In This Episode
Public health is really cool! Ok … maybe it’s cool to all of us who do it for a living. But to be honest, public health’s got a serious brand problem — a “rizz” gap. Abdul reflects on how the turn toward individualism left us wagging our fingers at people rather than taking on righteous fights. Then he talks to Prof. Jerel Ezell about how to address the public health swag gap.
[AD BREAK] [music break]
Dr. Abdul El-Sayed, narrating: The state of California bans four popular food additives found in candy, fruit juices and some desserts. States across the country prepare to start negotiating prescription drug prices. Murderous violence erupts in the Middle East. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] Hey, kids, want to know more about the coolest thing in town? It’s public health. What’s public health, you say? Well, only all the efforts that keep us safe each and every day. Crickets. Yeah. So I’d be the first to admit that public health doesn’t make the list of coolest professions. And even if we occasionally try to change that, you and I both know we only usually end up sounding like I just did. Let’s face it, we’re not running into burning buildings. Strumming our guitars in front of thousands or making second by second life and death decisions. Okay, that last one, We definitely do. But that swag gap, as today’s guest has called it, has had a serious impact on our ability to effectively do our work. Look, before I get sub tweeted here, is that subX now? I love public health and I think it’s one of the most badass professions out there. The work we do protects some of society’s most vulnerable people every single day. But I’m a nerd. I like to fancy myself a nerd with some rizz, but I’m still a nerd. And a lot of what I think is cool about public health just isn’t shared by most people. That swag gap though, isn’t just a matter of winning some popularity contest. It’s a matter of our ability to fundamentally do a job. That’s because the first word in public health is public, which means there’s something about being able to appeal to the public that is absolutely essential to what we do. And when people think we’re the antithesis of cool, they’re just not as likely to listen to what we have to say. We’ve talked a lot about our communications challenges, the fact that most of us are trained to think in numbers rather than stories. The fact that the way we explain ourselves is backwards to most people. Only after saying all of our reasons do we actually say what our conclusion is. The fact that we tend to want to be comprehensive rather than concise, losing people in our details. But if all of that is true, this coolness factor is basically our Achilles heel. People don’t want to listen to you if they don’t like you and they won’t like you if you don’t command their attention. Here’s the challenge, though. What makes something cool? Think that through for a second. Things that we think are cool are usually edgy or bold or imply some kind of action in the face of risk, come what may. Singing your heart out in front of people you don’t know. Cool. Dunking over seven foot tall basketball players. Also cool. Running toward fires to save lives. Also cool. But so much of what people know about public health, telling them not to smoke, to click on their seatbelt, or to watch what they eat. That’s like the antithesis of cool or anti boldness personified. Watch that risk. Be careful of the consequences. So much of what the public knows about us is about the risky, edgy stuff we tell them not to do. But honestly, that’s only a reaction to the risk averse, individualized version of public health we’ve become. See, a long time ago, when public health was about taking on the structures that were hurting people. There was a time when public health was known for picking fights with much stronger foes in the name of the public’s health and winning. And yeah, that’s pretty cool. Rather than just telling people not to smoke, which we should keep doing, by the way, we took on the cigarette manufacturers who were telling them it was fine. Rather than tell people to eat better, we took on the industries who were peddling poisons to kids. And that shit, picking bold fights with opponents many times your size? That shit’s cool. There’s a lot we can do to rizz up public health, as the youths say these days, but most of it deals with the margins if we’re not serious about rethinking our main purpose. We can’t keep being nerds who crunch a bunch of numbers and tell people what they shouldn’t do. As much as that’s really important. We have to be the nerds who pick fights with bullies who are hurting people, and we have to win. My thoughts only crystallized about this a few weeks back when I came across a really interesting talk by a thinker who put in words so much of what I had been feeling. That talk was by our guest today, Professor Jerel Ezell, a social epidemiologist and incoming director of the Center for Cultural Humility at UC Berkeley. He joined me to explain public health swag gap and what he thinks we can do about it. Here’s my conversation with Professor Jerel Ezell.
Dr. Abdul El-Sayed: Okay. Can you introduce yourself for the tape?
Jerel Ezell: I am Jerel Ezell and I’m an assistant professor in community health sciences at University of California Berkeley. And I think there’s a huge swag deficit in public health.
Dr. Abdul El-Sayed: And Jerel, we’re having this conversation right now because I tend to agree. When did you first start thinking about public health’s swag problem or as the youths these days call it, a rizz gap?
Jerel Ezell: Yeah. So, you know, I think part of it is just based off of personal experience. I mean, when you’re working really intimately in public health, so I’m a social epidemiologist and I’ve had a lot of different uh jobs in the public health space. Some of it’s been very academic. Sometimes I’ve been working in departments of public health, and it’s very clear that uh these spaces are just very kind of uh sanitized, they’re very dull, they’re boring. And, you know, at the same time, there’s this element of you don’t really expect more than that in these spaces. But then you start to wonder, what if they were transformed [?] these ways, right? [?] what if we did treat them like, you know, when you’re going into um [?] like Aeropostale or something like that, it’s kind of an old store but when you go into a space that you want to go into, most people don’t look forward to going into a health care clinic, they don’t look forward to going to the hospital, which makes sense. But what if the experience of being there, the way that you’re engaged in terms of your senses, what if it mirrored one of these places where you go shopping right? What if it was like a Whole Foods or something along these lines? And I found that to be a really compelling way to look at some of the issues we have. When you think about the gaps between the uh public and then the Public Health administration and clinical force.
Dr. Abdul El-Sayed: Yeah. You know, I’d even take it a step further and say it’s not just that our spaces tend to have a real swag problem. It’s it’s unfortunately, it’s sometimes our people do too, or at least–
Jerel Ezell: Yes.
Dr. Abdul El-Sayed: The conversations that we share when we’re together, like I’ve seen some super cool public health folks and they get with public health folks and you’re like, what? Why?
Jerel Ezell: Yeah. Right.
Dr. Abdul El-Sayed: Um.
Jerel Ezell: Yeah.
Dr. Abdul El-Sayed: And I want to ask you, what do you think is behind that?
