In This Episode
The truth should speak for itself. The problem is that it just doesn’t speak very loudly — we have to speak for it. Which is why public health has to be a lot smarter about the process of policy change. Abdul reflects on the contrast between publishing and publicizing. Then he speaks with Dr. Shelley Hearne, a co-author on a new book on public health policy engagement about how it’s done.
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Dr. Abdul El-Sayed, narrating: 75,000 Kaiser Permanente employees went on strike last week, the largest health care strike in U.S. history. The Nobel Prize in Physiology or Medicine was awarded to the scientists behind the mRNA breakthrough that powered the COVID vaccines. The CDC prepares to recommend a new approach to preventing sexually transmitted infections. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] Last week, we spoke with two leaders who helped expand public health funding in Indiana, you know the notoriously red state where Mike Pence once served as governor. One of the most important points of consensus in that conversation was that public health ought to be political, but not partisan. Politics has been called many things by philosophers and thinkers. The art of the possible, war by other means, etc., etc.. But in a democracy, politics, it’s a contradiction. A right to choose our leaders means they can represent our highest aspirations or our basest desires. Think about the contrast between how you felt the day Barack Obama was elected and how you felt the day the same electorate only eight years later elected Donald Trump to succeed him. On the other hand, there’s the nitty gritty of politics, the way the sausage is made. Too often, political influence is the emergent property of shameless self-promotion and the cynical peddling of support. The truth of it exists somewhere between Aaron Sorkin’s West Wing and House of Cards. And yet politics is the only way by which to shape our government, to push and prod it to do the things that serve the most marginalized of us. It’s the only arena in which ideals and evidence can be forged into action and outcomes. But what happens when our ideals are inconsistent with the process by which they have to be translated? Can pure ideals be translated through an impure political process and come out clean on the other side? I think that set of questions is at the heart of why public health so often loses. None of us who went into this work did it for money or power or fame. Most of us went into it because we wanted our work to be about helping folks. About uplifting people who are too often downtrodden. And that means that most of us do care about consistency and purity. Two things that politics is we’ll say not well known for. Then there’s the way we like to think about the world. We like evidence. We want to be absolutely sure that what we will do will help. So rather than a few heartfelt stories we’re more interested in the masses of data that have been rendered nameless and faceless by our statistical manipulation. So you get where I’m going here. Public health folks, by the very nature of what compels us to do this work are, by our nature, political animals, and that’s left us content to publish our findings in journals and leave it to the public and politicians to do what they will. The problem is they usually won’t. And that’s because publishing is not the same as publicizing and publicizing isn’t the same as policymaking. It’s time we learned the difference. Look, I wish we lived in a world where politicians were truly altruistic beings reading the American Journal of Public Health from cover to cover, waiting to find the nuggets of truth we drop and turning them into policy to benefit the masses. They’re not, and they never will be. Rather, we’ve got to become effective advocates for our work, and that means embracing the organizing and relationship building and advocacy and pressure campaigns that really do move policy. And if we don’t? Well, you better believe that there are folks who are not hesitating to embrace those tactics. And we won’t like the world they make. Our guest today has been driving public health folks to get political for a while. She and her coauthors recently published a great primer on the subject. Policy Engagement is the latest in a series on strategic skills for Public health Practice from the De Beaumont Foundation, one of our sponsors and the APHA press. Dr. Shelley Hearne is the director of the Center for Public Health Advocacy and professor of the Practice at the Johns Hopkins Bloomberg School of Public Health. She joined me to talk about how public health folks can drive real policy change and why it matters now. Here’s my conversation with Professor Shelley Hearne.
Dr. Abdul El-Sayed: All right, let’s get started. Can you introduce yourself for the tape?
Dr. Shelley Hearne: I’m Shelley Hearne. I have been part of a great team of authors who have put together a book called Policy Engagement. But we we have a lot of other things we’d rather call it to make it a little sexier. It’s really about advocacy and how the public health field needs to, can, and is so must get involved in the policy engagement world. I’m a professor over at Johns Hopkins, and I run something called the Lerner Center for Public Health Advocacy.
