Host: Hello everybody. Welcome to today's show of Health Chatter. We're going to be talking about, ready? Public Health. Now what? And um, and hopefully we'll have some happy endings to to this show that can uh, give us some insights on where we should be going. We have a wonderful, wonderful guest with us. I'll get to to John in just a second. Wonderful crew that's been with us for a long, long time. Uh, Maddie Levine Wolf, who's helping us record today's show. And she also does some research for us. Aaron Collins, Deandra Howard, Matthew Campbell and Sheridan Nygard, all incredible colleagues. Uh, they help us with research, marketing, production, the whole nine yards. Um, we couldn't be doing these shows with without them. They're a wonderful, wonderful crew and um, I I I try to give them virtual hugs every day. So they're they're wonderful, wonderful people. Dr. Barry Baines is with us today. Uh, uh Barry will provide some medical insight into our our discussion. Of course, there's Clarence Jones who's my partner in putting out these health chatter shows to all of you, the the listening audience. Human Partnership is our sponsor, wonderful community health organization, provides very, very creative and insightful programs out in the uh in the public. We encourage you to check them out at Human Partnership Alliance.org. We've that's that that has changed slightly so check that out. Human Partnership Alliance.org. Check us out Health Chatter at healthchatterpodcast.com where you can see all the background research. We put that on. We do transcripts of the shows and you can see all the shows that that we've produced and you can listen to them again if you if you like. They're all really, really good. Today is a real special special guest. Uh, Dr. John Finnegan was the former Dean of the School of Public Health. And, um, we go back to episode number one of of Health Chatter where we invited John and and I remember back then John, um, we invited you because we knew that Health Chatter or at least we wanted Health Chatter to be a communication vehicle and you with your your incredible background in communications was a natural fit for that first show. So, um, and and listening out, you can still hear that great show, number one show. And now we're at 125 or so. and we have to have John back for this subject. So John is the former like I mentioned, former professor and Dean of the School of Public Health, received his his masters and doctoral degree in at the University of Minnesota in uh mass communications. He's a board member and has been on boards and is still on boards going going forward. Um, and it's because a lot of people recognize his, um, his insights and his abilities to really put a lot of things in perspective. So, and that's included things like Children's Heartlink, Healtheast, Associations of schools and programs and public health, etc. He's done a lot of research and the list would be a mile long, um, listing all the different awards that that he's got. He's really, really a dear colleague of mine, for sure, I can speak for myself. Uh, we've been linked for a long, long time and, um, I really greatly appreciate you being on the show today, John. So, welcome, welcome.
John Finnegan: Oh, thank you. Thank you so much. I'm on all these boards because they can't get rid of me, I think. That's
Host: Oh, I don't know. But they don't they don't they don't want to get rid of you because of your your insights. So, all right, let me kick this off a little bit and um, all I'm going to say to everybody on the show here is just chime in um, with your ideas. You know, we're we're living, you know, at at one point we used to say we're living in interesting times. I've kind of changed that to I think we're living in troubling times right now and it's creating a lot of, um, anxiety, angst for, um, a lot people in general, public, um, professionals in uh in this case in in health fields, etc because I believe the the underlying aspect of it all, at least for the professionals is trying to do good and trying to help people with with their health and and medical issues. So, um, there are a lot of different things that are kind of, um, hitting us. But, um, first and foremost, I I guess I'd like to get a perspective from, you know, with what we're going through right now and where it might lead. So John, maybe take that and run with that. You're
John Finnegan: Yeah, I'll do that. I think that the phrase you used is a good one. it it I think it's been I've learned it as uh it's either a Chinese blessing or a Chinese curse. And I think it's may you live in interesting times. Yes. Uh if interesting means unprecedented, then certainly that's exactly where we are right now. Um, I you know, I'm going to uh say a few things here about where I think we are and and uh this isn't necessarily going to sound very hopeful, but I think it is realistic. And I think it's important that we face this in a realistic way. And this of course has with has to do with our current administration in Washington DC. And uh I think that we are headed for a global health crisis and it's going to have far reaching consequences and my point here is that it's not just about the dismantling of health research, of public health infrastructure, you know, laying off thousands and thousands of people uh in the federal government and now of course, that has a ripple effect. We're laying off uh hundreds in uh in local health agencies including our own dear Minnesota Department of Health. When you look at all of this, the US was probably the world's biggest player in public health. And closing USAID and uh really cutting back on people working for the CDC and the 34 uh at least 3,400 and perhaps even more that we're working for HHS. This loss of uh person power, this loss of uh person years in experience, this loss of excellence. um, makes no sense to me first of all because I I understood that uh we were going to have make America healthy again and I don't understand how that happens when you're dismantling everything. But the the I think the outcome of this and you're already seeing some of this discussion that's going on, uh you're going to see increased mortality and morbidity worldwide because the US is not there anymore. We're not providing the the drugs and the treatment. Uh Sub-Saharan Africa is a perfect example of this. Uh we are see we will likely see rises in drug resistance. We will see threats to global security on a variety of different levels. And basically, the US is pulling out of WHO and uh uh uh taking apart USAID. Um, is undermining the