Jerel Ezell: So I think one thing that’s really fascinating is we kind of take the broader view of all this is, it’s this idea of personality. So um when you’re in one of these spaces, this is not something that’s really taught. Now, maybe more, you know, on your end of things, the clinical side, you think about bedside manner, you think about these types of dynamics. But your typical person who’s working in public health, the people who are, you know, at the front desk, these aren’t skills that are necessarily taught. And even when you think about bedside manner, that’s not really expected either. Right? It’s not like you’re going into sales, right? You’re not an NBA. So that that type of skill uh isn’t something that’s cultivated. And also the types of people who have the personality where they’re going to be more into sales and things along these lines or tech. Uh. It’s just not something that you’re going to find in terms of public health. So I think it’s kind of coming from both of these directions. Um. But I also think another part of it is because of the gravity of what we’re dealing with, right? We’re dealing with very complicated things that relate to life and death in a lot of cases. So you don’t expect the type of levity or humor, you know, that you might get in some of these other areas. But I do think part of it also is just the fact that this is not going to attract people who have those really, you know, not to knock folks in public health. I’m in public health. But those really dynamic, outgoing personalities, you’re just not going to have that. And if you do have it, it’s going to get suppressed by virtue of the type of work that you’re doing and the folks that you’re around.
Dr. Abdul El-Sayed: Jerel, what are you trying to say about me man?
Jerel Ezell: Yeah, yeah, I know, right? Yeah, yeah. It’s a no I mean, you’re you’re you’re one of the exceptions, but it’s true. And not all I’m I’m hesitant here to, you know, go out on a limb and start knocking certain public health characters. But like, if I think about any of the the the more prominent uh researchers out there who are doing epidemiology or they’re clinicians, whatever the case may be, they don’t really have these really outsized personalities. Right. So I think in terms of that connection piece, it’s not really there because it’s not perceived as a need necessarily. Um. And another thing that I’ll mention here is also thinking about how uh there’s a lack of competition. So in typical cases, right as a consumer, when you decide which stores you do or don’t want to go to, you have options, right? If you don’t like Target for whatever reason, like the red is too much for you, right? You can go to Walmart. Right? So um you you have those options, right. In terms of how you are engaged with your senses in terms of the customer service but when it comes to public health, you don’t really have it. Now to an extent, you might say you have that when it comes to how you [?], uh how you pick um a health care provider. But by and large you don’t have the same options. And I think when there is that lack of competition, there’s no real impetus to change because it’s like, well, there’s only one show in town, so it’s either us or nothing at all. And I think either directly or indirectly, public health is very, very aware of that and they leverage that in ways that causes them to be a little bit complacent with how they present themselves to the public.
Dr. Abdul El-Sayed: You know, one of the places where I think this has shown up pretty dramatically isn’t necessarily just in the spaces that public health controls, which you’re right, tend to be painted in government sterile. And they’re generally uninviting, uh as you point out in in in one of the slides that you show in a talk that you give on this, they they tend to look like prisons.
Jerel Ezell: Yeah yeah.
Dr. Abdul El-Sayed: Most of the folks aren’t excited to go there, uh and we don’t do much to to try and dress them up. But where I thought this really showed up is in the way that we communicate. And this is the thing about it is, you know, traditionally in public health, a lot of what we do has nothing to do with the spaces that you come see us at. It’s actually what we–
Jerel Ezell: Yes [?].
Dr. Abdul El-Sayed: –do in the spaces in which you are living and working and playing. And when we show up in the competition for ideas, we bring that same complacency about what we’re carrying. And so we assume that because we have science at our backs, we have a monopoly on what people will listen to and that everyone’s–
Jerel Ezell: Yes.
Dr. Abdul El-Sayed: –just going to be drawn by our expertise and the many credentials behind our name and listen to what we have to say. And so we say it in in frankly the most uncharismatic way and–
Jerel Ezell: Yes, right, right.
Dr. Abdul El-Sayed: –and we almost pride ourselves in that. Like there’s a pride that’s taken in being as dry and multifactorial as possible rather than having–
Jerel Ezell: Yes.
Dr. Abdul El-Sayed: –a message with a pop. Right. And that inability to think about our brand or how our brand projects it speaks to a certain failure to appreciate this current moment. So I kind of want to ask you.
Jerel Ezell: Absolutely.
Dr. Abdul El-Sayed: Where do you think our rizz gap developed? Where did it start where we just sort of fell behind, I mean do you think this is just essential to what we do? Or do you feel like this is something that has grown over time?
