- (female announcer) Production funding for Behind the Headlines is made possible in part by the WKNO Production Fund, the WKNO Endowment Fund, and by viewers like you, thank you.

- The role of public health in Memphis and around the world tonight, on Behind the Headlines.

[intense orchestral music] I'm Eric Barnes with The Daily Memphian.

Thanks for joining us.

I am joined tonight by the Dean of Public Health, the School of Public Health at the University of Memphis, Dr. Ashish Joshi.

Thanks for being here.

- Nice to be here.

- Absolutely.

- Thank you for having me.

- Along with Bill Dries, reporter with The Daily Memphian.

We'll start really big.

We'll talk about some of your history.

We'll talk about all kinds of things around public health and what it means.

But I actually wanna start with your definition, your quick definition of when you say public health, what does that mean to you?

- Health for all.

Health for all.

And that's the most easiest way to communicate what public health is, and that health is a fundamental right for every individual.

So I think, to me, what it means is that we all need to take care of our own health, irrespective of what area of focus we are in, what discipline we are working in.

We can be a lawyer, we can be a physician, we can be a journalist, but we need to be responsible for our own health and how best we can deliver that health.

So I think in a very layperson language, I would say, public health is for all.

- Yeah, the notion of public health was obviously elevated to everyone's, the top of their list some five years ago at this time.

We were doing shows virtually by Zoom and fighting bandwidth and power and cameras.

And you were in New York at that time, which was really a hotbed of COVID outbreaks, and were working in public health there at the city, University of New York.

How has that changed the whole notion of public health in this country and around the world, the ramifications, good and bad, and everything in between from COVID and the pandemic?

- Thank you, Eric, this is a very important question.

I think I'll give you very three clear points of what has changed.

One, we are all interconnected.

And I say the word, a lot of people use the word local versus global, I use the word glocal.

So it's a glocal world.

I think COVID has shown us one thing, that it's a glocal world.

What I mean to say is something that is happening in one part of the world is impacting anybody else.

Second, public health is not my business is not the case that has changed.

It impacts economy, it impacts trade, it impacts health of the people, it impacts employment, it impacts everything.

It impacts academic and learning.

A lot of students could not go to the schools.

They had virtual, so it impacts everything, so that's the second.

The third thing is, I think the importance of data and evidence and how do we really respond to bring more objectivity to the field of public health.

So if you really ask me from the local to the regional to the national and the global lens, I think those are the three pillars.

- Let me bring in Bill.

- And talk a bit about those three pillars.

- So I think when I say glocal, glocalization basically means that I might be actually living in Nigeria, and I want to travel to the United States, not for education, but for my business.

I could not travel.

And in some way, nobody could think that public health could impact somebody's business.

I'll give you an example for New York.

We were asked by Broadway when to start the Broadway, because musicians need to play instruments.

Now, which instrument do you need to play the best that is the safest one during COVID?

Nobody thought that Broadway, public health is going to be integrated to Broadway.

So to me, that's the definition of glocalization.

That's a big change, huge change actually.

The second thing is, which I mentioned to you, is like sensitization, the importance of public health to a common person.

Nobody thought, like people knew medical, they knew physician, they knew nursing, they knew Allied Health, they knew radiologists, technicians, but public health could impact day-to-day life is not, for example, people have to stay back into their homes.

So, how do you basically cater to the healthcare delivery services.

Students were not able to come to the schools.

Kids were not even able to come to schools, virtual learning, but those who do not have access to the internet, digital platforms, how do they get connected?

So I think social connectedness was a big hit problem.

So yes, physical distancing was a key, but social disconnectedness was a very important element, and that was impacting everybody.

I'll tell you, at the relationship level, parents could not visit the kids, the kids could not visit the parents.

So I think public health became into light a lot more.

But what also brought the challenge, which, Eric, you asked, was misinformation about what is causing, what's happening, what's right, what is wrong.

So I think that's where the role of data and objectivity comes in.

And I think public health tried to elevate itself and must elevate itself to bring more objectivity and bring more data into decision making.

So I think those are the key pillars of responding through these three pillars, what I feel.

- Right, and those sound very easy.

But during the pandemic and in its aftermath, they weren't, they weren't at all, and we continue to have that discussion about public health.

Where do you think we are at and especially with what is happening at the federal government level on this?

- So I think, let me say it this way, public health, as I mentioned to you, is focusing on helping people to prevent the disease and promote good health and wellbeing.

That's kind of the underlying premises of all who are in the field of public health are focusing on, that's one.

The second component becomes this, what are the things that are priorities in terms of what we need to address?