Dr. Abdul El-Sayed: Well, I love that. And thank you for writing this book. Um. And I want to ask you, what motivated your team to write a book about public health advocacy? I mean, I can think a lot of things, but I really want to hear from you, what’s the impetus here? If you think about the big challenges that we face with respect to public health and public health advocacy in particular? What did you what intervention do you want to make with this book?
Dr. Shelley Hearne: Well, it comes from a few places. First, we got a phone call from the De Beaumont Foundation who had done a survey of the public health workforce, and it was a series of questions out there asking them what were the most critical skills they needed and what were the ones they had and they didn’t. And what came up at the top of the list was the it was how important it was to be able to talk, to engage and be effective with policymakers. But no one had ever been trained on how to do that, wasn’t taught at school. It wasn’t encouraged in many leadership positions. And it’s it’s it’s kind of um atrophied over the years. We used to be good at being advocates and champions on public health policy, but we’ve lost that over the past few decades. And that’s what really motivated me. And I said, Sign me up. I’m writing this book. And I pulled in some very other dear colleagues, Keshia Pollack Porter, Katrina Forrest. We made up a team of different experiences who have been watching, experiencing and seeing how public health has suffered, that we are in the back seat. We have not been informing and helping drive policy. We were the change agents 100 years ago. It had to change and that was part of what stimulated us to write this book.
Dr. Abdul El-Sayed: I fully and 100% agree that somehow, somewhere we lost our taste for, or our capacity for advocacy. As you think about what happened first, what do we get wrong today? And then second, why do we get it wrong?
Dr. Shelley Hearne: Recently when I say recently you know past 10-20 years. We’ve seen more and more of the public health leaders if um they take a risk. And they have not been able to uh explain and have the political support, the political will behind them. They’ve been kind of out there left hanging to dry. They’ve been they’ve been left on their own. There’s not been uh political support rallied around them. We also in the field have been told, if you’re a scientist. That if you engage in policy, that somehow that means that you’re being biased, that your um advocacy has somehow become a dirty word in the last few decades. And I keep Abdul going back 100 years ago the way that public health field emerged and was so successful in passing the housing, uh you know, better quality housing, sanitation systems, all the things that really help us live longer today were all done as social movement engagement. The public health emerged at that time when so many different movements were taking place, and it was first and foremost engaged in that policy policy maker experiences. That’s the heart and soul of our success. But over over those those that time period, we’re told not to do it. We’re fearful that we’ll get in trouble if we do and when some do, there hasn’t been that again, political support. So it’s kind of a triple whammy here of of getting us to be paralyzed as a field.
Dr. Abdul El-Sayed: Why do you think we we got here right? I have my I have my pet theories. I think in some respect at some point we became academic as a field. I mean, if you look at our our major government public health institution, the CDC, one of the biggest challenges it’s faced is that it, in effect, became a um government academic institution. And a lot of CDC scientists and workers were more interested in publishing the paper rather than getting the intervention right. I think there has been this sort of hard science envy in public health sciences where especially, you know, in in my field of training in epidemiology, we get real jealous about the fact that we can’t run full experiments. And so we do everything we can to bend over backwards to prove that we too are a real science. Um. And I think that those conversations have I actually think sort of um cuts us off off at the knees before we even got started. And in public health schools, when people are graduating from public health programs, they’re taught to venerate the science and not as much to be asking where does the science lead? And then what do we do about it? I want to ask you, I mean, you wrote a book on this. Where do you think we went wrong? What are the things that led us down this path where we’re sort of afraid of our own political shadow and um we care more about getting it right in journals than we do in in actual people’s lives?
