How to build a resilient public health workforce. | Crooked Media
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April 23, 2024
America Dissected
How to build a resilient public health workforce.

In This Episode

Public health professionals are people, too. Too often, though, we don’t think about them that way — their needs, their hopes, and aspirations, their individual skills and areas of passion. But if we want a functional public health system, we really should. Abdul reflects on the experience of leading public health teams. Then he speaks with Dr. Brian Castrucci, President and CEO of the de Beaumont Foundation and co-author of a new book, “Building Strategic Skills for Better Health: A Primer for Public Health Professionals,” about how to build a better public health workforce.






Dr. Abdul El-Sayed, narrating: A new Colorado law extends privacy rights to data from brainwaves. Senator Bernie Sanders proposes a long Covid moonshot. Congress faces a deadline to end or extend pandemic era telehealth policies. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] To say that it’s been a rough couple of years for public health folks. That’d be an understatement. It’s been the worst couple of years in living memory. As much as the rest of the country has moved on from the pandemic, we’re stuck in a bit of a we’ll call it suspended animation. On the one hand, as much as the pandemic era of Covid 19 has been declared over, the virus, SARS-CoV-2, is still here. That’s true both as a seasonal virus that continues to make thousands of people sick every single day, and as a persistent illness for millions of people living with long Covid. And that means that while the rest of the weight of the pandemic has subsided, it still occupies a weighty, liminal space. But here’s the rub. Public health challenges don’t wait for each other. There’s no complex gating procedure that viruses engage in to make sure that we’ve had sufficient time to recover. They don’t wait. On the heels of Covid came Mpox. And now we’re all girding ourselves for measles. And there’s this whole cows infecting people with bird flu. And yet, where you’d think that the experience of a world as we know it, ending pandemic, might have forced a broader conversation about the value of public health and the importance of consistent, uninterrupted investment in it, the effect has been just the opposite. The pandemic has become a touchstone of collective, unresolved trauma, the very mention of which elicits a fight or flight response that leaves us avoiding the subject at all costs. So rather than a sober look at what we ought to do to protect ourselves from the next one, we all but refuse to talk about it. Meanwhile, those of us sitting in the bowels of America’s public health departments are dealing with the double pathology of PTSD from the pandemic and anxiety over whether we’ll have the resources we need to fight the next one. And can we all agree that the combination of trauma and anxiety probably aren’t the optimal mindspace for performance? Public health professionals are people too after all. But there’s another part here that’s worth thinking about. There’s no doubt the public health pros are booksmart. After all, we spend a lot of time learning about that space where biology and statistics, sociology and psychology meet. But book smarts are only half the battle. Making things work under challenging, resource limited and implicitly political circumstances requires a level of street smarts, too. And that’s where our public health workforce might need some work. Knowing the right policy is great, but knowing how to get the right policy implemented, that’s more about understanding public communication, movement organizing, political lobbying, and the interplay between all of them. It’s pretty important to secure our funding too. And that mismatch between the skills we have and the skills we need contributes to the burnout and frustration that so many in public health are feeling right now. Too often, we’re preparing future public health professionals for the cookie cutter, inside the box version of public health. But the real thing is anything but that. And that delta between the two only makes the anxiety worse. I had no idea what I was getting into. Really isn’t a position of strength. Our guest today is a friend of the pod who spent a lot of time thinking about these issues. Dr. Castrucci Brian Castrucci is the president and CEO of the De Beaumont Foundation, one of our sponsors and coauthor of the new book, Building Strategic Skills for Public Health: A primer for Public Health Professionals. He joined me to talk about what a grittier, more street smart public health should look like and how we train our future leaders to embrace strategy and substance. Here’s my conversation with Dr. Brian Castrucci. 


Dr. Abdul El-Sayed: Can you introduce yourself for the tape? 


Dr. Brian Castrucci: Brian Castrucci, president and CEO of the de Beaumont Foundation. 


Dr. Abdul El-Sayed: Brian, you guys have written a new book. You, along with uh Michael Frazier, have written a new book really focused on um a Practical Strategies for Public Health Professionals. Can you tell us a little bit about what motivated you to write this book? 


