Of course, this isn’t without some conflict, considering the amount of dubious information and conspiracy theories involving COVID. But Jha, who returned to Brown earlier this year after serving as the White House COVID-19 czar, seems to relish his role as a spokesman on public health. So what will it take to shift the disease-centered focus of much of American medicine? What does the future hold for Rhode Island’s hospital and healthcare landscape? And what can be done about all that misinformation? I’m Ian Donnis and this week I’m going in depth with Dr. Ashish Jha.
TRANSCRIPT:
Ian Donnis: Welcome to The Public’s Radio.
Dr. Ashish Jha: Hey, thank you for having me here.
Ian Donnis: We see how COVID cases are climbing. And that seems likely to continue as we head into the winter. What do the next few months look like to you?
Dr. Ashish Jha: Yeah, look, we’re heading into another winter, where what I’m most worried about is really the triple-demic that we saw last winter: flu, RSV, and COVID. And what I’m most worried about, is unless we get our act together as a country, we’re going to see probably 100,000 Americans, mostly elderly, medically vulnerable, die. And so we have got to do everything we can to protect that population. Number one thing is we got to get older people vaccinated. That’s what’s going to keep people alive this winter. So yes, COVID is a problem. But I’m looking at the broader picture here.
Ian Donnis: Let’s switch gears we want to congratulate you on the celebration this week of the 10th anniversary of the School of Public Health at Brown University. As part of that, you said that you want to fundamentally change the face of public health in America. What do you mean by that?
Dr. Ashish Jha: Yeah, what I said was, I want to change the face of public health leadership in America. And what I meant by that, is, look, the public health workforce is pretty diverse. Public health leadership, still is not, we don’t have enough people. We don’t have enough people of color. We don’t have enough people who are from rural areas, we don’t have enough people who really represent the communities that are most impacted by public health. So we have launched a program called the Health Equity Scholars program at the school, that basically aims to train a whole new generation of public health leaders who are from those communities who are going to be far more effective and sensitive to the challenges that those communities face.
Ian Donnis: On a related note, the rap on health care in America is that too much of the focus is on treating disease. We see how Costa Rica has a model of emphasizing health and people there have a longer life expectancy than in the US. So what would it take to move more in that direction?
Dr. Ashish Jha: Well, there’s no question that investing more in public health is really, really important. Like, look, we can invest at the end of the path when people have got disease, we obviously should take care of people who are ill no question about it. But if we make investments upfront in keeping people healthier, promoting exercise, dealing with the opioid crisis, dealing with all the other social factors that drive health, we will make our population healthier. We have not done that as a country. Obviously, investing in primary care is another important part of that.
Ian Donnis: Rhode Island’s two largest hospital groups Lifespan and Care New England have faced some financial challenges because they rely heavily on Medicare and Medicaid for their payments which pay a lower percentage than private health insurance. From your perspective, what can be done to improve that situation?
Dr. Ashish Jha: Yeah, there’s no question here, that there are some substantial challenges that our health systems face. But I also believe that both of these health systems can be more effective, more efficient. I know that the new leaders of both of these systems are working on that. I think that’s going to make a big difference. And I think and we’ve started seeing some movements towards this, I think again, investing more in primary care, investing more in prevention, will lower the cost of health care over the long run. And I think that’s going to make an important difference as well.
Ian Donnis: My friend Ted Nesi at WPRI recently reported on the very high salaries paid to top executives at lifespan and care New England, and how spokespeople for those organizations cited the need to offer competitive pay regionally. But a nurse with a union said that when frontline workers asked for more money, they’re told if they want that go work in Boston. So is having a little hypocritical and if so, what would it take to narrow that disparity?
