From WXXI news.

This is connections.

I'm Julie Philipp filling in for Evan Dawson.

Our connection this hour was made during the COVID 19 pandemic.

To many observers, that marks a critical turning point for the nation's public health system, and I use the term system loosely.

In the U.S., public health is a mishmash of federal, state, local, and tribal entities without a clear hierarchy or means of accountability.

The sector has long struggled with issues related to funding, staffing, technology, communication and more.

All of these problems were laid bare when COVID struck, and to many observers, the public health crisis turned into a crisis for public health.

Add to that a presidential administration that has dismissed scientific evidence, spread misinformation about vaccines and other public health measures, cut public health spending withdrawn from the World Health Organization, and fueled distrust in public health and the problems for public health.

Show no signs of ending.

So what happens now when public health threats arise?

How worried should we be and what can we do to fix this?

We're going to talk about all of this and more with my guests in studio today.

We have, Doctor Paul Graman, who is the professor of medicine and senior associate hospital epidemiologist in the infectious diseases division at the University of Rochester Medical Center.

That's a mouthful.

Welcome.

Thank you.

We also have Doctor Michael Mendoza, senior medical director for Town Square Health and a former public health commissioner from Monroe County.

Thanks for being with us today.

Thank you.

And we have Doctor Anja Bottler, service line division head for infectious disease at Rochester Regional Health.

Welcome.

Thanks for coming in.

And last but not least, Laura Sugarwala, MBA, R.D., director of community health partnerships for the center for Community Health Prevention, part of the University of Rochester Medical Center.

Thanks for coming in today.

Thank you.

All right, so before we even get into defining public health, because I think that might be important to do for a general audience, I just want to go around the room and ask if you agree with those people who say public health is in crisis, and why or why not?

Doctor Graman, you want to start?

Graman.

Graman.

Yeah.

I'm sorry.

It's public health in crisis.

I'm not sure I'd want to use the word, crisis because, you know, I think fundamentally there is an infrastructure of people who really care and are expert and are out there, helping us navigate, public health, issues.

And there are a lot of them out there today.

On the other hand.

To some extent, I think the public health system is hobbling, because of cuts that have been made and, public support that has, kind of wandered off.

I think.

And, after COVID, there is a level of fatigue, that people have, kind of listening to advice through the COVID era.

And it's harder for them to listen to that advice and to accept, expertise.

And it doesn't help that people at the very top of our, government, and political, system are not necessarily, in support of, of public health as we see it.

So yes or no, there are there are critical problems in public health.

Are we in crisis?

Like screaming with our hair on fire?

Not quite yet.

Okay, how about you, Doctor Mendoza?

I got you getting a glass of water there.

I think the word crisis is problematic because to call something a crisis, we have to know what it looks like when it's not in crisis.

And I think COVID is an example of a crisis.

We knew that that would end when there was a treatment and a vaccine.

I think public health is different because I don't know that we can define what a system looks like when public health is not in crisis.

I think we can all describe what it looks like when it's better.

But to use the word crisis, I think is hard because, you know, if everything's a crisis, then nothing is a crisis.

And I think public health warrants attention.

But if we, are all, you know, screaming as though the sky is falling, then that actually doesn't get us the attention that I think is important to have.

Okay.

And now your turn, Doctor Bartlett.

Yeah.

I think, public health is in flux.

There's changes.

There's changes that we have to make.

We have, through the COVID pandemic, found out where we have problems or even before and even.

And since.

So we know some of the problems we have as Doctor Graman and said, very dedicated health care workers out in the community and we need to support them.

And they don't always get the support that they deserve.

So I think there's a lot that we can work on and make better.

But it will never be a perfect system, as Doctor Mendoza said.

And it'll always be.

We will always be a little bit behind.

So this is not an ideal world, but I think we can make a lot of changes and improvements.

Okay.

And Laura Sugarwala, anything to add to this.

Yeah.

Thank you.

And there are so many dimensions within public health.

Within public health there are so many dimensions.

And when I think about the current landscape, we're really talking a lot about trust and how we build it within our partnerships in the health care system and within communities.

And as others said, that doesn't necessarily mean we're in crisis.

It also means that there's opportunity.

And when we think about how we're approaching this, it is a collaborative approach.

And that can mean that some of us get very frustrated and challenged and are also looking at how we can acknowledge that and work together to fix that.

Okay, so consensus in the room is it's broken, but we're not a crisis stage yet.

Okay.

So let's back up just a little bit then for our audience.

Doctor Mendoza, how would you define public health?

