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
But I don't think healthcare is set up to do that. Not the way healthcare is paid for. So I think a lot of this, I know this is kind of wonky, but so much of this comes back to financial incentives and how the healthcare system is paid and how the public health system is funded or isn't, that we just really need to, you know,
to have a much more specific question about, and I think we've got good roadmaps from CDC and others about what would it take to fund things at a robust enough level population-wise to to make a difference. There are recommendations about what should public health funding per capita be? No state is close. If we really wanted to intervene on the upstream end, how much more should we
Should we invest upstream? You know, I mean, it's still, what is, maybe you guys know the current data better than I do, but it's, you know, what is it still like 97, 98% of all the dollars are going into the intervention and a pittance is going into prevention. Well, you know, guess what? Part of the reason that other countries spend less money and get better results than we do.
They put more money, not only into kind of classic, you know, classic, if you will, public health, but also into what we were talking about earlier, the social determinants of health, the social net is stronger in places that invest more in housing and economic development and, you know, on and on.
And so I think the economics are actually on our side, but we got to really sharpen our arguments around that and broaden the coalition of people who can see that picture and see how all these things really are so interconnected and start to move more of that money upstream, because we will all suffer from it.
Yeah.
Great question. Well, I think we need to be partners. And the critiques are a part of that. You know, like to help us understand what isn't working from the community's perspective. But then we also need...
for community organizations, community leaders, community members to kind of embrace their role in changing some of the conditions so that it's not all like, you know, you out there, you government people, you need to fix this. It's like, how do we fix it together? You know, how do we
how do we get the community the resources and the support, but also look to the community to lead and to learn how to Let me take that back. It's not about learning how to take responsibility, because I think community knows that a lot, but how to exercise some of the The muscles, if you will.
I am so glad you did. I think you said it way better than I did. I was kind of trying to get at the same point, I think, that We have to support communities to be able to be more responsible and to create those expectations. Absolutely. You know, you're right about that. I think we need to be more explicit.
The expectations shouldn't be lowered for, you know, investing in the capacity of more community-based organizations to take more charge. But they also need to then, you know, be able to to deliver, as you say, and that's not a one way street.
So I love what you said about, you know, let's let's set the expectations higher and then let's have a dialogue about, you know, what is needed to be able to fulfill those expectations and get, you know, get the get the outside in, you know, perspective switched to the other way.
You know, I'm not sure I'm in a great position to answer that just because the last three years, as you said earlier, were hijacked by everything. So I don't have a great answer to that question, but I do think. that we need to do a better job of lining up our state priorities with the national.
And we've spent a lot of time writing plans, and I'm not always sure that we're using the plans that already exist well enough to save the resources. I did want to, if it's okay, Stan, I know Clarence was trying to make another point there before. I know we're getting close on time, but I just wanted to turn it back to Clarence and see if he had another comment that he wanted to make.
Sorry about that, Clarence.
Well, I think there's often not a lot of time for that. And I'm so proud of Commissioner Cunningham and the work that she has been doing and will be doing on equity and so many other things. The job is like you're in the deep end of the pool right away and having to juggle a million things and there's not as much time for that sort of
reflection and bigger picture conversation that things tend to be more like, how do I handle this thing? And anything a former colleague can do to help their successor. I think there certainly is a willingness. I know I'm part a member of the Alumni Society of the Association of State and Territorial Health Officers. And we talk about that a lot.
It's like, how do we make this easier for the folks who've been around the block a few times to be helpful to the people who are in the hot seat now? Because it's just The pace of the work doesn't really allow that as much as you would wish. How do we build more time into the jobs of leaders at any level for this kind of continual learning and reflection and improvement?
We don't do a very good job of saying how much of the leader's job is that.
Thank you. Nice to be with you this morning.
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