global health infrastructure and we have played this role really since the end of World War II with the establishment of the United Nations and later on with the establishment of the World Health Organization. This is scary stuff to me because uh um, you know, the US becoming more isolationist as it was in the early uh 20th century isn't viable anymore when you talk about, you know, travel, when you talk about uh the ease of getting uh around the world. That really worries me. And um, of course as I mentioned, this has a ripple effect on local health agencies. It affects the health, the the uh state health agencies first and then it affects the counties. And as we know in the United States, the primary responsibility for public health is not the federal government, it's the states. And the states are heavily assisted by the federal government and cannot really do their job unless that assistance and that expertise is there. So I want to get that out there first of all so that uh that we understand this is uh likely going to go on. I think it is a global health crisis. It has far reaching consequences, some of which I probably haven't even uh touched on here. Food insecurity would be another area, um, that's affecting so many people. Um, and that's the situation that we're in right now and I think we certainly don't want to see it get worse. We want to see this situation improve in some way and that's what I think we have to grapple with. Those of us that are that are in the professional medical and the professional public health uh in any wing of the health professions. We really need to sit down and figure out what's next? How are we going to be able to deal with this and improve the situation.
Host: Well, you know, for me, the the the
Patty: thank you. Uh Dean, I think one of the things for me is this, from a community perspective, uh, I want to know who's benefiting from all these changes.
John Finnegan: Good question.
Clarence: I mean, I mean that that that for me is who's benefiting from from from I mean, you know, the uh, uh Follow the money we used to say in journalism.
Host: Yeah, right. Yeah. I mean you can't you can't make this up. I mean it's just like it's going to have effects for for sure. So John, let me let me ask you this, you know, you know, for those of us who have been involved in public health, you know, we we say that we have said that many of the things in public health, um, are invisible. Okay, but yet it's it's helping to maintain the safety and health of of communities and and and populations. Um, do you think that's part of the problem? That that it's that it's it's kind of reached a head where, okay, if it's so if it's so invisible, who cares about it? Do you think that that's a a sentiment that that could be hurting us?
John Finnegan: Yeah, it's sort of out of sight, out of mind is the the mechanism and and I think that there's a certain amount of that. You know, I've been working in public health since 1980 and and that was one of the first things I learned is that uh there's so much of the public that doesn't understand what public health effects or changes or or uh supports. And uh and the reality is, the reason, part of the reason I got into public health was because of uh community uh partnerships that were going on for the prevention of heart disease and things of that kind. And uh the people that were running those out of the University of Minnesota recognized that hey, communication is going to play an enormous role in this whole thing. Now this is in the analog days. This is long before we had uh the uh digital communication we have today. But it it they realized that it was extraordinarily important that you get out there and actively talk about prevention and promotion of healthy activities and and so forth. And so, um when they started these studies, they said, wait a minute, we don't know anything about communication. So that's when people like me and I'm more in the academic side. I was a journalist at one point, but I moved into the academic side of communication. And that's how I actually got involved in public health because people like me and the social and behavioral sciences were starting to flood into public health. Well, that was as I say, it was the analog era. Um, things changed is when we moved into the digital era of communication. And that's when it became possible for people to isolate themselves in their little bubbles and you know, you only listen to MSNBC or you only listen to the Fox News or Newsmax or whatever it is. And um, and it becomes almost cult-like in some way and anything outside of that bubble, you don't necessarily see as true. But to get back to where public health is, the the um, I think people have taken a lot of things for granted. Um, nobody sees or sees uh seat belts as public health anymore, but that saved an enormous number of lives every single day, you know. Right. And uh and street lighting. I mean, simple things, street lighting. Uh, we didn't have a uniform plumbing code in the United States until 1918, if you can imagine that. So you had all kinds of diseases and and cesspools and things of that kind. All of this stuff is is public health. It's and uh I know uh Dr. Banes and I were talking about this a little bit earlier. Um, you know, what's the difference between medicine and public health? Well, rather than focus on the difference, let's say we work together, but we work uh generally in different ends of a spectrum of supporting health. And those of us in the public health side and docs are in the public health side too, by the way. They help with populations. We look at a whole population, a whole state, a whole country if you will. And we look at what what are the diseases everybody's suffering from? What are the major things people are suffering from and so on. Docs are very uh are certainly into that, but they're also into providing the individual with care. But I think over time, we've seen enormous advances in public health to the point where a lot of it is taken for granted and that's the problem of the invisibility issue. So I I do believe, um, that's uh certainly something that we need to have conversations about with the public and especially after COVID now, um, I think there's there's uh an enormous amount of of lack of trust. Not in public health per se, but in institutions that surround public health, like health departments and things of that kind. I think that's part of the issue. And there are things we can do in the communication world, lots of things that we can do to uh to try to rebuild some of that trust.
