Why study public health?, with Dr. Jan Carney, MD, MPH, MACP

Jan 0:00
Public health changes really, really fast. And that’s both the challenge and the excitement. And if you are in public health, or thinking about public health, if your instincts and your passion is you want to help people, and entire communities, find a way to educate yourself about it.

Sujani 0:27
Welcome to PH SPOTlight, a community for you to build your public health career with. Join Us weekly right here. And I’ll be here too, your host Sujani Siva, from PH SPOT. Hi, Jan. Good morning, and welcome to the PH SPOT podcast.

Jan 0:48
Thank you. Good morning. I’m delighted to be here.

Sujani 0:51
Amazing. So I heard a little bit about this before we hit record, and I’m gonna ask just so that our listeners can kind of hear the story. So you were telling me that you kind of were introduced to the concept of public health during your medical training, but then it wasn’t until you started working as a clinician, that you- you had those aha moments of, you know, there is the field and in science, where preventing the disease was kind of at the forefront of that kind of career path. And I’m curious if you have any early memories, or stories that you’re able to share with us when- when you did have those aha moments or you were kind of, you know, making those connections and realizing, okay, public health could be the field that I want to kind of dedicate the rest of my career to.

Jan 1:43
Thanks Sujani, as an internal medicine physician, a physician for adults, and I always knew I wanted to go into medicine as a young child, I was fascinated with science and with the concept of helping people. And that was the concept as I understood it. And then I went all the way through medical training, medical school, and residency, and was trained to provide clinical care to patients. And I had gone to a conference where there was no discussion about public health. And we really didn’t have that much of medical education. You know, it’s all kinds of patient, even in residency, who were very ill with conditions, cardiovascular disease, certain cancers that might be related to what we kind of call lifestyle factors, long term tobacco use and poor diet, lack of physical activity. And it didn’t really sink in until I went to this conference and learned a little bit more about public health, and got interested in and actually went and got my MPH. And it was during that time of getting my MPH that I had the aha moment, which was, oh my goodness, there’s a whole science and practice around preventing diseases, illness, risk factors, entire populations. And if you can figure out how to do that, you can help so many people and prevent illness, in addition to taking care of when people do become sick. So that was my aha moment. And I came back and look for opportunities to put those skills into practice in my day to day.

Sujani 3:29
I’m curious, prior to that conference, did you find yourself kind of speaking with your colleagues or, you know, friends, you went to school with, about, you know, your patients, but from a public health lens, but not being aware that you were doing that?

Jan 3:45
I think that my own personal awareness was thinking about, and you would see someone who, for example, used tobacco for decades, probably at a at a high level. And, and they might have been in the hospital for lung cancer. And it was kind of it was just sad, we were sad. And then we saw people on a day to day basis, who were, for example, smoking cigarettes, and you would talk to them one at a time. And you would get every time you saw them, you would really help them, remind them that it was important to quit smoking, give them what available resources you had. And you did that one percentage time on every single visit over a period of time. What I did not realize at that time was the things that in public health practice, you know, there’s ways to make an environment that reinforces that message. So if someone only comes in to see a doctor or a nurse, say every year or less frequently than that, they hear some of these prevention messages in public settings, you know, educational campaigns, they might hear that in different places that we work. In the community, those things, we reinforce each other. So it was that there are different ways and strategies that are very effective depending on what you’re talking about, for prevention, and creating an environment where it’s easier to be healthy. And the importance of communicating those messages with the opportunity do that, at every available moment, one person at a time, or in a public setting, I think that if you think about that concept, another area that think about communities, and maybe the example the walkable community, the people in you say, what’s really good, most people are not as active as they should be. And that’s one of the single most important things we can do to be healthy and to have a long and healthy life. When you talk to someone about your destiny, to change your behavior, and make time in your work in your daily schedule, to be more active, that’s really hard. Because it may or may not be possible in someone’s environment, and what their family or work responsibilities are. If you take the neighborhood, and you have a walking or bike path, it’s right there, that’s accessible. It’s easier for someone to be active. So these sorts of environmental, individual strategies complement each other. And so sort of that broader environmental, and population and community perspective. That’s what I learned from my public health education.