I think public health, can be defined as the health of a population.

When you look at health care or medicine, that, in contrast, is when you look at the health of an individual or perhaps a family.

But the approach in public health is looking at communities, and that can be defined at a lot of levels.

It can be a census tract, it can be a neighborhood and can be a town, city, state, country, world.

But the tools that, public health utilizes are very different tools than medicine.

Although both use data, we use data in different ways.

You know, I think to cut to the chase, you know, the end goal in public health, where I don't think it's the case in medicine, but the end goal in public health is as policy change.

If we can study a problem, test interventions that work or don't work, communicate about them, which is really hard to do.

And then cause, there to be a policy change that can, make that that improvement permanent.

I think that's the end goal of public health, whereas I don't think that that is exactly the case in health care or medicine.

No.

A lot of the definitions of the more formal definitions of, of public health equity at the center.

The focus of public health is to keep everyone's everyone's strong, safe, healthy.

But as we know, equity has become sort of a political word, a hot potato in a sense.

So it is is that harmful or is there another I mean, having that as the base and knowing what happens to the word equity, these days, is that a problem?

Doctor Raymond?

Yeah, that's a good question.

I, you know, to say that equity is the centerpiece of public health.

You know, it's a critical piece.

Piece of it.

But as Doctor Mendoza said, you know, we're we're looking at the overall health of the population that's everybody.

And if we are leaving people out, that's the problem.

And that's where equity comes in.

But to say that equity is, is, you know, is the main goal.

I want to see everybody healthy or I don't want to be selecting out a certain population to make them, you know, incrementally, healthier than they were before.

I don't think that gets us, you know, where where we need, where we need to be.

Anything to add to that?

You look like you had something to say.

You know, equity is hard because it's become politicized.

You know, when and when you look at, studies of communication, you know, the question comes up, what's what's a better way to say that, fairness, justice.

Those are terms that have been used then get at the issue.

But I think the issue is very important.

And regardless of what we call it, I wish we were in a world where we didn't have to worry about the word.

But but regardless of what we call it, I do think that you can't understand the health of a community just by looking at the average.

I think you have to look at the distribution of those outcomes and, you know, not to get too statistical, but, you know, if the standard deviation is really big, then I don't think we've done a good job.

I think we need to to to raise the mean, to raise the average, make that better, and ensure that there's equal access to that outcome.

At the same time.

Okay.

So I do eventually want to get into some of the fixes and some of the things that need to be done, to public health.

But let's start with some of the biggest public public health threats we're facing today.

And again, I want to go around the room.

We can go the other way.

You're going to be on the spot of what you know, what you see is as a major public health threat right now.

And and whether we are not well equipped to handle that, I think in terms of funding for public health is continually a challenge.

And as Doctor Mendoza was talking about, there are a lot of ways that we can measure what our impacts are.

And those vary by different, organizations, agencies.

And so I think a challenge to public health is really the outcomes and how we see those occurring within communities.

Who's getting who is healthy.

How is that health distributed?

And when I think about, even the definition of public health, we are responding to individual's needs and that can become a challenge for making those large scale interventions.

And we have to keep meeting that challenge.

Okay.

How about you.

What do you see as a big threat.

So I think one of the main issues is the, the trust that is broken between different communities.

And we are getting further, further away from a common goal.

And I think we as a society always have to also have to decide how much are we individually able to give to help others out.

And I think there's a little bit of a disconnect these days.

I mean, it comes to vaccination.

Do they only benefit me or do I protect somebody else with the vaccination I take?

So I think there's a lot that we need to work and bring people back together on a common path to accepting that and trusting that and trusting your physician, your, educator about these things.

And I think that's where I see a big challenge.

Okay.

I want to, like, clarify the question a little bit because both of you are still addressing the issues within public health.

I'm looking at it from the other side, from the person in the community.

What are the big public health threats out there that I should be worried about right now?

You want to.

Why don't you guys.

So I'm I'm working on measles right now.

We know there are increased measles cases that are closer in the community.

In New York State now in upstate New York.

So I personally for me, the the following week is going to be a lot, making sure that all the hospitals in the system have good protocols, have vaccinations available and so on.

So I think there's a lot of individual problems that we are dealing with on a daily basis.

And measles clearly is a big one right now.

I would say screening and making sure that people are keeping up to date on, cancer screenings and things that will be preventative, having access to those on in a timely way.

That is something to have that you're aware of, that's front and center for you.

How about you, Doctor Mendoza?

