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. Erin Collins, Deondra 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 uh, 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 HumanPartnershipAlliance.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.
Guest: 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 Yeah,
Guest: 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 Suharan 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 this situation.
Host: Well, you know, for me, the the the
Clarence: 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. Good question. 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. 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 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?
Guest: 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.
Clarence: So you know, for me, the the the
Host: oh, that's absolutely true and you saw that in the very first SARS virus that that happened, you know, where did that well, it it showed up first in Hong Kong. Then it showed up in Vietnam, then it showed up in Canada. What? You know, well, that's jet travel.
Clarence: Exactly.
Host: You know, so so the whole idea of somehow, you know, what goes on in Africa or what goes on in in Asia. I mean, we should have learned by this time that it it's going to affect us. You cannot simply dismantle everything and say, well, we're going to withdraw from the world, you know, so we don't have to deal with these things anymore. Sorry, that doesn't work.
Clarence: The other problem I think is is also the connections. Um, when we do things like um, uh pull the funding from mosquito control, that's a problem because you know, uh mosquitoes are notorious vectors for a whole variety of diseases and we've seen them some of them end up in the United States and diseases we haven't seen in decades, you know. So so that those are the that's the kind of dynamic I would love to see the public health community and the medical community and all health professions start to think creatively of how are we going to provide the absolute best care that we can for populations, communities and individuals. And what do we need to do that we haven't been doing up to this point to make that happen.
Host: Thank you for that clarification. You know, I am so glad to hear you say that. I about both from you and Stan both because it it's really been the the passion for me uh and the the work for us to to talk about how do we collaborate across these boundaries in order to have uh community health. I agree with you that it is a community uh has to be a part of the of the equation. But one of the thing and I'm I'm going to say this because this again this is just me, uh I think that in this word, you ask how do we find the right ones? You have to find those organizations that self-identify that that is their passion. And I think that one of one of the things that has happened for me, one of the one of the one of the uh uh uh headaches for me has been we can no longer afford to, uh, you know, uh to do this work with folks that just because it's a job. There has to be some pat there has to be some real self-identified self-interest in this work. I mean we're at that place right now where we have to have people self-identify what they want to do. and we have to be willing to help them to make that to uh to help them to do to do those kinds of things. And so I um, I I'm very much uh, I believe very much 100% of what both you and Stan have just said. I believe that. And I and I think that we have to get to a point where we start working together more collaboratively in order to really address these issues and it's going to be more and more important as we go through this this new transition. Uh, and I was going to say one thing too, Barry, uh you talked about uh as a as a physician, we we're not political. You know, we we try not to be political. But you know, a lot of the people that we serve, their health is political. Will or will not take a vaccine because of their political views. You know what I mean? And so how do we how do we how do we work together to help people to understand the importance of of uh the choices that they make. So, those are just things I want to throw out there, but I am in 100% agreement with what you guys are saying.
Host: You know, and I've got guys doing yard work behind me, but I'll make this quick. Um, you know, it's easy for us to kind of belly ache about this, you know, because we've been so involved with it. But, um, what are reasonable steps, reasonable steps that we can take perhaps within the next three to six months that, um, can assure that, um, health and and and medical aspects are are really maintained. What is it that we can do? So to this end, one, one thing that we are going to be doing, John, is we're, um, we're planning a live show of of Health Chatter where we're going to invite people, you know, to in the in the audience and say, okay, look, here's the situation. We all know it. We all know what what's not good right now. But what is it that we can do that's reasonable and doable going forward? So I'm going to ask you that question, John. What do you think is reasonable and doable within the next three to six months. One idea that I've come up with is, okay, look, let's identify and I think you alluded to this. Let's identify foundations for instance that you know, we can go to and say, listen, we need some stop gap measures here and we need some financial support in order to assure that some of the programmatic initiatives that we have in place can continue. Can you help us out quickly. So that would be, you know, one, one angle. What other angles might you think of, John?