Dr. Ashish Jha: It’s a really good question. Look, there’s there’s some truth to both of these points, right? There is no doubt about it that you, you want the best leaders, you want the best managers. And that means that you often do have to pay what is quote unquote, market rate. But when we see these very large gaps between CEOs, large payouts, when they’re leaving, these are nonprofit organizations. And I think massive payouts when people are leaving just don’t make a lot of sense. And obviously, it’s hard to make the argument that someone deserves 10s of millions of dollars when you have a healthcare workers that are not getting paid adequately. So we really do need to make sure that that we’re addressing that issue directly.
Ian Donnis: To come back to the healthcare landscape in Rhode Island Attorney General Peter Neronha, has been a kind of lonely and outspoken voice in criticizing a lack of long term plan, a lack of long term planning. He says without that there could be some serious problems. And even right now we hear about a shortage not just in Rhode Island but also Massachusetts of primary care doctors and nurses. So what do you think of Neronha’s criticism? Do you think he’s right?
Dr. Ashish Jha: The AG has, I think been very thoughtful on a lot of these issues. And I completely agree that we need a long term strategy here. So yes, both of these health systems are struggling. Obviously it’s important for them to get their finances in order for this year, but the long term health and well being of the people of Rhode Island depends on a long term successful set of health systems, like lifespan care New England, others. And so I completely agree with the AG that we need — sure we need some short term work. But we need a long term strategy here if we’re going to really make the health systems deliver for the people of Rhode Island.
Ian Donnis: We’re talking to here with Dr. Ashish Jha, Dean of the School of Public Health at Brown University. And we see how it’s been a struggle to promote a public health based approach to trying to curb gun violence. Your former colleague, Dr. Megan Ranney, now at Yale was a leader in that and the White House recently launched an office to try and reduce gun violence that will, would probably go away if Donald Trump wins election next year. But how do you see the outlook for a greater emphasis on a public health based approach to reducing gun violence?
Dr. Ashish Jha: You know, I’m optimistic about it. And here’s why I mean, gun violence has now clearly become epidemic proportions, we’re seeing that it’s the number one cause of accidental deaths in kids. This is unacceptable, it should be unacceptable. And we have had the wrong fight about this we fight about do you take away guns? Or do you let people keep their guns. So I think the right approach on this is to say, when we saw cars, automobiles killing a lot of people, we didn’t say we should take away people’s cars. We said, Let’s make cars safer, let’s educate people, let’s take a public health approach to driving down automobile mortality. And we have, we’ve got to take the same approach to gun violence, we should have a country where people can keep their guns, but at the same time, have much much lower fatality rates than we do now.
Ian Donnis: You formally served as the White House coordinator on COVID. I don’t need to tell you that there’s a lot of conspiracy theories and bad information about COVID. I believe you’ve talked about the need to flood the zone with good information. And you have a big footprint on social media with more than 300,000 followers on X, formerly known as Twitter. But can that really overcome the amount of bad information that’s out there?
Dr. Ashish Jha: Yeah, you know it’s a really good question, Ian. And the way I look at this, is that there’s no question that flooding the zone with good information is important. And I’ve made that point. But there’s actually another important part of this, which is we often think about information as a supply side issue that what do we want to say to people? We don’t think about it as a demand side issue, meaning what do people want to know about? We have got to do a better job in public health in trying to understand what’s on people’s minds? What are the questions? You know, the misinformationists, they do a good job of that. So we in public health have to do a better job understanding what’s on people’s minds, and then give them good information. Until we do that we are not going to make the kind of progress we need to make.
Ian Donnis: I think we could agree there that some mistakes were made by government and public health officials when the pandemic started. Certainly a difficult situation to deal with. But what needs to be done to restore confidence for those people who feel that government and public health officials got some key issues wrong?
Dr. Ashish Jha: What I would remind them is no one got me everything right. This was a this was a pandemic, where, by definition, we didn’t know anything about the virus when it first appeared. And we all I think most people acted in good faith and try to get the answer, right, I think the mistakes are mistakes of the people often acted much more sure than they were, I think it’s been that’s a really important lesson. We didn’t have the right surveillance and disease systems, we didn’t know where the virus was spreading, we have made progress on that. The way I look at the long term building confidence is humility, taking a look at your mistakes, owning them, working on doing better, training people to do better. If we do those things, and we’re doing a lot of that at Brown for our next generation of public health leaders. If we do those things, I really do think we’re gonna build back a lot of that trust.