What do you see as some of the bigger public health threats out there facing the community?

No, I do think vaccination is, at the top right now.

I think what we saw come from the federal government, the the thought that shared decision making should be part of the vaccination discussion is, you know, on the face of it, a lot of goal.

We don't want to take away somebody's choice.

At the same time, though, I think we need to call out the difference between medicine and and public health.

You know, if shared decision making, and as it should be a part of how we approach, chemotherapy for somebody newly diagnosed with cancer, that's that's a difference, because one person's decision about chemotherapy doesn't necessarily affect the next person, but one person's decision about a vaccination can affect somebody else.

And I think that's the difference that we need to consider when we read about shared decision making.

Because on the face of it, that sounds like something everybody would want.

But I think public health, unfortunately, unnecessarily means that we have to look at the whole and not just individual.

Sometimes.

How about you, Doctor Grossman?

Well, you know, there there are the, kind of immediate threats and maybe that's what you're asking about.

And certainly measles, is one of them in the United States, if you look at what are the outbreaks currently facing Americans?

We're having the largest measles outbreak in the United States in the last 20 or 30 years.

We have already now exceeded the total number of cases from 2025.

And that was a big year of measles outbreaks, which you may remember, was in, Texas and the southwest and a few other areas.

And now it's been much more widespread, including and in New York.

So, measles is a big one.

And, you know, I think, to, Doctor Mendoza's point, you know, there are vaccine preventable diseases.

These are outbreaks that we can do something about, and we can do it extremely well.

And extremely safely.

We know how to do it.

We've been doing it for decades.

And the idea that we change it on a whim, which is more or less what we hear, from, some of the leadership and this administration, is frankly, unacceptable, I think, to those of us who really care about medicine and public health.

So measles is clearly one of them.

Cyclosporiasis.

Everybody hears about on the news, pretty much every everybody's been avoiding lettuce all summer and, you know, kind of avoiding lettuce.

You know, I made a salad last night, and I. And I cleaned more than more than I usually would.

That's one, you know, that is not vaccine preventable.

It is treatable with certain antibiotics of cases are more severe.

So it's a treatable disease, and it perhaps could have been more prevented.

From spreading if some of the public health infrastructure was more robust in identifying cases early, trying to figure out where it came from.

In this case, probably products more from Mexico than the United States.

So that's done an absolute, line drawn there.

And, you know, that's where you start thinking about the public health infrastructure.

Where are the people in place?

And, you know, it's not just, as we talked about public health being a matter of policy, which it is in large part, but you can if you have policy without the boots on the ground, so to speak, it's not going to go anywhere.

And, boots on the ground and people keeping track of things like cyclosporiasis, and trying to intervene in the outbreak before it spread all over the country, could really, make a difference.

So, you know, you're talking about the epidemiologists, the contact tracers, those people that we saw following COVID there.

We're lacking those people still.

Additionally, regulation and public health infrastructure also includes, people who can go to those facilities and make sure that the practices are in place to prevent those types of outbreaks, inspections.

Okay.

Well, we're on the subject of measles, and then we'll get back into some of the threats.

I know there's a lot of confusion.

Schools about to start and parents, whether or not they're getting their kids vaccinated are wondering or has anything changed in New York State?

And B, does it matter when we have all these cases now that appear to have started in other states?

I mean, disease does not look at state lines.

So anyone want to take that one?

Help parents out as to what what they should expect for the school.

So yes, if we discussed the measles specifically, we we have good data.

New York State actually has excellent data about what the vaccination rates are in different schools or in different counties.

And measles is so infectious that if one person in the room has it that everybody's exposed.

We have also a different population of students.

We have immunocompromised students with poorly, with diabetes or with cancer or other diseases that cannot receive the vaccine.

So we have to protect them.

And the vaccination rates are not high enough to to keep every child safe from that.

So parents really should talk to their pediatrician and make sure that vaccinations are up to date.

Measles and others, they are usually done at one year and then when they enter school, the second shot.

But if they, for whatever reason missed a shot or if they're moved from somewhere else, then just make sure that all these vaccinations are up to date.

And then as we approach fall season, or winter season with respiratory illnesses, think about that flu shot and that COVID shot, you know, that could protect your child or somebody else's child.

But the recommendations requirements to go to school in New York state, has that changed?

Nothing's changed.

No, no.

So so a parent presumably would be sending their child to a school where all the children have they required vaccinations to attend that school.

Nothing has changed in New York State.

Well, as it has in some other states.

