Painting a Picture of a Post Pandemic World
That Includes Vulnerable Populations, Is Population Health Management the Way Forward?
How do we create a post pandemic world that is more inclusive of vulnerable populations? We speak to two distinguished physi- cians who see health inequities every day and who are commitment to improving the health and wellness of vulnerable popula- tions. We ask the questions (1) is population health management the way forward to building healthy, sustainable communities? Do we have a plan to reduce or eliminate the glaring inequities showcased in our national healthcare systems during COVID-19? How do we reimagine wellness at the personal, family and community levels?
This week’s episode of Muslim Life Planning Institutes’ Profound Conversations is presented in conjunction with the National Wellness Institute’s Reimagining Wellness Live Conversations series.
Show Topics and Highlights
We know that that good health is so much more than the absence of disease
“Can we talk a little bit about what is the difference between wellness, health, and health care? Because people use those terms sometimes interchangeably?”
I think policies should align around creating the conditions that will generate health.
“Population health, from my perspective is a concept that is attempting to transform our healthcare delivery system in a way that pays more explicit attention to not just clinical outcomes, how long people live, and ideally how well people live by of life.”
“Why did COVID-19 become the epidemic it has become in the United States?”
COVID isn't creating the problem, but it is highlighting the existing problems.
So the the infrastructure which was fragile to begin with, has been to some extent unintentionally disrupted by being shut down and being a bit more isolated, well intentioned as those responses have been, I think it places those at greater risk.
“I think it's important that people feel connected, ours is a journey meant to be shared.”
“I think as we all strive to become more effective stewards of our own health and the communities that we are part of this.”
Profound Conversations Executive Producers are the Muslim Life Planning Institute, a national community building organization whose mission is to establish pathways to lifelong learning and healthy communities at the local, national and global level. MLPN.life
The Profound Conversations podcast is produced by Erika Christie www.ErikaChristie.com
Full Transcript
Trina Laube
I would like to welcome everyone today. My name is Trina lavvy. And I'm the VP of strategic initiatives with the National wellness Institute and we've been offering reimagining wellness live conversation series here for a few weeks. And we're really pleased to be partnering with the Muslim life planning Institute's profound conversation series, bringing together some really dynamic speakers today to look at painting a picture of a post pandemic world that includes vulnerable populations. So you'll see three fantastic individuals on your screen. Today we are joined by Linda Howard, Dr. Sandro Galea. And Dr. Mark Pettus. So just as a brief introduction, Linda Howard is the CEO of alternative which is a healthcare compliance consultancy that helps build people forward organizations and establish compliance ethics and quality standards for the health, fitness and wellness industries. She serves as the Chief Compliance and impact officer at the Muslim life planning Institute and she is also president of the National wellness Institute Board of Directors so she keeps herself pretty busy. As does Dr. Mark Pettus Who is a Board Certified internist nephrologist, and integrative met medicine. He's the director of medical education, wellness and population health at Berkshire health systems in western Massachusetts, Associate Dean of medical education and clinical associate professor of medicine at the University of Massachusetts Medical School. And he also serves on the NWA board of directors. And last but not least, we're joined by Dr. Sandro Galea, who is a physician, epidemiologist and author. He's also Dean and a Robert A Knox professor at Boston University School of Public Health. And he previously held academic and leadership positions at Columbia University, the University of Michigan and the New York Academy of Medicine. So we know you are all extremely busy individuals. So we thank you so much for joining us for this conversation today. And I'm going to go ahead and turn this over to Linda.
Linda Howard
Thank you, Trina. So during the conversation today If you have some questions, there's a q&a option. You can type your questions in that space. And we will try to get to the questions. We may take some questions throughout, but the majority of the questions we will handle at the end. And I will ask our guests to tell us a little bit about themselves about what they do and why they do it. And I'll start with Dr. Pettis.
Dr. Mark Pettus
S o as a Trina had noted, Linda, I've been at Berkshire health systems in western Massachusetts now for about 35 years and my clinical background is in nephrology, kidney related diseases, and for many years, I did what nephrologist do, I cared for people who were very sick, usually hospitalized critical care on dialysis transplants. And it was about 20 years ago that that I became struck by need to be committing more of my life and development around prevention and wellness. And that was a real pivot point for me. And since that time, have been directing much of our medical educational work out here in the Berkshires, we have residency programs and internal medicine, surgery, psychiatry, dentistry, and weaving that into more community based wellness and prevention work, which is very much central to these population health models that are that are happening in every community. really passionate about my work, I love what I do, and I love being able to translate the science for folks in a way that can perhaps help them empower and realize possibilities. And it's it's a it's an honor and an honor to be with you, Linda on this conversation and to be with Dr. Galea.
Linda Howard
Thank you, Dr. Pettus. Dr. Galea.
