Jan Malcolm
speaker
82 appearances
1 recordings
1 series
first heard Sep 2023
last heard Sep 2023
Jan Malcolm’s voice in public audio — every appearance, attributed to the second.
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Appearances
Wow. So many inspirations along the way. But, uh, you know, I, I go back to, I mean, many years ago, I was a much younger person, you know, somebody who really inspired me a lot was Dr. David Satcher, former surgeon general of the United States.
I mean, I can remember him, you know, talking about this, you know, kind of the social determinants of health before very many people were using that terminology. Um, You know, and he would talk about I can remember vividly a speech that he gave. He was talking about how this was in the in the 1990s, talking about how unacceptable infant and maternal mortality rates were back then.
And he said, you know what the most important factor is for infant and maternal mortality? Maternal income security. I was like, whoa, you know, light bulb just kind of went off. It's not just prenatal care or not. It's that more fundamental, do people have what they need to be safe and healthy? And so he really was, he sort of put that spark in me, you know, early, early on.
And since then, it's really been, you know, leaders in the community, many of whom were were rightly kind of critical of kind of what we were doing with the response. And this is a dilemma, I'll just call it right out, between focusing on the largest number of people versus focusing on the biggest degree of harm, if you will.
So the whole tension between how do you deploy the resources from an equity perspective
Um, you know, whether we're talking about testing or vaccination, you know, how do we, how do we prioritize the populations that, that are at the greatest risk while the, the other side of the coin is saying, but you got to get the countermeasures and, you know, as broadly spread as possible, as fast as possible. And that kind of makes you do these sort of more, more untargeted mass events.
And, and so that, you know, I, and I, you know, I kept being challenged appropriately. So by leaders in the community saying, this isn't working, you need to do more to get the resources deeper into the community. You know, and, and I mean, the, the, the, I will just call out, you know, kind of the black religious leaders, you know, the, the, the, the churches, the pastors, the,
You know, and the folks in service organizations like yours, you know, working with communities to try to get communities access to the resources and to get the resources deeper into communities.
I think we got better as we went, but it was always a challenge to, you know, to get that balance between the big, you know, the big P population and the more targeted communities where the needs were particularly great.
Well, I think that is, you know, that's a question, that too is a question that really needs a lot deeper discussion. I mean, we've, to your point, public health is hugely underfunded. No matter what part of the public health Absolutely. Infectious disease is underfunded. Emergency preparedness is underfunded. Chronic disease is certainly underfunded.
You know, analysis and planning is certainly underfunded. So it's it's kind of I think where we in public health are kind of expected to do all of it. But but really without any appreciation of of. what it takes to do it, to do it robustly and well. I can remember you raised tobacco as a great kind of lesson, if you will, of how this works.
I can remember in my first term at the health department with Governor Ventura, it was right after the tobacco settlement. And, you know, so we had this boatload of money coming from the tobacco settlement with kind of lots of differences of opinion about how that money should be spent. But very little support for spending it on prevention. Oh, let's spend it on cancer treatment.
Yeah. Let's, yes, exactly. Let's, you know, let's help people stop smoking. Well, yes, let's, but let's. try to work on the prevention side as well. And I think we had some real successes there because with that money and with, frankly, Governor Ventura's support, we were able to get more money put into the prevention side than we ever had before. We went from funding our
our anti-tobacco efforts at a couple million dollars a year, which was like, if that's all you're going to spend, frankly, why don't you save it? Because it's not going to make a difference. It's not going to move the needle at all if you're battling against all these bigger forces that are much more
successful in uh in getting people to smoke on the marketing side or use tobacco commercial tobacco but but when we could really appropriately resource it we actually produced some pretty good results it wasn't just the money but it was this multi-layered strategy of understanding oh you got to work at the individual level you got to work at the family the community the policy level
And we had all these things kind of working in synergy. And we dropped youth smoking by 30 percent in about five years. It was like, wow. And it was a combination of lots of different strategies. So to me, that just sort of says we and I think we did it again in the pandemic with a lot of resources. We moved mountains in a hurry. We can do it.
But it takes it takes resources that we don't typically have in public health. So in chronic disease, I kind of went off a little bit there on a tangent, other than the point being our role is prevention of chronic disease.
And that's where, again, I think we need our healthcare colleagues to say, we have to be working at the population level to try to reduce these risk factors overall, because just trying to remediate or treat or cure at the other end is going to overwhelm us.
And because, you know, people just like, well, you know, if I get diabetes, I'll take the drug, you know, or if I have a heart attack, the hospital will save me. You know, I mean, that's sort of how we think about, you know, kind of our individual perceptions of risk.
And, you know, and I think a lot of folks in the legislature, for example, think, well, the chronic disease, you know, managing that, that's healthcare's job. We want you public health people to, you know, you do this emergency stuff because we just saw that we really need you to do that. You stop the outbreaks. And healthcare should deal with chronic disease.
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