But does that matter when, you know, we're starting to see some measles cases in New York state and, at least the ones I've seen look like they originated in Pennsylvania, which has it has a lower vaccination rate.

So does it matter if New York State has a pretty good vaccination record?

We've kept track of that.

We know what's going on when other states aren't, you know, the the challenge with measles, as you said, is that it is highly contagious, highly infectious.

And, you know, we have herd immunity.

We have a goal of herd immunity, which for the MMR vaccine is north of 95%.

And I think the last time I looked, it was in the high 80s.

So, you know, we're really playing with fire here.

We won't know until it's a problem.

And when it's a problem, it's a big problem.

And in the health department and I think it was 2019, we had a local, spread a case of local spread.

And that's a real problem.

That's a very different, situation than a travel a travel acquired, cases of measles.

And when you have that, you're contact tracing.

You're hoping that you're hoping to have heaven, that everybody who's been in contact with that individual has been, you know, vaccinated.

And when we're talking about people who are older and age, you know, as we get older, sometimes with our protection from those vaccines wanes, when we have high herd immunity, we can sort of assume that we're okay.

But when we don't have herd immunity, then we have to be very cautious because, you know, it's like setting a match in a in a dry forest.

It's really playing with fire.

Okay, so but for now, parents in Monroe County, in the surrounding counties can rest pretty easy sending their kids, I think.

So for those young for the vaccines that they have.

Okay, so we, we talked about the immediate ones.

And you brought up there are some other not so immediate big issues facing public health.

Can you talk about what those are?

Yeah.

I mean, I think it's helpful to think about public health challenges on different horizons.

You know, measles is immediate and will be probably and, and in fits and starts for, for many years to come.

Cyclosporiasis is here.

But, you know, what are the longer horizon, threats?

You know, I think climate change is one of them.

We're already seeing, shifts in some infectious diseases, that are associated with warmer climates.

Certain bacteria that, live in coastal waters for example, that can cause serious infections.

One of these is called Vibrio vulnificus, and I've just heard about it on the news the other day that there seem to be more cases in the Southeast United States, but we're seeing more, I think, in the northeast United States.

And part of that is because of coastal waters are warming, other insect, vectors and ticks, for example.

And the diseases that they spread, like Lyme disease, and others have shifted in the country.

So, you know, climate change is going to affect the diseases and illnesses that people have.

And ultimately, you know, when people can't live in certain places and they're all trying to move somewhere else and, and, all the, infrastructure of supporting the population in terms of water, quality and housing and so forth start being stressed.

You know, climate change is going to have a real impact on people's lives.

So, you know, that's the longer horizon.

People have trouble looking at that horizon.

What they're thing, from day to day.

But I think it's important, you know, that we keep our eyes open and know what's coming if we are not, or attentive to these issues.

And climate change isn't just a horizon thing.

It's a yesterday thing.

You know, this, this summer, we've been exposed to some pretty awful air and and those wildfires that are occurring north of the border, are a result of climate change.

And and people don't realize that, but but the climate change has far reaching impacts that have very immediate impacts.

And, you know, anybody who was in Rochester over the summer can remember those days, regardless of your baseline level of health.

We all noticed that there was a little, you know, sticky and, and, and smoky and I think that that has huge impacts for people who have chronic, you know, lung disease or, other conditions that make it hard for them to, to breathe sometimes.

Okay.

I want to continue this conversation.

We're going to take a short break right now, and then we'll get back to this.

When we come back, we will continue our conversation with the state of public health with Doctor Anja Bottler from Rochester Regional Health, doctor Paul Greenman from the University of Rochester Medical Center, doctor Michael Mendoza from Townsquare Health, and Laura Sugarwala from the center for Community of Health and Prevention.

If you want to join in our conversation, you can.

We have a phone number 2639994 and a toll free number 844295 talk (844) 295-8255.

You can email us at connections@wxxi.org or leave comments on the WXXI news YouTube live stream.

We'll be right back.

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You are listening to connections.

I'm Julie Philipps sitting in for Evan Dawson and we're talking about public health.

I want to go back to, climate change.

All of the issues that we see coming is the public health system equipped to deal with all of these issues that are looming.

Isn't this the time to start?

I don't know who wants to start with the answer.

Big question.

Go ahead, Doctor Bottler.

I don't think it should solely be the health care system.

I mean, this is a again, a societal question.

How do we value our environment and what do we do about preserving it?

And it needs to be on a much higher scale than that.

Now, should I, on my individual scale, be all be mindful?

Absolutely.

But I think the real change has to come from much, much higher up.

