Jason Reynolds, 2015, Lena discussed on All Things Considered

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We've been talking about infrastructure pretty much all week. But let's step away from that for a moment to talk about another kind of infrastructure. One that is undoubtedly an extreme inextricably linked to the economy. Public health infrastructure is about Dr Leana. Wen has devoted her career to improving. She's an emergency room physician, former health commissioner of Baltimore And she's written a new memoir about the links between public health and really everything else. It's called lifelines. A doctor's journey in the fight for public Health. Lena Welcome to the program. Thank you. Great to join you today. The way you describe the concept of public health really stuck with me. Basically, you say that every day public health is saving our lives, but we just don't realize it. What do you mean by that? By definition. Public health is successful when we have prevented something from happening, and then by definition, there is no phase two public health. I mean, there is the face of a child who was lead poisoned. But not the face of a child who could have been lead poisoned except that his home had been remediated. And I think this is the reason, though, why I'm public health becomes the first on the chopping block because people don't understand it. Well, you were the health commissioner of Baltimore. And one thing that surprised me. It was just the broad scope of your job. How you described it. In the book, You did everything from animal control to fighting the opioid epidemic. And it made me wonder if people really understand the role that local public health departments play in their lives and ultimately in the economy. Well, I definitely don't think that people understand the role of health departments at all. I mean, I think there may be better understanding now because of covid as and I would wager that prior to Covid. People didn't even know that there was a state health department. There is often a city and county health department and the interplay between them. I bet people never really thought about that. And I think now people equate public health with infection control, which is, of course, an important component. But that's certainly not all we do. And so, for example, in Baltimore, Um yes. Restaurant inspections fell under the health department also oversaw of school health in every single one of our 180 public schools. As well as senior centers. I mean, that all is public health. Of course, The scope of public health depends on where you are in the country. But I think that coming out of Kobe not that we're done with Covid, but I think there is a real opportunity to let people know about how whatever issue they care about. Directly relates to public health. And if somebody cares about public safety or the economy or education, there is a direct link to the work of health departments to it's all interconnected like you write that public health is housing. It is food. It is clean air and his education. And it's basically the ability to level An unequal playing field. And you, you know you're a doctor. Um, And there's this phrase that you borrow from medicine to describe the public health condition of the U. S. And that phrase is acute on chronic. What does that mean? And how does that apply to the situation we're in today? Yeah, There are ongoing chronic issues. But then you overlay on top of that, and acute exacerbation, if you will. This is what we often talk about in medicine is in. Somebody may have diabetes. But then there is something that occurs and then they have, um they have an acute exacerbation. It suddenly is getting worse. And now they end up in the hospital with very high blood sugars. Because of that, maybe I'm getting too clinical with technology. You know, this is something but for the non doctors out there. Yeah, but the idea is that in public health, this often happened so one of the chapters of the book, for example, I talk about the uprisings that occurred after the death of Freddie Gray and how in the aftermath of the uprisings There were so many people who had mental health concerns for experiencing acute trauma. But it wasn't new, as in. There was already this undercurrent of unmet need. When it came to mental health and trauma, Then you lay on top of that this acute exacerbation both have to be treated. We have to talk about systemic racism and equities disparities how racism itself as a health issue. I mean, you got to get there, but there are short term things that you can do right now. So for example, at that time we set up at 24 7 Mental Health and Trauma hotline. We did healing circles with our schools. I mean, there was there were short term actions that you can take will also longer term addressing these issues that for a long time have been there, too. Well, yeah, to your point you mentioned in your book that back in 2015. You started calling out racism as a public health issue, and that raised a lot of eyebrows. You know, people understood racial disparities as a public health issue, but Not necessarily structural racism. Do you think the pandemic has helped shift people's understanding? I do. I definitely think that people understand the idea of health disparities but again sometimes when these issues are interrelated I think there can be decision paralysis as in. I think some people could say Hey, if everything is related to everything, and the problems are longstanding, what can I do right now? And that's what I try to make a point of in lifelines of same Yes, these problems are really hard. But there are things that you can do. There are tangible steps that you can do. I mean, for example, around the opioid epidemic. I got criticized, Frankly, for why it is that we focused on naloxone initially getting the opioid antidote to every resident in our city, right? And people said that's not a long term solution. Why, Why are you doing that? That's that's only helping somebody right now. Well, first of all, if somebody is dead today, there's no chance of a better tomorrow. But second of all, it was something tangible that we could do and show people that while we're working on long term solutions, we can address this right now. Lena When is an emergency room physician, former Baltimore health commissioner and contributing columnist for The Washington Post, and she is the author of her memoir, Just Out Lifelines, a Doctor's Journey and the Fight for Public Health. Thanks so much for your time, Lena. Thank you for having me join you today..

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