CDC Director Talks About Building Trust, Addressing Health Disparities During Yale Visit

Mandy Cohen, MD ’05, MPH, director of the U.S. Centers for Disease Control and Prevention (CDC), joined Yale School of Public Health Dean Megan L. Ranney, MD, for a ‘fireside chat’ about health care leadership and the future of public health on Oct. 5 in Harkness Auditorium. From 2017-2022, Cohen led the North Carolina Department of Health and Human Services, where she was lauded for her outstanding leadership during the COVID-19 crisis. She became CDC director in July of this year.

In a conversation before a packed house of Yale students, faculty, and staff, Cohen discussed a variety of topics including the importance of data collection and the use of data in health care, building trust as a tactical plan, and addressing health disparities. Cohen also offered advice to Yale MPH students on the importance of stepping outside of their comfort zones and asking questions.

The event was a collaboration with the Yale School of Medicine, Radiology & Biomedical Imaging – Boroff-Forman Lecture Series. It was sponsored by the Yale School of Public Health as part of its Dean's Lecture Series, the Yale Medical Student Council, and the Solomon Center for Health Law and Policy at Yale Law School.

The following is a summary of some of the key points raised in the conversation. The content has been edited for length and clarity.

On Building Trust

Dean Ranney (DR): Did your understanding of public health and the role of government, the private sector, and nonprofits change during your tenure as secretary of the Department of Health and Human Services in North Carolina?

Dr. Cohen (DC): At the state level, you see the problems up close and personal in a different way. North Carolina is a challenging place to work. We have a very stark divide between urban and rural [communities] and a big political divide. I was so lucky to work for, I think, the best governor in the country, Roy Cooper. He called out right from the beginning that trust was going to be the most important thing that we could focus on as we went into the COVID-19 crisis. How do we build trust and how do we maintain trust with the people of North Carolina? And that really has shaped me as I think about public health. If we want the world to be different, if we want the world to be healthier, it always, for me, comes back time and time again to trust. Trust, yes, is a feeling, but trust is also a tactical plan that you have to execute every single day. That's a lot of what I learned about leading through a public health crisis at the state level, and certainly a lot of what I bring to the CDC.

DR: I love that idea of trust being a tactical plan. We all cheered you on when you got the directorship of the CDC. It's just such an incredible honor and I can't imagine anyone better in this country to lead the organization. I know that creating trust has been a linchpin of what you've been talking about. Can you share a little bit more about how you think this can be done within the CDC?

DC: What I took away from that, building a tactical plan for trust, are really three buckets of work. The first is transparency. In North Carolina, leading through the COVID crisis, we did 170 press conferences. That transparency and being willing to take questions, is really, really important and builds trust. The second is simplicity in operations or great execution. Were there tests in my community? Was there PPE for folks? Was there a vaccine when you said it was going to be there? We can study vaccines and their effectiveness, but if they sit on the shelf, they're not effective. The third is relationships. We're all humans at the end of the day, and it is remarkable how sometimes we forget that. Sitting down with folks and building relationships takes time. We spent a lot of time showing up in communities that were historically marginalized, showing up and listening.

On Health Disparities and the Importance of Data

DR: There are two things that have been a long-time focus of your career, but also are key to your work at the CDC. One is data and the accuracy of data and the accurate capture of demographics so that we can address equity and pay attention to historically marginalized communities that are experiencing a disproportionate burden of disease. The other is community. I would love to hear your reflections on either or both of those and how you're thinking about these things now on a national level.

DC: I think that data is the oxygen that powers our work, particularly in public health. If you can't see problems, you can't solve problems. We know that there are disparities in our system. So clear, crisp data that changes action is really necessary. In North Carolina, we said equity was at the center of what we were doing. And it was just unacceptable to us to not be able to stratify every piece of data that we had by race and ethnicity. We did it for gender and age too. And so, you couldn't log a vaccine in North Carolina without race and ethnicity. We had a 99% completion rate on our race and ethnicity data. We won awards for that. I’m very proud of that work. We all have to collect race and ethnicity in the same way every time for every program, so we have an apples-to-apples comparison. It seems super basic, but we don't do it at the CDC right now.

We have to, all of us, no matter where we sit, whether it's at the CDC or in academia or in health systems, get away from the mindset of “this data is mine.” There's a lot of, “Well, I've done the hard work of collecting this data and I get to publish my data,” and I appreciate that. But what I'm working on at the CDC and with our state partners, is how we are going to protect this nation as we go forward. We have to find ways to be able to share that data across the board. If we can do it for COVID … we have to do it for … flu and RSV. Let's start there. I'm looking for a coalition of the willing to go on down that path with me and then I'll work with Congress to show why that's so necessary.

Advice to Students

DR: If you had the chance to go back in time — and you have the opportunity now to speak to a bunch of aspiring leaders themselves — what do you wish you had learned? What are you thankful you learned?

DC: I have two pieces of advice that I've been giving for a while now, one which I think I followed and one which I was disappointed I didn't. The first is: Be uncomfortable.

So, if I had just taken jobs that were fit for a doctor, I don't think I would have been able to make the progress I did in my career. There were times when I was the communications lead, times when I was the data lead. There were times when it was my clinical expertise that mattered. Sometimes it was my policy expertise. Sometimes I was just needing to be a good manager. Building different kinds of skill sets requires you to step out of your comfort zone.

The other part is about asking great questions in whatever environment you're in. And I feel like this is where I fell down. Looking back, I think there were moments where I didn't take advantage of opportunities to ask questions of people because I wanted everyone to think I already knew the answers. No one expects you early in your career to know all the things. So please, ask good questions. Don't feel like you have to know all the answers.