Sujani 6:31
But public health lens that you know, many of our peers in this field have, I think we don’t give enough credit to that ability to see the entire world through that lens and be able to identify opportunities for change and intervention in order to make those communities a lot healthier. And I think that’s where the training and the on the job experience kind of gives to us. And I was speaking to somebody who was in like the private sector, and she was talking about how we need to get more public health professionals into, you know, these industries that don’t traditionally hire public health folks. And it was a question that I was hoping we could talk about, and maybe we can talk about it once we get into that discussion. But I just wanted to mention that here and see if you had anything to add about how we can educate organizations that don’t traditionally see, you know, from that public health lens.

Jan 7:34
I agree with you, I think we could do a lot more. And I agree with you, I think that’s really important. So think about where people spend their time, they spend their time a little bit of time at home, they spend their time at work. Or if you’re in school, you spend your time in school. So think about those environments, where there may be missed opportunities to make it easy for people to be healthy, provide education or information, you know, worksite wellness programs, there’s a great literature behind them. But sometimes they may not be as affordable. And so there may be opportunities there. But in terms of how you schedule a day, and people want for 20 or 30 minutes, when they would be eating lunch, for example, things like that. And likewise, what we do during the school day to allow children to be active, to be physically active, and to make sure that there are healthy food choices available to them during the school day. I agree there’s- there’s many potential opportunities. In healthcare, I think that that is a place where healthcare has changed dramatically in the last couple of decades. And it’s gone more towards health systems, and notes systems take care of sometimes now entire populations of patients. So I think that looking there, you have the opportunity to look use electronic health records, and look for an entire population of patients who’s had their flu shot, who’s up to date on their immunizations and vaccines for adults, for example. And I agree with you, I think there’s a lot more opportunities.

Sujani 9:23
Agreed. So you’re kind of you know, first quote unquote, public health job was almost 35 years ago, and you were the deputy commissioner of health. And then shortly after he became the Commissioner of Health in Vermont, Department of Health. Some of our listeners, they don’t need to be clinicians to kind of relate to this question and reflection that I’m very curious to hear from your perspective. Did you have a moment of like an identity crisis where you’re thinking to yourself, Oh, I was a clinician all this time. And then now I’m stepping into this role where maybe I might not be seeing patients every day. And I’m wondering if you had any of those conversations with yourself around like your identity?

Jan 10:07
I did.

Sujani 10:08
Yeah.

Jan 10:09
I absolutely did. You know, you go to and you have a very academic experience in some places, public health curriculum has become more practice oriented. And that’s a really good thing. But if you have you learn the science, of protecting, improving the health of entire populations, you don’t yet know is how you actually do that. Right? So if you’re trained as a, as a physician, you know how to ask questions and diagnose and treat conditions. So when you take that analogous kind of question for an entire population, or community and then state, the first question that pops into your mind is, how do I know if we’re making a difference? How do we figure that out? There’s so many health needs, and so many choices. Where do you start? And there’s never enough resources? So how do we go about the work and keep the science and put it into practice, to help people make improvements in their own lives and improve the health of entire population, I can give me an example of that. There’s this, it’s called Healthy People. It started in a big line about 1990 and 10 year measureable goals and objectives for the nation. It was done through a series of broad advisory panels that included all kinds of people, academic people, practitioners, and came up with priority areas looked at the data, very data driven, made some decisions about and judgments about what was ideally, what ideally didn’t want to see. And then what was achievable on a 10 year period. And then you can go on just Google it, it come up with healthy people, probably 30. But one of the things that it the concept here was that you use the available data. And all states have a variety of that. And now there’s even more available. And you can use that to pick and choose and set priorities for entire communities and entire populations and entire states, based on what your own data shows. And it’s not just a data exercise, through this conversation to people and community leaders, for example, and other people that you work with in public health, determine some priorities. And when you’re able to do that, it helps focus your work, or additional resources to the table. And I don’t mean that money doesn’t change hands, it’s that everyone is committed to the same goals. So that sort of strategy. We used to, there wasn’t enough prenatal care available, and infant mortality was too high. So that was an organizing approach to help fix that, to make it better. And it worked very well, who all people and all children and didn’t have access to health care, and they didn’t have health insurance, that and that became one of the goals of how do you gained support, figure out how to do that. Advocate for that, whatever resources are needed to make that happen over a period of time. And I would say we had lots of examples in terms of reducing tobacco use in our lessons and making preventive cancer screening more available. Well, the idea was you worked with a series of partners. And it wasn’t just one organization. So we have to find a shelf. Can’t do this, you have to work closely with health professionals, community organizations, not for profit organizations, rules and school nurses, many other people and your policy makers in your legislature to really move the needle on a challenging health issue. And that was the idea. That was the beginning of a series of measurable goals and objectives. And if you choose ones that you can measure you now within that very long time, you know a few years if you’ve made things substantively better by applying the best science and practice of public health and actually doing that, and that’s the idea.