Dr. Brian Castrucci: Absolutely. When you think about the scientists in public health, we are great scientists. We know great depth, whether it’s maternal child health or epidemiology. We have really, really great depth in our field. But you also need to be able to to do a whole bunch of other things to deliver that message to other people. So a scientist who can do science just amongst themselves in a room doesn’t change the world. Right. It’s like the tree that falls in the forest doesn’t make a sound. So you have to be able to do a whole bunch of other things. You have to be able to know how to communicate effectively, how to change systems. A whole bunch of skills that we are calling strategic skills. So think about a T. That vertical part of the T, that’s the depth of our training. But that horizontal bar, that’s how you really get that message out to a whole bunch of people. And that’s why this was important. 


Dr. Abdul El-Sayed: Yeah I really appreciated it because I think you guys are spot on on the fundamental analysis that leads to a need for this kind of book. Um. You know, one of the the frustrating parts of this is that when you think about public health, we think a lot about the health part, but we don’t think enough about the public part. And there is something about the way that we engage in the public space that, frankly, up until the pandemic, we just didn’t have to actually come to terms with. And I think the pandemic threw us out there. It’s almost like you throw an actor on stage and they don’t know the lines. They don’t really get the plot of the, the play. Uh. And we kind of felt like that. And I think this intervention on the education of public health professionals, I think, is about reinserting that public piece back into public health. I want to ask you, though, you know, we have really great public health training programs. And as I was reading through your book, it became really clear that so much of what you are talking about are just practical skills that have to do with leadership and communication and workforce development that we don’t actually teach or learn in academic public health spaces. And it just struck me as being such a gap in how we train and it also struck me as being a byproduct of the fact that so much of the public health infrastructure has been built out as almost an academic exercise as if, you know, doing the science and interpreting the science was just it. That’s like what we do. Versus having to go out and be and do in the world, change public policy and ideally make people healthier. What, you know, as you think about this book and the need for the book, what does that tell you about the way we should be thinking about public health curricula writ large, and the way we train, trainees in public health more generally? 


Dr. Brian Castrucci: I was trained in amazingly good schools of public health. Um. And I appreciate that training. And it gave me a lot of amazing skills. But where I learned how to be thoughtful, how to be strategic was actually when I worked at the Robert Wood Johnson Foundation. It’s a whole bunch of skills that you get on the job that we’re not getting in school. And I think this is a real moment to reflect on public health education. Do we want to be knowledgeable or do we want to be impactful? And if you want to be knowledgeable and know a lot of numbers I mean that’s great. But the first four letters in numbers is numb. And if you just get up there and start throwing data on a wall, no one’s gonna really care what you’re saying. How you package it, how you help people with change, how you really think through a system. This is what we’re supposed to be doing. I mean, no one, no one got into public health to figure out an odds ratio. We didn’t get into public health just to do a case control study. We got into public health to change the world. We got into public health to figure out how to make people who otherwise aren’t healthier. And we’ve realized that it’s wrong that everyone can’t achieve their optimal health in this country, in the richest country in the world. How is that even possible? So that’s what drew us to this field. But then we’re trained in this wonderful skill set, but not really taught how to apply it. How to seed movements, how to lead people, how to be humble in leadership. How to pair community and science and and really, Abdul, I you know, the pendulum swings. We’re all about science, now we’re all about community. What we need is we need the community to be the peanut butter and the science to be the chocolate. We need to put it together and eat the Reese’s. Either one on their own is okay, but not as good as a Reese’s. And that’s that’s how we have to change our thinking, working with community and bringing their skills to the table. We bringing our skills to the table. And when we work together, then we’re unstoppable. But as long as we stay in our silos, we’re going to continue to be ineffective. 


Dr. Abdul El-Sayed: Yeah, Brian, I really appreciate that. That point and also, that you are one of the only public health professionals that I could have on my podcast, uh who’s encouraging us to eat Reese’s, which thank you because they’re delicious. And you got to have a little bit of joy in your life. Um. You know, this point that you’re making about this divorce between community driven versus, evidence based, you would think that in a in, in sort of a practical public health educational space, we would do both. And I worry that, you know, we’ve gotten very theoretical about what public health is and does, and it’s almost like because we’re so top heavy as a practice, so much of the discourse is dominated by the academic space that we think that the theory is the practice, and it’s it’s just not, um how do we create a space where we have a little bit more? We can wait what is taught and engaged with, with a little bit more attention to public health practice rather than public health theory. And I say this as somebody who started my career, you know, in the academy, and I deeply appreciate the elegance of a beautiful study. I also know that the world is not the elegantly designed study by definition, we do a whole lot of things to try and pull our study out of, right, the sullying aspects of the world to to make it elegant and beautiful. But then you also have to apply it back into the real world. And I worry that that is the place where we have fallen on our face pretty profoundly. What is the conversation you feel like we need to be having amongst ourselves or in this space to bring our, uh our theoretical work back to real life and maybe sometimes even turn the volume down on some of the theory people?