Jerel Ezell: Yeah, I think if you if you try to construct a timeline for when there was a divergence, which is to say, well, at some point everybody did this one thing because marketing as a philosophy, as a paradigm, wasn’t really a thing. I think that’s fair enough. But what I think you would find is that public health is government in a lot of cases, right? We think about public health, the health department, as the government and the government is meant to be serious, right? It’s meant to be pretty austere. So it just kind of naturally flows that your typical government affiliated entity is also going to be in that particular way. And there’s um I’m not sure if you ever read uh work from uh Max Weber before. He’s a sociologist. And what he essentially says is there’s this idea of a bureaucracy right? [?] Which we all know about. And what it says is that the government is essentially meant to be austere. It’s meant to be kind of boring because it’s such a serious thing. Right? It really is a center of gravity in terms of our rights, our capacity to do X, Y, and Z, right, our infrastructure, all these other things. So it makes sense. And one part of his logic is if it was a little bit more playful, right, if it was like a circus or something like that in terms of how it marketed itself, then people wouldn’t take it as seriously. So uh it’d be a bit of a leap to say that people are following Weber, you know, who was writing this stuff hundreds of years ago, but there is something in terms of how government is projecting itself as an authority. And there is this sense, which is a bit logical, that when people are more dressed up and formal, right, when they’re in their business suits, we take them more seriously than somebody who’s wearing, you know, jean shorts right and a tank top. So there’s there’s something very logical about it. But what has happened over time is that I think, to your point, public health hasn’t adapted. Uh. And there is this assumption, again, to your point, that because we are experts, because we have these credentials, you’ve got the MD or the PhD or the MPH behind your name that you are an authority and whatever I say is really going to be golden. And uh COVID, and it didn’t just start with COVID but COVID was a big, um you know a really a big reckoning point, I think, for a lot of us in public health in realizing we don’t have that type of clout that we thought that we did and that um people are looking beyond the affiliations and the accreditations to say what else are you about? And the other piece here that I think weaves all this together is to think about this idea of relatability. So when you are operating as a clinician, you go out for the most part, I won’t speak for you because I don’t know what you’re thinking in your head, but in general, you’d probably say most clinicians don’t enter into a clinical space and think, I wonder if this patient thinks I’m relatable or not. Uh. They’re probably more thinking, does this person think that I’m credible? Right. Do they think I’m qualified? But the type of insecurity of whether or not I’m relatable is not something that really exists in public health the way that it does in other spaces, where we actually do care a lot more in those other spaces about the extent to which the people who work for the organization are actually looking like and reflecting the the population of the public. Um. And another thing I’ll mention, I’m kind of thinking about this idea of experience. So if you think about your typical store, well, say like in all your Fortune 500 companies, think something like Apple, right? Steve Jobs was hugely, hugely into design from, you know, from the whole 360 type of experience, right. Uh. Both with the product, how the product is packaged, not to mention what the product does and how it’s designed. But those little minute details were really important to him. And then furthermore, if you go in to an Apple store, that is a very unique experience, right? That’s unlike any other store that you’ll likely go into, like a Best Buy, or you know, back in the day, something like Circuit City. So he recognized that. And granted, we shouldn’t expect public health to go out and get, you know, super fancy buildings with all glass. But there is there could be a reasonable expectation that they do more subtle things to improve the spaces. Right. And I think this happens in two ways. There’s kind of those little gestures that communicate to clients or patients in that setting that they actually care about our experience here. Right? [?] walking into a space that feels like a you know mental health ward from the 1910s, I’m going into a space where there’s, you know, a little bit of music playing or something like that, right? Or there’s some flowers up or there’s some paintings or artworks and things like that. Little things that signal that we’re aware that you’re here. We’re not taking that for granted and we also want to make a connection with you, right? We like the same things that you do, and we’re not operating from this ivory tower, which is one of the big perceptions of public health right now.
Dr. Abdul El-Sayed: I really appreciate a number of points you made. I want to draw out one of them, which is that, you know, government, by its nature uh, can’t can’t have swag. Right. And and I–
Jerel Ezell: Yeah. Yes.
Dr. Abdul El-Sayed: –appreciate you bringing up Weber and the the nature of the bureaucracy. But I’d argue that A, a lot of the corporations that we know have a certain kind of swag, they’re huge bureaucracies. They’re just–
Jerel Ezell: Yeah true.
Dr. Abdul El-Sayed: –bureaucracies that care a lot about how they’re perceived. The second, though, is that, you know, I think about the canonical government, good guys and gals and there are fire people, Right?
Jerel Ezell: Yes. [?]
Dr. Abdul El-Sayed: The fire the firefighters got a lot of swag. There’s there’s no question–
Jerel Ezell: Yeah for sure.
Dr. Abdul El-Sayed: –that if somebody walks by like and and the way I think about swag, is like when a when a kid interacts with them, either a teenager or like a toddler. There’s just a sense of, awe, right? And the reason–
Jerel Ezell: Yes, right right right.
Dr. Abdul El-Sayed: –that they got a sense of awe is because those people run into burning buildings. And–
Jerel Ezell: Sure.
Dr. Abdul El-Sayed: I wonder, you know, if a lot of the way we do public health has been about curtailing the implicit risk that people face in their lives. And there is something–
Jerel Ezell: Oh.
Dr. Abdul El-Sayed: –about risk that that is you know, I think that is foundational to having charisma. Right. It’s like–
Jerel Ezell: Sure.
Dr. Abdul El-Sayed: You know, when you see a rock star up there on stage, there’s something about you thinking, man, if that was me, I think I’d I think I’d die, right?
Jerel Ezell: Sure yeah yeah right.
Dr. Abdul El-Sayed: If you see an incredible athlete, right? They’re doing what they did and you’re like, man, that is like putting yourself out there like that.
Jerel Ezell: Right.
Dr. Abdul El-Sayed: And then you think about firefighters and they just run into burning buildings, which is insane, right? It’s incredible that they do it. But like most of us, right wouldn’t willingly every day sign up to run into burning buildings. And I would argue that most people in public health say, nah, I do that every day. And and they’d be right.
Jerel Ezell: Sure.
Dr. Abdul El-Sayed: But it doesn’t–
Jerel Ezell: Right.
Dr. Abdul El-Sayed: We don’t it doesn’t come out the same way. And I guess I’m wondering, you know, for a um for a profession that has in some respects framed itself around telling people not to do risky things–
Jerel Ezell: Right yeah.
Dr. Abdul El-Sayed: Is almost like the anti swag. Right? [laughing]
Jerel Ezell: Mm hm. Sure. Yeah. Yeah. Yeah. Yeah.
Dr. Abdul El-Sayed: Right? And I wonder if it’s just essential to what we do that, you know, we come off as being finger waggey know it alls rather than folks who are willing to brave the odds. And, you know, I want to hear your thoughts on that. I got a follow up question about what it means about how we should be thinking about public health.
