know,
service sites, libraries couldhave therapists, for example, in
a no-rong door approach, sort ofto thinking about mental health
(21:33):
on a continuum while reallyworking on that treatment.
We went from between three and4,000 people getting care that
year that I came in ascommissioner to while COVID was
going on, uh, up to over 70,000Chicagoans, you know, getting
care, getting treatment.
And that was through the work ofreally building collaborations,
(21:56):
helping to think about how younavigate and you know, this
system and making sure that whenwe were uh promoting any of
these resources, funding any ofit, pulling together, it was all
by definition for you, no matterwho you are.
This is not, we don't care ifyou're insured, we don't care
what language you speak, wedon't care, we don't care, but
(22:18):
it's again thinking about asystems-wide approach, which is
actually public health is prettygood at that.
Like, where what do we need todo kind of as a whole system?
And then getting upstream,saying for the people with the
most acute needs, yes, there'swork to do on treatment, and
we're gonna embed for the firsttime mental health professionals
into the 911 uh, you know, callresponse system.
(22:39):
Yes, we're gonna for the firsttime embed behavioral health
care in homeless shelters.
Yes, for the first, you know,there are these sort of pockets
you work on.
But when you think upstream fromthat, what does it look like?
First of all, to change theconversation around mental
health.
Mental health is health.
We had a campaign in Chicagothat was called Unspoken that
was really about trying to takeissues of mental health or
(23:00):
substance use disorder or, youknow, suicide prevention, things
that we frankly often don't talkabout, turning these into things
that we talk about.
What does it look like to reducestigma around that?
Again, working in very focusedways with a whole host of um
people from differentbackgrounds and communicators,
and thinking about things likewe're never gonna treat our way
(23:22):
out of this.
And so, what does it look likefor coaches?
What does it look like for uhfaith leaders?
What does it look like forpeople who interact with young
folks, especially sort of acrossthis city?
What does it look like for peersto feel like they have some
language to start thoseconversations and then know what
to do for more resources?
(23:42):
And this really for me, just totag into the work at CDC and the
injury center, I've been reallypleased in the way that the
center, and I know this is workthat we've shared with PCA
America, working on this adversechildhood experiences prevention
work.
Um and, you know, I think youraudience knows about adverse
childhood experiences, but butthe work of thinking about
(24:04):
things like child abuse orneglect as being something that
when it happens in childhood,first of all, it is preventable,
but then when it happens, umthere is the potential for
longer-term uh mental health,physical health, all kinds of
outcomes there.
And when I see data like that,if we were able to decrease the
(24:25):
amount of adverse childhoodexperiences that Americans were
having, we would cut adultdepression diagnoses by more
than 40%.
That's the kind of upstream workthat we need to do.
And so CDC has a website, forexample, um, it's veto violence,
uh, V-E-T-O-violence.cdc.gov,that puts together trainings
(24:45):
around ACEs prevention that aretailored for a whole host of
different groups.
It's not just about um pediatriccare providers, although they're
in there.
There's there are modules inthere for training educators,
uh, for training spiritual andreligious leaders.
Like again, this idea of how dowe broaden the conversation
(25:08):
beyond clinicians?
How do we think about creatingconnections uh in all of the
ways that we that we mean thatas communities?
And that work of buildingconnections, building networks,
making sure that young people inparticular know where to go,
have people to talk to, um, areable to sort of feel some more
(25:30):
support around that at a timewhen brains are developing and
there's a lot of impulsivebehavior, that is the kind of
work that you do to preventmental health crises, right?
To prevent some of that suicidalideation attempts work.
Um, and so that's just that, Imean, that's just one example.
But I really think that thiswork of thinking about what
(25:53):
happens early, how do we preventwhat happens early, and then how
do we promote the positivechildhood experiences that can
help mitigate some of thoseadverse childhood experiences?
That kind of work is prettyinvisible a lot of the time, or
it can be, but it is what setsyou up later in your life to
(26:15):
have fewer challenges in sort ofbeing able to lead that full and
healthy life from both a mentaland physical health standpoint.
