Every spring, hundreds of students graduate from the Yale School of Public Health eager to apply their newfound knowledge and training to the most pressing health issues facing society today.
But that can be a tall order when it comes to large-scale, multi-faceted challenges such as climate change, health equity, and the national opioid crisis. Add to that eroding trust in public health, limited funding, and a chronic shortage of resources, and potential solutions can get complicated quickly.
In the latest installment of the Dean’s Leaders in Public Health speaker series, YSPH Dean Megan L. Ranney, MD, sat down with New York City Commissioner of Health Dr. Ashwin Vasan, MD, to discuss ways that government and academic institutions can work together in solving macro-level health issues. Ranney, an emergency physician, called Vasan “one of the most transformative” health commissioners of this century.
Since becoming New York’s health commissioner in 2022, Vasan, a practicing primary care physician and epidemiologist, has dramatically re-envisioned the city’s public health system to focus on the main drivers of declining life expectancy including chronic and diet-related diseases, overdoses, gun violence, and birth inequities. Among other accomplishments, he also developed an innovative mental health plan to address a mental health crisis among the city’s youth, people with serious mental illness, and those at risk of drug overdose.
Watch a video of the fireside chat with Dr. Vasan on our YouTube page.
Defying the odds
Vasan credits his early career work with two health pioneers – Dr. Paul Farmer at the nonprofit Partners in Health and Dr. Jim Yong Kim at the World Health Organization – with instilling his belief that positive sustainable change is possible even in the most daunting circumstances.
As a technical officer working with Kim in the WHO’s HIV/AIDS department in the early 2000s, Vasan helped launch the “3by5 Initiative”, an aggressive international effort to get 3 million people in the Global South on HIV treatment by the end of 2005. Many doubted the initiative’s success given limited resources and its potential cost. “We were laughed out of the room,” Vasan said. But Kim persisted, setting an ambitious goal that people could rally around and one that came with clear obligations, responsibilities, and motivations regardless of the uncertainties about whether it could be achieved.
In the end, Kim’s strategy energized organizations into action. Although the 3by5 Initiative would not reach its goal until 2007, it spurred new treatment strategies for AIDS in Africa. Twenty years later, UNAIDS officials say today they are closer to ending the HIV epidemic than they ever have been.
“If you told me 20 years ago, [that we would be having a rational discussion about ending the HIV epidemic in our lifetime], I would have thought you mad,” Vasan told a packed audience of primarily YSPH students at the Feb. 15 event. He said he tries to incorporate Kim’s “visionary, ambitious, and goal-oriented thinking” into his leadership role at one of the largest public health agencies in the world.
At the end of the day, public health is truly an applied interdisciplinary science. In its best form, it is the intersection of science and society.
Dr. Ashwin Vasan, NYC Health Commissioner
Merging science with social impact
Vasan’s goal-oriented approach can be seen in his latest initiative – HealthyNYC, a citywide campaign to raise the average New Yorker’s life span to 83 by 2030. Life expectancy in the city dropped dramatically from 82.6 years in 2019 to 78 years in 2020, with Black and Latino New Yorkers hit the hardest. Vasan galvanized Mayor Eric Adams and other city leaders behind his health agenda and, in a critical move a few weeks ago, the city council passed legislation committing to the project long term.
Vasan said he is delighted HealthyNYC is taking on a life of its own beyond his expected tenure as commissioner. “This has to be a collective project,” he said. “This has to be something that lives beyond the political cycles and the vagaries of elections.”
When asked by Ranney what role academic institutions like the Yale School of Public Health and early career professionals like YSPH students can play in advancing important initiatives like HealthyNYC, Vasan said both are vital to the future of public health.
Institutions like YSPH provide critical evidence-based science that helps policymakers and resource allocators focus on programs that are proven to work, he said. And students represent tomorrow’s public health’s workforce. To be most successful, Vasan urged students to not only train in public health sciences such as epidemiology and biostatistics, but also learn how to work within communities to implement that science to improve health.
“At the end of the day, public health is truly an applied interdisciplinary science,” Vasan said. “In its best form, it is the intersection of science and society…How we apply the scientific method to answering population health questions is really essential.”