Dr. Brian Castrucci: Yeah. I was never big on theory. I’m an action guy. And, you know, I look at folks who say we need to study housing. Housing’s a crisis and we need research. I don’t think you need much more research to know the way you solve a housing crisis is you get people homes. And the way you solve a hunger crisis is you get people food. That doesn’t need research. Instead of what we need which is political will. That’s really hard to generate. We go back to the research, say, okay, let’s study it, right. I mean, how does every legislative initiative that they really don’t want to deal with, but they want to do something they put in a study committee, or they create a panel or a coalition and study it for a while, and then nothing happens because we forget. I think we’re at a moment where we have to rethink a lot of public health. The post pandemic, we we need to ask, you know, what is the continued role of the health department? What is the continued role of advocates? What is the continued role of public health education? I don’t think it’s the same as it was before. There are far too many public health programs that aren’t teaching enough communication. They aren’t teaching change management. They aren’t teaching data interpretation. Right. We need a DrPH, not an epidemiologist but a DrPH in social change. And that’s going to be a bit of a change because how do we do that given current SIF requirements. All the things that one has to do to to get a doctoral degree, a PhD or even get an MPH. They have to write the dissertation or the capstone. I mean, let’s make sure that the capstone is community based. Let’s talk about real change, not just discovering knowledge. Right. That’s a it’s a very noble pursuit. We could take all the knowledge and put it in a library, and we’d go there and go, oh, knowledge. Knowledge is good, but knowledge applied to problems. That’s the game changer. That’s what gets people. You know, I mean, I don’t want you to study, you know, how to transplant a heart with never the goal to actually put a heart in someone different. Like, that’s the beauty of it is making change in people’s lives. I mean, this is what makes public health the most important career there is. It’s that you get to change not one person’s life, but the lives of entire communities and populations if we’re doing it right. I mean, my daughter Chloe, when when someone says, what’s what’s the difference between your dad as a doctor and the pediatrician? And she’ll say, well, my pediatrician helps one person at a time. My dad helps everyone all the time. And that’s what the power of public health is. But we’ve we’ve kind of shackled our own power, right? We’ve we’ve minimized it to to doing studies or doing programs instead of really getting in and doing policy and advocacy. 


Dr. Abdul El-Sayed: I really appreciate, a couple of the points you made there the [laugh] the uh analogy of, of heart surgery, I think is really um important because I studied both public health and medicine. In medicine, there’s always this end outcome where you are going to be with a patient. And all of your training while there is a lot of theory involved, all of your training is still wedded to that question of a patient physician interaction and how you’re going to engage in that moment. And so there’s a set of practical skills, not just technical skills or knowledge, but practical skills that you cannot graduate medical school without at least having learned about. I mean, some people are better at it than others, like anything, but um, but at least you will have had time to, to practice it, whereas it feels like in public health, too often, uh everything is studied in theory. And then folks roll off the truck into the real world and they’re like, I’m sorry, this is just not what I I had signed up for. Then you’re like, but it is actually what you signed up for. The problem is that we trained you for something very different. And, you know, it’s interesting when I think about uh department design, so and I’ve I’ve been in this, this, this sort of second uh rebuild job of a, of a of a public health department. And um it’s interesting because the way that people think about a department and the way that we’re taught to think about it is you do a community health assessment, then you identify the challenges that need to be addressed. Then you work with the community to suss out uh what their needs are. Then you take that to the literature, you look at evidence based interventions, and then you start to apply the evidence based interventions. But that’s all theoretical, right? There is nothing that is engaged with which with okay, so how do you advocate for resources for yourself? What are the kinds of things that elected officials who are your bosses are interested in you delivering? How do you make sure that you are a go between between those those elected officials in the community? How do you engage with funders to have a conversation about what their goals are and what your goals are? How do you design a program so it actually gets rolled out in the community that you’re engaged in. And these are things that, you know, folks don’t teach us in public health. And I think your book does a really great job with. 