SPEAKER_00 (26:22):
Yeah, no, I just love how you've underscored that
we all have a role to play inkeeping children and families
safe and healthy and thriving.
And like truly, the scienceshows that when we get it right
in the first place, it's lesscostly, it's more effective, it
has all of thesetransformational
(26:43):
intergenerational impacts aswell, right?
So when we really think about,you know, especially as it
relates to child abuse andneglect, I think still there's
this dominant narrative thatit's like that bad mom or that
poor family or whatever, andreally demystifying that for
people that it's like we're alljust trying to do the very best
(27:05):
we can do, but none of us doesthis job of parenting and and
and uh nurturing alone.
We all rely on each other.
And I mean, in some ways, I'mlike a perpetual optimist, but I
think a silver lining of COVIDwas that we kind of saw public
health in action, right?
We saw how my health wascompletely connected to my
(27:26):
neighbor's health, right?
Or the person next to me on theairplane.
And, you know, if I wore a mask,but my neighbor didn't, it's not
as effective, right?
I curbing, and the same is truein prevention evases, right?
It's like we all have a role toplay.
We want to get to those rootcauses, which are not bad
parents.
It is structural and socialdeterminants of health, you
(27:46):
know, all the isms, all the, youknow, uh uh things that we
challenges that we're allexperiencing and that some of us
have experienced forgenerations.
And it's like, yes, but evenwith all of that, we know and
the science show that thatprevention is possible if we
reduced ACEs, right, in thiscountry.
And I love that you quoted thevital science.
(28:07):
I was uh an author on that, andand just love the work that you
can find on veto violencebecause those are some of the
coolest, most interactive toolsthat CDC has, you know, those
trainings on ACEs, obviously,our website, other tools for
people who are listening whowant to get to that.
But I just feel like reallypreventing ACEs, preventing
(28:29):
early adversities, earlychallenges for families is
really such a critical publichealth lever that really the
primary prevention of, as yousaid, mental health problems
start with healthier children,right?
Of insert health outcome here.
There's been over 80, you know,that have been tied with ACEs in
(28:50):
the literature.
So I guess as we're wrapping uptoday, what do you see in your
really like just unique rolegiven the collection of
experience and leadershippositions that you've held?
Uh, what do you see as thefuture of primary prevention in
this country?
And what should we really befocusing our time on now so that
(29:11):
we were all prepared in thefuture?
SPEAKER_01 (29:14):
Yeah, you know, I really think, I mean, I think so
much about that.
I think one thing, and I thankyou for doing this, is
continuing to really help folksunderstand this space.
We talk about it in publichealth, but not everybody
outside public health evenunderstands the term primary
(29:36):
prevention, right?
And again, most Americans, whenthey think about health, they
think about when they go andseek health care.
It's very obvious when thathappens.
So much primary prevention workgoes unseen by definition, when
the outbreak doesn't happen,when the abuse doesn't occur,
(29:56):
when the overdose doesn'tresult.
And helping uh I think folks torecognize that this work is also
quantifiable, that this work isextraordinarily cost effective,
actually.
Um, and that it is we actuallywe have a lot of data on what
(30:19):
works.
And so when I think about thefuture, the future of primary
prevention, I think some of itis about just continuing that
education.
And I would hope, you know,folks who are listening uh into
this podcast, you know, are partof that, really thinking about
how do I, how do I help peoplewho maybe aren't in public
health all the time understandthis work, understand the
(30:41):
criticality of it.
I also think we've got to makesure that we are getting health
outcomes clearly inserted intoother investments.
So you take something like umensuring a strong start for
children through things likeaccess to high-quality
childcare, right?
We've got all kinds of evidence,you know, the conversation tends
(31:02):
to be on are the kids ready toread, right?
Like what's gonna happen, likesort of on the educational, and
those are amazing.
But those, those are also,there's good evidence, as you
know, that that that kind ofwork helps to prevent aces,
right?
Helps to lead to better healthoutcomes.
Similarly, you know, work ofthinking about, you know, skills
(31:23):
for both parents and kids aroundhealthy relationships and
resilience, like those kinds ofreally concrete investments,
they actually do pay off.