Ranney, who has a degree in history of science, echoed that response.
“Any science that is done is done in the society and culture in which we live, ranging from the types of data that we collect to the ways that we analyze it and of course, the way we put it out into the world,” Ranney said. “My hope is that we can provide the best possible evidence about what will advance health and to do so in a way that allows other sectors to thrive.”
The importance of data
Ranney has said that the future of public health will center on four pillars – inclusion, innovation and entrepreneurship, communication, and data-driven leadership. She pointed out that Vasan recently highlighted the importance of data with the launch of a dedicated Center for Population Health Data Science.
Vasan said he views the center as a “single point of truth about the health of the city” that will bring together siloed data sets and leverage health informatics to improve public health. He described informatics as a critical layer connecting data analytics and infrastructure. Health informatics seeks to efficiently use biomedical data to improve health through such tools as modeling, data visualization, and machine learning.
“I need to know how to do public health planning for the things that are killing New Yorkers today and I don’t currently have the ability to do that,” Vasan said. “The future of public health leadership is one where we develop those informatics and data…for the entire city of New York and eight and a half million people at a geographical level.”
Centering equity, building trust
Vasan urged students in attendance to seek out internships with New York City’s Department of Health and Mental Hygiene where they can apply their knowledge and training “to push us forward and help us innovate.”
“There isn’t a path to achieving our life expectancy goals that doesn’t center on equity,” Vasan said. “I think it’s going to be your generation that comes into government, that comes into the public sector and the nonprofit sector and helps us figure out how to do that. Because right now, we are these large, often clumsy bureaucracies that struggle to get dollars out the door fast enough and into the communities and organizations that might be long on trust and capability, but short on capacity. So that’s the real challenge for you. I need your help…we need your help in New York to do that better.”
Ranney added that there are a wide range of opportunities for students to get involved in public health and options are not limited to government roles.
“It may be working in public service, but it may also be working in those community-based organizations and creating those liaisons back to city, county, state, federal, or even international departments of health, recognizing them as partners and using your knowledge, your experience, your expertise to help advance the work that you are doing,” she said.
When asked by Ranney what advice he would give students regarding improving trust in public health, Vasan stressed the importance of community collaboration.
“We need to unlock the power of our community organizations that, as I said, are long on trust, long on credibility, long on relationships and that know how to work in and among the communities that have historically had the greatest need but also have historically been disinvested in,” Vasan said. “They need to be linked up to something bigger and that means resources, training, technical capacity, and often government is one of the partners to help do that.”
During the height of COVID-19, New York City’s health department used federal emergency dollars to support over 100 community organizations that helped the city reduce what Vasan called “a massive Black/white vaccination gap.” Vasan’s department leveraged a program called the Public Health Corps to station community health workers within small, trusted community organizations to help with vaccine education, testing distribution, and engage people in care.
“In the course of six to seven months we saw a closure of that [vaccine] gap and it was all because we invested in communities and in the people in these organizations that reflect the communities and that people actually wanted to hear from…people who could actually convert a conversation into a vaccination,” Vasan said.
In closing, Vasan urged students to enter into public service – either in government or the non-profit sector – and to not fall victim to false narratives that change can only come from the top-down or bottom-up. It’s both, he said. When it comes to addressing large scale health issues, collaboration is key.
“It’s all connected in a service of something bigger than the ability of any one institution to achieve on its own,” he said. “Let’s aspire to something bigger than any one of us can achieve. We have to have a collective drive and a collective mission to make this country the healthiest place it can be…We need your voice, and we need your perspective. Even if it’s only for a short amount of time. Come do it.”
During his visit to YSPH, Vasan also spoke with students from the Department of Environmental Health Sciences about how New York City is addressing the health effects of extreme weather events tied to climate change. He also participated in a roundtable discussion about climate resiliency and public health, hosted by the EHS department, that featured Connecticut Health Commissioner Manisha Juthani, Deputy Commissioner Lisa Morrissey, and Professor Robert Dubrow, faculty director of the YSPH Center on Climate Change and Health, among others.