Dr. Brian Castrucci: It’s the basic WIIFM. What’s in it for me? We believe that public health is a universal good. And so everyone should do public health and support public health because we are a universal good. We help poor and vulnerable communities. Yeah, but what if I don’t care about poor and vulnerable communities? What if I’m living in a rich neighborhood? What if I’m a business owner? Well, great. You go help poor and vulnerable communities. I don’t have any value there. It’s like a whole we just we misbranded public health almost from the get go because we talked about public health serving poor and vulnerable communities. And unfortunately, those communities don’t have a lot of political power. We didn’t brand public health to help every person in every county, in every corner of this country. That public health touches you every day. So if you are a rich person in a rich county and you own a business, guess what? Public health is helping your employees. It’s helping the community. It’s helping the people who are buying your product. It’s the foundation of your house. And it’s something we don’t think a whole lot about. But when it’s cracked, everything else is in jeopardy. [music break] 




Dr. Abdul El-Sayed: I want to ask you, as you think about the um fundamental skills, you talk a lot about workforce, both from a motivational standpoint and also the whole implicit value of the book is about about building out the workforce. If you if you had to think through the three most important and unfortunately, most efficient um practical skills, strategic skills for public health, what would they be? 


Dr. Brian Castrucci: We got to start with communication. We have to. Um. If I asked you to draw a hamburger right now and hold it up, it would look like a hamburger. Almost I’ve done this in in you know speaking events throughout the country, there’s not one single person who can’t draw a hamburger and have someone else see it go like, yeah, it’s a hamburger. So then I ask all these public health leaders, people who’ve been in public health for decades. Okay, now draw public health. And silence. No one can do it. Even if when someone tries, it won’t look like someone else’s drawing of public health. And yet, we expect elected officials and laypeople to be able to understand public health, when we can’t communicate it in a very succinct way. So so that’s one. 


Dr. Abdul El-Sayed: You made an earlier point that I just think is worth reiterating, which is we assume we commit what  we what’s called in philosophy, the hermeneutical fallacy, which is the assumption that the thing that someone else values is the same thing you value and vice versa. So we assume that when we make arguments on public health grounds, that those are self-evidently more important than other arguments. And we fail then to communicate at core why our value matters. Because we assume that it’s taken for granted that this is just this is just something we share in common. And that in and of itself, I think, is so core to our failure to communicate. And it’s interesting, obviously, I spent some time in politics, and the thing that you’re always doing is two things. You are always, always communicating values and you’re always introducing yourself. And that’s the thing we don’t do. We don’t introduce ourselves and we forget to communicate our values and so on so many,  on like the foundation of of communication, we fail. 


Dr. Brian Castrucci: I 100% agree with you. We have to train that skill. I actually think that’s what makes you effective is that you spent time in politics. And so you learned, hey, this is how I have to work with people. This is how you know I please. I say all the time, I use your line that we are linguistic absolutists. And if we’re not saying the right language, then you’re not showing that you’re part of our group and therefore we’re going to shun you. And I think that’s one of the second skills, is it’s super important for public health. In the ten essential services of public health, it is the center. And that’s justice, equity, diversity and inclusion. But how we do it, I think is really important and I do I think we’ve trained public health how to say words. What does your health department do? It does equity. But what do you mean? Well, I mean we do equity. No, no. Can you actually break it down for me? No, I can’t do that. Right. In our [?] survey, only three quarters of the public health workforce felt fighting racism was their job. And I think that’s too low. I think it should be much higher. But how we do it? Not in San Francisco or in New York City, but how do we do it in Tuscaloosa, Alabama? 


Dr. Abdul El-Sayed: Right. 


Dr. Brian Castrucci: How do we do it in Macon, Georgia? How do we do it in Florida? And I believe it was Alabama that recently outlawed DEI in schools and and other government functions. So we have to and and Robert Wood Johnson Foundation’s done a really great job with this with some of their new messaging. How do you talk to people about health equity without ever saying the words health equity? 


Dr. Abdul El-Sayed: Yeah. 


Dr. Brian Castrucci: Without–


Dr. Abdul El-Sayed: Especially since–


Dr. Brian Castrucci: –ever saying things that will trigger people. 


Dr. Abdul El-Sayed: Like equity for finance people means the proportion of something that you own. We’re not even talking using the same words for the same meanings. And we we like to do this to your point about [?] linguistic absolutism is we like to do this because we are more interested often in communicating to our tribe that we’re in, rather than we are communicating to the people we’re trying to build and bring into our coalition. And so we use words that are by their own nature, exclusive. And then we think we’re doing this to, to, to build a sort of level of inclusion. And it like you can’t make it make sense. 