Sujani 14:55
So for you, you know, once you started in your public health role, in 1988, how many years do you think it kind of took you to have that realization that, okay, you know, unlike in you know, your- in your clinical practice, where if you prescribe a patient with whatever medication they need, and you kind of can track the the progression of their illness getting better, how long would you say it took for you in that public health role to have that realization that, okay, that the work I’m doing is truly making an impact in the community, because, as you explained a lot of these interventions and pieces of work, they take time, right, to- to see the effects and the impact on the community. And often, if you’re working on like a really big problem, it can feel frustrating, because you’re not seeing it, you know, in action in the community.

Jan 15:49
Probably a few years. And then you use sort of the public health, the traditional public health data, and some of the national surveys, the Behavioral Risk Factor, surveillance system, and there’s one for middle school and high school, and the vital records, of course, I think at the beginning, some of the areas, you identify the priorities, and you start talking about them, and then you start to make the data so that people broadly can see, oh, yeah, this is a problem, I had no idea. And you start to make, for example, depends on the issue. One of the moments in cutting tobacco use, and half among our young people was creating a big tobacco coalition. And that included all kinds of people, and including our legislators. And it wasn’t just run by the Health Department. It has doctors and school nurses, and parents and representatives and senators, and just all kinds of people who share the common goal that we really had to prevent young people from using tobacco. And when they were adults, they would have all kinds of health conditions that we knew were preventable. Creating those coalition’s and then figuring out, for example, and the CDC was great for them, they would put out their recommendations, and you would look at, they would put out something the Surgeon General, and put out a document that sort of summarize the science, and you prevent tobacco use in young people. Okay, so there it is. And you say, how can we do that, and then there will be a number of extra pairs. Continuing on with that example, it would be, for example, raising the price of tobacco product was, it didn’t really impact tobacco use rates and adults. But for adolescents, it was like a brick wall. So the legislature said, we’re going to do that. And so that was one of the things and of course, education. But also the policy initiatives, like making sure access to tobacco products was not easy for young people to remember series of policy steps. The concept was, because science you had a big team of people. And everyone agreed that this was one of the priorities. And then you moved on and ultimately look at, you know what happened, and huge rates have dropped by, like half and not that long.

Sujani 18:32
I was recording an episode with somebody else a couple of weeks ago was Sue Griffey, and she kind of broke out her career into x. And that conversation is kind of coming back as I’m listening to your journey. And your first phase was as a medical doctor and a clinician, and then you had this 15 year period as the Commissioner of Health. And then you’ve always had your foot in academia and kind of training the next generation. But I guess you went in as a full time faculty member at the University of Vermont. And I’m curious about the motivation behind transitioning into that role completely.