Host: Barry, go ahead.
Barry: So what I I I guess what I'd like to do is uh try and make the invisible of public health, make it visible uh from a a physician perspective. Um, and and there's a couple of analogies I I could use but um, you know, when you're a physician in a clinic or a hospital, uh, you know, even, um, you know, you're you're still pretty isolated and and all you can see is what you could see out your window and you don't know what the landscape looks like. And public health provides that view of of a wider view of what's just, you know, beyond across the street. How does that play out, you know, when I was in an active practice? Well like the morbidity and mortality reports would be very helpful for me to knowing sort of like, well what diseases are going around in my community so that I'm a little bit more aware of it because sometimes they're not the most it's not everything is just a common cold or an ear ache. Um, so that there may be, you know, things for me to that surveillance just lets me to be more aware of those kind of things as it's happening. From a real preventive part, which is really the bulk of what primary care physicians, what family physicians do is how do we keep people healthy? It's, you know, you want to keep them away from um all these acute problems. Uh you talked about seat belts, that you know, that's a prime one. Um, we had a show on not too long ago on gun safety, um, and you know, trigger locks and thing and how that has actually uh from a death perspective kills more kids than just about an anything else. So it's sort of introduces uh and again, this is public health that a family physician could take that information and translate it into communication with my patients. And what I'm talking with my patients, it doesn't really doesn't make a difference what their political, you know, who they vote for. Uh it's, you know, how do we keep, you know, how do we keep them healthy? And so, um, and physicians offices and many people might not not know this is that we do rely on public health information in order to make better decisions and helping our patients. And then one other piece I just want to talk about. Maybe I'm reading a little bit too much science fiction with dystopian universes and things like that. But what I'm most afraid of is seeing the dismantling of uh structure and information not only locally but globally. You know, John, as you pointed out and my biggest fear is that we're going to have like a descent into the dark age. You know, I mean it's a different version, but a version of the dark ages and health, um, because we're going to lose so much and it's, you know, it's much easier to wreck something than it is to build up again. If you ever did any house stuff, you know, I did kitchen remodeling. Well, I had people to do the remodeling, but I got to use a sledgehammer and within two hours I knocked out walls and stuff like that. It doesn't take long to wreck something. Uh, but you know, you can't put that wall back up in two hours. And that to me is um, how do we maintain enough reserve, um, so that when we get to a time of reversing the destruction and go back to, you know, building what would be a better society and better health, you know, etc. So that's the that's the stuff that makes me lose sleep quite honestly.