Jerel Ezell: Yeah, well, if you think about uh public health kind of broadly right now, we talk a lot about innovation. This has been a big thing for a long time. We’re talking about [?] things along these lines there. There’s this sense from the perception of public health leaders that we are innovative, right? We’re developing new treatments, we’re you know designing new ways to engage with our patients in our communities. But this is speaking to the the product, right it’s speaking to the product, but it’s not speaking to how the product is communicating. And as you are aware, right, there’s a whole field for public health communications or health communication. Right. But it really does not signal this interest in making that relatability connection. Right. There are a lot of studies out there which you’re also probably aware of. Right, that they have like really cool names. They’ll put like, you know, like the the lit study or something like that. Right. Things that are obviously pandering to a certain population, but they’re not really making this case for how we as public health workers or practitioners are similar to you. We’re just trying to speak your language, but we’re not trying to say that we have this sort of, you know, comparability. And if you take somebody right now, think about like people who have been regarded as as cool in public spaces, right? Think about somebody like uh President Barack Obama. Right? Was considered very cool from the outset. That was a big part of his appeal, worked for him, worked against them in other cases, but by and large was considered a really cool president. I think about somebody like Jay-Z, now we don’t expect someone like you or Dr. Fauci to to have that type of swag and that type of personality. But that doesn’t mean, again, that’s kind of the extreme of it. So the argument is that when we talk about swag, that you have to be, you know, decked out in Prada and Gucci and things like that. It’s just to say, can we focus a little bit more relatability and create an experience for people, recognizing that the experience is a big part of of health care, right? It’s not just about what you’re getting. It’s very much about how you get it. And that’s a part of public health that’s really been lost or arguably was never even there. So there’s also that argument that it was never really there. And we’re kind of just catching up and picking it up on trends and other spaces. But one place where we really don’t innovate in public health is communication, something we really do poorly in. And you probably [?] I mean, I don’t think there’s any public health program for MPHs where they teach you about marketing. They teach about communications. And that is slightly different from marketing, right? There’s kind of like this thin margin between them, but there is a distinction between those two. So it’s really complicated. And and I want to try to wrap my brain and think about who are the folks out there who are really recognizable, who are known by the public when it comes to public health? There aren’t many. Right. And and that makes sense in a way where we just don’t expect scientists to be very cool to be uh, you know, like Bill Nye the Science Guy type. But uh what if that changed, right? What if that was a paradigm that we that we sought to change. That I think could be really impactful.
Dr. Abdul El-Sayed: I also think there’s a paradigmatic shift that we need to make in public health, because when I think about what makes, what makes charisma. It is a level of boldness. It’s a level of edginess.
Jerel Ezell: Yes sure.
Dr. Abdul El-Sayed: It’s a level of authenticity. And it is a willingness to to play a role you didn’t have to. And I think what has happened in the last 30 years in terms of what public health is and has been willing to do. Has shifted the way that the public thinks about us. And let me let me try this on for size.
Jerel Ezell: Sure.
Dr. Abdul El-Sayed: I think that in the seventies, eighties and nineties, public health turned inward rather than being the folks who are willing to take on the powerful to protect the public. We became ornery about individual risk factors, and as we individualized, we went from being the folks who step up to those who are more powerful, to the folks who wagged their finger at you to tell you, don’t eat this, don’t smoke, click it or ticket. And not to say that those things aren’t important. They’re very important. And I don’t want anybody listening here to be like, well, wow. Okay. Abdul’s encouraging–
Jerel Ezell: Yeah yeah. [laughing] Right, right.
Dr. Abdul El-Sayed: No I’m not. I’m Just saying that when we stopped being the folks who thought about the environment writ large and started being the folks who were a lot more focused on individualized behaviors, we lost a lot of our rizz. And I think that there is a way for us to regain it. When we talk about things like air pollution or enforcing on that major factory that’s polluting in those kids lungs, or it’s taking on the major corporations that you know spilled opioids out into our communities, or it’s being willing to step up to to policy makers who are clearly right on the take from a large corporation that’s more interested in their well-being than yours. When we advocate for something like universal health coverage, that is the kind of thing that people look at and say, okay, all right, there’s a there’s an edge there. There’s a risk there.
Jerel Ezell: Yup.
Dr. Abdul El-Sayed: Those folks are putting themselves on the line for me.
Jerel Ezell: Yep.
Dr. Abdul El-Sayed: Rather than just telling me not to eat stuff. Right.
Jerel Ezell: Exactly right.
Dr. Abdul El-Sayed: And I think that’s a that is a a a philosophical regression to what was safe that then made us look like people who aren’t willing to actually pick fights that matter. And–
Jerel Ezell: Absolutely, right right.
Dr. Abdul El-Sayed: Until we start doing that, I think we continue to move out. And, you know, this is an issue. I know you’re from right outside Flint, and you you’ve done a lot of work on the Flint water crisis. When I think about somebody who’s got uh a lot of charisma, I think about Dr. Mona, right?
Jerel Ezell: Yeah absolutely yup.
Dr. Abdul El-Sayed: What did Dr. Mona do? She stepped up to the state of Michigan when they wanted to deny that there was a water crisis in Flint that was poisoning thousands of kids. She stepped up and said, You need to pay attention to this data and you need to come to grips with what you’ve done to these children. And I think there was a moment where folks were like, damn, [laugh] she got it.
Jerel Ezell: Yeah.
Dr. Abdul El-Sayed: Right?
Jerel Ezell: Exactly. Yeah. Yeah.
Dr. Abdul El-Sayed: So I wanted to sort of ask you, as you think about where we go from here, what does it look like to get our our swag back?
Jerel Ezell: Good question. So just just to piggyback for a second off of your comment about Dr. Mona, so one thing that was really impressive about that case, and I know Dr. Mona somewhat um because I still actively do work in Flint, is that uh she was one of very few who was willing to say the things that she said ,right? Now it maybe wasn’t one of these really dramatic cases where, like, you know, ten years from now they make a biopic about her. But it was enough to say, like there were some consequences for her decision. And one thing that I found as I was talking with various people in Flint, that there’s actually a considerable amount of jealousy for what she did, in part because she really broke that paradigm of we are scientists, right? We pay attention to data. We are not advocates, we are not political. And there’s no way to talk about the water crisis without getting somewhat political about it. Right. [?] to start singling out specific politicians who were doing right or wrong, but there was something inherently political about what she did, and there’s a lot of resistance to it because the idea of what a clinician should be is very much antithetical to what she was doing. To be out there, to be, you know, like, you know, really kind of on a press tour circuit, having these conversations was very new, right? Is very novel, it’s not something that we’ve ever really seen, especially not in the context of a place like Flint. Right. Um. Another thing that I’ll mention in terms of the this kind of lineage of public health advocacy is thinking about those truth ads. Do you remember those? Related to smoking? Yeah. So um the truth ads I think came out maybe like 15 or 20 years ago, and um they’d be these ads where you have people who were typically like former smokers with some pretty grave you know consequences as a result of smoking for–
Dr. Abdul El-Sayed: I remember these yeah.