Dr. Sandro Galea
Well, first of all, thank you for having me. Join them. It's really a delight to be here with Dr. Pettus with you, Linda. So I'll tell you what I do. But maybe I'll tell also story with it. So I'm right now, I have the privilege of serving as dean of school public health at Boston University. And for the past 20 years of my adult life, I have been researchers and indeed for about six years now, but the A lot of my research has been about understanding how the world around us causes health and about understanding how forces like racism and poverty and how we build our cities, how that causes health and in particular, how it causes mental health and behavioral health. That's been really what's been my focus now, going back in time a little bit. I'm trained as a physician like Dr. Pettus is and my area has was emergency medicine and primary care. And I was a physician for several years before transitioning to a more academic role and The transition happened for me when I was working with the humanitarian organization Doctors Without Borders. In Somalia, I was working in Somalia, and this is in the late, late 90s. And I was looking after a community of hundreds of thousands of people as the only doctor there. And I was doing a lot of clinical good in a very tangible way, I think. And I oxiclean that experience, had the effect of me of wanting to think beyond the clinical world and, and the metaphor that I use is I felt like the guy at the side of the river pulling people out of the river. And like 1% River, put another person river but I was never really stopping to say what or who is throwing them in the river to begin with. And I became determined to understand that to understand what throws people in the river, who's throwing people in the river, and I realized that to do that I had to go back to school. And so I went back into the training and public health and a bit of me which eventually led me on my path. So I see myself in my path as having been really concerned with understanding the forces that throw people in the river, obviously, so that we can keep people from being thrown over. And that's really, I think, has been the animating force behind my work for the past couple of decades.
Linda Howard
Thank you. Thank you. And Dr. Pettus, I know that you also have a podcast show. You didn't mention that and what is it, Health Edge?
Dr. Mark Pettus
I do a podcast called the health edge Linda, which is a really a conversation with a colleague of mine john bag new low dr. john bag new low who has a PhD in nutrition, a master's in public health and john and i try to do a weekly recording where we translate the science and very much aligned with what Dr. glia was saying, really, what are the what are the drivers of chronic complex disease, what are the drivers of behavior, and so we spent a lot of time reflecting on top And do a pretty deep dive and it's been a fun way for us to collaborate, to maintain our understanding of the literature and to touch others. Okay,
Linda Howard
well, I'm gonna ask because we have we have a lot of people that's on the line and, and some of them may not understand what is population health. And I'll throw that out either one of you can answer or both of you can answer just give us an understanding of exactly what is population health.
Dr. Mark Pettus
I can I can start with you.
Dr. Sandro Galea
You start.
Dr. Mark Pettus
Population health, from my perspective is a concept that is attempting to transform our healthcare delivery system in a way that pays more explicit attention to not just clinical outcomes, how long people live, and ideally how well people live by of life. But also looking at the cost of care. We know that in America, we spend far more per capita than any other country in the developed world. And yet, when you look at our health outcomes from mortality rates to the burden of chronic complex disease to infant mortality, we really do not do that well. So from the perspective of value outcomes achieved, related to the cost of that care. Americans have not realized the system that has really created a lot of value for them from the perspective of prevention and wellness. So population health is a model that attempts to align clinical services with community based resources, sort of clinical community integration. And usually in alliance with a payer with an insurer that is partnering with you in a way that can attempt to manage the care of a particular group of people within a demographic and in a way that can reduce the cost care for those individuals. And it's a model that attempts to manage more in the community less than the hospital less than our emergency departments. And ideally, it's a model that should be empowering people. But it's a concept and one that that we're all evolving into and with, but but the emphasis is very significantly skewed toward the drivers of health. And we all know why is a system that has not been well designed to address that.
Dr. Sandro Galea
Well, let me let me take what Dr. Pettus said and sort of pick it up. And I think population health from an even higher level than when Dr. Pettus said so population health is the health of populations. It's the health of people. Now, that sounds unnatural. I understand that I understand. Somebody says, Well, why is he telling us this? But the reason I'm saying this is because when you say to yourself that your goal is to create healthier people, informs what you do. So how do you create healthy people? Healthy People by creating safe housing, nutritious food, livable wages, gender equity, reduce violence, clean air drinkable water. That's how you create healthy people. So population health is an approach that says, How do we create as much health as possible for populations and a subset of that would be narrow health equities, health inequities. And the medical care system is a part of that. So this is why I said I'm sort of taking with a grain of salt and going up a notch because I agree with everything Dr. Pettis said, but I would put that within a broader conceptual framework that ultimately we care about the health of populations. And once we understand that, we want to put in place the elements to do that. And those elements, which are housing and food and education and in income and wages and safe parks. Some of those, and perhaps many of those are outside of the remit of the myth of the medical system. So I think the medical healthcare system has a real role to play there. But a lot of it is actually outside of the medical secure system. And part of our job, once we understand what population health is, is to make sure that those who are responsible for housing, realized that they are also responsible for health, that those who are responsible for transportation realize that they're responsible for health and that is a conceptual leap beyond what most people good people have good conscience will really try and do the right thing in those sectors recognize it's also part of their job.
Linda Howard
Now, Dr. Pettis, I know you do a lot in the wellness space as well. But before we jump into that, because I got a couple questions on the wellness side, Can Can we talk a little bit about what is the difference between wellness, health and health care because people use those terms sometimes interchangeably? And just so we understand what is the difference in those three Thanks.