Host: Yeah, I I get it and you know, this is this is where I I do think that there are approaches that we can use um until the country recovers its senses uh and it will at some point, you know, whether it's two years from now or four years. But uh one thing I mean communication certainly is part of it. I think that that um uh you know, transparency with people, I think admitting uncertainty with with people and again this isn't from the public health perspective. Uh listening. Uh sometimes those of us in the academic world are not so good at listening and listening I think is really critical. But this is and this is where I want to uh Clarence to jump in if he will. I think one of the really critical areas of this is community partnerships. Uh there's no doubt in my mind that um if you can empower uh local leaders, if you can work with local leaders in a whole variety of different sectors, are you know, uh faith leaders, barbers, teachers, you know, people that are trusted messengers in the community. I think you can break through the bubbles with people. Uh it's got to be consistent and it's got to it's got to happen um in a an ongoing way. And the other thing is is that um so much destruction of the infrastructure has happened even up to now, um, that I I really think you know, the states as I mentioned at the beginning, states have the primary authority for public health. And um, I would say this is a point where the states, previously have depended very much on federal government funding and I think one strategy that they're going to need to look at here over the next couple of years or four years is how can they um form let's say regional collaboratives or interstate compacts and focus on data and so forth so that we're not just seeing the data in Minnesota which is important to us, but you know, whatever happens in Minnesota is going to happen in the other states, you know, especially if we're talking viral or infectious diseases in some way shape or form. And I think that's going to be the state Departments of Health. I hope who will be motivated to form uh perhaps regional uh partnerships or interstate compacts or something like that. And I think there are also going to have to partner differently and I would say partner with academic and non-profit institutions to get some of the resources back because you know, I know we have a lot of resources in the University of Minnesota. It's a big R1 university and almost every state has a an R1 or R2 university. So I think that's going to be important, but I think also, um, you know, partnering um with private sector organizations, um find those businesses that can that can really help us out and and build rebuild or or or uh on a permanent or temporary basis. And you've got to engage better as Dr. Banes was saying, you really got to engage better with local health systems. and um healthcare systems and so forth. And you know, there's some other tricks that we've learned during COVID that work really well. One is, um, let's focus on wastewater and environmental surveillance. Wow, did we learn a lot from that. Uh, you know, from the standpoint of what's in the wastewater, it gives us a sense of of what's what viruses are floating around and so forth. So that's an area. And then I think wherever we can, we've got to go after the regulatory and the legal tools that may be available to us to assure that we can do the job that needs to get done until the country returns to its senses politically.
Host: So you know, one I think you know, one of the things when it when it comes to this kind of thing about, you know, we talk about different groups and talk about different uh strategies that we have to use. This is a this is a very, very impactful issue that's going to affect us one way or another, economically. Right. Right. You know what I mean? And that's that's the one thing that sometimes we don't we don't talk about, but it's true. I mean, in families where you have these issues, I mean, it could hinder families from working, you know, or it could it hinder families who don't have insurance, you know, I mean, and if you let it go long enough, then all of a sudden it still becomes an economic issue because somebody's going to have to take care of it. You know what I mean? So I think that part of, I mean, part of what we never lose the humanity and talking about this topic, but you also I think we also have to be honest that this is a this is a very, very important issue for us uh individually as well as as uh as as group.
John Finnegan: You know, I it's it's notable for sure. Uh hold on Barry one sec. I want to I want to make sure that our our listening audience understands specifically the distinction between dementia and Alzheimer's. Often times when we're talking about Alzheimer's, we're kind of talking about both of those at the same time. So maybe you can you can touch on that a little bit.
Patty: Do you want Barry to touch on that?
Host: No, you go ahead. Oh yeah. Well, dementia is an umbrella term that describes a set of symptoms and Alzheimer's is the most common form of dementia. So when we're talking about Alzheimer's, we're just being more specific.
John Finnegan: So Barry, um, I'm sure in the work that you did, you were involved with with Alzheimer's and and or dementia. Right. But you
Barry: Yeah, actually that's why I was just raising my hand is that, um, you know, we're kind of chopping at the bit to get into hearing all the stuff that Patty, you know, is doing and all all those good things. And and again, I think for our listening audience and also for our panel members who are in the in the podcast, it never hurts to uh kind of go over things because, you know, about uh specifically the difference uh between dementia, Alzheimer's, dementia and and of course, Patty hit the nail right on the head. Uh the idea that dementia is the broad umbrella and then underneath it there's a number of different kinds of dementia of which Alzheimer's dementia is the, you know, is the most common. So I was I just wanted to jump in and make sure that we at least had a uh basic uh leveling of the playing field so that we, you know, we don't get confused uh between Alzheimer's disease, which is really Alzheimer's dementia. And so to be clear about that. Um, and that that's just where I was going.