Ian Donnis: The good news on COVID Is that we see far fewer deaths and serious illnesses than there were at the height of the pandemic. Is that due mostly to vaccinations and how immunity has been built up over time.
Dr. Ashish Jha: There’s no question about it, that with immunity building up we have a virus that’s just causing less and less serious illness. But here’s the point. Even now, we have way more people dying of COVID than we do of influenza. And by the way, 30,000 Americans die of influenza every year of the flu that’s unnecessary, we can prevent most of those. So the reason is that we don’t have enough vulnerable Americans, people over 65 medically vulnerable, who are keeping up with their vaccines. If they do I think we can drive those steps even lower. Yes, we’re in a better place. I want us to get to a much, much better place than we are now.
Ian Donnis: Based on your former work in the White House. I’ve got to ask you, if Donald Trump was to regain the presidency, how would that affect public health in the US?
Dr. Ashish Jha: Well, look, I try not to think about what the future is going to do. Certainly politically, I don’t have any particular insights on what’s going to happen. What I know is that public health has gotta be a bipartisan issue. Because the virus does not discriminate. Opioids don’t discriminate. Gun violence doesn’t discriminate. And so whoever is in the White House, Public Health has got to remain at the top of that list of things to work on. And we’ve got to do it in a bipartisan way.
Ian Donnis: As I said a bit earlier, you have a big following on X, formerly known as Twitter. Some of those of us who are active on Twitter have some mixed feelings about how Elon Musk has managed it, there have been some changes for the worse. How do you look at that? Do you how do you assess whether Have you reconsidered getting off x? Or you see it otherwise?
Dr. Ashish Jha: You know, look at it, there’s no question about it that the amount of bad information on Twitter, X, whatever we call, it has really, in my mind, skyrocketed. But what I also know, is there a lot of people I follow for good information, there are a lot of people who follow me because they think I have useful things to say. And until there is an alternative. I think it’s really important to continue engaging, and sharing good information, I still think is a very important source of information. The hard part is sorting out the noise from the from the message, and I say to people is like find reliable voices and listen to them. That is the way to get good information on this platform.
Ian Donnis: One final question on COVID with about 30 seconds left, what is known at this point about the long term effects of multiple infections for one person?
Dr. Ashish Jha: It’s a very good question. Look, the bottom line is that the risk of long COVID long term complications is clearly declining. And we know that vaccines, prior infections, all of that lower your risk of future long COVID. One of the key reasons I tell people to stay up with their vaccines. It is going to lower your risk of long term complications.
Ian Donnis: Dr. Ashish Jha, Dean of the School of Public Health at Brown University. Thank you so much for joining us.
Dr. Ashish Jha: Thank you for having me here. It was a pleasure to be here.
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One of the wonders of contemporary life is how you can order something from Amazon and sometimes get it on your doorstep the same day. The mega-retailer has removed a lot of the friction in the buying process — and Jeff Bezos is reaping the rewards. But is this good for us as a society? What about the Amazon employees who complain about their punishing work conditions, or the many companies that can’t compete with Amazon? A huge distribution center is being built in Johnston, and town officials say payments from Amazon will fill a variety of local needs. Now, however, the Federal Trade Commission is suing Amazon, calling the company an illegal monopoly, and a number of attorneys general, including Rhode Island’s Peter Neronha, have signed onto the case. You can read more about this in my weekly TGIF column, posting around 4 this afternoon on what used to be known as Twitter and at The Public’s Radio dot org.
That’s our show for this week. Our producer is James Baumgartner.
I’m Ian Donnis and I’ll see you on the radio.