Dr. Mark Pettus
Well, I think health traditionally and what most of us are taught in medical school is essentially the absence of disease. You know, many of us are taught how to diagnose and treat diseases and if somebody is disease free we we have historically and the traditional medical models considered that to be a healthy individual. We know that health span, one's quality of life, one's functional and performance capacity. one's ability to thrive in whatever community or setting that they are in, has many upstream influences, some of which Dr. glia briefly touched on influences that we might consider social determinants of health, good, good quality food, housing, transportation, literacy, social connection. And so when you begin to look at health, from a broader or wellness from a broader perspective, you really have to include really the attributes of day to day life, the the quality of the environment, that that person is in the ability of that individual to leverage whatever resources they have to choose in ways that can optimize their happiness, their health, their ability to thrive. And again, as Dr. glia noted, these are these tend to be non clinical attributes. They speak a lot about the the environment of one's home, one's relationships, one's community, one's availability of quality foods. So I think of wellness as a as a much broader context that clearly is a driver of good health. But we know that that good health is so much more than absence of disease, it is really trying to create a biology or resiliency that can allow one to realize a capacity to thrive or to to to manage a particular challenge that may come up in lives in a way that will allow them to maintain a sense of control a sense of empowerment, and, and and self efficacy. So that that that's one way that I think of sort of wellness much more broadly than just sort of health as we have traditionally defined it in our medical models.
Linda Howard
Now, now, Dr. gallia, when I'm when I listened to your last comment, she talked about just the those responsible for transportation need to understand that they're responsible for health, those responsible for housing need to understand that they're responsible for health, when we're looking at addressing issues for vulnerable populations. Is that something that we need to be looking at at a policy level at a government level or at an individual level?
Dr. Sandro Galea
I think we need to be looking at at that at all levels. I think the housing policy is health policy and transportation policy is health policy. There is a movement which has been around in many countries, the American Public Health Association this country has also taken on called health and all policies approach that essentially says that when we make take action on anything that builds the world around us, be it our housing, be it our food, be it our education, we need to ask, what impact is this having on our health now Why? Why should we do that? We should do that because health is a universal value. You know, I speak to audiences all over the country. And people disagree on all sorts of things. But I have yet to find someone who says to Me, I would like my children to be less healthy. We all and I'm sending about children specifically because sometimes things get complicated with those but everybody wants their kids to be healthy and this healthiest possible. So when I hear that and you know, people want all sorts of different things for decades, but everybody wants their kids to be healthy. So that means that health is a universal value. So when something is a universal value, then it behooves us to align our world to maximize that value. So coming back to your question, Linda, I think policies should align around creating the conditions that will generate health. And I think we as individuals should act in accordance with that. Now, what can the individual do? Well, what often you'll hear from someone like with things the way I do is, the individual needs to demand this then demand this health and demanding this health, not only from the elected officials in public office, have the capacity to change policy, but also from the private sector because a lot of our world is shaped by the private sector and we should invest in the private sector that will benefit our health.
Linda Howard
Dr. Pettis, yeah. Any thoughts around that?
Dr. Mark Pettus
I mean, I would agree that I think at every level from from policy to implementation and execution and really on a more grassroots level. And again, as Dr. Ghali alluded to developing capacity social capital community capital, it's it's partnering in ways that traditional healthcare models have not done a very effective job of doing with with community constituents that, again, become part of this holistic approach to how people engage their relationships in their lives and in their communities. And so it's it's clinical community Coalition's, and a lot of that is very grassroots, as you attempt to leverage policy and resources and you know, I think when I look at what's happening in our community, we see many people from our faith communities to Schools, certainly to our our workplaces that do I think begin to see themselves as stewards of community health in ways that historically, you know, they might not have have have considered in quite the same ways. So all of those things are very important and probably never more important than you are right now.
Linda Howard
So let's talk a little bit about the COVID in the room. COVID-19. This is where we are right now. We're really dealing with all of these issues around some of the health inequities, you know, the population health, but we're now dealing with it in the reality of COVID-19. And I know both of you are out there working, you're on the frontlines. Tell me what are you seeing around COVID-19 and what could we be doing a little bit differently if we take in consideration two predictions that we might be seeing another wave of this coming fall.
Dr. Sandro Galea
Let me perhaps start and
and I would take a step back again with COVID. And see, why did COVID-19 become the epidemic it has become in the United States. And I think there are two reasons for that. Number one, is because we had not invested in the infrastructure to health infrastructure to contain an epidemic like that. We have had decades of underinvestment in the public health systems that allow the federal government to respond to coordinate with the state governments, the state governments to interact with the local government, local municipalities, for example, in Massachusetts, where I live, and where Dr. Bettis lives, we have 300 something small health departments that is that is not a system that's designed to deal with something like this. So reason a is that we have another are invested in health systems reason be, is because we have under invested in creating a healthy world, like our world is far more unhealthy than it should be. Considering that we spend far more on health care than all other high income countries, we spend 40% more than the next closest high income country, we get far less out of it just to give concrete examples. Our life expectancy is about five years less than other high income countries. We have more people die from chronic disease from infectious disease than all other high income countries, we have higher obesity rate than all other high income countries. And these forces mean that we have a much less healthy country than we should have. Now when something like COVID happens then it's not about the COVID is about COVID buts about the underlay that is behind COVID. That is why we are seeing the disproportionate burden that we are bearing of COVID in this country compared to other countries. It's also by the way, my We're seeing these racial differences in what's happening with COVID. Because people of color people who have low incomes have greater burden of disease to begin with. And they are much more likely than both to contract COVID and have serious complications from COVID. So COVID isn't creating the problem, but it is it is highlighting the problem. It is elevating, and it's eliminating the problem. So to my mind, the lesson from COVID is, how do we understand this? And now go and build a country that is not so vulnerable to COVID. Next time that pandemic happens for pets love to hear your thoughts.