Dr. Brian Castrucci: It’s ideals over impact. And I mean, I’ve worked with people [?]– 


Dr. Abdul El-Sayed: Or even more so like identity over impact. Right? 


Dr. Brian Castrucci: Identity [?]. 


Dr. Abdul El-Sayed: I’m a public health professional, I speak a certain language, I’m trained a certain way. And I’m going to use my words because they’re my words to tell everybody else who’s like me that I’m like them, rather than actually communicating to people who don’t know the definitions of those words. 


Dr. Brian Castrucci: Yeah. I had a great opportunity to work with a lot of different political leaders throughout the pandemic, and I didn’t necessarily agree with everything they believed politically. But what we both really cared about was getting people vaccinated and in that sense, getting conservatives vaccinated. And so we found common ground then we worked together. It’s it’s all the the wonder of making that McCain Biden relationship what it once was. And that relationship just doesn’t happen anymore. And that hurts our country. It hurts our health. So lastly the third strategic skill that I think is super important, is policy engagement. And we’ve been working with the the Learner Center at Johns Hopkins under the leadership of Shelley Hearne, to bring more of an advocacy focus to public health, because we we both know that every conversation about health in this country devolves into a conversation of pills and procedures instead of policies and partnerships. Because ultimately we love a good Band-Aid in our culture. So, like, let’s feed someone tonight, right? Because that’s going to feed them for the rest of their lives? We need to feed we need to feed people routinely. You need to change the system. And and honestly, the only way that you can get at the social determinants of health is by doing policy change and policy engagement, and that that may be the space for for public health practitioners in a governmental setting. But it also may it may need to be other people. Um. I am I am floored by the work of Catherine Patterson and Katrina Forrest in the City Health Project. They are out there with a policy package of 12 policies working with governors, working with municipal staff, passing policies. They reward the cities with a medal. I’m super excited. Um. I think it’s, week after next, during Public Health week, I get to go to San Antonio and give a medal to my close friend and health Commissioner Claude Jacob and Mayor Nuremberg, who has, over his tenure as mayor, become an awesome health policy [?]. Right. And he had the bravery and the courage to be the first city in Texas to pass Tobacco 21. And what was really important about that is remember, this is the city of San Antonio, which is in Bexar County. So at one point on one side of the street, you had to be 21 to buy cigarettes. But on the other side of the street you only need to be 18. Imagine the political pressure that the mayor was under. But he believes in health, and he believes that the prescription for better health is policy. Because while I like physicians, the impact that a county commissioner can have on one’s health is far greater than that of a physician. 


Dr. Abdul El-Sayed: And that I want to I want to highlight a couple words that you use, which are bravery and courage. And I, I believe that these can be taught. And I also believe that we’re actively not teaching them. And I think that the challenge that we face and that a lot of the, the, content about about leadership that you write on is that advocacy and policy change require you to come up against power and they require you to question the status quo and potentially take risks because any time you come up against power, you take risks. We say a lot about speaking truth to power. The thing about it, though, is it’s one thing to speak truth to power. It’s another entirely to confront power and force power to to change. And that’s those are two different things. It’s easy these days to speak truth, right? People have been able to power has learned how to tune you out. What you need to be able to do is actually come up right against it and face the risks of engaging with it to to force it to change. And unfortunately, I think in public health we tend to be unfortunately, like it’s like part of the culture to be a rule follower, that we tend to select against people who are willing to do this and to engage with power in this particular way. I want to ask you, what does it mean for us to select a different or select against people who are more interested in following rules and and select for people who are more interested in changing them? And how do we start rebranding ourselves to to inspire folks like that to come into this field? 