Jerel Ezell: You remember those, right? Yeah. So they they’d come on from time to time and people would watch them and, you know, they would be kind of freaked out by it, right, this person’s lost their teeth because of this, right? Like it was it was pretty pretty provocative. Pretty much, you know, people’s faces. Now, I don’t think that there’s probably strong empirical evidence that shows when people watched these ads they started or stopped smoking. But the fact that public health came out and said, we care about this, we think this is important for us to acknowledge and we’re going to put it out there in this really raw way. That’s very provocative, right? That’s very powerful. And I think even those people who were smokers, they have to look at it and say like, yeah, your point, like damn that that’s something. Um. And that’s not something that we really do anymore. We’re we’re much more tame and um it’s hard to look at something like Covid and say, oh, maybe we could applied that model to Covid uh because there’s not a direct kind of apples to apples comparison there. But we didn’t engage in ways that made the public feel like we were relatable, right? We were in the ivory tower. We were wagging that finger at them. Right. And we were being super paternalistic. And, you know, in this day and age and arguably even for this day and age, people don’t really respond well to that. So when I start to think about what are the solutions to this, I think there’s a couple of different paths that you can go. Now, one level you were just saying that we just need to think more about relatability as a genuine question, when you are in a clinical setting, when you’re in a classroom, as I am right with students, to what extent are those people looking at you as relatable and what does relatability get you? So another thing that sometimes I talk about is this idea of equity clout. So it’s very similar to swag. You could say that it gives you more of this swag, but Equity Clout is thinking about what is your level of authenticity, how trustworthy are you? And then as a result of that, how much authority do you have? So to really amplify those types of things, we have to ask those fundamental questions, right? And it’s not just the patience of their students for engaging with this. Like, you know, when you go to Walmart and you’re in line and checking out, right. What about that cashier? Did they look at you and think you’re relatable and not just because of how you dress, your race or ethnicity, but in terms of how you engage with them because there’s this huge buffer that I don’t think existed 50 to 60 years ago. Right where you went in, you knew your PCP and you had some sort of connection. That feels very gone now. I mean, it feels very much gone. A part of it, I think, is because medicine is very much politicized now in ways that it probably wasn’t 50 or 60 years ago. Right. So operationalize that we have to ask that basic question. Am I relatable or not? And we have to stop avoiding some of these more complicated conversations about people’s backgrounds and the politics and not saying, you know, now that we need uh when we do our intake forms to have questions all day about people’s politics, but we have to start thinking about people more holistically because that’s how they look at us. Right on one level, when you go in that clinic, they see you as a physician, but on another level they see this person probably has some politics. They may or may not agree with mine. They may feel this way or that way about these social issues. So we really have tried to be agnostic to those issues, and it’s very much to the detriment of public health. So um the way I see it, I think it’s a long road. It’s not something that I think is being prioritized, but I think we are getting to a point of at least recognizing that there’s a huge gulf between us and the public and having credentials is not enough to make them trust us or want to engage with what we have to offer.
Dr. Abdul El-Sayed: I don’t know if you if you put Anthony Fauci in some buffs, I’d listen to him.
Jerel Ezell: Yeah, [laughter] there you go right? Yeah. [?] I mean, honestly and that that’s a subtle point that people may not know what we’re talking about there. But when they did that with um with our governor uh here in Michigan, Gretchen Whitmer, like are people going to vote for her because of that? Probably not. But at least it’s like, you know, you know, let your hair down a little bit. You know, we don’t have to be so serious all the time and know when you’re going in to get you know tested for chlamydia. You don’t want to have, you know, a rollicking time. But there this argument that we can kind of rest a little bit and we can be ourselves a little bit more. And that may be just enough to get a person to see us as more than, you know, the institution and the man. So.
Dr. Abdul El-Sayed: Yeah.
Jerel Ezell: Yeah.
Dr. Abdul El-Sayed: I think there’s–
Jerel Ezell: Get the buffs out if we can. Budget for that.
Dr. Abdul El-Sayed: [?] if not– [laughing]
Jerel Ezell: Budge for it yeah.
Dr. Abdul El-Sayed: I’m gonna talk, I’m going to talk to the the county executive and see what he thinks. Um.
Jerel Ezell: Yeah. Let’s do it. Let’s do it. [laughter]
Dr. Abdul El-Sayed: For public for public purposes only. [?]
Jerel Ezell: I mean just as an experiment. If you went into the clinic and you had some buffs on, like you cannot tell me. Yeah, I mean, it’s not going to be like, Oh, I’m going to come back here, you know, like every other month. But, like, people would have a very different perception of you, right? There’s no doubt–
Dr. Abdul El-Sayed: There’s no doubt.
Jerel Ezell: –about it. It may not be worth the money, but it would. Right. At the same time it’s silly but–
Dr. Abdul El-Sayed: There’s no doubt.
Jerel Ezell: –it would happen.
Dr. Abdul El-Sayed: Next time I do a press conference, I’m a just go, I’m a pull down my buffs a little bit.
Jerel Ezell: I would love it. I would love it. [laughter]
Dr. Abdul El-Sayed, narrating: We’ll be back with more of my conversation with Professor Jerel Ezell after this break. [music break]
Dr. Abdul El-Sayed, narrating: And we’re back with more of my conversation with Professor Jerel Ezell.
Dr. Abdul El-Sayed: And there are a couple of things that that that you shared that I really want to pick up on. The first is that, we tend to think of our communication as episodic, meaning we only show up when we got something to say. And when you talk about relatability, right, the first piece of that word is relate. And sometimes you just got to build a relationship with folks, and it’s just showing up, you know, in the mundane moments um to talk about the things that people are thinking about and getting out in the community. I think there’s there’s this sense that sometimes we only need to show up in a crisis and then we uh wield our credentials over folks and they shall listen to us rather than having been out there and having conversations that um that that really focus on the issues that are that exist in the nitty gritty of people’s lives. I think there’s also a true elitism problem in just the way that we talk.
Jerel Ezell: Yes. Yes. Mm hmm.
Dr. Abdul El-Sayed: We use words that I don’t think we think through, but feel intentionally uh elitist that they are–
Jerel Ezell: Yes, 100% yeah.
Dr. Abdul El-Sayed: They are big words to describe small ideas that um feel like we’re talking down to folks. And when we’re engaged in a discussion about something as critical as people’s health, nobody wants to be to be made to feel stupid.
Jerel Ezell: Yes right.