Dr. Mark Pettus
I could not agree more with what you just said a doctor believes that it and I would reiterate that this has revealed the limited infrastructure we have from a public health perspective and every aspect of the structure and function of our environments is one That tends to make the least healthy choice, the easiest choice, the least expensive choice. And, and and in the example of food, addictive qualities that can make it very hard for any human who was engaging regularly to distance themselves. These are the structures that guide how we choose. again back to Dr. Work, Dr. glia was saying the environment really plays a critical role and ultimately influencing that choice, the choice architecture perfectly designed to produce the outcomes that we see in the US which is the one of the least healthy countries on the planet. I also totally agree that this has unveiled the extent to which those who are more vulnerable those with a greater burden of chronic complex disease as an ethnic minorities have as people of lower socioeconomic status have as people who are more socially isolated have will have an accident rated impact from from something as violent as as COVID-19. We then see in response to this pandemic, and I'm not being critical, it's just an observation that the infrastructure that would ordinarily support these more vulnerable individuals has been disrupted profoundly food delivery, not quite as as as easy now or as effective as it was a pre COVID. Many kids who who get two out of three meals a day at their local schools may not have the same capacity that they had prior to this virus. We know that the transportation volunteer, ride sharing has all but dissipated, making it very hard for people without transportation from getting from A to B. So the the infrastructure which was fragile to begin with, has been to some extent unintentionally disrupted by being shut down and being a bit more isolated. well intentioned as those, as those responses have been, I think it it places those at greater risk. For even more concerning challenges around recovery and reentry, if you will.
Unknown Speaker
Let me let me just build on that for a second as they think they're better some brought up something I really was hoping we'd get to. So I'm very grateful to you for doing that on the, you know, Linda, you asked about COVID. And you know, and I give you an answer with a resource giving us about COVID and the immediate consequences and why we are vulnerable to it. But there are two stories about COVID. One is COVID itself. The other one is our response to COVID. And our responsible because we were so ill prepared our response, which has been a a sort of a big mallet approach to shut down the economy has resulted in this enormous set of economic consequences that ultimately are going to affect more people who already had low incomes. Who are unstable rehoused populations of color people who are single parents, these are the populations who are going to be feeling these economic consequences and the health consequences of the economic consequences are going to linger for months and years to come. So I am deeply concerned about the health consequences of our response to COVID. And as we start thinking about, so moving past the acute pandemic phase and, Linda, you mentioned, there might be a second wave we can discuss that may or may not be, but what we do know there is, is an enormous spike in unemployment, a reduction in economic functioning, and that is going to have enormous consequences for next month and year. So I actually feel like the public conversation needs to shift much more dramatically, to think about those consequences. Then, we have so far, so thank you for just for introducing me.
Linda Howard
And Dr. Pettis, because I We have Muslim life planning Institute. We do a lot of work with the organ procurement community. And I know that you are a nephrologist. So, have you been experiencing an impact with those that might be on dialysis or waiting for transplants? We have recently received transplants? What have you seen in terms of this period that may have impacted those patients?
Dr. Mark Pettus
That is a really good question, Linda. And while I don't practice nephrology, as I once did, and I may not be quite as attuned to some of the more recent data, we know that that there are far more people on waiting lists for transplants than there are available organs, that that has been a reality for many, many years. And we know that many people will die waiting because of the the burden of chronic complex disease and just not having enough time to ultimately be procure an Oregon. I do think there has been some evidence and again, I've not looked at this carefully that organ donation whether that be living related donation or individuals, gifting an organ from someone who is clinically brain dead has gone down some whether whether that is being influenced by some of what's going on now you're there there are many people now that are fearful of engaging the healthcare system. There are many people once they engage the system are doing so without without family with them because of just how things are configured right now. And many conversations that might otherwise be happening are probably being being marginalized some, but I think it can, it can be said that the the issue of organ donation continues to be a huge issue. I don't know to what extent this will aggravate some of the current challenges.
But I think it'll be an interesting thing to follow.
Linda Howard
Yeah, when we think about the vulnerable populations that is, you know, one of the populations where there's a lot of vulnerability around. We also have the vulnerability when we start talking, as both of you have talked about when we talk about African Americans, other people of color, people of low income. And so I've heard that there's two plans for Okay, how do we do testing? How do we do tracing? We're working on a vaccination. These are also communities that that oftentimes as you just suggested, Dr. Pettis may have some distrust of engaging with the healthcare system. This distrust that predated COVID-19. So how do we begin to take how do we take actions Situation some of those distress issues when we start looking at a plan to actually put a plan in place to actually provide the health care services that are needed in either one of you can jump in on this.