Dr. Brian Castrucci: Well, I think we also have to expand what the field means, right? If it’s just governmental public health, as someone who was a disruptor in governmental public health, you kind of did that for a couple of years and they got tired of you and they moved you on. Right? Then you went to the next health deparment. I had a really, really good friend explain the way that health department work health departments work is they kind of grow into this thick thatch, and then you need a fireball to come through every so often to create space for it to grow. And so we need to think about the complete ecosystem of public health. There is a place for the governmental public health practitioner, but there is an equal place for the advocate and the disruptor, and we need to feed the ecosystem so that we can have all things. I mean, where I am, I can be more disruptive and that’s that’s acceptable. But if the health official of a state is going to only be as disruptive as their governor would will tolerate, and in some places that’s a lot. In some places that’s very little. But then they have to be skilled in how you work that broader ecosystem, right? If you want to, if you want to get invited to talk to the to the legislature, you know that maybe telling your state health official, I would like to address the legislature about women’s health, or it’s finding someone who knows the legislator who can get you the invitation. But we have to be able to work all aspects of the ecosystem. And we’re not just training people for for working in a health department. The health department alone is not going to deliver what we need in public health any longer. They are a critical piece. They are a backbone piece. But if I was just a backbone, I wouldn’t be much of a skeleton. So we need all the other complementary bones to make a full skeleton that can stand up to the power, as as you mentioned. 


Dr. Abdul El-Sayed: Yeah, I really appreciate that point. And you know, what you can do versus what you can say. And those differ depending upon where you sit. But the other side of it is also we need to work in concert. And I think unfortunately, we have sort of lacked that ability to bring a coherent scientific analysis to the public activism piece of things. Right? Because oftentimes you end up having activism, but that activism might not be as moored in a lot of the science that that drives public health, and then vice versa you end up having, you know, government actors who are moored in the science but are not willing to rock the boat because of exactly the political circumstances that you that you named. And so it really does take all of us working in concert to know who can play what part and what needs to be said. I mean, I’ve had conversations in previous roles where I sat down with activists and been like, this is what you need to say to get to to create the space for me to move. I can have this conversation inside and there’s things that I can I can say outside, but there are things that you can say out loud to create the circumstances that can move a conversation. Right. And it’s public health folks working together around a certain goal, understanding that not everybody’s gonna be a trumpet, not everybody’s going to be a cello. Right? But you can make beautiful music when you have a trumpet and a cello and and you got to understand, you play different parts. 


Dr. Brian Castrucci: 1,000% and actually it reminds me during the pandemic, Bill Foege, you know, Mount Rushmore health public health, Bill Foege said that Redfield, CDC Director Redfield should resign in protest. And and I, I always hate a good resignation in protest because then you’re losing the people who are on the inside who can make change and work if working together and in concert with activists to then make the space. But when you resign in protest, trust me, they’re going to find someone worse than you. Who more aligns with their goals to replace you. So I spent, you know, I’m getting old now, so it’s the percentages are changing, but I spent a good chunk of my career in governmental public health, and I felt that I did really good work there, trying to move things incrementally when activists and others outside that system were helping by creating the space to make those changes, whether it was legislative or regulatory. Um. Now I’m on the other side. I’m on the private space in, in the philanthropy. And I have resources to try to make change, try to bring data to, to different people. I mean, that’s that’s why we do the public health workforce interest and need survey. It’s it is a diagnosis of what’s wrong with your workforce, where they need help, where they’re excelling, so that leaders in the workforce can then make the appropriate tweaks and changes. 


Dr. Abdul El-Sayed: Yeah. 


Dr. Brian Castrucci: So again, it’s it’s a synergy. And if we’re working together, I mean, come on we’re taking on wicked problems, we’re taking on problems that we, we know how to solve. The issue is we don’t have the political will to solve them. So we’re going against power. We’re going against entrenched power. We’re going against colonial determinants of health, of political determinants of health, of every determinant that you can think of. And we’re not going to win unless we are on point. 


Dr. Abdul El-Sayed: Yeah. 


Dr. Brian Castrucci: And I think that’s coming out of the pandemic if there’s one thing that the strategic skills book is trying to say to everybody is we can’t be just scientists. We have to be better than that. We can’t say that we are tired or that we’re overworked because we’re trying to do things and fight power that is entrenched and generational. And if you want that kind of change, you got to be on point. 


Dr. Abdul El-Sayed: Now, I really appreciate that point, because I think you’re also making an argument to the activist community here, which is you gotta also be strategic. And I worry that the incentives of social media have also corrupted activism in a certain way. We’re a lot more interested in tearing down than we are in building up. And it’s you’re always going to get a micro flame going on social media by calling out, rather than thinking bigger picture about how you architect, a real movement. And I do think that, you know, because social media is so performative, we will trade a small or what’s seen as a small victory, over a broader architectural win. I mean, you think about, you know, the kinds of uh work that folks were able to to, to build in activist circles before the social media era. And this was all about trying to build a community, a movement around a goal. And I worry that in public health, you know, a lot of times what public health activism looks like is calling out a want, an individual leader, rather than trying to create a movement around a particular set of goals. Just like, right, we need folks on the inside in public health departments and agencies, uh to be able to respond to that movement and translate that movement into real policy change. And it takes both sides doing their job well. And unfortunately, I think on the practitioner side, there is a failure to think strategically about how to engage people on the outside and on the outside there’s a failure to think strategically about how to empower people on the inside, and you need both of those things happening to create and architect real change. 