Jan 19:15
First, you have to understand that when you are a commissioner of health, or someone running a federal organization, your political appointee, and so you serve at the pleasure of, you know, might be a governor or an agency secretary, but your political appointee. So you have to think a little bit about that and say, so you can’t really you don’t plan to retire from those positions, because you watch the world around you. The average tenure of people who were leading health departments was just a few years. And largely that was related to if a political party changed often the people had their own point. And so that was just how the world was. And you say, so that motivates you to do the absolute best you can, when you have that opportunity. And the responsibility was huge. And the opportunity was just amazing. And if you can figure out how to organize, get a team of like minded people, you can actually make a huge difference. Okay, so I had an opportunity to work for three different governors, both Democratic and Republican. And that was an amazing journey, adventure opportunity. It was just incredible. And then the whole time, I always love to teach. And when you are in public health in those roles, you have to be a teacher and educate, you have to talk to the public, you have to talk to the legislature, you have to communicate scientific and health information in a way that resonates with people, they can ask you questions. And those are some of the same skills that you use when you’re talking to patients one on one, those are the same skills you use in a classroom, if you’re talking with students, so I always love being a teacher. And so when I was at the end of my time, and the last administration, I worked with that transition to full time in academics and getting involved more in staying in community engaged practice around public health, because our work with communities is really important for universities, figuring out ways to expand the education and medical students wanted more education in public health. So how can we provide that such that they can see, they can learn how to care for individual patients that really have a social consciousness? And how can they advocate for entire populations? How can they learn to prevent disease and illness, and be champions in the community, wherever they are? Those were some of the roles that been very involved in public health related research. And then we decided that we needed to create graduate education in public health, because Vermont didn’t have it.

Sujani 22:32
And as you’re kind of, you know, pulling this program together for the University of Vermont, are you kind of going back to people that you had come across in your public health career journey and kind of learning from them as to what was missing in education for public health in Vermont,

Jan 22:52
when we did this, we have faculty at the university, and some who had Public Health Training, some who didn’t, but had some public health experience. And then we continue to work with lifetime faculty worked with the health department or other organizations, so that we had a mix of individuals with both practice and academic backgrounds, some with clinical backgrounds, in forming our curriculum. So that’s what we included a broad group of individuals.

Sujani 23:26
And I’m guessing you didn’t really have to go and convince people to study public health, right? Because you knew the need was there, because you had people going out of state to go and get this education. At at a graduate level, at least.

Jan 23:42
Students wanted this, asking for it for a while. People who worked at the Department of Health, I was there. Some of them had formal training, but many did not. So I would say that there were people in the medical profession and health care, doctors and nurses, people who work in public health already. People are interested that the health challenges are complicated. They’re fascinating. And people were asking for it. So now, we had to figure out what kind of program do we put together? How should we do that? And then make it very practical for people who may not be able to leave their job for years to get another degree. So we talked to a lot of people, we had a lot of conversations and we ultimately, based on those conversations and talking to potential students decided to design our program intentionally to be 100% asynchronous online.

Sujani 24:46
Before we started recording, we kind of got into this a little bit and it was, you know, the question of why studying public health or even working in public health is so important at this period of our kind of life and I’m curious, you know what your take is on that. I mean, a lot of our listeners are already convinced that they want to work in public health. But I think, a conversation around just solidifying that decision for them, because, you know, as we as we talked already, sometimes it can be frustrating to continue doing work in public health, sometimes when you’re not seeing change, or, you know, you’re a student, and the graduation feels like it’s never coming, and you’re deep into exams, you know, at whatever point where you need a little bit of motivation as to why what you’re doing is really important, and you should keep going.

Jan 25:42
In my opinion, public health has never been more important than it is now. And we talked about some of the health issues that maybe 10 or more years ago, that we were facing, we’ve just experienced a global pandemic. When there were huge challenges, I mean, think about the kinds of issues that are still present in our society today. We know that both health and social needs are widespread. Not everyone in our country has access to affordable health care. That’s in form of health insurance. We don’t have enough health professionals in rural communities, people struggle with having enough food, and the right food to eat, transportation, and many other health and social factors. In our day to day lives. Many people still experience discrimination, we don’t have a clear path to health. And there are so many needs, and the science and practice of public health, in my opinion, help give us a path forward, we learn about how we actually improve the health and the entire populations, we have to learn about math, epidemiology and statistics so that we can make use of the data that’s available or create new data to help us know how serious a problem is, and most importantly, whether or not we’re making any progress and making it better. We have to learn about our environment. And we know all the challenges and climate change. That’s a global problem, or seeing extreme weather events, we have to figure out how to make that better. And at is, as a long term and sustained commitment, those social and behavioral factors. And I use tobacco use as an example. But we know that finding ways to get people to be more physically active, in part by thinking about the environment in our communities. Opioid addiction as a huge show, those habits and behaviors are sterile, widespread, they may look a little bit different. All of those things are part of learning about the science and practice of public health. The students I see today, typically in the last few years, have come in with a strong sense of we want to make things better you advocate for change. What public health education helps you with is how do you make that change?