Dr. Shelley Hearne: Well, let me try to unpack that a few few oh a few components there. One, I love your line of hard science envy um, let’s let’s come back to that one, because I do think there’s there’s a truth in that where CDC um has struggled in budget fights with NIH. NIH we’ve watched over the past few decades literally doubling efforts, huge political support and campaigns to get their budget increased. And there’s a whole advocacy campaign that’s actually behind that. It’s really fascinating. And you go over to the CDC side and I 100% agree with you that there has been a academic siloing that is it’s almost a dual challenge of here’s the agency that is to be the rapid response to parachute in when crisis outbreaks occur. And on the flip side, there’s this effort to if you’re going to keep the best and brightest of scientists, there’s this sense of, well, you have to allow them to publish. You have to allow them to build up that credentialing because that will keep them on board. But the reality is that most of the people who are at CDC are there for the mission, for the passion. They care immensely. But I’ll tell you, I’ve run in hard smack into the wall of the agency not being able to move and engage on the policy side. Years years ago, when I was running the Trust for America’s Health, which is a advocacy organization designed to build support for the public health system. But it also does it by challenging the old ways of doing business. We were putting out a report, wanted to on uh who was tracking asthma rates? Asthma was on the rise. We needed to see where the data sets were in different states on um were we doing the basics in disease surveillance? Could we do better in connecting the dots of what was the cause, not just the rise of cases? And we asked CDC to give us the information on who was receiving dollars, federal dollars to do these surveillance systems. Um. Which states and what was the data. And it came back saying, no, no, we can’t do that because there was going to be a publication on the surveillance systems in the Journal of Thorax. Thorax, I believe at that time was about 200 readers. Can’t get you the data. This even though this is public information and it was critical for the for the debates that we were having actually on the Hill about trying to get more money put into disease surveillance systems. But we were told we’d have to wait a year because there was a journal submission. That’s not the job of the agency. And that’s the problem of it had rolled back, and I think we saw that in part during the pandemic. We’ve seen this in other issues of a slowness that only hurts when trying to explain and engage to a policymaker world that wants immediate answers, wants to people want to see what’s happening what it’s doing for them and there’s become a disconnect again, I’ll use that word siloing. How did we get here Abdul? There are a lot of a lot of people have written different pieces on this. I think um you know you you’ve you have your own um uh comments and uh speculations on this. I do think it is because CDC, toiling out there and doing a lot of the not necessarily glamorous, glamorous work uh in the in the public health arena um housed down in Atlanta, doing the science, doing the research, doing the background support for a lot of state health agencies. It’s kept its head down. It’s kind of in the we’re just going to do the good work. We’re going to make good things happen. And the more we get involved in politics, which flared up around a number of vaccination issues and there, you know, there’s a lot of history back there. More and more that leadership and staff learned to stay low. Just do your work, get off the radar screen. And the problem is that disconnect has come back to haunt. And people don’t know what public health systems do. They don’t know what their health agencies do. They don’t. We have um many vast majority of policymakers have never even met their health officials, whether that’s at the local, state or federal level. And we’ve got to fix that.
Dr. Abdul El-Sayed: You know, I and I don’t I don’t mean to disparage the CDC, but I just think they are a case in point of some of our having put the cart uh before the horse. One of the things that tends to happen when you have a perspective and I say this as someone who, you know, has made public advocacy a big part of my career, having spent the first piece of my career as a scientist, is that you are labeled with that sense of bias, that you actually care how it all turns out. And the thing about it is we do care how it actually all turns out. Like none of us, none of our work matters. If people are not healthier on the back end of it, none of it. You could publish as many papers as you want. And if those papers don’t directly translate into people being healthier, we have failed. I don’t care what your H index is. I don’t care you know if you got tenure. I don’t care if you get tenure twice. Like it does not make a difference. And I worry at times that having turned ourselves into a scientific enterprise, hasn’t just left us with this um this this sense of anxiety about what we actually are. But also it has it is divorced us from like the end outcome of the work. And your book is an intervention on that question. I think you are embracing the idea that for public health to matter, for public health evidence to matter, you actually have to dress it up, trot it out and get people who can make decisions to make decisions with it in mind. I want to ask you, you know, what um skill sets do you think uh we we lack as a public health community and what are the ones you think we need to develop most?