Okay.

Anything to add to that?

I would say it's a, connection between research and action.

Especially not only led by those who are directly impacted, but also in partnership with the researchers are, environmental Medicine and Public Health Sciences Division has a lot of expertise and, understanding of of these larger issues and how to, to provide information about them.

And so understanding what's important to people and those messages that really, impact people's ability to act on those.

And I think we are individuals within a larger within the system.

And so once we understand what can what we can, be affected by how we act on that is also important.

Okay.

You brought up research, how has that been affected at all by the new, administration research dollars?

Yes, yes, there there are, a number of ways that we've been affected and that has, definitely happened over time.

And we our, our, divisions continue our, our leadership at the highest levels continues to address that.

And we have seen, challenges to our funding.

We've seen some funding cuts.

And so that is an ongoing conversation.

Absolutely.

Okay.

And on top of that, you have an administration that at times has, denied and has taken actions in the face of climate change that might not make sense.

So if it takes, as you said, somebody from much higher up to kind of coordinate this response, and it shouldn't just be public health, who is going to lead that charge?

Well, this has been a question I've been pursuing my whole career.

Who owns public health.

And, you know, nobody owns public health.

The reality is that it lives as a collaboration between pretty much everything.

Health care cannot own public health.

Health care is far too expensive.

And health care isn't expert at doing the things that public health can do.

By the same token, public health can't do it all either, because public health has been underfunded chronically and the workforce for for public health has been dwindling for the last 50 years.

So, I mean, this is a real question around workforce and how do we look at health care and the interface between health care and public health?

You know, I do think that, at some point we all have to take some ownership on this.

And as we've seen, for better or worse, for the last 3 or 4 years, information and misinformation can can spread like wildfire and so I think the first step that we all take is, is how do we all become a more informed public.

And that gets into a lot of the information and misinformation that we're hearing these days.

But I do think that that's a step that we can all own, regardless of what corner of the world we work from.

How do we promote good information, evidence based information in the right ways, at the right time?

You know, the the generation that is coming out of college now is going to be far more well equipped to handle, you know, information management than our generation ever was.

How do we capitalize on that?

Because the reality is that this administration won't be in office forever.

And at the end of all of this, whatever that is and whatever that looks like, we're going to be faced with a real problem.

And that is how do we leverage this new generation?

Who is going to be more savvy with information than anybody else before them?

How do we have them help lead us into this place where I hope public health and medicine, work better together?

Anything to add to that, doctor Grossman?

Well, your first question, I think, was, is public health prepared to deal with climate change?

And I think the answer is no.

Public health is not really the dimension, in, in society that that can, address the underlying, problem of climate change.

And, and global warming having to do with fossil fuels and so forth.

I mean, you know, but what about the health impacts?

Who's going to take the lead on that?

Well, I think I think we're all going to have to, try to take the lead on that.

Part of it is, is projecting what's to come.

And also, kind of reacting.

Sacramento's has said to what's already here, we never, we're breathing smoke, in Rochester, New York, that I can remember in 40 or something years that I, that I've lived here until the last two summers.

And that was clearly because of fires.

And that are closely related to global warming and, you know, drying out of huge, forest tracks in the U.S.

and Canada.

So we are going to have to react to people becoming more ill with respiratory illness, for example.

And I think public health can have a role there, you know, but being reactive to climate change is one thing.

Trying to stop it, is another.

And that seems far beyond this.

Yeah.

Know and I wasn't trying to imply that the public health has to solve climate change.

I was thinking more about the health impacts and how you prepare to deal with those that are inevitably going to come, but I think it's important that those of us who are in, in medicine and in public health make the connection between climate change and health so that people who are in a position to say, hey, you know, we're not drilling for more oil every opportunity we get, we're not going to tear down all of the, the green energy projects as is happening around the country.

Because of edicts from this administration.

You know, those kinds of decisions, convincing people that this matters, it matters to their energy bill, but it also matters to their lungs and their well-being.

And I'm not hearing a lot of concrete.

This person is leading us here.

This this organization is leading us here.

I'm hearing a lot of we're still kind of in reactive mode.

Public health is not in a formal, proactive mode when it comes to climate change.

Is that an accurate assessment?

I well, I was thinking that there's specific to climate change.

I would not be able to speak to that.

But in terms of the way that public health works, there's so many interconnected entities.

And when I think about, a specific entity taking a lead on an I, an issue, it my, observation, is it works.