Host: To your to your point, uh, I dealt with a lot of, you know, as a family doctor, uh, again, I was one of those womb to tomb uh doctors, you know, delivering babies all the way to the end of life where, um, a lot of my uh care in the last 20 years of my uh practice was in hospice and end of life care. And over time, what wound up happening is I would say, um, the majority of the hospice patients that we wound up having uh reflected the commonality of Alzheimer's dementia when it got very advanced, that became one of the most common diagnoses in end of life care in hospice. It was end stage end stage dementia of which Alzheimer's was um the most common. So
Clarence: You know, I it's uh you know, as Barry was saying, we're talking about different groups. Even within groups, there are also other groups, sub groups, you know what I mean? Uh, you could do things even regionally. There's a there could be a difference in terms of how people handle things. You know what I mean? And so a lot of times when we when we throw out a, you know, throw out a a uh a word, people automatically assume that it's just those people, but it's also us, you know, because a poor family might handle this topic a whole lot differently than a rich family will. Yeah. Yeah. You know what I'm saying? I mean economics, economics. I mean, so I I think that part of what what what has to be considered is the fact that all of us are going to be impacted by this just as your your your uh your comment a little bit earlier about uh quoting, it's going to happen to us. I mean, and so we need to be aware of the importance of us addressing the issue, um, even though it may not affect you the same way it'll affect somebody else. So that's what I'm hoping that we do, you know, as Barry was saying with health chatter is that at least we enter the conversation to to to talk about it and do something.
John Finnegan: And increase awareness about it. Yeah.
Host: So Patty, this has been really good. It's probably, you know, we're only probably touching the the tip of the iceberg here for sure. But, um, so for our listening audience, what might be, you know, a um, a good takeaway from from your perspective on this subject?
Patty: Hey, my big takeaway would be that dementia is not a normal part of aging. Right? Um, there are risk factors that that influence, um, our risk for dementia and we didn't really get into the social determinants of health, but you know, some there are modifiable but obviously there's there's policy changes that that uh if we don't have uh we can say, oh, physical activity is good for your health, right? But we need to actually create an environment in which that's possible. Um, earlier detection and diagnosis helps families. It helps families understand what to expect, it helps them plan, it helps them um identify, you know, if it's if it's mild cognitive impairment, why, you know, are there helps understand what's going on with the person, what treatments are possible, um plan for the future. Everyone wants that. I know it's scary, right? But it's better to have a plan. Um, and then another one would be just that, you know, dementia can be detected anywhere. It doesn't need to be in a healthcare office. So we need to equip our community organizations that are trusted across the state to identify signs and symptoms and then have a understanding of what to do next. So getting people connected with the resources that exist and just building that network so that we can all work together to influence, you know, like by 2060 these numbers are supposed to double. What are we going to do? We have to do something about that. And I can tell you, you know, from a policy perspective, we have a tiny amount of money to support community partners to do this work. Um, so like for an example, we have an Alzheimer's awareness campaign and we we recently put out an RFP, um, requests for proposals for community organizations and we can fund four, right? There were like 40 applications, 40 proposals. Um, and they were all great. You know, people are ready. And this this was like an implementation ready project we were asking them to do with this short time frame. And people like these organizations are ready to go but they can't just, you know, they need support to be able to do this. So to me that's like we we have the connections and the collaboration, um, but we need I think that just more support, you know, is needed to address this topic.
Host: Well, you know at at the top of the show, I I had mentioned that, you know, we're really looking at it from from different angles, you know, the public health angle, the medical angle, the uh community angle. And I think we've, um, we've certainly touched on that in this show. Um, not in depth, but certainly enough that we hope we we've sparked some some interest in the uh, in the subject matter. One thing I can say is that, um, you know, once this show goes out, you can use it. Use it for, you know, in in the I will. Yeah. for uh to get the information out to the public in in in in different ways. Last thoughts, Clarence.
Clarence: Thank you, Patty. That's all I want to say. Thank you Patty. It was good. It was good.
Host: Yeah. Barry, last thoughts.
Barry: Thank you Patty. It was great to meet you. We covered a lot and uh again it's an ongoing conversation. Appreciate your expertise on this. It was very helpful.
Host: And my thought is beyond beyond, um, thank you. Thank you for delving into this subject matter from a, um, from a public health perspective. You are a uh, a true public health gem and so thank you very, very, very much. Um, you're a great colleague, um, and thanks for being on the show. For our listening audience, we got a interesting show coming up. Uh, Dr. John Finnegan who used to be the Dean of the School of Public Health, um, is going to be talking about public health. Now what? So stay tuned for that show coming up. That'll be interesting. In the meantime, everybody out there in Health Chatterland, keep health chatting away.