Dr. Shelley Hearne: Well, first and foremost, we lack the ability to understand who’s making decisions. And how to influence them, how to engage with them, how to have relationships with them so that it’s actually not a matter of dressing up our evidence or our data or our experience. It’s about us understanding who we’re working with because we need those policies to get in put in place. We need the policymakers to care about our evidence, our science, our data. And if we don’t focus on what are the decisions they’re making? Who are they and what are their political pressures? What’s the cultural dynamics? What’s the economic considerations? What’s the social fabric? What’s the pragmatism of what you’re even suggesting? If you don’t understand the policymaking environment and why those people are making the decisions they are. Then we’re just standing on a mountaintop shouting to ourselves versus going into the offices where those decisions are being made and really working and getting at the table, getting the the trust, getting the ability to talk about your evidence in a way that resonates with those people, whether they’re from red states, blue states, rural, urban. We have to be working in all different levels with all different types of policymakers, because if we’re not the ones translating and ensuring that the data is getting there, those policymakers won’t have an avenue for it. They’re not reading Thorax, they’re not reading the different academic journals. It is our job to make sure they are informed so that the policies we need are getting on the books. [music break]
Dr. Abdul El-Sayed: I hear you saying um, you know, put simply, we don’t have an understanding of power. And and I think that shows up in a couple of ways. I think one of them is that were unwilling to have those conversations, map power relationships and engage policymakers. We think that the evidence should speak for itself. But the other part of it is that we don’t appreciate that actually evidence not only doesn’t speak for itself, but when we speak on that on behalf of the evidence, we don’t really do a good job of it. I um one of the terms I use with students when I talk about this is the term mis-mented, which means, you know, we spend a lot of time learning how to think empirically, which is actually a very unnatural thing if you think about the way that most people communicate. You don’t sit down with your friends and say, hey, I repeated the same thing 15 times and here’s what I found. You’re like, let me tell you a story about what happened. And I actually think that there is a way of having to tell the story of the individuals underneath our data that actually is above and beyond simply just speaking the data. Right. Because I actually think it’s really hard to understand uh data the way that it’s interpreted. In fact, most of us went and did many degrees to learn how to do it, right? And so in that respect, it’s like you have a responsibility to be very scientifically cogent and follow the data where it leads. Yes. But you also then have a responsibility to back translate that data into stories that actually move people. And one of the things that I have found in sort of watching public health very awkwardly try and engage with power is that most of the policymakers in rooms like this are people who are truly uh engaged with stories. Right? So you think about elected officials. One of their key jobs is to understand their constituents stories. And if you can’t relate what you’re working on to those constituents, if you can’t point out those constituents who sit underneath the valence of the data that you just pulled out, it’s very difficult for those folks to care. Right um and I think that’s sort of the other part of it. It’s like not only are we unwilling to map power, but sometimes we’re not even good at speaking to folks when we speak about our things. And so we sit down and say, hey, the evidence speaks for itself. And you’re like, well it actually doesn’t like it really doesn’t. And so it would be really great for us to be able to identify individuals or tell stories at the core of the folks who are affected by the dynamics that we study. You talk a lot about storytelling in the book, and I’d love to hear you um talk a bit about how storytelling can look in public health because I, you know, I can hear somebody uh listening say, well, you know that storytelling by its nature is biased. The whole point of evidence collection is that you are you are um not overweighting one story, right? Like, technically a story is a selection bias. It like really is you’re selecting one story and telling that, but that’s the way people communicate. So I’d love to sort of hear how you think about um the way that we should be staying true to the data while being compelling in our uh engagement with policymakers and the public.