We work in harmony together that there's, there's and then, the community health improvement plan that is, and analyzed for Monroe County really is all health systems and community organizations working together.

So I, I anticipate that a combined effort is needed for these types of problems.

Or if the if the federal government doesn't give us, a framework that we can work with, then is it more of a state government?

Is it the local town government that can help and and advance projects that are helpful for that?

I think we have to then dial it back to an area that we can't control better, which is more of a local.

So on the on the local level, different projects, different partnerships are being proactive on this issue.

You would say, and there's spots of it around the country I think.

So I you know I think I think the question really here is leadership.

Who's taking leadership who's taking ownership over this.

And it really depends on what what problem we're looking at.

You know, if it's climate change, we have a whole host of great, you know, agencies in Monroe County that are working hard to promote good information, promote activism, promote things that that everybody can take part in, whether they're, you know, health related or not.

But the question about leadership is a big one right now because of, you know, the FDA, you know, is undergoing new leadership, HHS undergoing new leadership.

The CDC leadership has always been in flux.

You know, the staff at the CDC has been has been decimated since, two years ago.

So the question of, you know, federal leadership right now is very much in an in flux.

And then, you know, when you look at local leadership, you know, the real question is who's leading, you know, public health in this county.

And, you know, when I was in the health department, I had the, the fortune of of leading us through a crisis because, you know, we all sort of had one goal is to get out of this crisis.

But we don't have that luxury right now.

We have multiple priorities, and there isn't a single agency that can own all of that.

Really.

And what we do need is a a local voice, a collective voice that speaking about what we can do here in Monroe County to make public health and health better.

Okay.

So a lot of people around the country, in the public health sector have talked about, and this is not new.

This has been going on for some time.

A reimagining public health, a new public health 3.0 or whatever.

I don't know what number they're up to now, but I again, I want to go around the room and if you, could think about how to fix public health, and I know it's a big that's almost as big as climate change, but where does your mind go first?

What do you think needs to be done?

And what would a what a reimagined public health system look like?

And I'm going to start with you, Doctor Greymon.

Oh, geez.

You have to start.

You had to start with me on that one.

You know, I, I think it comes back to, public trust and, and the quality information of information and how we communicate and some of that communication is on us.

It's not only on the listeners out there who don't want to hear it or, you know, kind of refuse to accept expertise.

And I, you know, I think we learned some things during COVID, you know, things we did right, and things maybe we could have done better, as everybody struggled with something that was, very much in crisis, that we didn't fully understand and so forth.

So, you know, there were miscommunications that happened.

And I think part of that really eroded the public trust.

So, you know, how do we how do we get that back?

How do we get out there and communicate with people in a way that they trust us?

You know, we're on their side.

We're experts, but we don't know everything.

We're here to work, you know, work in partnership with you, to make all of our lives better.

How do we get to that point?

You know, I don't have a good answer.

I think some of the proclamations and the way that, communication occurred by proclamation during COVID, was not ideal.

And, you know, many of us, at the table here, lived through some of that or even participated in it.

And I can remember, for example, being on a, a panel with Doctor Mendoza when we were talking about masking very early on in this.

And we were not we were we were not recommending to the general public that they mask.

And one of the concerns, frankly, was that there were not enough masks to go around.

And then people in hospitals who were taking care of these patients wouldn't have masks.

But was that the right message?

Six months or whatever later, we were telling everybody to wear masks.

So the messages were mixed.

They changed over time.

Not all of that was preventable, but in my mind, you know, there were things that I learned and I think we collectively learned.

How do we get back to communicating?

So people believe us and come to us.

Okay.

You had some.

Yeah.

So communication I think is really key.

And it's also communication between different agencies.

Sometimes the health department is this nebulous.

Where are they even located and who is who do I reach out to.

And more cross communication there.

If if COVID gave us something it is video calls and these kind of things.

So we beefed up on that.

So I think even between agencies to have communications, even between Rochester Regional and the university, some we have common, meetings and so on.

So we are doing pretty well with that.

But again, communication.

So everybody knows, has the same goal in mind.

I think that's very important too.

So five years later, we're still digging out of the the trust issue.

Doctor Mendoza, what else?

If you're thinking about reimagining public health, in a perfect world, we would, you know, public health would be trusted and a good communicator.

What else?

You know, let's start at the end.

You know, when we look at when public health has really worked, it's when policies were enacted at a governmental level that codified good practice.

You know, we don't have to look that far into history to see good examples of this at a national level.

Tobacco use and cigaret smoking are a great example of how things started on a small level.