Dr. Brian Castrucci: I’ll give you a perfect example. The we know from the Edelman Trust Index that people really don’t trust media and people really don’t trust government, but they trust their employers. Why didn’t we have a network of employers ready to send out pro vaccination messages to their staff? Because we’ve never made that partnership. 


Dr. Abdul El-Sayed: Yeah. 


Dr. Brian Castrucci: Because we are too busy often, you know finger wagging to hear this is how we can work together. You know public health never wins when we’re wagging our finger. And we have to find a way to make partnerships with people we never thought we’d speak to, let alone partner with. That’s when you know you’re working and you’re really making change is when you are so uncomfortable and again, through the pandemic, I worked with folks I never thought I’d work with, folks who I still work with now, and I learned a lot. I learned hearing what they had to say. Some things they said I was like, I just simply don’t agree with this, and that’s okay. But then there are other things. I was like, wow, okay, that’s a different perspective on things. A perfect example we said the lab leak theory was a right wing conspiracy and we took people off of Twitter for spreading conspiracy. But then we came back around and we’re like, well, maybe that’s a plausible hypothesis. Wait a second. In one breath you’re saying I’m a right wing conspiracy theorist? Now, this is a plausible hypothesis. This seems inconsistent. And that’s unfair. And we did that. Like misinformation is prevalent, but I think we have to do some introspection to figure out how much we kind of tilled the soil where misinformation grew. Like public health. Yes, Joe Rogan is scary. And we can say he says a lot of crazy stuff. But, you know, we weren’t always consistent. We changed our message sometimes, and this is a time to reflect on that. Not the public health apologists, but to be improving our practice so that we never have to experience the ridicule and undermining that happened throughout Covid. 


Dr. Abdul El-Sayed: Yeah, no, I really um appreciate that point. There’s a great MLK quote, which is if you feel comfortable in your coalition, your coalition is too small. And I think we would do really well to think a little bit about that. Um. Because I think we we are really comfortable in our small coalition, and we are missing out opportunities uh to build toward our goal. 


Dr. Brian Castrucci: Public health is a great church. If you come to the Church of Public Health and we all say the same thing and we all read from the same hymnal, it’s a great place to be. But then somebody walks past the church doors and instead of embracing them and reaching out to them, we shut the door. We may be great preachers, but we’re no we’re no missionary. And that’s our problem is how do we bring people to our understanding. Because when I sit with people and I explain how public health helps them, they’re like where do you sign me up? Well I’ve never heard of this public health thing. Yeah. You have. It’s just never been put you in this way. 


Dr. Abdul El-Sayed: Yeah. 


Dr. Brian Castrucci: Public health helps people have better lives, build stronger communities, and build strong economies. And you put that third point in to appeal to those that the first two points don’t engage. 


Dr. Abdul El-Sayed: Right. 


Dr. Brian Castrucci: But we never did that. Like we have to have messaging that crosses political lines if you care about individual health. I got you. If you care about community health. I got you. If you care about business now, I got you. Now, public health is all of those things. And now I want to talk to you more about it because I understand how it benefits me. And and we just we can’t just be the silent warriors who are they are crusading in the shadows and are are keeping you safe. Because that that is not a winning strategy. No one, no one funds what’s in this in the shadows that they don’t know about. And so we have to be a little less humble and a little more clear about what public health does. And I, in my perfect world, there is never a public health practitioner at a political hearing championing more funding for public health. It’s the superintendent. It’s the business leader. It’s the clergy. It’s the religious leader. I want them talking about public health, not us. That’s when we win, when we become ubiquitous. Not when we continue to say we don’t have enough money. We don’t have enough of this. We got, people have to understand our value. And that’s that’s our business now going forward because we closed businesses that never opened again. We maybe did harm to people who didn’t know who we were or who elected us. And then they figured out no one elected us. We have to really build these partnerships, and they gotta start right now before the next pandemic. We got to get more people swiping right on public health. But right now, I don’t blame all of them. Not because, again, we shut down businesses and we never met them before. We didn’t call them and say, there’s a respiratory  virus out of containment. Buckle up, buttercup, this is going to get bad. And here’s my cell. And when you’re up at two in the morning and you’re worried about this virus, you call me because I’m up at the same time. Imagine how powerful that would have been. But in most places, we didn’t do it. 