Dr. Shelley Hearne: Abdul, I I always learn a lot from you so that there is some great. I wish I was sitting in some of your classes and there’s there’s power absolutely matters. And the ability to map that out and understand who has it, who doesn’t and how do you start connecting the dots is critical. One. Then you talked about storytelling and how do you connect and how do you give a voice to evidence, right with you. Those facts don’t you know, we don’t have little icons and and uh um cases coming out of our fact patterns. You know that’s our job is to is to is to help bring that to connecting those dots with, again, the people who have power or who we’re trying to influence and inform again on their decisions. The way I always think about it is is to put people back into public health. It was just as you were talking about, we get so fixated on our facts and we have a hard time almost remembering what are the health outcomes that we’re after. Though what I actually teach and sometimes it’s through stories and sometimes it’s just by showing empathy, sometimes it’s actually just by showing yourself and just being, again, very real and connected and listening to your to your audiences and the people you’re trying to engage with, understanding where they are, what they care about, what their values are gives you the pathway to figure out what evidence do you highlight and focus because public health oh, do we love to have reams and reams and reams of data. And I’m going to spew my facts. I’m going to give you ten reasons why. And at the end of the day, we won’t remember one thing that was said. So if it’s maybe one, two key points and a way to personalize that for the person that you’re trying to listen. That you’re trying to to engage with and help inform so that like the story I I I somehow told the Thorax Journal, well, you know, we’re going to be laughing about I don’t even know if it still exists, but we’re laughing about because that kind of captured. You know, both the inanity of the moment. And also you gotta remember that oh, my yes that was a really. Oh, why would that keep CDC from doing its business? But but it was a story that I didn’t show with bias. It was more of it helped elevate what what has long been discussed, is known, and in fact, CDC’s just past uh director had pushed that the academic nature of the agency needed to change. So all the story did was add a punctuation mark. But it helped remember. It helped get through all the evidence, noise and facts and and and again, uh uh busyness that’s out there. It helps remember, it helps connect. And sometimes um those are the stories that help you take back and hold why you need to make something happen. So it’s not I don’t see it as bias. It’s really the it’s it’s the um icing on a well-done cake.
Dr. Abdul El-Sayed: Yeah, I really appreciate that. It’s identifying the um, you know, the the representative individual and giving it color, right. That Thorax story. It sticks in your mind because it highlights that they care more about or at that point they were they cared more about some inane paper in a journal called Thorax, which is a word that most people don’t understand. Instead of actually empowering you to go and take this data and use it to advocate, which is in theory why you would want to publish the paper in the first place. I want to ask because policy making feels very opaque, and I think part of our training is about trying to be objective at almost all costs. And I think folks, you know, even even when they engage in this in good faith, worry that they’d be sacrificing the the veracity of their work in the policy engagement. And I think there is something about the fact that our political process breeds compromised policy, that that really gets public health people uh all up in a huff. And if it’s not the perfect policy, then it’s not really worth engaging. How should we be thinking about the policy process in terms of iteration, in terms of being able to get what you can and then come back tomorrow uh and get even more? Um. And why do you think we’re so dead set against you know, it’s like it’s like perfection or nothing? Why do you feel like we’re so dead set against, you know, the nature of compromise that that um that is fundamental to the policymaking process in a democracy?