I'll give you one example of that, for example, and coming to Memphis, if I take a living example of that, let's say the challenge of obesity when I came here, the challenge of crime, the challenge of substance abuse, that's a problem to me.

It's an output, it's an outcome.

But what is causing that is a root cause.

So the root cause is, do the youth know what public health is?

So, I'm coming to your answer, but I'm giving you an example on how to demonstrate that.

So, let me say when I...

They say, "Oh, what do you think Memphis has a problem?"

Yeah, obesity is an output, it's an outcome.

It's not a cause.

Yes, it's a cause for diabetes and cardiovascular diseases, but what is causing obesity?

Lack of sleep, not eating healthy, not doing the physical activity?

So I'm glad to tell you how we are addressing that now.

We are the only school of public health in the nation and in the globe that has established public health clubs in high schools.

Create documentation, evidence, quantifiable that shows that intervention at a young, early level could actually impact obesity.

So I think what is really needed is reimagining of public health to respond to some of the things that are happening, not to reinvent, but reimagine.

Second, for too long, I would say, in my view, we've been identifying problems, but the problems have been there for too long.

We need to come up with solutions, so solution-centric approach.

And I'll give you another simple example of that.

We are also the first school of public health in the nation and in the world that has brought public health education to the high schools.

We are the only school in the country and in the world.

So I think if we start to reimagine public health, that it is not just looking at the lens of disease that, okay, we need to now manage obesity, now we need to manage cardiovascular diseases.

But look at what are causing them.

I think that is a dialogue, which I think would be impactful in that way.

- What I wonder about though is understanding public health always going to be a fraughtful undertaking?

Is it always going to be controversial?

Because of talking about long-term outcomes versus the pandemic is here, people are getting sick, and we need to deal with it now.

How do you balance that?

- That's a great point.

Do we need to be responsive or reactive to situations in the terms of crisis?

- It's both, isn't it?

- Totally agree.

And to be honest, that's why it has to be reimagined.

We can't just do the things the way we've been doing for too long.

And it's also comes as an accountability on us as public health professionals and practitioners.

So that's why I'm saying, I could have come here and say, "Yeah, obesity is a problem.

Let's figure it out."

But no, let's figure out a solution.

So I think we need to little bit shift that we are not just reacting to the situations of crisis, but we are also trying to avoid the crisis.

So I would say that it's not that one is going to be against another.

I think it's gonna be one with another, but it has to work together in sync.

Can this be balanced and managed?

It has to be balanced.

That means we need to train the workforce on how to respond to these things.

We have to be more, not just preemptive, but also proactive about some other things.

So that's how I see that.

I describe our school as more innovative and entrepreneurial school, which is looking to find solutions to the problem, rather than just looking at the problems from the lens that have been there for too many years.

- As we record this, we record this a week ago, and we had to hold it a week 'cause of my schedule, so I appreciate you being here.

I think the morning that we record this, the CDC Director and the federal government are in a fight, trying to be fired.

I don't know how that's gonna play out.

I'm not gonna ask you to comment on the politics of this, but do you worry that one of the outcomes of COVID and changes in leadership at the top is vaccine skepticism?

There have been measle outbreaks in various communities in the country.

And where, in your mind, does vaccine skepticism come from?

I mean, it seems pretty clear the science is pretty overwhelming the benefits of measles vaccines, of the COVID vaccine, of all these things, the science, you're talking about data, pretty overwhelming, but the skepticism is not insignificant.

- Love the question.

It's not the data, it's the communicating the data.

It's the communication.

How do you communicate the data into a meaningful way that is understandable to a layperson?

I can't go and explain science to the layperson, I have to translate the science into practice to make it understandable.

So yes, we are, and that's where the health literacy comes into the play.

It's not about just being educated, it's about being healthily trained.

I can give you an example.

Most of us know that if we do physical activity, we are gonna be healthy, right?

But how many of us do that?

There's sufficient data to support that, but people still don't do it.

So there's a difference between being informed, and there's a difference between being literate on the issues that matter to the individuals.

So I think the skepticism is coming really from how best we can communicate the evidence and the data in a way that is understandable to a common person.

- Do you look back, and people, not just you, but I mean you, again, you were in ground zero of COVID, and you were part of the addressing COVID, which, in New York City, was very scary.

My daughter was there at that time.

It was a very scary time around the country, but New York was one of those places, that you look back and you, people in the public health sector and say, "We did this really well during COVID.

This, we didn't do so well."

And did some of the things that you didn't do so well feed the skepticism and misinformation, not intentionally, I don't mean it in a political way.

But I mean, I can remember early on, they closed the parks, don't go outside.

Well, in hindsight, you can sort of say that seemed silly.