Dr. Abdul El-Sayed: No. And and that’s the thing, is that I think we uh fail to recognize the strategies about how we engage with our communities to build toward a goal. And that implies building stronger, bigger coalitions. And I really appreciate, you and your coauthor, Michael Frazier, for highlighting that. And the book is Building Strategic Skills for Better Health: A primar for public health professionals. And our guest, of course, is Brian Castrucci, president and CEO of the de Beaumont Foundation. Brian, really appreciate your passion, your insight and, of course, your strategic thinking. Thank you. 


Dr. Brian Castrucci: Thank you. [music break]


Dr. Abdul El-Sayed, narrating: As usual, here’s what I’m watching right now. Imagine this scenario. In 20 years, someone creates a product based on research that’s still in its nascent stages today that can predict behavior based on brainwaves. But it’s not perfect. No tool ever is. Imagine they form a company trying to sell that technology to police departments as a tool to predict who’s going to commit crime. Imagine that tool is used to apprehend people based simply on their brainwaves, even though they’ve done nothing wrong. And that’s just one example of the kind of fresh hell brainwave data could create. You can imagine folks using AI driven algorithms to track brainwaves, to identify what kinds of ads would be best suited to get you to buy something. Or employers using that data in employment decisions. If you’d rather not live in that dystopia, I agree with you. So does the state of Colorado it turns out. Colorado became the first state to pass a law extending privacy rights to data generated by neural technologies that collect and analyze brainwaves. I hope that other states, and maybe, just maybe, the federal government, too, will start to take privacy concerns of this type seriously because consumer data protection is bad enough as it is, and I’d rather nip this in the bud while it’s still early. Last week, Senator Bernie Sanders, chair of the Senate Committee on Health, Education, Labor, and Pensions, or HELP, announced a new effort to take on long Covid. His moonshot for long Covid calls on the federal government to invest $10 billion over ten years to support new NIH based research into the causes, consequences and treatments of long Covid. The effort highlights the fact that upwards of three in ten American adults said they’d had symptoms lasting longer than three months, and about 10% said they still experience those symptoms today. Considering the fact that Covid approached nearly full penetration, we’re talking about upwards of 35 million people who are still suffering Covid symptoms. As I talked about earlier today, the political economy of Covid means that there’s no incentive to continue to talk about it for most politicians. Republicans have basically denied that a pandemic ever happened, while Democrats want to take credit for ending it. But it turns out that neither want to talk about it anymore. And in that context, calling for a moonshot to address a condition still affecting one in ten adults is both courageous and good policy. While we’re learning a lot more about long Covid, which we think has to do with a prolonged immune response to the infection, it can’t come fast enough for millions of people whose symptoms can range from mild brain fog to debilitating pain and fatigue. Finally, one of the silver linings to come out of the pandemic was a change in policies regulating telehealth, or the use of modern internet tools to provide health care remotely. In the midst of shutdowns, this was a lifeline for millions needing health care, particularly in the area of mental health. But these changes still aren’t permanent. And now Congress is under a deadline to make final decisions about them. What often goes unsaid in conversations about telehealth is that it’s about a lot more than ease and convenience. Telehealth has unlocked health care access for millions of people who just went without it in the past. It’s particularly critical for rural Americans, where the combination of poverty, inadequate Medicaid reimbursement, and broad distances have led to hospital shutdowns and limited health care access. The boon in telehealth has been a lifeline for these folks and so many others. Ending that could have major consequences for these communities. And I hope Congress does the right thing here. That’s it for today. On your way out. Don’t forget to rate and review the show. It really does go a long way. And if you love the show and want to rep up, do drop by the Crooked Store for some American Dissected merch. Don’t forget to follow us at @Crooked Media and me at @abdulelsayed no dash on Instagram, TikTok, and Twitter. [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. Charlotte Landes 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, and me, Doctor 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 may not necessarily represent the views and opinions of Wayne County, Michigan, or its Department of Health, Human and Veteran Services.