Rizzing Up Public Health? with Prof. Jerel Ezell

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Abdul El-Sayed.

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Kids want to know more about the coolest thing in town. It's public health. What's public health? You say? Well, only all the efforts that keep us safe each and every day.

Crickets Yeah, so I'd be the first to admit that public health doesn't make the list of coolest professions. And even if we occasionally try to change that, you and I both know, we only usually end up sounding like, I just did. Let's face it.

We're not running into burning buildings, strumming our guitars in front of thousands, or making second by second life and death decisions. Okay, that last one, we definitely do. But that swag gap, as today's guests call it, has had a serious impact on our ability to effectively do our work. Look, before I get subtweeted, here is that sub X. Now. I love public health and I think it's one of the most badass professions out there.

The work we do protects some of society's most vulnerable people every single day. But I'm a nerd, I like to fancy myself a nerd with some riz, but I'm still a nerd. And a lot of what I think is cool about public health just isn't shared by most people. That swag gap, though, isn't just a matter of winning some popularity contest.

It's a matter of our ability to fundamentally do a job. That's because the first word in public health is public, which means there's something about being able to appeal to the public that is absolutely essential to what we do. And when people think we're the antithesis of cool, they're just not as likely to listen to what we have to say. We've talked a lot about our communications challenges.

The fact that most of us are trained to think in numbers rather than stories, the fact that the way we explain ourselves is backwards to most people. Only after saying all of our reasons do we actually say what. Our conclusion is the fact that we tend to want to be comprehensive rather than concise, losing people in our details. But if all that is true, this coolness factor is basically our achilles heel.

People don't want to listen to you if they don't like you, they won't like you if you don't command their attention. Here's the challenge, though. What makes something cool? Think that through.

For a second, things that we think are cool are usually edgy or bold, or imply some kind of action in the face of risk. Come what may singing your heart out in front of people you don't know, cool?

Dunking over seven foot tall basketball players also cool, running toward fires to save lives also cool, but so much of what people know about public health. Telling them not to smoke, to click on their seatbelts or to watch what they eat, that's like the antithesis of cool.

We're anti-boldness personified. Watch that risk, be careful of the consequences. So much of what the public knows about us is about the risky, edgy stuff we tell them not to do. But honestly, that's only a reaction to the risk-averse, individualized version of public health we've become.

See, a long time ago, when public health was about taking on the structures that were hurting people. There was a time when public health was known for picking fights with much stronger foes in the name of the public's health and winning. And yeah, that's pretty cool. Rather than just telling people not to smoke, which we should keep doing by the way, we took on the cigarette manufacturers who were telling them it was fine. Rather than tell people to eat better, we took on the industries who were peddling poisons to kids.

And that shit picking bold fights with opponents many times your size, that shit's cool. There's a lot we can do to rizz up public health, as the used say these days. But most of it deals with the margins if we're not serious about rethinking our main purpose.

We can't keep being nerds who crunch a bunch of numbers and tell people what they shouldn't do, as much as that's really important. We have to be the nerds who pick fights with bullies who are hurting people, and we have to win. My thoughts only crystallized about this a few weeks back when I came across a really interesting talk by a thinker who put in words so much of what I had been feeling. That talk was by our guest today, Professor Jarell Azele, a social epidemiologist and incoming director of the Center for Cultural Humility at UC Berkeley.

He joined me to explain public health's swag gap and what he thinks we can do about it. Here's my conversation with Professor Jarell Azele. Okay, can you introduce yourself with the tape?

Sometimes I've been working in departments of public health. And it's very clear that these spaces are just very kind of sanitized. They're very dull, they're boring. And you know, at the same time, there's this element of you don't really expect more than that in these spaces. But then you start to wonder, what if they were transformed in these ways, right?