Dr. Mark Pettus
Sandro please,
Dr. Sandro Galea
Let me offer my thoughts, I think distrust is a really critical issue. And entrepreneurs use the term earlier about social cohesion, which I think captures this very well social cohesion and is a sense that we belong to the same community. And when we belong to some community, we are much more likely to trust that others are here to help us including others in the healthcare system. We have not given people who are in vulnerable populations reason to trust the health system, frankly, because because anyone who's vulnerable knows that we do not treat health as a as a public good we do not see health as something that is a right that we should all have. The system is not trying to go out of its way to help promote your health. In fact, the system creates barriers for you to access your healthcare creates barriers for you to access the drugs you need. With those with that obvious personal experience that people have, why would they then then trust the system? So I really think the question of trust very seriously. And I would go back to why is there a mistrust? And I think there is the mistrust, because frankly, we have not created a system that is going out of out of its way to help people the way it should. So to deal with that, I think we really need to look take a long, hard look at our systems and say, are we building health systems that are designed to truly help people once we fix that, once we treat health as a public good, something that's available to everybody something that is does not have to be bought or sold, then I think we'll see trust changing, Dr. Pettus.
Dr. Mark Pettus
That's totally agree With those those great comments, I think relationship capital is really the the lever upon which all that we do in healthcare and all that we do in life is is essential. And I am often struck at how limited relationship capital can be between a caregiver and those that they are engaged with. Some of it is, as Dr. gulia noted, a byproduct of a system that's not well designed to enhance capital short visits, complex agendas, lots of people discord nation, it's it's it's a very good model to produce an output where a person is going to feel less connected and less than franchised. So I do think that relationship capital, and some of the ways that we are attempting to address that involves much more community outreach. You know, we all know that healthy living doesn't happen in doctors offices. It doesn't happen in hospitals, healthy living happens, the choices we make each and every day in our lives. We have we have many people now as part of our collaboration that involved community health workers that involve more community outreach, doing more house calls, meeting people where they're at, whether that's the food pantry or the local faith community, or the senior center. You know, I think we need to be doing a better job of integrating what we have to offer into the lives of those outside of clinical settings. And so we might see, for example, someone who's addicted, someone who's been in and out of the hospital 40 times in the last year, who after 20 calls from a community health worker finally engages, starts to see a relationship from someone who cares about them, and then you start to try to incrementally build on that relationship. And it's, it's, it takes a lot of effort. But I think I think the trust can capital is a huge, huge issue and ours is an enterprise that needs to be doing a much better job of connecting with people redesigning our models. I think one of the unintentional and maybe positive consequences of COVID has been an acceleration of our telehealth platform, for example, so telehealth is having an encounter with a health care professional via your smartphone or, or tablet. And because of the conditions of the response to COVID, we know that people just aren't going to the doctor's office or maybe the emergency department. So we're doing a lot more visits virtually. What we find is that our no show rates for virtual encounter is virtually zero, because that individual is in their home. You know, maybe they're in their car, but there are very few obstacles to making the connection.
You know, I so I think that
We're seeing a bit more innovation and acceleration of our ability to connect to people to meet them where they're at, to try to reduce or navigate some of these obstacles that Dr. glia had had alluded to, in a way to try to enhance that that level of engagement. But this is, this has been evolving over generations, it's probably going to take some time to turn around. But I think that's where we need to be focusing more of our attention.
Linda Howard
I'll ask both of you. What is the way forward? And I know Dr. glia, you made reference to that perhaps we need and I correct me if I get this wrong and Marshall plan in place. So why don't you talk a little bit about what that is, and what would that look like?
Dr. Sandro Galea
Yeah, I use the me you right. Um, I wrote a piece for the hill, which was intentionally for the hill because it's read by politicians. calling for a new Marshall Plan for health and I was using that to be grand but also because I do think it's a big effort actually, Dr. Peterson's last comment saying that this will take time is correct. I think a Marshall Plan for health is one that says your health and my health and our health is determined by the places we live, where we work and where we play is determined by whether we have access to safe Parks and Recreation where we have access to nutritious food, whether we are stabili housed, whether we are part of a fairer economy that can allow us to get the assets that we need to live healthy. Once you understand that once you understand that, then you say health should penetrate all policies that we should be thinking about health all the time. And we should make sure that what we do as a country is going to be promoting health. Once you say that you also realize that you need to structure your health system to promote that to encourage that means moving health system in a way where providers are rewarded for keeping people Healthy This is some of the elements of population health management that Dr. Pettis mentioned earlier. And where you have primary care providers that look after a person's Whole Health after a person's wellness, all of those would be elements of a Marshall Plan for health. Unfortunately, that is far from where we are today. Unfortunately, where we are today is a system which enormous amounts of money, enormous amounts of money into advanced medical care, advanced sick care care, that helps people once they are sick. And, you know, I asked this of audiences all the time. Would you rather live in a society let's say where there's a treatment for you after you get Alzheimer's? Or would you like to live in a society where you don't get Alzheimer's at all? I have yet to get somebody raise their hand say no, no, I want to get Alzheimer's and get the drug No, and another one of them is to begin with. So so but we keep putting all our money in the sick care system, rather than creating health. So a Marshall Plan for health says, Let's understand where health comes from and let us take the steps necessary so that we generate Health in everything we do, and create systems that can help whole populations be healthy.