And people were studying, you know, the effects of, of nicotine and, and cigaret smoke, you know, in the 1930s, 1940s and 50s.

And then slowly over time, policies began to become enacted.

And, you know, not only were the policies in place, but the communication followed.

And fast forward 30 or 40 years, you know, cigaret smoking is is at an all time low.

And it's because it became a part of life.

And that part of life didn't come out of nowhere.

It came through dedicated decades of communication and advocacy and policy change.

We don't have that kind of a runway right now because public health communication changes every week.

And so the question is, how do we get back to public health 1.0, because that's working a lot better than public health 2.0.

You know, some of the fundamentals around communication, some of the fundamentals around how we gather information and communicate about information, and more importantly, how do we make decisions based on information that's all changing.

You know, we know media is here.

And it wasn't absolutely.

And we can leverage that for good.

And and we see that happening in very small scales.

But but right now information is so scattered it's really hard to know where to go okay Laura Sugarwala.

Well back to the question of of reimagining what what would you like to see happen?

I really think about this in terms of power and how power is shared across not just organizations, but within communities.

And when I think about public health and the lived experience of people who have experienced wild wildfire smoke or are making decisions about vaccinations, how does that lived experience reach the larger scale?

And how do people know that what they're experiencing is informing overall action?

And I think some of that builds the trust toward making sure that if there's, large scale interventions that there's, use of those, and also it's, sort of bidirectional.

How do we ensure that when there's localized understanding that that reaches the larger scale?

And so I think that, that concept and that that structure of ensuring that there's power in all dimensions and that people are, aware of it and experience it, really does build this next level of public health.

Okay.

Some of the other things that I've heard, one, just investment in technology that that the ability to collect the data and, and manage the data, is just not, not there in a, in the most modern sense of the word.

Doctor Mendoza, you may be the most familiar with with this on and a public health issue is that of how big of an issue do you see that?

I mean, we have smart people in public health who do this all the time.

And, you know, we can trust them, but we don't all the time.

How do we surface those the data that are that are being, you know, analyze how do we make conclusions from the data?

You know, I think it comes down to leadership.

I think it comes down to communication.

You know, we don't we have the technology.

We certainly have the technology, and we have the workforce probably to to analyze a lot of these data.

You know, I don't think that's the challenge.

I think the challenges are how do we make meaning out of the data and how do we communicate that meaning?

You know, we saw during COVID that you can take a data set and make a whole bunch of stories out of it, and they don't all have to agree.

But if we have good leadership, then we can take the leading explanations, those that are based in evidence and fact, and we can have somebody trumpet those as, as the recommendation.

And without leadership, then, you know, data analysis doesn't really get us very far.

Okay.

So it sounds like before anything can happen, there might need to be a bit more leadership at the very highest level.

And, I want to bring what's happening in Washington down close to home.

And I know you said your research dollars have been affected.

How about you, Doctor Graman?

And have you had any direct affect from from the whether it's research dollars or anything else from the current administration?

Well, you know, I myself don't, rely on research dollars for my, for my own work.

But many of my colleagues do, they are, very sophisticated, and in, some cases internationally renowned, researchers in vaccines, for example, and, influenza vaccines, RSV vaccines and COVID vaccines, and their work has definitely been impacted.

And their, and their level of, comfort, if you will, or, in the, looking to the future, I think there's tremendous concern, that their work will be ended, or severely hampered.

And that's, you know, that's hugely concerning.

It also affects the University Medical Center.

More globally, because the, the, the dollars that are coming to us, for, for research, which is a large portion of what we do.

But also, the clinical dollars when, when, there's, there's great concern, of course, about people losing, Medicaid, coverage in, all around the country and when, when patients, which is overall a public health issue when people are not insured.

Right, they're not insured.

And when they come to our hospitals, we don't send them away because they're uninsured.

We take care of them.

But then there's no reimbursement for their care.

And so the whole system gets more and more and more squeezed.

And this is affected departments across, the university, medical center, we're still there.

We're taking care of people.

We think we do a fantastic job, but it gets harder and harder to do it with fewer and fewer dollars.

Okay.

Doctor Bottler, do you want to add to that?

Yeah.

Similar at Rochester Regional, we are more of a community based organization with more community hospitals.

So we rely more on Medicare, Medicaid, funded patients.

And there are cuts to medication substitutes that the federal government gives out, and that amounts to millions of dollars that you have to find somewhere or somehow, you know, these medications cannot be given to the patient.

You have to have restrictions and Indian medications, panels that you have, that is all.