Dr. Abdul El-Sayed: And unfortunately, that’s kind of how we talk. And then when people challenge us, rather than trying to explain ourselves in more simple language and and having the humility to engage and to recognize that the only value of our work is that other people pick it up and do something with it, right? We tend to fall back on our laurels and try and–
Jerel Ezell: Yes. Right.
Dr. Abdul El-Sayed: –you know statistic the hell out of people and that’s just not effective. And then the last piece is um thinking a little bit about about how we um engage in the challenges that are a problem to people but don’t feel like a problem to us. And that’s, I think, one of the biggest challenges I’ve always seen in terms of the way we communicate. Like, you know, you think about the the vaccine campaign and we’ve talked about this before on the show, but the number one thing that undercut the vaccine campaigns is the fact that a lot of the folks who did not get vaccinated for COVID 19 were folks who did not have health insurance. So imagine when we deny them access to health care, meaning you cannot come to this clinic or hospital and get the care you need, and then all of a sudden we’re like, but here’s some care for something you don’t even know you obviously need because you’re not even sick yet. So imagine you’re somebody with diabetes. You’ve had to ration your insulin your entire life. And they’re like, I know you won’t give me the medicine I know I need. And now you’re coming to me with some medicine that you’re telling me I need.
Jerel Ezell: Right [laugh].
Dr. Abdul El-Sayed: But but didn’t exist last year?
Jerel Ezell: Yeah. Yeah.
Dr. Abdul El-Sayed: So, you know, and we don’t have the empathy to to step into somebody’s shoes and be like, I wonder how that would make me feel. And I think that really I mean, when you know when you think about inequality. We think about it in this grand sense of like the extremely rich and then extremely poor.
Jerel Ezell: Yes right.
Dr. Abdul El-Sayed: But we don’t think about the inequality of experience and–
Jerel Ezell: Absolutely.
Dr. Abdul El-Sayed: The fact that, you know, what seems plainly obvious to someone with a Ph.D. in epidemiology or another public health field is obviously not plainly obvious because it took you how many years to get that stupid degree, and then you can’t sort of climb down your ivory tower ladder and put yourself back in the life of somebody and be like, I wonder how this seems to you or how you’re experiencing it and what can I say and how can I say it in a way that explains it to you in language that is not the one I took seven years to, to learn. Right, but is language that I–
Jerel Ezell: Abosulutely.
Dr. Abdul El-Sayed: You know, walked into my college knowing. Right? Because that’s the reality of the majority of people that we’re trying to um support and empower. And I just think that, you know, part of this is this this notion that we think we’re smarter than other people when–
Jerel Ezell: Yes absolutely right.
Dr. Abdul El-Sayed: –really more than anything else, it’s a privilege gap. And then we just exploit that privilege gap in our discussion and wonder why people on the other side of it don’t want to listen to us.
Jerel Ezell: Absolutely. Yeah. Yeah. I mean. Yeah. I couldn’t have said it better myself. There’s a huge set of presumptions that come with the work that we do. We have and and granted, you know, when you have knowledge and expertise, it is hard to look over. I’m sure you know I had a patient who doesn’t have the same competencies as you do and say, I’m going to listen to you. I’ll let you kind of articulate what your condition is right, and what you think is the best way to approach it. But that really is the essence of shared decision making. But to really kind of suspend that um that that [?] that we have, that is a really difficult thing to do. Right. And it’s not restricted just to public health. It’s a universal thing. Anytime that you have more power or capital over other people, you think, I’ve got something you don’t. So I’m really not in a position where I should be listening to what you have to say. And yet these are what people are screaming out saying is essential in order to make that connection with them. So, you know, the question of what does it take to get there? On one level, I think comes back to this idea of evaluation. So everything that we’ve talked about here, I think people could be listening and say, well, how do you measure any of that? Right? How do you measure a person’s equity clout? Right. How do you measure their swag? Those are very difficult things to articulate. Right. And certainly, like there’s no clinic that has you know a form that patients fill out to say, hey, you know, how much swag do you think your doctor had today?
Dr. Abdul El-Sayed: Five star swag or four star swag?
Jerel Ezell: Yeah, exactly. [laughter] And as cool as that would be right. But on some level, it’s like maybe we kind of need it. And obviously that would drive clinicians crazy to have to live up to that standard as well. But those aren’t things we track, right? We track patient satisfaction, but it’s not really along the lines of like when I talked with this clinician, like they are respectful of my race and ethnicity, right? That’s not a question. When I talk with this clinician, they’re respectful about my politics, right? Or they ask about my politics, all these different facets that would give us a sense on the other end as epidemiologists, as health care administrations, in terms of connections, we don’t really capture, right? We have very antiquated metrics for looking at that patient experience. And that’s why people are starting to tune out. And that’s why we’re having these deep, deep, deep persistent disparities, because people don’t trust us, right? They don’t feel in connectivity with us. And it it seems at least to me, very obvious that that’s a problem. Obviously, it’s less clear what the solutions are, but it seems like it’s kind of hiding in plain sight some of these issues.
Dr. Abdul El-Sayed: I want to um close out just on two questions. One is about the efforts that sometimes we make. And one of the words that came out of our conversation that I think is really important to remember is authenticity.
Jerel Ezell: Yes.
Dr. Abdul El-Sayed: And sometimes in public health, you people try to make up this swag gap by doing some of these just the most cringe things.
Jerel Ezell: Yeah. [laughing]
Dr. Abdul El-Sayed: And and I want to I wanted to ask you. You know, why do you think we keep doing stuff like this? It’s just everybody knows it’s ridiculous. And–
Jerel Ezell: Yeah.
Dr. Abdul El-Sayed: And yet we do it. And then not only that, but in public health, we’re like, here we are. Right. And then in your talk, you cite that famous meme of like, how are you fellow youths?
Jerel Ezell: Yeah. Yeah yeah. [?]
Dr. Abdul El-Sayed: And it just feels so absurd.
Jerel Ezell: Yes.
Dr. Abdul El-Sayed: Why do you think we do that rather than just showing up authentically as who we are and respecting that like, you know, many of us are in this field because because deep down inside we really love numbers and we’re super nerds. But there’s a way of–
Jerel Ezell: Right.
Dr. Abdul El-Sayed: –communicating that love of numbers that’s authentic to who you really are and that people will respect and appreciate. Right? And but you can’t show up and try and be something you’re not. Why do you think we keep doing this?