Linda Howard
Ah, Dr. Pettus,
Dr. Mark Pettus
I just have to add that I love the whole concept of the Marshall Plan. That's, that's beautiful.
And I would I would echo you know, the the extent to which health as a fundamental right and the Warped financial incentives of our system really need to be radically revisited and revised and that's they're powerful forces that play there but I think a lot of this work ultimately has to be grass roots and and I see many communities stepping up and people looking to create, you know, different ways of connecting. But this is these are very challenging forces that we are up against.
Linda Howard
Now if if you had to give some advice to our we have a lot of wellness professionals, a lot of on the line. We also have clinical people that are on the line, if you had to give some advice in terms of what could they do in order to help address some of the issues that we're seeing in our in our health care system, in the health and well being of individuals and vulnerable populations?
Dr. Sandro Galea
Well, I can take a stab at it. And I think, I don't think it was gonna surprise anybody who's been listening to this, I think that the clinician needs to see the whole person in front of her. And by that, I mean, as a clinician, you are trained, whatever, whatever space you're in as a clinician, you were trained to narrow down and the person comes to you and she is a broken arm. And the question is how do you fix her broken arm? But that's not really the only question. The question is, Why is her arm broken? What? What kind of living condition is she in? Is she at risk for violence, she in a neighborhood that actually leaves her with no option but to do things that are dangerous? Now, once you start thinking that way, you understand that our health, my health, your health, and Dr. Pettis, his health is inextricably linked from the world around us. I think the challenge for the clinician is what can I do? What can I as one individual do? And I do I have I'm deeply sympathetic with that question, because I do think that it's hard sometimes to think of what a condition can do and I often come to my head to think that two things one, is that even recognizing this and labeling it, and helping the person herself recognize it, to help figure out solutions that encompass her whole life is a real value. Number two, clinicians and wellness professionals are an important voice in our society, the world will listen to you. And speaking with one voice about the importance of nesting health within the world that produces it will eventually bring about change.
Dr. Pettus, over to you.
Dr. Mark Pettus
I totally agree. Thank you for that. And I do think that more and more clinicians, I've been practicing medicine now for 35 years, are confronting value conflicts in their lives. In part because they they're part of a system and they can they can inherently experience and feel the shortcomings of that system and many choose as I did to depart from that, that roadmap, that playbook. And one of the challenges for caregivers today, I believe, particularly in the wellness field is one. It was David Sackett, sort of the father of evidence based medicine who said that within five years of your graduation 50% of what you learned will be will be shown to be untrue. Part of the challenge is knowing what 50% that is we we are in the midst of a knowledge revolution, an explosion of knowledge. And it's very difficult to translate that knowledge into day to day practice and execution. But I think I think it for the for the wellness caregiver, there is a tremendous amount of research that continues to emerge that may take a little bit longer to weave its way through some of our mainstream structures, academic structures, clinical pedagogic theory if you will, and and not to sound too Renegade, but I do think wellness practitioners that are motivated as as self learners to maybe challenge some of the conventional ways that that guidelines may be informing how best to serve another is a very important attribute as one attempts to bring that knowledge into the empowerment and life of the individuals, they're engaged with an example of that. You know, we know for example, that that carbohydrate restriction and people with cardio metabolic syndrome, they're overweight and insulin resistant, which is probably one of the major drivers of most chronic complex diseases, has evidence for nutritional approaches that that may contradict current guidelines. So I think there has to be a willingness to in a trusting partnership to individualize an approach to tailor an approach to meet a person where they're at. I can't be talking about gluten, if the person I'm engaged with is food insecure and reliant on their local food pantry for for the food that they consume, which may have variable quality associated with it, so meeting people where they're at and empowering one selves, the typical physician may get a couple of hours of nutrition over the course of their They're medical training. So there has to be a commitment, I think to self development, professional development, individualization and and meeting people where they're at as you attempt to help somebody find even the smallest possibility that they can realize is is essential. And I and I think that that can that can require a lot of patience and persistence, particularly if you're trying to make a living outside of an insurance model, as many wellness professionals have to find themselves navigating toward because it's very hard to sometimes apply this work in the context of a 10 or 15 minute visit, or an insurance model that won't always reward the work or the effort or the capital that you're sharing with a with another individuals. So those are just some thoughts off the top about wellness providers today.
Linda Howard
Well, I know my I know my wellness, my national wellness Institute family, they always have a lot of questions. And we have quite a few people on the line. So Trina, do we have any questions lined up?
Trina Laube
Yes, we do have definitely have some questions coming through. So I'll try to select a few here for you. Can you speak a little bit about how individuals could actually advocate in a few different areas? So we know that there are emergency rooms that are already overcrowded on a normal day. So how can we advocate to be better prepared to handle those future surges? How can the average citizen advocate for better infection control in nursing homes? Can you speak a little bit to what the average citizen can do for advocacy and how we can support
Dr. Mark Pettus
Dr. Galea, do you want to start with that?