Dr. Shelley Hearne: Well, it certainly isn’t um limited to public health, I think, as you’re alluding to. This is a constant challenge in any field on any issue. You have competing interests, competing views, and you have competing datasets. And what’s so critical that sometimes those competing sets of information and perspectives they’re, all can be true. They can all be correct. We have um different ways at coming at issues, of problem solving again with with very diverse audiences. And in the policymaking process my experience has been for the most part in these last few years of the extremism and theater that’s going on at the federal level uh is disturbing and I do hope and pray that it’s a pendulum and we will get back. I’m not sure how, but we can come back to that in a moment. In general, good policy takes engagement from all different parties, putting in their perspectives, shaping it so that it really is a policy that can work for your community and a community has a lot of different, again, cultures, values, perspectives. But the nature of the policymaking has got to um you’re going to have Republicans, you’re going to have Democrats. You’ll sometimes have independents. And typically you have got to have some kind of bipartisan engagement in order to get good policies in place. And I certainly believe and have seen for at the local level, it’s not as much about politics as it is about getting good things done. And sometimes parties don’t even matter as much because the policy makers are about how do you keep the lights running, how do you keep your budget balanced, how do you have good agencies working and taking care of those communities? If we were in a place where it can only be, um the data says this is how we shall do it. But it doesn’t take into consideration how different interest groups, different social communities would respond and interact. That policy is not going to work. It’s not going to be representative. And it often takes many iterations. Many voices have to be heard to help shape it. And that while we might sit here and say that’s not perfect, that would certainly be true all around. But if we can get to something that is workable, agreeable and supportive and it improves health outcomes. Yeah. Sometimes it takes incremental work. Sometimes miracles happen and you can have huge sea changes. But like in the health care arena, if we had held out back 20 years ago for universal health care, there would be hundreds of thousands of people who never had insurance over that time period. If we had only said the only thing we could accept was universal health care. Now that may be the end goal and we can slowly work our way there. But it is those various steps that you have to take along the way that, one, can improve health outcomes and it gets you closer to your goal. So I didn’t directly answer your question Abdul, but it’s it takes a village out there and yet and it’s how policy at the end is going to work if you’re going to keep it in place and you’re going to keep it improving.
Dr. Abdul El-Sayed: One of I think the bigger frustrations isn’t even what the goal is, um right, because, you know, reasonable folks can disagree about like what is our goal? It’s we get stuck in the process questions. About a particular intervention. And then what happens is we end up we end up completely stymieing the fact that we actually agree on a goal [laugh] and that that tends to be an issue. The other part of it is because so much of the work has been so um captured by academia and academic culture, we tend to be very stuck in our frameworks and then the language behind our frameworks. And so the number of times I’ve been in rooms where you’ll be talking about a particular intervention, a particular community where someone says, well, we’re not sufficiently tackling the social determinants of health. And you’re like, yeah, I fully agree with you. But you know right now we’re here to talk about, you know, air quality and that we’re not going to be able to ho– answer the housing question here. We should. I really wish we could, but like this is a one hour meeting about air quality, so let’s just stay on task. Not to say that, you know, there aren’t bigger fish to fry. And I think in the expansive world of the mind, you have the ability to draw infinite bounds and then and then answer the question theoretically in infinite bounds. Whereas in policy, there are actually real things that need to be done with real dollars in real places in real time. And that’s another place where we tend to to miss out. And it’s not even just like the frameworks, it’s like the language that we use. I mean I, people on the show will know that I hate the term social determinants of health because it doesn’t mean anything to the people who don’t know what it means. Right? And then people use it as like the catch all term for all the things that we need to do. And it ends more conversations than it starts. Um. When we think about our work in terms of translating, what recommendations do you have for getting folks who spend a lot of time learning these terms to stop using these terms?
Dr. Shelley Hearne: Well, if you want to stop your policy arguments from going forward, use jargon. I mean use language, use, speak in speak in a language that the policymaker doesn’t understand. And then you guarantee that your policy isn’t isn’t going to go through. I mean part it’s if if our job is to translate and connect the dots of here’s the evidence, here’s the data, and this is therefore why you should do the policy. We’ve got to speak a language in that translation that resonates and that gets back to your, you know, fundamental rule. Do not use jargon. And and we sometimes we get so caught up in our little bubble of public health we don’t know that social determinants of health means absolutely nothing to the outside world. I hate to tell you this, but epidemiology doesn’t really I mean the pandemic has changed that a little bit. But sometimes maybe epidemiology has become a dirty word, just like advocacy. We have all kinds of phrases that are just in our world that that like having a tick when you’re speaking an um or a, you know, whatever your little catch is, is speaking. That’s what jargon is. It it it stops you from being effective as a speaker. So rule number one is get that out. But two, it’s getting back to if your job is about translation, it’s this point I made earlier. You’ve got to really understand who’s got the power, who’s making the decisions, and what are the issues that that policy maker actually controls. So you can go in there and rail and scream about one issue. But if that policy maker doesn’t have any jurisdiction or control over that, you’re alienating that person.