Sujani 28:45
In your opinion, do you think we need to go beyond the traditional public health roles and have public health? Only in those traditional organizations like governments nonprofit research? Can you see public health kind of being embedded? Essentially, everywhere, every industry?

Jan 29:09
I can. I absolutely can. And because important you mentioned it earlier, it’s it’s a way of thinking. It’s a way of thinking about the world around us, our environment, entire communities, and not perspective gives you a complimentary one to how we look at day to day, if any, if you’re in healthcare, it’s those day to day health challenges that people have, and they complement one another. Some of the models, you know, back then, the Institute of Medicine formally announced the National Academies of Science, Engineering and medicine. And they wrote some books on the future of public health and really talked about the first one was probably in the late 80s and talked about how, you know, government and they didn’t fail, but they really had done enough. And then the subsequent looks at public health recognize that, you know, health is beyond just one single organization. If you’re going to focus and really see health improvement, you do need to bring your any broader perspective. So that, you know, we talked a little bit about that include schools and businesses, and certainly the media on education, and government organizations and healthcare entities, but a focus of the focus on the importance of preventing adverse health outcomes, and illness, and promoting health and addressing those social needs in order to do that, so that it does, it’s a broad responsibility, it is complicated. But I agree with you that we, we need to extend our conversation beyond traditional public health or healthcare organizations.

Sujani 30:59
I sit and think about this all the time, you know, what role can PH SPOT play, you know, the organization that I’m kind of trying to build? And then I think about what role can the individual play? And then what role can you know, organizations that are educating the next generation play in trying to share that message more widely? And I don’t know if you ever think about those pieces of the puzzle and have any ideas. But I’d say many, if not all of our listeners are public health professionals. And if we’re trying to embed public health or the way of thinking into organizations and industries that have never thought about public health, what can we do kind of collectively, to expand that conversation into areas that have never thought about public health? And I don’t- I don’t know whose role it is. And I’m sure it’s a combined effort. But yeah, I always think about, how can we take those first few steps?

Jan 32:01
Been talking about it. And those conversations are really important. If we think about it, health as a priority for our society, is influenced the perception. And when I talk to my students, where we start is, the perception is that that health is just healthcare. And health is determined by whether or not we have health care and the quality of our health care and the accessibility of health care. But that’s not enough. We know that it is also determined by our environment around us, we talked about that, and habits and behaviors, and our- our social needs. And whether we have a house to live in, food to eat, transportation, work, community connections, social connections, which are so very important. Privacy conversation is absolutely important. Guys at the Department of Health, I always encouraged everyone to we need partnerships. So if you are working in a government agency, a partnership with a community organization, or a healthcare organization, now in academics, and in a healthcare setting, we have partnerships on our research, and education, with people in health departments and nonprofit organizations. So those partnerships embody conversation. So the conversation is, is absolutely the place to start. And expand that conversation through the partnerships with other organizations, even if their primary mission may not be health.

Sujani 32:24
And I think part of having that conversation is, you know, a little bit of education on our front as public health professionals to be able to speak in the language that those other organizations can understand. Right.?And, you know, one obvious language that we all need to pick up is, you know, is the return on investment for those organizations sometimes, because whether we love it or not, if we’re trying to build some sort of a partnership with for profit companies or businesses, sometimes they want to hear, you know, how is this going to be helping my company kind of on, like the economy of it, right? So, I think there’s, there’s language that we may need to pick up so we can speak the same way and kind of show them the impacts of the public health intervention in a way that they can understand it. Obviously, some of them do have social agendas or social impact teams that we can maybe tap into, but from some of the conversations I’ve had, those teams and large organizations, they don’t often have, you know, a large voice. So I think that’s what I would probably add to your piece.

Jan 35:07
Yeah, I agree. And one of the nonprofit organizations that we work regularly with, said there was at one point, you know, people in public health have a lot of jargon. And we need to be able to understand about more about public health. And the opposite is just is true. Also, if you’re trying to work, for example, with a business, you need to understand what’s important to them, right? There are those places of common goals. And I bet they’re there.