They're not just sort of nice,fluffy things to have.
Uh, there's evidence aroundthem.
And when you do them well andyou do them at scale, uh, you
are able to make an impact in away that is measurable.
(31:48):
Uh, and we're able to reallystart making progress on these
issues that we are we're nevergonna get ahead of, I fear, as a
country, if we can't get, if wecan't get upstream and if we
can't help sort of tell thisstory um in really concrete, uh,
in really concrete ways.
The theory of change, I knowthat PCA America has done a lot
of work on.
You know, I love that work.
(32:09):
I love that really thoughtfulpiece around, you know, how do
you create this?
How do you raise awareness ofthis?
How do we change thisconversation?
COVID did offer someopportunity, I think, to think
differently about that inconnectedness, in prevention,
um, in in being more sort ofprepared and thinking kind of as
(32:29):
a society ahead of a crisis thatmight come.
That is the entire bench ofpublic health.
And so, you know, I'm glad CDC'sdirector, uh, Mandy Cohen, Dr.
Mandy Cohen, you know, has madesupporting young families a
priority for this agency, um,just as she's made improving
mental health a priority forthis agency.
And the ability to do that withpartnership across the
(32:52):
government, across partners likeyou outside of government, but
also with people who don't arenot the most natural partners,
but can understand that we'vegot to, for these huge problems,
like it, like the injury centerfaces, like PCA America faces,
we just have to think aboutpreventing them from the
(33:14):
beginning uh and and make thecase for that with with one
concerted voice that is not justcoming from public health.
SPEAKER_00 (33:23):
I totally agree.
I am so honored um to be inpartnership with you, with the
CDC, um, you and and Dr.
Cohen, who you referenced, youknow, we are just coming on the
heels of Women's History Month,and I'm in awe of your uh
leadership.
Uh, and now we're in Child AbusePrevention Month, and prevention
(33:45):
is possible.
You've helped us understand um alittle bit better what a public
health approach to preventionlooks like.
Something that requires all ofus, there's a role for all of us
to play.
And we need to make preventionvisible, and you know, because
it can be really invisible, butprevention visible is joy,
(34:06):
health, well-being, thriving,prosperity.
It's all the good stuff.
It's all the stuff that's withinour reach.
And so not only is preventionpossible, we want to always be
maximizing that possibility.
Thank you so much for your greatleadership, Dr.
Rwoody, and for yourpartnership.
And um I hope soon friendship,because I want to talk more and
(34:26):
more to you every day.
And I want to, you know, learnabout your uh favorite hobbies
in Chicago.
And so we'll take that offline.
Um, and maybe we could have apart two that's like a more fun
conversation.
So thanks so much um foreverything you do and the way
you do it and for joining ustoday.
SPEAKER_01 (34:46):
Yeah, I mean, it's really, it's really been my
pleasure.
I, you know, I know from my mynew colleagues here at the
injury center, you know, howvalued your your work personally
was while you were here, butalso the work that you're doing
at PCA America.
And I just want all of us tothink about how we broaden this
conversation so that it is onethat is happening um in kind of
(35:09):
all corners of this country,because that's what we're gonna
need to get on top of theseissues.
So, yeah, looking forward, ofcourse.
Uh I love always, you know, Icould talk about this stuff
forever, as you can tell.
Um me too.
So um thanks.
Thanks for thanks for doingthis.
Thanks for having me on.
Um, and certainly moreconversations to come between
(35:29):
you and me, but also I thinkmore conversations, I hope, for
the folks who are, you know,listening in on this podcast.
Um, because we've we've got toget this conversation happening
uh across the country.
SPEAKER_00 (35:40):
Absolutely thanks for tuning in to this exclusive
episode.
The 2024 Cat Month series can bestreamed on our Cat Month page,
preventchildabuse.org backslashcatmonth 2024, and wherever you
listen to your podcasts.
You can find more information atpreventchildause.org and on our
(36:03):
social media channels.
Remember, prevention ispossible, and together we can
prevent child abuse, America,because childhood lasts a
lifetime.
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