Dr. Abdul El-Sayed: I want to ask you, because this is this is one of the places we also sort of fall off, which is I think a lot of folks would say I would love to be an advocate and and get engaged. But I’m also worried about making the political partisan. And that’s been a real challenge in this moment where public health itself has become, unfortunately, really quite partisan. And there are certainly circumstances that prove otherwise. Uh. You know, the recent um uh expanse in public health funding in Indiana, we interviewed um Dr. Monroe and Dr. Weaver on that. But there is this worry that in the way that we engage, it does become a very partisan issue. How do you recommend advocates stay away from the partisanship um even as we engage in the politics of trying to translate public health insight into policy?
Dr. Shelley Hearne: There are two ways I’m going to answer this. One is, depending on who you are, you personally, and also the job that you have. It’s going to shape and inform what kind of advocacy that you can do or you feel comfortable doing. So that can range from you’re comfortable providing data and sitting down with an agency representative. Providing comments that take your scientific article and translate it as to why, what its implications are for the policy decision that that agency has to make. Like the epidemiologist who has data on air pollution and the agencies making decisions about a standard. Your data directly relates to that. Put it in English as to what it means with the implications of what they should set based on your findings. That’s pretty straightforward. That’s not that is advocacy, but it’s not getting into uh what would be viewed as partisan. Agencies tend are are not in that function. You could be working with a community group, a nonprofit group, an advocacy group, and being counsel to them. Again, providing your information data, helping them write letters, helping them make sure their science is correct, helping them on figuring out how to translate it. You don’t have to be the person directly engaging, but you can be working with key groups to help build their knowledge and their power in engaging the process. Or you can be directly working with a legislator, an appropriator, um the head of an agency, But you’re doing it in a fashion of again, in the translation and I have literally worked for Republicans. I’ve worked for Democrats. I find um when I’ve been in either academic or non-governmental organizations or in philanthropic entities, I’ve gone and met with policymakers. And I do it on all sides of the aisle. I make sure that everyone is getting that information. I go out of my way to sit down with those who I think are potentially opposing but could be on the fence with our data, may not be a solid no or may have been against us at one point, but they aren’t necessarily always against these issues. There might be ways to find common ground, common values, or we have, say, um board members or we know public health officials who are friends uh have their kids go to the same school. Their uh the pediatrician has been their their grandchildren’s doctor. They could go and sit down and discuss that information with those different legislators and help get people who have been opposed to come over. So engaging fairly with everyone. Again, finding the ways to connect your values with your evidence, and crossing the lines of uh different political parties. Doing that in a nonpartisan or bipartisan way is going to help build power and persuasion for public health. We’ve got to we’ve got to get out there and do it.
Dr. Abdul El-Sayed: I want to finish on one last question. Um. A lot of your book is geared for public health professionals, but a lot of our listeners are folks who are just out there who believe in public health and want to see uh it thrive. What can they do as advocates um to continue to build power for public health?
Dr. Shelley Hearne: Well, I think the nonpublic health professionals might be even better than the public health workforce in making the case. And part of it is the more that we can have and generate political will. I’m going to do an egghead thing for a moment. But the National Academies of Sciences have had report after report after report starting back in 1988, saying public health is in disarray. It’s underfunded. It lacks political will. And it’s because we we don’t have the organizations. We don’t have the people. We don’t have the community groups the way environmental field does or the education field does, it’s standing up and demanding that we have to have better systems to protect our health. We we’ve seen it in certain instances and kind of um on tobacco reform or on uh the Affordable Care Act. But we don’t have a sustained voice champion advocating calling for stronger public health capacity in this country. And that probably could be better organized by people outside of the public health field. By tapping people who have both the passion, who have the knowledge on these types of issues, who have relationships with policymakers, who will stand up and be a voice. That can make the biggest difference in the world. Because we can train our scientists, we can try to push our field, but it may take champions from outside to show the way.