You know, being outside was incredibly important.

But people, critics and conspiracy people really picked up on some of those sorts of decisions and said, "See, the whole thing was a farce.

"The whole thing was poorly managed.

The whole thing was a mistake."

- So I think messaging is a critical component.

I think one of the lessons, which I think public health practitioners or even public health professionals, even in the academic setting, were being challenged on how best to create our messaging.

Because the messaging is not limited to something that is of how you and me are talking, it's also communicating through the digital channels.

So I would say that if I have to pick one thing that probably could have been done a lot better, would be messaging about how and why things were important.

It was not just data, but we have to communicate the data to the audience in the way they understand.

That's, I think, where the skepticism was coming from.

- Do you also say, before we go back to Bill, do you also think, I mean, one thing people picked up on is that when the messaging changed and the rules changed, and the people, I think, you know, you've got Dr. Fauci, you've got other people who said, "Well, we were adapting to a worldwide pandemic "and trying to adapt to the data, "and realized, yeah, we didn't need to close the parks, "we just needed to make sure people were appropriately distanced," or et cetera, et cetera.

Is that just something people don't understand that the science isn't perfect, science is learning as you go.

Is that part of the message that didn't get out there?

- I think that's a great point.

I think if you really think about it, who's our audience and who's communicating that message, and to whom you're communicating the message?

So if I'm communicating my message as a scientist that data is critical, but not everybody may not even understand what data is actually.

I'm telling you that it's a big surprise.

Like I'm going to the schools right now, a lot of students may even, parents, like parents would ask from much aware of information, should I get it, should I not get it?

So I think yes, we must even tell and inform more that science is an evolutionary process, it's an evolving thing.

As the data is coming in, we are trying to make certain decisions, but it has to be communicated at multiple levels for multiple stakeholders, cross-institutional, cross-sector.

It cannot be just limited to a certain audience who's already receptive to understanding what that means.

So I think the broader network has to be there.

- All right, and I think some of that is the scientific method and that experts work at, because even locally here during the pandemic, we had examples of where the situation changed.

And some of the scientists and researchers who were working on it here were saying, "Well, we were wrong about that.

Isn't it great?

"Now we know that we were wrong about it, and we can move on and find out what's right."

And people who weren't scientists were going, "Wait a minute, you were wrong about that," and had a totally different outlook about that.

- Yeah, and I think that's the whole thing.

And we have to admit certain things that might not be the right, which means we have to explain that that's what science is all about.

It's not a fixated thing.

It is evolving as new facts come in, as new data comes in, we keep on letting people know, I think.

So it's kind of more educating on a continuum basis about not just the findings, but also about why the change is happening, why it is.

So I think that educational messaging, I would suggest, should be the emphasis to be better prepared for the next time.

That's what my take is on.

- As we were waiting to go on with the show, you told Eric and I something very surprising, and that is that New York did not have a school of public health-- - Public school of public health.

- A public school of public health before you came there.

I would've assumed New York would've had that kind of an institution you know, in sometime early in the 20th century.

Is the US slower in the uptake on this than other nations are, or are we about where other places are?

- No, I think, a lot of people look at the US as a best evidence-based approach, the best practices that come out of it.

But I also mentioned that the word is glocalization.

So I think in public health, we have to take the best solutions which are available across different parts of the world and see what works in our context and what, in our context, can work in other people's context.

So I think, I view that the solutions that are best...

The world is not really different in terms of some of the public health challenges that we see.

So if you really look from the public health lens, whether it's a problem of substance abuse happening here, or it's a problem of crime, which is happening, or it's a problem of food insecurity that is there, or obesity, or diabetes, hypertension, it's a problem which is worldwide.

But some things that might be very applicable to our context could be easily replicable and reproducible to the other parts of the world.

Something that is going better there, how do you bring that over here?

I think that's where the intersectionality of local to global comes in.

So I wouldn't say, I would say that there are plus and things to be learned about to make them better, and that's where our school is trying to focus on, get the best practices, bring the data, bring the evidence, make our students trained on how to distinctly make an understanding what is right information versus what is misinformation, so train them to be prepared to these challenges.

So that's how I would view it.

So I think it's not like we are lagging behind or somebody else is doing better.

I would rather put it in this way that there are a lot of good things that we are doing, and there are a lot of good things that are happening around the world.

How do we bring them all together and see what fits into the best context where we are?

- So, it's the experts who have the knowledge, but it's also more than that.

It's what you do with the knowledge, right?

- Mm-hm, it's about the application of the knowledge.

- Another aspect, you mentioned a bit of this in the COVID context of the social disconnectedness and the outcomes of that with kids being separated from one another in school, people in workplaces, families being separated.