Dr. Sandro Galea
You start.
Dr. Mark Pettus
i think the more your knowledge is power, and I think the extent to which people can be more active and proactive and acquiring as much understanding as they can with respect to who they are and how they function will enable choices, whether that's a decision to go to the emergency room or not for what might otherwise be a self limited viral upper respiratory infection, maybe not the best analogy today, but I think I think the more empowered people are in terms of their understanding of how the system works, how they can engage it in a way that can serve them better than they're currently being served. And a lot of this really does come down to fundamental practices. I think when we look at hygiene, you know, we know that these are long standing fundamental practices of you know, hand washing, maybe washing vegetables before we consume them. I think this awakens us to the fact that a lot of this is blocking and tackling as it relates to infection control, common sense but I'll also say that I think the fear factor is quite palpable now. And one of the challenges for people as they attempt to empower themselves is how do you develop some strategies that can help you maybe mitigate some of that fear in a way that that can help you navigate a bit more clearly and that that's, you know, that's a complicated issue. But whether these are simple breath techniques, greater self awareness of when perhaps your your ability to choose is being compromised or undermined by a particular pattern becomes an important part of that self development. We all need help with that. I think it's important that people feel connected that you know, these are ours is a journey meant to be shared. And I think the extent to which people can foster connection can better understand where in their sphere of influence, they can choose more wisely, you know, becomes paramount to how you sort of help the system and help yourself
Dr. Sandro Galea
Yeah, I I agree with everything Dr. Pettus said and I like I like the phrase our life is a journey meant to be shared. Thank you. I would just add one thing in answer to the question of how do you advocate, mom? vote? I think we are within a system where voting closes the responsibility and authority loop with accountability. Voting is what means that we hold people who we trust, to create the conditions to generate held accountable, so vote.
Trina Laube
Thank you. And Christy here is also asking as wellness practitioners, what current government policies issues conversations should we be paying attention to that may have actually the potential to undermine and threaten the progress and gains that have been made with population health Among vulnerable populations
Dr. Sandro Galea
well where to begin and I think it's gonna take hours.
You know, when when, when the when the president says that to protect us from Coronavirus. We are going to shut down borders. That is a statement that is based not on science. It's based purely on xenophobia and political game. There is no evidence that shutting down our borders is going to do anything to protect anybody from porn virus. What that will do is it will, it will sow division and will sow hate, and it will create fractures. In our social compact. This reflects what our parents were saying earlier, which will harm health. So I'm using that as an example. I started with that as an example. Because we need to look at these policies and these statements for what they are which are ways that result in a fracturing of social compacts a disinvestment in creating this sense of our common good. And as a result, something that harms health. So I would encourage everybody to look at policy statements and decisions through this lens and says that asks very simply, is this creating a world that's going to promote our health is a policy on immigration Greenwald is going to promote our health as a policy on incarceration grading was going to promote our health as a policy on housing green was going to promote health and when it does not, we should speak up for we should speak up. And we should say, this is not what we demand because we, the citizens of Health, Dr. Pettis,
Dr. Mark Pettus
I think as we all strive to become more effective stewards of our own health and the communities that we are part of this. I'd like to come back to just basic instincts. You know, we're a species that has has been evolving over the last modern humans couple hundred thousand years we have a lot of intelligence, a lot of innate wisdom that has guided us in the generations before us for a long, long period of time. And I think sometimes and in the hubbub of political commentary, maybe media, it can become easier to lose connection with some of those deeper instinctive guides that at the end of the day can help us choose more wisely, whether it's who to engage with, or whether to go out or not. If, for example, it's very hard for somebody may find that they have a yearning to be outdoors because really, that's what they are wired, to be doing to, you know, to be outside to be in nature. So I do think this is an opportunity for us to come back to some of the basic ancestral wisdom, the compassion, the ability to begin to look inward and you No, all I believe all health starts with loving oneself and, and being compassion with oneself and with others. And so I think we probably know a lot more than then we might realize in terms of just our instinct survival and and how to connect but but it's easy to lose touch with that. And so I would encourage people to be still to take advantage of moments where they can they can do some of that that inquiry and to trust their instincts, particularly when they're hearing things that don't quite resonate with where their energies that
Linda Howard
Do we have another question?
Unknown Speaker
Yeah, we have a couple of people who are mental health providers, and are asking how they can support both the physicians and nurses as well as the general population. And particularly during this time.
Unknown Speaker
Yes, I can take a quick stab at that, but that's the I think the coming epidemic is one of mental illness. And we know this we know from any number of other large scale traumatic events and covert is a traumatic event that there is an increase in mental health problems, particularly mood anxiety disorders, particularly like depression and anxiety and post traumatic stress. And there are early studies that show that this is the case in a population. So this is coming this is there's no mystery here. So I do think that providers need to be aware of it. And what can be done well, I think there's tiered approaches number one is talking about it, talking about a D stigmatizing mental illness and saying that our mental health is something that we all have and we can all be at risk of having mental health problems talking about it, creating the license for people to speak up, if they have mental health problems, number one, number two, is creating the opportunity for people to talk about their symptoms because some anxiety in a time like this is reasonable. Some sadness in a time like this is reasonable. That does not mean anybody has been problem, that simply means it's a normal reaction to troubling times. Number three, is to make sure that one creates the opportunity for then dealing with a provider when symptoms of mental illness emerge. And by that, typically, the line gets crossed is when you cannot carry out your personal and professional responsibilities because of your mental health symptoms. That is when it becomes important to see a provider and to make sure that the people who we encounter realize when that line is crossed and when they should be talking to provider.