Dr. Abdul El-Sayed: On that note, we really, really appreciate you joining us and um for your work and your advocacy. Our guest today was Dr. Shelley Hearne. She is a professor of the practice in public health at Johns Hopkins Bloomberg School of Public Health and uh the lead author of a new book on policy engagement for Public Health. Thank you so much for joining us today.
Dr. Shelley Hearne: Abdul, it’s a pleasure and an honor. [music break]
Dr. Abdul El-Sayed, narrating: As usual. Here’s what I’m watching right now.
[clip of unspecified news reporter] A massive three day strike begins across the country against Kaiser Permanente.
Dr. Abdul El-Sayed: On Wednesday last week, 75,000 workers at Kaiser Permanente, one of the country’s largest health care providers, went on strike in what is the biggest health care strike in U.S. history. Striking workers included therapists, nurses, lab techs, pharmacists and others. The strike is occurring all over the country, including in Colorado, Oregon, Virginia, Washington State and California, where it’s expected to have the largest impact. Workers are striking over inadequate staffing, which they say creates unsafe working conditions and therefore compromises patient safety. As we’ve discussed, health care unions are among the most important force for a more equitable health care system. And this strike won’t just improve working and patient conditions at Kaiser. It will reverberate across the health care system. And that’s why I want you to remember that these strikers, well, they’re striking for themselves and for all of us. The latest Nobel laureates in physiology or medicine are professors Katalin Karikó and Drew Weissman for the development of the mRNA based vaccines. The team began working together way back in 1998 over a chance meeting at a copier. In the ensuing decades, they developed their mRNA vaccine in search of an elusive HIV vaccine. As they experimented with mRNA, they identified a critical modification to mRNA that shielded it from being attacked and destroyed immediately by the body’s immune system, allowing it to stick around just long enough to get translated into a protein before it was disposed of in the body. The two labored with limited funding and support at the University of Pennsylvania for decades. Professor Karikó was never awarded a tenure track position. In fact, their first paper on the subject was rejected from top journals way back in 2005. But the study ultimately led to the founding of Moderna and Biontech, which eventually became household names with the advent of SARS-CoV-2, for which the mRNA platform was tailor made to allow for vaccine development in record time. And we’re all the healthier for it because, well, science always wins. Finally, the CDC is set to recommend a new approach to the prevention of sexually transmitted infections, which have boomed since the pandemic, when nearly all of our infection prevention resources were focused on stopping COVID. Syphilis was almost eradicated in the US 20 years ago. But cases are up 74% in the last five years. This new approach, called Doxy-PEP, involves taking a dose of doxycycline right after an unprotected sexual encounter. And the CDC will likely recommend it for those at particularly high risk, including gay and bisexual men and trans women. The whole point of this approach is administering a dose of antibiotic before the bacteria that cause chlamydia, gonorrhea and syphilis have the chance to replicate and to spread. But the approach is, well, not without detractors. As more widespread use of low dose antibiotics could contribute to antibiotic resistance. Still, reducing the risk of STIs is absolutely critical, and this is a great step in that direction. That’s it for today. On your way out, don’t forget to rate and review. It really does go a long way. Also, if you love the show and want to rep us, I hope you’ll drop by the Crooked Store for some America Dissected merch. [music break] America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producers are Tara Terpstra and Emma Illick-Frank. Vasilis Fotopoulos mixes and masters the show. Production support from Ari Schwartz. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Leo Duran, Sarah Geismer, Michael Martinez, and me. Dr. Abdul El-Sayed, your host. Thanks for listening. [music break] This show is for general information and entertainment purposes only. It’s not intended to provide specific health care or medical advice and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health. The views expressed in this podcast reflect those of the host and his guests and do not necessarily represent the views and opinions of Wayne County, Michigan, or its Department of Health, Human and Veterans Services.