On the one hand, there was a huge spike and clearly, of mental health issues during COVID and substance abuse issues probably is tied to that.

Since COVID, one thing that's interesting to me is it seems like there's so much more discussion about public health, about mental health in a much better way than there used to be.

It isn't a dark secret.

It isn't an embarrassment.

You can't turn a podcast on without getting an ad for a telehealth online-based therapist.

There's just so much more conversation about it.

People talk about an epidemic of loneliness, particularly among men, and that has become part of the conversation.

Is that a shift in the time you've been in public health, where you've talked about exercise, you've talked about food, we've talked about vaccines, but that mental health is a part of this because if you're not in a good place, mental health, you're not gonna eat right, probably, you're not gonna sleep right, probably, you're not gonna get out an exercise, probably.

- Eric, thank you so much for bringing question up.

Actually, I'll give you this way.

So our curriculum that we have established for the high schools is built on four pillars.

One is called C, which is coping, A, adaptability, R, resilience, E, empathy.

It's a CARE approach.

So, if you're going to talk about mental health, how do you cope with complexities, uncertainties?

A, adaptability, how do you adapt to the situations that you are not prepared for?

How can you be resilient, and how can you be more understanding on how to respond and cope?

The reason is, yes, mental health and wellbeing has been a big, big problem.

And I would say that that got more triggered with COVID.

- But it was there.

- It was there.

It was there.

- Yeah, it was almost, I mean, I don't wanna say it was a good thing, but it was almost like we talked about it a whole lot more.

- It's more evident- - Because it was so prevalent.

- And it became more evident and there was more emphasis, more focus, more talk, talking about it.

But as I said to you, in public health, our focus cannot be just on how to just manage mental health, but also, to look at what is actually causing that.

So I think what we are really focused, think of a way.

I can be a student in a school.

I am going to my high school.

I am struggling.

I just don't know how to cope with it, where to go.

What do you do with that?

We wait 'til the person responds in different ways to those crisis, or we actually go there early and identify what the challenge is and try to see if there's something which can be modified around that environment and then make it a better situation for somebody to go around.

So I think that's where I see that the role of public health is to look and make a paradigm shift on not just talking about managing things, but also creating enough evidence and repository that what is actually working for the root cause analysis of that brings that narrative more and more about that.

A high school student, if I may just add one more thing.

- Sure, yeah.

- A high school student not always is going to come to the career in public health.

They might go into something like a business, engineering, information systems, anything.

But they need to learn how to cope.

They need to know how to adapt.

They need to know how to be resilient, how to empathetic.

So I think these are the four pillars to no matter, if you have prepared that kind of student or youth in that way, at least they're better equipped to respond to those things.

So yes, we are looking at providing more care to the people with mental health issues, but at the same time, we also have to have another aspect of layer that talks about what we can do to prevent that from happening.

- And to recognize it.

- And to recognize it.

So I think it cannot be just a singular approach.

It has to be a multifaceted, multidimensional approach.

It's an ecosystem.

So we have to look at things from the systems approach rather than just from a singular lens.

- We've just got a minute left here and I could ask about, one thing I'm curious about, and you talked about weight, and we can do a whole show on this, is GLP drugs, like OZEMPIC and so on, is a kind of, I mean, a remarkable change in terms of addressing people's weight.

And we kind of saw it originally where people maybe were doing it more for aesthetics.

I mean, I don't know how to put that, but more and more people taking GLP drugs.

Is that, from your point of view, a good thing, or, and/or it isn't really addressing the root causes of obesity?

- I would say...

I wouldn't say whether they're good or bad, but I would say it this way.

We want to address the issue of obesity.

We need to have a better understanding of what will work for what is causing obesity.

I am of the opinion that if somebody says, "I'm not eating healthy," why is somebody not eating healthy?

We just need to know.

If somebody says, "I don't like to sleep late night."

You can't be eating healthy and not sleeping well.

I think it's a shift in how prevention and health promotion has to be done that actually really creates individuals more sensitization to the field of public health.

So I think, I feel that to address these broader things, we need to go more early and more to the root cause analysis of that.

- That is all the time we have this week, but we appreciate you being here for a thoughtful conversation.

Thank you, Bill, as well.

But again, that is all the time we have this week.

Last week, we had a show, if you missed any recent shows, we had a roundtable discussion about all kinds of things going on in the city.

You can get that at wkno.org or on The Daily Memphian, or YouTube.

Also past shows on MLGW, early childhood education, Memphis-Shelby County Schools and so on.

But thanks very much, and we will see you next week.

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