The Health of All for the Health of One

Welcome to Massachusetts College of Pharmacy and Health Sciences Podcast, the Secret to Living to 200. My name is Jennifer Persons and I'm your host. In each episode of this series, we will explore different aspects of health and the factors that allow us to live longer, healthier lives. With the help of a thought leader from the university this year, MCPHS is celebrating its 200th birthday, and what better way to kick off our bicentennial celebrations than with a podcast about longevity and wellbeing? Joining me in the studio today is Dr. Carly Levy. She's a professor of public health and director of the Master of Public Health Program. Welcome, Carly. Thank you. Grateful to be here. We're so excited to have you. Before we dive into our conversation, we're going to start with an icebreaker. So my question for you is, if you had a time machine and could travel 200 years into the future or 200 years into the past, which would you pick and why? That's a really terrific question. I think I would travel 200 years into the past because I think in order to shape our future, we have to better understand our past. So not that I would necessarily try and change anything, but I think maybe to understand where we're at now to get a better picture of the past, I think that would be helpful. Very insightful. I love that answer. As I mentioned, you are a professor of public health. So just to start, for those who are not familiar, what does public health encompass and what do public health professionals do? That's a great question. So largely when we think of public health or community health, we often think of governmental public health. So people think of their local or county or state health department or they think of the federal public health department, the Centers for Disease Control and Prevention in Atlanta, Georgia. So we think of this sort of governmental structure of public health, and we think of public health in sort of a silo that they have their own responsibilities and their own profession. When I think of public health, I also think of how we can integrate public health into sectors across the society. For example, when we think about education, when we think about religion and where you pray, where you play the social determinants of health, I like to think of public health in every aspect of our life. When we think about our workplace, do we have an employee wellness program? How are we keeping our community at work healthy? How are we keeping our communities at school healthy? So when I think of public health, I think of it in a much more broad, much more systematic way, and that's what I would like to see us get to as a society is thinking about public health in all we do. And I'm sure that has been integrated into your classes. As you're teaching these up and coming professionals, what do you see as their motivations and interests in this field? At M C P H S, we're very lucky to have clinicians that have done our professional programs, so occupational therapists, pharmacists, optometrists that want to learn more about public health and population health to practice as a provider. And we are so grateful for that. But we also see individuals who come in and they want to do public health as their profession. They want to be a public health practitioner. And so in those cases, typically what we find is they often want to enter governmental public health or public health nonprofit. But it's interesting because when they come in, we show them that public health can be practiced anywhere, in any sector, in any discipline, in any geographical location. And we try to broaden their horizon about what they could do with this degree that we are providing them a skillset and a information, but not necessarily a pathway. They get to decide their own pathway because to me, public health is everywhere and they could really do what they'd like with this educational pathway. You mentioned the different types of places and parts of our lives that can be affected by public health. So how does the health of those communities and areas affect our health as individuals physically, mentally, socially? There is so much data, decades worth of data that shows us that where you live impacts your health right down to the neighborhood. So if you were to go to and you Googled county health rankings, okay, county health rankings.org, and you were to go and see the differences in health status by county in the states, it is mind blowing how you can have life expectancy drop 10 years from one county to the next. Wow. And we see that at the neighborhood level too. And so what is that? Why do we see differences by neighborhood in health status? And when we say health status, we mean rates of diabetes, rates of chronic illnesses, life expectancy, maternal mortality, birth weight, all of these things that comprise the health of a community. And we haven't even scratched the surface of mental health either. That's another huge exploding area in public health is really looking at mental health and behavioral health as a sort of SubT of public health. But I think at the end of the day, we can look at the policies in those communities that keep communities healthy. We can look at zoning practices, job availability, we can look at income, whether there's graffiti in a neighborhood, we can look at pollution and exposures, and we often see that in the neighborhoods with lower life expectancy, you have lower averages of income, you have worse schools, worse roads. So when I think about community health, I think about what are the policies and practices that are driving the health within a community, and that's the first place that we need to look. And then when you take that community's health, that affects an individual health over their life course. Again, because of those exposures, because of the things that you are seeing, it's hard to be adherent to medications if you don't have a working fridge. It's hard to get to the doctor's office if you don't have great transportation or it's hard to make time in your schedule to work out if you're working three jobs and you don't have adequate childcare. So all of the policies that shape our health in our work, in our school, where we pray, where we play, all of that impacts community health. And at that individual level, that translates very, very easily. In recent years, the role of public health professionals and their expertise has played a big part in current events and recent efforts and initiatives. Can you just talk about where people in the public may have seen these professionals and not known that their expertise is in public health? You talked about government officials, but can you just expand on that? Absolutely. I think during the Covid pandemic, certainly I think people started to learn what an epidemiologist does or what a local public health professional might do, but I think we're only going to see the role of public health become more prominent, particularly as we see climate change, we see an increase in infectious diseases. We're going to see an increase in zoonotic diseases and diseases that cross from animals to humans. We're going to see an increase in chronic disease prevalence across society, having more people have diabetes or cancer or things like that. So that's where we're going to start to see public health again, play a more prominent role. We are also starting to see it in the health professions. Many health professions programs are incorporating public health and population health in their curricula. We're also seeing hospitals and healthcare facilities dedicate entire sectors or sections to population health or public health. So I think we're only starting to see this grow in terms of public health as a profession, but then also other professions incorporating public health. We're going to see it in our legislators. I have an example of my local legislator in Massachusetts just introduced a bill for pay equity for transparent pay scales. When you post a job, this is something that you might not think would be directly