From Public Health On Call
Joshua Sharfstein: Welcome to Public Health on Call, a new podcast from the Johns Hopkins Bloomberg School of Public Health. Our focus is the novel coronavirus. I’m Josh Sharfstein, a faculty member at Johns Hopkins, and also a former secretary of Maryland’s health department. Our goal with this podcast is to bring evidence and experts to help you understand today’s news about the novel coronavirus and what it means for tomorrow. If you have questions, you can email them to publichealthquestion@jhu.edu. That’s publichealth@jhu.edu, for future podcast episodes.
Today, I’m talking to Dr. Georges Benjamin, executive director of the American Public Health Association. Dr. Benjamin is one of the most experienced leaders in the field of public health. He is an emergency medicine physician who has served as a state and as a city health commissioner, leading responses to a variety of crises and infectious disease health threats, including measles and West Nile virus. Our topics cover the critical tasks for public health departments in this crisis, including reaching out and serving communities at the greatest risk for being left behind. Let’s listen.
JS: Dr. Benjamin, thank you very much for joining me today.
GB: Dr. Sharfstein, glad I could be here.
JS: So, you also are the executive director of the American Public Health Association. That is an enormous organization that touches every aspect of the public health field from state and local health officials to private organizations to the federal government. What is the state of the public health response right now, from your vantage point?
GB: Well, the public health response, in many ways, we’re struggling, to try to address this. This is a new disease, it’s rapidly emerging, and obviously we’re like everyone else, we’re kind of chasing it. But, we understand this, we have experience doing this, and people should be comforted by the fact that we’ve done this before.
JS: And when you say we’ve done this before, you’re talking about even respiratory diseases that are transmissible, but you’re also talking about the kinds of activities that are needed to respond broadly to a situation like this. Is that true?
GB: That’s correct. You know, the public health community has to first know, and be able to identify, when a new disease enters a community. Then we need to figure out who’s affected by it. And then we need to put in place measures to try to mitigate its impact and reduce the number of people who get sick or who die from this disease. And we’ve had to do this every time we’ve had a new infectious disease of this type.
JS: So what are the kinds of things that public health officials have to keep in mind to make sure particularly with this kind of transmissible disease, that people aren’t left behind in the response?
GB: You know public health is very much concerned about everyone’s health. And one of the particular areas we have to be concerned about are people who are underserved, homeless individuals, people who are low income, people who are in incarcerated settings, people who live in group home settings, people who are the extremes of age – very young and very old – because they have a different risk factors than healthy young people do. And we have to focus all of our efforts in ways that address all of their needs, in many ways. We also have to deal with people…
JS: Sorry, that seems almost like an impossible task. How do agencies need to go about that?
GB: Well, the first thing is to have a good plan, and have a plan on how to address it so everyone knows what their role is. We need to have built trust in those communities upfront. This is not something where you go in this community and say, “Hey, we’re here to help you” for the first time. You have to have been in those communities to try to help them for a variety of problems before. The good news is, we do this through some of our food programs, we’ve done this with HIV and AIDS, we’ve done this with sexually transmitted disease, we’ve done this with some of our programs to reduce teen pregnancy, so public health has relationships and trust in those communities that need our help the most.
JS: So what kinds of areas of distrust are risks here, for certain communities, around the coronavirus?
GB: Well, the big thing is that people are always worried that folks are not there for their best interest, or that they’re trying something new on them that they’ve not tried on anybody else before. So we have to make sure that people understand that we are giving them best practices and giving them the best advice. The way you do that is you speak clearly to people. You tell them what you know. You tell them what you don’t know. And you have to be there throughout the whole disease outbreak, and you have to come back after the outbreak is over, in order to make sure they understand that you’re there for the long haul.
JS: And that includes speaking in their own language sometimes.
GB: That includes speaking to them in their own language, absolutely. Because one of the things we know in many of these communities is that some communities, 15, 20 languages are often spoken, sometimes different dialects. And you need to have people that can go in and deal with them not just from a language perspectivee but to be culturally competent as well.
JS: And what are the economic dimensions of this challenge? How do you see the coronavirus affecting, particularly, low-income communities?
GB: Well, the first concern of course is for people who get up and work every day, but they don’t have paid sick leave. People who, if they don’t go to work, they don’t get paid. And they’re less likely o go to the doctor or to stay home if they’re sick. And of course one of the things we want people to do, if they have a respiratory condition like this, is not go to work. Well, you know, people may decide to go to work because they have to, because they gotta pay their bills, and that isn’t good for infection control. The other thing, of course, is your uninsured, people who, when they really do get sick, may delay going to the hospital because they’re concerned about having to pay that bill. And so people who are uninsured or underinsured remain big challenges for us as part of these kinds of outbreaks.
JS: What do you think communities can do to address those issues, or policies can do to address those issues?
GB: Well, paid sick leave ought to be a policy. Employers need to have policies that actually pay workers so that they can stay home if they need to stay home. Secondly, be flexible with schedules, so that people can you know get their kids. Let’s say the kids can’t be in school on a particular day or we decide to close schools. They ought to be able to help them with processes to be able to take care of their children and still maintain their jobs. We need to make sure that we have universal coverage. Everyone has to have the health insurance that they desperately need when they get sick. And of course we have to pay people adequately. We have a growing wage gap in this country that we need to address.
JS: In way you’re saying that some of these fundamental challenges to health and social policy don’t make the coronavirus job any easier.
GB: They don’t. Dealing with people requires a social support system that benefits everybody. And we need to pay particular attention to the underserved and the uninsured.
JS: How much do you think that is going to become a focus in the coming days and weeks as this epidemic unfolds?
GB: Well, you know, the initial people that we’ve had concerns about have been people that have been on cruises or have been overseas either at work or on vacation and other things. Those folks have had the means to do that. So as this outbreak infiltrates itself and penetrates the broader community, this is going to become much more of an issue.
JS: Well, great. Thank you very much for this quick opportunity to catch up. I know you are very busy on many aspects of this response as are many of the American Public Health Association members, and. I look forward to keeping in touch.
GB: I Thank you. And we’re in this to make sure that people are better.
JS: Thank you for listening to Public Health on Call, a new podcast from the Johns Hopkins Bloomberg School of Public Health. Please send questions to be covered in future podcasts to publichealthquestion@jhu.edu. That’s publichealthquestion@jhu.edu. This podcasts I produced by Josh Sharfstein, Lindsey Smith-Rodgers, and Namari Morales. Audio Production by Nile Owen McCusker with support from Chick Hickey. Distribution by Nick Moran