Jerel Ezell: I think I think part of it is because it’s low hanging fruit. It’s not that hard to have you know, a a certain week dedicated to a certain population or certain study and just like add in some cool hip words, add in, you know, ri– you know, for example, there could be something that’s very kind of meta about the talk that I gave, the fact that I’m introducing swag. People become more interested in it automatically. Right? I had people write me and saying like, Hey, like, what is this? Like, what you’re talking about swag? What is that about? And that’s kind of the point, right? That when you introduce something new, that’s kind of silly and fun, but also you look at it and say, that is possible. You could have a lack of this one thing, then that becomes interesting to people. Right now obviously you have to go in and deliver, and make it compelling, but at least on the surface, that’s not something that we do. So when you think about what’s been done histori– I think one part, you would say, and I’m not trying to make this um, you know, something that that’s ageist, but it is a generational difference. So if you kind of spend your life on the fringes of, you know, the millennial culture and you’re paying attention to the news from time to time, you see TikTok is a big thing. You’re going to say, let’s go to TikTok and that’s where we should, you know, recruit for our study. Right? Meanwhile, you’re going to get a very specific type of person there that’s not going to be totally representative. So there are people who are in public health, are kind of grasping on to whatever they’re hearing, certain words that are being used by youth and saying, hey, let’s do that, because then once they see those words, they’re going to want to jump into that study. Right. And these things aren’t really happening. So the other part of it. Right. And, you know, we’ve been a bit cynical about these folks, You would say, well, you know, they’re well intentioned. And I do think that’s very true. Right? Because I’ve certainly had studies.
Dr. Abdul El-Sayed: Definitely.
Jerel Ezell: I’ve been tone deaf. But they’re well-intentioned. Right. But still, there’s this very obvious dimension of if you want to connect with these groups, you need to learn what their pain points are, right, and what their touch points are. And we also don’t do that. Like, how often does a public health department or clinic go out and say, hey, we’re going to, you know, try to educate you around PREP or we’re going to talk about, you know, getting screened for HIV AIDS, What sort of things would you like us to talk about? How would you like it to look? Uh. The other thing that I’ll say just quickly here is that one thing we’ve done I think well is like we are a little bit more inclusive in our advertising. So when you see commercials for different types of medications, like you’ll see a fairly diverse group of people, right? That is a vast improvement because ten, 15, 20 years ago only people who appeared to be getting any of these medications or interventions were pretty much you know white people. So that is an improvement. So it’s not all bad, but the disconnection comes from the fact that we don’t talk to people to say, What would you like to see? Well, we don’t do that because we’re looking at the evidence and saying, I don’t need to ask you because I’ve already read this lit review about it. So, you know, I’m just going to rely on that. And that is kind of being, you know, really linked up and chained to evidence as opposed to experience. And those are pretty significantly different things. And potentially elitist.
Dr. Abdul El-Sayed: Last question I want to leave you with is a lot of our listeners may not work in public health. Some of them do, but most folks don’t. And they’re involved in public health conversations consistently. I mean, we just had a new COVID 19 vaccine drop. And–
Jerel Ezell: I like how you said drop.
Dr. Abdul El-Sayed: Well, like–
Jerel Ezell: Like it’s a new album coming out or something [?] [banter].
Dr. Abdul El-Sayed: You know. I’m just trying to I’m just trying to take notes. I’ve been taking notes on this entire conversation. It’s like just speak like you [?].
Jerel Ezell: So you’re saying, like Drake’s album just came out. Okay. [laughter] Yep. Got it. Got it.
Dr. Abdul El-Sayed: So so now we’ve got this new COVID 19 vaccine, and you’ve got folks trying to have conversations with their loved ones about taking it. And it is hard not to feel school marmy. Right. It’s hard not to feel finger waggey. And–
Jerel Ezell: Yep.
Dr. Abdul El-Sayed: And and I think that, you know, that that sort of the public health uh rizz gap translates even into having public health conversations, even if you’re not in public health. So–
Jerel Ezell: Yes.
Dr. Abdul El-Sayed: How do you recommend, you know, folks out there doing the good work, whether they’re advocates or they’re professional professionals in public health or just try to have a conversation with grandpa? Like, how do you bring some of this um to your communication and how do you do it in an authentic and honest way?
Jerel Ezell: So that’s a that’s an excellent question. So in my opinion, I’m going to I’m going to lean a little bit on the evidence that I’ve read versus what feels like something that’s fairly intuitive to me at least. So I think with all this type of work, anything that’s related to persuasion, persuading people, it usually falls along one or two lines. So one line is going to be, I’m going to make an ethical argument for you. Right. So if you take something like diversity trainings, which is something we do, we say, you know, you should take this training on anti-racism because it’s the right thing to do and makes you a good person. So that’s one argument. And what we know from COVID is that that does not resonate with a large number of people. And more importantly within that, it’s also kind of irrespective of race, ethnicity, class, etc., etc., which is to say when people hear that they don’t feel like this is really a moral thing. It’s not ethical for me to take this vaccine. There’s something more to it. So that’s one path. The other path is a more practical one where we say, you should take this because it’s going to offer these particular types of benefits. Right? And on one level, you’re kind of making the same case, but you’re also extracting all that moralistic argument. Right. And what we saw during COVID was really not in my mind. I mean, it was definitely resistance to vaccines and public health, but it’s also resistance to people telling you what to do. Right. And people making it seem like you were bad if you didn’t do that particular thing. For those of us who are pro-vaccine like us, right? We’d say, well actually yeah, maybe it does make you a bad person to not want to do this, but that is a very heavy handed message. And that was the one that initially kind of came out, right? And we did spend a little bit of time talking about collectivism, but we’re not a collectivist culture, right? We have collectivist cultures in the United States but biologically aren’t that. So you’re delivering a message when you are making that more humanist message about collectivism. But that’s not us. We’re not really a community driven type of country, like we have our ethnic enclaves in places like Detroit and elsewhere. Right? But by and large, that’s not what we are. So the message was just inherently wrong right from the get go. Now, does that mean if we had gone with the more one of these more practical approaches of saying, if you do this like it’s you know going to contribute to better health for you, etc., etc., maybe that would have worked a little bit better. But in general we went in too heavy handed and that really just turned off a lot of people. So I think when we’re in these spaces it’s worthwhile for us to think about those two avenues, right? Either I’m going to give you that heavy handed response for the ethics of it, and sometimes that does work. Or I’m going to give you the more practical side. And then the other part of it, so folks don’t end up, you know, tearing their hair out over um Thanksgiving dinner is saying, well, some people, they’re just not going to get there. Right. If you are just adamantly opposed to this idea that you should have to do anything related to public health that kind of comes from this policy type of uh, this overarching policy type of idea. There’s not going to be any number of things that you can say that convert a person. So I think for everybody’s sanity, it’s worthwhile to think about that. You know, probably a relatively small fraction of people who aren’t going to be moved at all. Um. The other thing that I will say is people when you talk about authenticity and authority that come from lived experience. So um again, as a clinician or even as a researcher, when you are across from that patient or the research participant, on some level they want to know, have you gone with this too? Right if you’re telling me that I should be taking this diabetes medication, have you taken it before? Do you have diabetes? Does anybody in your family have it right? And we’re not going to like go out and try to get diabetes right as practitioners. But it’s a legitimate point, right? We expect people who are telling us to do certain things that have lived with that experience. And when that hasn’t happened, there’s this huge disassociation. So when people during COVID were observing their politicians going out unmasked, not social distancing, that contributed more and more to that disassociation. Right. And we’re all just people, right? We’re all kind of slipping and, you know, sometimes cutting corners when it comes to these regulations. But those things add up. And if you’re not living what you’re saying you’re living, then that’s going to be very problematic and rightfully so.
