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Solving global health challenges locally

May 05, 2023
by Matt Kristoffersen

Every day, global health experts use their experience and training to tackle issues across the world.

They can make big contributions closer to home, too.

In its final Conversation Series for the academic year, the Yale Institute for Global Health (YIGH) invited two distinguished public health officials to share how valuable an international perspective can be for tackling local health disparities.

The April 19 discussion featured Connecticut Department of Public Health Commissioner Manisha Juthani, MD, and from the state of Washington, Secretary of Health Umair Shah, MD, discussing their efforts to address local challenges. Juthani, a professor at Yale School of Medicine and Yale School of Public Health, took a leave of absence in 2021 to serve as the state’s public health commissioner. Juthani and Shah’s talk was co-sponsored by the Walker Fund at the MacMillan Center.

Much of their recent work in applying global health lessons locally has centered around COVID-19. As YIGH Director Saad Omer said in his opening remarks, “What we’ve learned from the COVID-19 pandemic is that health transcends boundaries.” COVID-19, he said, was a virus “that emerges from China and shows up in Washington, and then, within a week and a half, in Connecticut, and in many other parts of the country and the world.

“We have also learned that promoting healthy behaviors, investing in health care infrastructure, specifically with a focus on equity, helps everyone, both domestically and internationally. Especially if these lessons are shared,” Omer said.

Juthani stressed the need for investment in health departments at the city level.

State departments of public health, like the one she leads in Connecticut, cannot match the boots-on-the-ground knowledge that the experts in cities like New Haven can apply to a given situation, she said. Her experience witnessing the COVID-19 pandemic in Connecticut showed her that preparedness plans in the state’s biggest cities helped to facilitate the response to COVID-19.

“We really have to take ‘local’ to the really local level,” Juthani said. “It’s on us as a state health department to be able to work well with local health officials to be able to execute these concepts.”

For Shah, who served on the frontlines of Washington’s response to COVID, the pandemic changed the way he thought of global health. The first reports of domestic deaths from the disease alerted public health officials to what was to come, he said. The ability to prepare was instrumental in preventing the spread of COVID-19, and more deaths. For Shah, it proved a powerful point: “We cannot sit and rest on our laurels when something is happening elsewhere,” he said.

“There is no ‘over there.’ ‘Over there’ is here,” he added. “Very quickly, something that can happen in Hartford or New Haven can spread all the way across the globe.”

The speakers also discussed other global health issues which appear in U.S. cities, like structural inequities and the erosion of public trust.

For Juthani, her time leading the Connecticut Department of Public Health has emphasized the universality of health challenges. Early in her work, for example, she found that unequal access to maternal health services had led to a concerning rise in congenital syphilis rates in the state, a situation that she referred to as a travesty.

She added that the COVID-19 pandemic had stretched her department’s resources. Shah agreed, saying that public health as a global profession has been worn down from the pandemic.

“Our workforce is challenged. It is tired. It’s ragged. It’s been beaten up, it’s been vilified, it’s been attacked. It’s been demonized,” he said.

Omer called on the rising students and young professionals in the audience to work to improve the state of public health. “There are two types of people: those who run away from fires, and firefighters. You have to decide: Are you going to run to it? Are you a firefighter? Is that your calling? That should be,” he said. “Take that as a challenge. You’re coming out of programs in public health and nursing and others. Take up that mantle and help redefine public health.”

Submitted by Jane E. Dee on May 04, 2023