Unknown Speaker
I totally agree with those excellent comments. We often talk about this concept of allostatic load, that this concept of how the stressors in one's environment can reach a point beyond which one's ability to adapt effectively becomes compromised and and and clearly Beyond the allostatic load already present particularly in vulnerable sectors as we've been reflecting on when added to the traumatic event as this clearly is, Will predictably drive many of those behavioral health issues and we all see that in our own lives and in those that that we may be serving and I love what you said Dr. gelei about not stigmatizing about understanding that this these can be normal feelings and experiences of any living organism in a stressful environment. And and I think that perhaps more than ever, our ability to connect and and our ability to create more of that relationship capital to help people feel more comfortable expressing their sadness or their anxiety is especially important right now and the extent to which we are again just as an example To integrate behavioral health, all of our community teams have a social worker with a community health worker with an RN. Because we know that as many as 40% of the people that we may be helping with their diabetes are also depressed or dealing with generalized anxiety. So anticipating the escalation of those expressions is, is something that we're all trying to get out in front of, both with the personnel that we have out in the field, other ways in which we're trying to create more safe and comfortable environments for people to come forward. And then focusing a lot where we can on empowerment, mind body skills and stress reduction. Understanding that the food insecure will not easily overcome anxiety without adequate food. And so it's this holistic, managing the anxiety, the depression, the PTSD, as Dr. glia was alluding to becomes part of a whole mystic context within which you are attempting to assist those individuals, but this is what it is to be human at a very challenging and interesting time. And so as we attempt to be less judgmental, and and more loving and compassion, and and again, leveling the playing field is especially important right now.
Trina Laube
Thank you. And I think we could probably stay on for another couple hours with all the questions that are coming in. But I'll ask one more here. As we've been seeing the country of Cuba has been traveling around the world helping countries in Europe and now South Africa. So why are we trying to reinvent the wheel when Cuba is actually making great strides with fighting the virus? Who anybody want to take that one on?
Dr. Sandro Galea
I think I think there's a lot of wheel reinvention. I think many countries have done things that are that are immutable, you know, we as a country have have had To some notion of American exceptionalism that says that we shouldn't be learning from others, you know, I'm an immigrant to the country. So I came here because actually, I really love this country. And it's because I love it, I would like it to be better. And one of the ways we can be better is stop having the arrogance to think that we have all the answers and learn from other countries. So yeah, I think there is a lot of wheel reinvention. I think we should pause I, I really appreciate how medicine, sometimes it's good to be still be still and think about it. And when you still think about it, we think about, we think about that. Others do have solutions that are perhaps better than ours, and we should adopt those and we should use those to create the healthiest population in the world.
Dr. Mark Pettus
Thank you for saying that. Dr. Galea. I, I would agree that ours is an enterprise that that has always sort of perceived itself in a very sort of superior way. And, you know, ego and arrogance are our great obstacles to innovation and compassion. And I do think we're going to learn a lot about the many things that we could have perhaps done differently or better. Or we're always looking for best practices and all the work that we do and trying to reproduce them. I'm not sure how well we've done that as as a nation, perhaps not too well when you look at most of our health metrics. But I think the humility factor is a very important one, and . . . I'll stop there.
Trina Laube
Thank you. And I think like I said, I think we could continue this conversation and I hope that that we do so take the opportunity to advocate and discuss with your peers. I do want to give you all the opportunity to speak. I will say just a little bit of housekeeping quickly for those of you that do need continuing education credit. If you've attended this live webinar, you will be able to request your continuing education credit by a link that will be sent in an email tomorrow. So again, that's for the live webinar. Like I want to close this here.
Linda Howard
Okay, um, thank you, Trina for helping us with the questions and some of the technical stuff. I also want to thank Erika Christie, who is our Muslim life planning Institute technical engineer. So she does a lot of the work behind the scenes that makes profound conversations happen. We also have with us Karim Ali and Samuel Shareef, who are my partners with Muslim life planning Institute. And as Trina mentioned, as we started and a lot of you know, me in my role as the president of the board for the National wellness Institute. So I'm really, really want to thank the National wellness Institute for co sponsoring this event and for all the work that they did to help market it and I see that there are tons of questions. So I wish we had more time to be able to get to get to some of the questions but I think So maybe we need to continue this conversation in another episode of profound conversations or conversations to reimagining wellness conversations live. So I thank all of you for for joining us today. This has been a really great episode.
Dr. Sandro Galea
Thank you. Thank you for having us.
Dr. Mark Pettus
Very grateful,
Linda Howard
I want to thank both of our both of our speakers for for being here and taking time, because I know both of you are extremely busy in this time. So Special thanks to both of you.
Dr. Sandro Galea
Thank you. Thank you very much for having
Linda Howard
Thank you.