Sujani 35:07
Yeah. And even you know, we talk about public health, education awareness, if we can look at it from a marketing angle from companies who have been able to do marketing and branding in such effective ways. Those are some lessons that even public health can take back when we’re thinking about education campaigns, right? And I think there’s lots of going back to, like collaboration and partnerships. I think, even within the educational settings, there’s lots we can learn from, you know, the way that marketing students are learning marketing versus how maybe public health students are learning public health education. And that’s always something that I’ve reflected on.

Jan 36:24
Absolutely, you know, that’s a whole area of and that’s something that we’re trying to work more on now, the whole, how do we get better evidence based or scientific information out there in a credible way? Because we know and we saw that a lot during the pandemic, and we’re still seeing that is there’s so much misinformation out that can not only harm people, but it’s just, it may not be true. And so that is, you know, how do we get evidence based public health information out to people and show them places they can go for information they can trust? How do we further strengthen people’s trust in science and health? I think that’s an absolutely critical.

Sujani 37:17
Yeah. And we just have a few more minutes. But I love the intersection of education and public health. So anything to do with that space, I- my interest kind of picks up and I saw that you are also a director of an office called enterpreneurship, at the University of Vermont. And I’m curious about that, and in what sort of work is done there.

Jan 37:39
When we were envisioning our graduate public health program for the University of Vermont, one of my close partners and colleagues was in our it was the Office of Continuing and Distance Education, Professional and Continuing Education, University of Vermont, and there are absolutely partners on a day to day basis. And what I learned initially was that whatever organization, so let’s say, you’re in the university, you’re in your organization, and you think that you have this great idea for education. That’s how you develop it. What he taught me was that when you have to look at is there a need for that kind of edge? Meaning, not only do people on it, are there already 100 other different people doing the exact same thing? What your idea is, is it forward thinking? Or is it something that maybe needs to be modernized? So what they taught me was that it’s sort of you have to think about education in a more holistic way. Meaning that when you develop something, you know, how might is it practical? How can we use it? You know, how can we use it to advance the workforce? And in our case, we’re looking to further strengthen the workforce, the public health needed so that our graduates can go out and actually and help people, in our communities and in organizations that serve people.

Sujani 39:18
I love that. I love when we’re thinking about new ways of educating the public health workforce. So really great work there. To wrap it up, Jan, I don’t know if you have any kind of final words of advice or tips for any of our listeners around just you know, building their public health careers.

Jan 39:39
Public health changes really, really fast. And that’s both the challenge and the excitement. And if you are in public health, or thinking about public health, you find a way to educate yourself. That could be a conference. That could be a course it could be non-credit opportunities, it could be formal education. If your instincts and your passion is you want to help people, and entire communities find the way to educate yourself about it.

Sujani 40:15
Thank you so much Jan for joining us on the podcast. This is such a, an important conversation to have. And I’m really happy that it was with you.

Jan 40:24
Thank you for inviting me.

Sujani 40:29
Hey, I hope you enjoyed that episode. And if you want to get the links or information mentioned in today’s episode, you can head over to pHspot.org/podcast. And we’ll have everything there for you. And before you go, I want to tell you about the public health career club. So if you’ve been looking for a place to connect and build meaningful relationships with other public health professionals, from all around the world, you should join us in the public health career club. We launched the club with the vision of becoming the number one hangout spot dedicated to building and growing your dream public health career. And in addition to being able to connect and build those meaningful relationships with other public health professionals, the club also offers other great resources for your career growth and success, like mindset coaching, job preparation, clinics, and career growth strategy sessions in the form of trainings and talks, all delivered by experts and inspiring individuals in these areas. So if you want to learn more or want to join the club, you can visit our page at pHspot.org/club. And we’ll have all the information there. And you know, as a space that’s being intentionally curated to bring together like minded public health professionals who are not only there to push themselves to become the best versions of themselves, but also each other. And with that, I can’t wait to see how this is going to have a ripple effect in the world as we all work together to better the health of our populations and just have immense impact in the world. And I hope you’ll be joining us in the public health career Club.