Dr. Abdul El-Sayed: Well, on that note, we really, really appreciate you uh coming and and, educating us on this a, this swag gap. And uh I promise we’re going to do the best we can in the most authentic way possible to to address it. And uh–
Jerel Ezell: We’ll be watching. [laugh]
Dr. Abdul El-Sayed: You know, when I tip those buffs down, you know that’s for you. [laughing]
Jerel Ezell: Thank you. I’ll be looking for that.
Dr. Abdul El-Sayed: Well, look, we uh we really appreciate you. Our guest today was Professor Jerel Ezell. He is an assistant professor in community health sciences, and he also serves as the director of the forthcoming Berkeley Center for Cultural Humility. Jerel, we really, really appreciate you joining us. Thank you.
Jerel Ezell: Thank you. I appreciate it. [music break]
Dr. Abdul El-Sayed, narrating: As usual, here’s what I’m watching right now. The state of California is the first U.S. regulator to ban four food additives already banned in Europe. The banned additives include brominated vegetable oil, potassium bromate, proplyparaben, and red dye three. These additives are common in candy, juice based drinks and some desserts. Predictably, the right is labeling the move as a nanny state, trying to tell you what you can and can’t eat. But let’s cut right to it. I’m not clamoring to eat propylparaben, are you? This is about protecting folks from harmful chemicals they don’t even know they’re eating. And forcing corporations to spend their own money to find healthier alternatives. The truth is, they’ve already found those alternatives. These four have already been banned in Europe, and food manufacturers have just had to adjust, albeit their costs are slightly more expensive. Here’s the thing, though. They just don’t want to spend the money to make sure our food is as healthy. And now they’ll have to. Meanwhile, in more local leadership for health, state governments are exploring ways to reduce prescription drug prices for their residents. Taking a page out of the federal government’s playbook. Many of them are exploring negotiating prescription drug prices on behalf of the residents. Remember, right now, aside from ten prescription drugs, the federal government will start negotiating for Medicare beneficiaries. The federal government is legally prohibited from bargaining on federal taxpayers behalf. Don’t forget, almost every single one of these drugs is one that the very same taxpayers already paid to discover through grants to scientists. But state governments don’t face the same prohibition, and they still negotiate for large numbers of people. So states are stepping into the gap, working out ways to address the ballooning costs of prescription drugs. Eight states, including Maryland, Colorado and Minnesota, have created price review boards that can limit the costs that either local government entities or in some cases, individual residents themselves have to pay for their medications across the state. And that could be a big deal for residents. Finally, a cycle of murderous violence erupted after Hamas attacked southern Israel by land, air and sea on Saturday morning. The carnage was immense as thousands of rockets were fired into civilian sites and civilians were brutally murdered and taken hostage by militiamen. We taped last week’s show on Friday. I haven’t had the chance to say this here yet. As a physician and public health leader, I condemn Hamas’s brutal attacks on civilians. And that’s because civilian lives should always be off limits, because I condemn attacks on all civilian lives. And since the attacks last Saturday, the Israeli military has responded by cutting off food, water, Internet, gas and electricity to Gaza and bombarding what has been called by observers the world’s largest open air prison with missiles. Hitting targets, including hospitals, mosques and apartment blocks. As of Sunday morning, more than 2400 Palestinians have been killed, including 800 children. That also includes 27 American citizens. This is being justified in too many minds as Israel’s response to the attack by Hamas, a known terrorist organization. But since when was collectively punishing millions of people justifiable? Since when was bombing hospitals and houses of worship justifiable? What about the 800 children who died? Surely they weren’t Hamas terrorists, were they? They can’t be responsible for the attack on Saturday. They were born in an open air prison that has been blockaded economically for decades by the very government that now killed them. We can both condemn the murder of innocent civilians in Israel and in the same breath condemn the murder of innocent civilians in Gaza. In fact, any real belief in the equality of all human life demands it. The innocent Israeli civilians murdered does not trump the humanity of the innocent Palestinians murdered. We talk a lot about health equity on the show and at the very basis of health equity, the most profound goal is that we value all life equally. And that’s just it. Feels right now like there’s a double standard. We’re appropriately mourning the lost lives of innocent civilians in Israel, condemning the people who took them while using statistics to sand down the humanity of Palestinians. Numbers to be ignored as the collateral damage of a response. They are human. They have dreams and hopes, aspirations and fears, as did the 1200 civilians were killed by Hamas. And today I’m just asking that we venerate their humanity equally. [music brak] 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 on 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 view and opinion of Wayne County, Michigan, or its Department of Health, Human and Veterans Services.