Will laid to much poorer care, potentially, uninsured patients have always been a problem too.

If you can't enroll them in Medicare or Medicaid while in the hospital, then that's also a big loss for the system.

Okay.

And, Doctor Mendoza, you're no longer in public health, just giving you an opportunity to.

Have you been affected in any.

Well, I still do research at the university.

Sort of on on the side, if you will.

Some of our grants have been, have not been funded.

So National Science Foundation grants, were delayed in funding finally were, you know, funded ultimately, but initially not funded because they were dealing with things like disparities and in this case, oral health, inequities.

You know, you would like to think that, you know, oral health is important to everybody and that, you know, disparities in that are not a good thing.

But when when a grant is written that's focusing exclusively on reducing oral health disparities, it wasn't it wasn't viewed very positively.

And I think that's a reflection of where we are in in the federal discourse right now.

Things are going to change, hopefully.

But, you know, this is an example where, you know, if we can't provide good access to oral health, a whole host of chronic illnesses can, can result.

And and this is a great example of where prevention in public health is, you know, trying to address diseases that we never want to see.

Okay.

So we have a few minutes left.

I want to do a big picture and then get into the specifics about what people might be able to do to help improve the situation for themselves and the community.

But first, I want to talk about the World Health Organization that we have withdrawn from.

Why does it matter?

Can any of you tell us?

Well, it's certainly mattered during a global pandemic.

You know, we wanted to unify around, you know, a global leader.

And and we did to some degree, you know, but but outside of a global pandemic, you know, it doesn't change the day to day work of public health.

You know, from my standpoint, it is somewhat of an embarrassment.

It makes me wonder, like, why are we so special that we should not be a part of the World Health Organization?

But but from a day to day level, I don't know that it matters.

I think from a global standpoint, from a diplomatic standpoint, that's a different story.

But I think the day to day work of public health will continue, as it has, even with changes at the CDC or the FDA or at the time not largely affecting us at this point in time.

Okay.

So now one more time around the room, if I am an average person in Monroe County or the Finger Lakes, what can I do to to make sure that my community is healthy?

Is there anything, personally, any steps I can take?

What would you tell them?

There's, there's also, well, we have our our center for Community Health and Prevention website, which people can, access for the community Health Improvement plan to understand what it is that our, you know, some of our major priorities are within the the region.

And we also, have access to programs and services on that website, getting involved within, local community spaces and attending workshops, offering workshops, requesting workshops, things that have an educational focus to really have that collaborative conversation around what people are seeing, what people are experiencing.

Those are the types of things that bring that public health discourse right down to, you know, the neighborhood level.

And so I would, you know, really encourage people to also, get to know researchers that are doing work that impacts their everyday lives because that is an important way to understand, not only what's happening, but also how to impact that and how to have that conversation around, what an individual, sees as important within their own sphere.

Okay.

Anything to add to that?

That's a very difficult question.

But I think, you know, do you know how your neighbor is doing?

I mean, when did you last say hello to your neighbor?

Do you know the the lady is how maybe she has struggles.

So I think we need to build community on the very individual and very basic level.

And then from there on, if everybody feels better, then we can extend that.

And this is also how we can communicate information.

So, you know, if I, my neighbor is an elderly person and I talk to them and I can, you know, gently ask how she's doing, is she getting to her doctor's visits?

Is she getting her vaccinations?

Maybe, you know, maybe I can drum up a friendship there.

So I think we we can do a lot very personal on a very personal and individual level.

Okay.

Anything.

We have a few seconds left.

Anything to add to that, doctor?

Well, we've talked about public health and how communications important communication comes.

You know, from information.

Information comes from trust and trust comes from safety.

And so what I tell people is have the conversation when you're at the dinner table, whether it's a holiday or not, don't walk away from that hard conversation, because I think that's ultimately what builds trust and reduces fear.

Okay.

And you're off the hook, doctor agreement because we're out of time.

Get vaccinated and wear a seatbelt.

Oh, good.

Good.

I'm glad you snuck that in there.

Thank you very much.

All of you we've had in studio, doctor Anja Bottler from Rochester, regional Health, doctor Paul Greenman from the University of Rochester Medical Center, doctor Michael Mendoza from Townsquare Health, and Laura Sugarwala from the center for Community Health and Prevention.

I appreciate you all being here today to talk about this.

I'm Julie Philipps, sitting in for Evan Dawson on Connections.

Thanks to our production team and to you, our listeners.

And we'll see you same time, same place tomorrow.

Have a great day.

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