Guest: Well, I I think you've got to have a leadership structure. I mean, I I I certainly I would I would argue that that if the governor were to support something along these lines, he's pretty much a a a good leader that could that could really help get this going. And I am impressed with with our governor because I know he's been meeting with with, you know, people on the conservative side of politics in other places. And he's been listening and he's been very humble about those meetings. He isn't coming in there to say, well, your philosophy is all wrong. He's been coming in there to listen to people. And I think he's got the skills to do this. And what I would say, I I like the idea of the forum that you're talking about. that's really important because that's really where it starts. It's got to be about people. And it's got to be about what people are afraid of. It's got to be about what people you know, see, what feel and so forth. But I think there are organizations of various kinds that are already here. Um, we've got the Chamber of Commerce at a state level, you know. Uh we've got the Itasca group, uh which is uh really thinks about planning and things of that kind. And there are other groups like that where I think it it becomes necessary for us to say, are we going to sit here and wait until Minnesota and the surrounding areas uh health infrastructure collapses. Right. And then say, oh dear oh dear, what what could we have done in the past? Yeah, now what's too late. It's too late. Yeah. And so that's what I'm what I'm interested in and I think that it can be done uh with uh starting with some leadership that says this is important. Let's start pulling people together. Let's listen to people, let's start pulling together. How can the University of Minnesota be engaged in this? You know, how can we engage the private business sector? How can we engage rural Minnesota which is so, so, so important and we're seeing that uh almost every day as they lose their health infrastructure and that's not necessarily from federal funding completely. That's also from uh, you know, health organizations basically saying we can't afford to offer these services anymore in your little town. You know, that's I think if we were to get a coalition of strong leaders together and maybe some of our senators and representatives and I would hope that if we engage some of the politicians, I would hope that it would be very much of a bipartisan effort as well because this isn't about our politics. This is about our health. And whether you're a Democrat or a Republican, it's the same.
Host: Yeah, you know, we've got a great colleague. Mike Osterholm has been on our show and um
Guest: I know Mike pretty well.
Host: Yeah, you know him pretty well. And and so anyway, and I I think I had mentioned that, you know, I was on a a plane coming back from DC a couple weeks ago and it turns out he was on MSNBC and and I can't help but state this because I think it's so true and it's worth restating. He said, you know, while all of us are pontificating about all this stuff that's going on around us, the diseases whether they're infectious or chronic are laughing at us because they'll just continue to do their thing and you know, they'll just say, hey, you know, you want to talk about it all you want, go ahead, go talk about it, but we're going to kill you.
Guest: Yeah, exactly. and we can't be dear caught in the headlights on this. Exactly. That's the and and I know to some extent I I I understand that impact. I've I've had feelings of it myself. It's like, I never imagined I would live in a country with a with an administration like this before. And and and with the what's what's been happening. It's just it's it just never anything that I considered. So, but what are you going to do? Are you going to sit there looking into the headlights or are you going to get up and do something? And I think that it can be done as I say with that kind of leadership who can begin and leadership when they when you get a a a critical mass of leaders in this area, it snowballs, you know. And it really gets bigger and bigger and you got people that are really involved in it and say, this is important, we need to do it, etc. And I fully understand the state is facing, you know, aum upcomingum where we're going to be, you know, we're not going to have the resources that we have had in the past. I don't care. Um, you can still build these relationships and move ahead. You have to move ahead. It's for the people and you have to figure out how you're going to do that.
Host: And the and the diseases don't care about your financial situation either.
Guest: Absolutely not. Would that they had an economic sense, but they don't.
Host: Right, right.
Clarence: You know, I think, you know, a thought that I hope that we can leave the show with is, um, forging ahead with what's reasonable and what's doable. If we carry those two torches, I think that we'll we'll come up with some fairly quick, creative solutions that'll make uh people feel comfortable that yes, we aren't compromising our our public health and and medical care going forward. And I'm I'm hoping that will be To continue this conversation, we're our next show, uh, we're going to be doing addressing health in anxious times and it's just going to be the health chatter gang. Um, and you know, it it's going to be some interesting perspectives because, you know, there's the the the elder statesman here and then on the other hand, we've got some really good young talent in the public health field that can give perspectives as well. So I think that that will be a a useful balance of ideas going going forward. And then down the road for all the listening audience, we're going to have a a live show. We'll keep you posted on that as well. John, I want to thank you for being on our show yet again and, um, I we we reserve the right to bring it back because you you you definitely bring in words of wisdom to the uh, to the whole enterprise here. So thanks again for for being on health chatter.
Guest: Oh, my pleasure.
Host: So everybody out there, keep health chatting away.