linked to health, but something like pay transparency could be a really important way for people to be paid equitably. Men versus women, different races, make sure that they're all paid the same. It also creates competition amongst employers. And so that's not something that we might automatically think is associated with health, but pay equity can be a huge part of improving community health, like I talked about before, reducing poverty, reducing pay inequity, reducing income inequality can start with something as simple as pay transparency. When you. Were talking about legislature, it reminded me of the more recent initiative in Boston about rent control. Would you also consider that an influence on public. Health? Absolutely. I mean, when you have families who are struggling to pay rent and they're struggling because frankly, minimum wage is just not enough. If you look across the country, there is no place in the US that you can make a minimum wage job and afford to pay rent on one salary. And that is distressing because 50 years ago, that was not the case. You could support a family on one income regardless of whether it was minimum wage. And so we need to support families in being able to pay their rent. And a lot of low income families feel as though they're being priced out of Boston because they can't afford it. They're in lower wage jobs. And so if we were to put in policies that help families pay rent that help families with fuel assistance in the winter, if they need to pay for their heat, help them pay for food and groceries, that will go a long way to help improving health. What, if any, do you think is the most pressing public health issue threatening our society? I think that's a great question, and I would have to say that structural racism and oppression is the greatest threat to our society because if you look at any public health issue, climate change, infectious diseases, chronic illnesses, a pandemic, there are disparate impacts by race and ethnicity by L G B T, qia, a status by disability status, any social identity that you could think of, there are inequities. And that is because we live in a society that promotes the health and wellbeing of certain populations over and our structures. Going back to the neighborhood conversation, if you have a neighborhood that has mostly black and brown populations that live there and it's also low income and there are also exposures to pollutants and there's not rent control, there's gentrification happening with housing, people are being priced out, you're not going to have a neighborhood that promotes health. And so I think that when we see these disparate impacts, it is made worse in any public health threat by the structural systems that do not promote health. There was a great documentary that Oprah Winfrey just produced called The Color of Care, and I think it did a great job of showing the disparate impacts of Covid 19 on largely black and brown populations. And so I think that is sort a starting point. We've known this for decades, and Dr. Fauci said, we are going to see disparate impacts in these populations. What are we doing about it? What is the next step? How can we build structures and systems that promote health across all populations? And I think that is the greatest threat, and I think that's what's going to require a system approach. It's going to require legislators and communities to work together and faith leaders and public health practitioners and clinicians. It's going to require a multi-sector, multi-disciplinary effort and sustained effort to dismantle systems that have existed for longer than M C V H S. So I think that is really where the conversation has to go. Absolutely. We can talk about the policies and how leaders can enact this change as individuals. I think it feels daunting to try and have an impact to fix this, but what are some things that people can do to help recognize or change these disparities? I think that's a great question, and it comes down to some ideas that are in existence in community organizing. You can't tackle everything, right? And so that's what feels daunting is I think we hear about mass incarceration and we hear about climate change, and we hear about all of these health threats to our populations. Pick one of those issues that you feel that you could dedicate time, effort, resources to and try to bring a friend. So if you can channel your energy into something that you really, really care about and you're passionate about, that's a start. Because if everybody did that, if everybody channeled a little bit of energy towards something they really care about, we can move the needle towards a more equitable system. So rather than trying to tackle everything and dismantle every system, let's look at something that we are really passionate about and let's look within our own spaces, and. It can look different for everybody. For some people it might be joining a community group, like you said, that meets one hour a week. Or for others it might be something like going back to school and studying these things and taking an active role in learning about them so you can change them in your daily lives and other people's lives. Absolutely. It could be education, it could be working for a nonprofit. It could be you deciding that you're going to run for city council could, and you're going to be a part of that change, or you're going to sit on a school committee or again, find something that you are passionate about, an area that you can contribute to, and you have the time and resources to do that for. Something that also resonated with me when you were speaking is in order to tackle these issues and make lasting change, I think we all have to realize that if we improve the quality of everybody's lives around us, not just focused on our own, that in turn will improve perhaps the quality and length of our lives. A hundred percent. I think that's such an important point that when we focus on the population, we are going to improve health outcomes for everybody. When we focus on maternal mortality and birth weight for black women and black babies, we are going to improve maternal care for everyone. Everybody, absolutely. So I think when you center health equity and when you center disparate outcomes, you're going to improve health for everyone. Wonderful. Carly, thank you so much for this insightful conversation. I've learned a lot and I know our listeners will as well. We've come to a part of our show called Red's Rapid Fire, so I'm going to ask you a short series of questions and the goal is to answer them as quickly as possible, whatever comes to mind first. Are you. Ready? I'm ready. What did you have for breakfast this morning? A. Bagel. What is your favorite month? October. It's my birthday. Beach or mountains? Beach. What is a hidden talent or skill of yours that might surprise people? I always feel like I'm one of those people that is very good at a lot of different things. I would say I'm a good cook. That's a great skill to have. Cats or dogs? Dogs, definitely. What is the best concert you've ever been to? We. Just took the kids to Imagine Dragons this summer and it was fantastic and had just an absolute blast. Who is your personal hero? I recently lost my grandmother in December, and I would say that she is my personal hero. That's. Beautiful. Thank you for sharing that. Would you rather be able to fly or be invisible? Invisible for. Sure. What's a food you could eat for every meal? It's got to be eggs. I love omelets. Very versatile. What is one piece of advice that you would give to your younger self? I think I would teach my younger self how to study. I really didn't know how to study when I was an undergraduate, and I just felt like by reading I was going to somehow absorb everything by osmosis, so I would teach my younger self how to study correctly. That's great. That was our last question. You did fantastic. Thank you again, Carly, and thank you for listening to this episode of The Secret to Living to 200. We hope you'll join us next time. And as always, stay curious. Cardinals.