And what if we did treat them? Like, you know, when you're going into a spa, let's say like Aeropostale or something like that, it's kind of an old store, but when you go into a space that you want to go into. Most people don't look forward to going into a healthcare clinic, they don't look forward to going to the hospital, which makes sense. But what if the experience of being there, the way that you're engaged in terms of your senses? What if it mirrored one of these places where you go shopping, right? and if it was like a whole foods or something along these lines? And I found that to be a really compelling way to look at some of the issues we have when you think about the gaps between the public and then the public health administration and clinical force.

And I want to ask you, what do you think is behind that?

You're not an MBA, so that type of skill isn't something that's cultivated. And also the types of people who have the personality where they're going to be more into sales and things along these lines of tech. It's just not something that you're going to find in terms of public health. So I think it's kind of coming from both of these directions. But I also think another part of it is because of the gravity of what we're dealing with.

We're dealing with very complicated things that relate to life and death in a lot of cases. So you don't expect the type of levity or humor that you might get in some of these other areas. But I do think part of it also is just the fact that this is not going to attract people who have those really not to knock folks in public health, I'm in public health, but those really dynamic, outgoing personalities. You're just not going to have that. And if you do have it, it's going to get suppressed. By virtue of the type of work that you're doing and the folks that.

And another thing that I'll mention here is also thinking about how there's a lack of competition. So, in typical cases, right? As a consumer, when you decide which stores you do or don't want to go to, you have options, right? If you don't like Target for whatever reason, like, the red is too much for you, right? You can get a Walmart, right? So you have those options, right in terms of how you are engaged with your senses, in terms of the customer service.

But when it comes to public health, you don't really have that now. To an extent, you might say you have that when it comes to how you pick a healthcare provider, but by and large, you don't have the same options. And I think when there is that lack of competition, there's no real impetus to change. Because it's like, well, there's only one show in town, so it's either us or nothing at all. And I think, either directly or indirectly, public health is very, very aware of that. And they leverage that in ways that causes them to be a little bit complacent with how they present themselves to the public.

It's actually what we do in the spaces in which you are living and working and playing. And when we show up in the competition for ideas, we bring that same complacency about what we're carrying. And so we assume that because we have science at our backs, we have a monopoly on what people will listen to. And that everyone's just going to be drawn by our expertise and the many credentials behind our name and listen to what we have to say. And so we say it in frankly, the most uncharismatic way, and we almost pride ourselves in that.

There's a pride that's taken in being as dry and multifactorial as possible. Rather than having a message with a pop right? And that inability to think about our brand or how our brand projects, it speaks to a certain failure to appreciate this current moment. So I kind of want to ask you, where do you think our risk gap developed? where did it start, where we just sort of fell behind?

Do you think this is just essential to what we do, or do you feel like this is something that has grown over time?

Yeah, I think if you tried to construct a timeline.

So it just kind of naturally flows that your typical government-affiliated entity is also going to be in that particular way. And I'm not sure if you've ever read a work from Max Vader before. He's a sociologist. And what he essentially says is there's this idea of a bureaucracy which we all know about. And what it says is that the government is essentially meant to be austere.

It's meant to be kind of boring because it's such a serious thing, right? It really is a center of gravity in terms of our rights, our capacity to do X, Y and Z right, our infrastructure, all these other things. So it makes sense. And one part of his logic is, if it was a little bit more playful, right?

If it was like a circus or something like that in terms of how it marketed itself, then people wouldn't take it that seriously. So it'd be a bit of a leap to say that people are following. Vader was writing this stuff hundreds of years ago. But there is something in terms of how government is projecting itself as an authority. And there is this thing, which is a bit logical. That when people are more dressed up and formal, right? When they're in their business suits, we take them more seriously than somebody who's wearing, you know, Jean shorts, right in a tank top.

So there's something very logical about it. But what has happened over time is that, I think, to your point, public health hasn't adapted. And there is this assumption, again, to your point, that because we are experts, because we have these credentials. You've got the MD or the P.h.D or the MPH behind your name, that you are an authority. And whatever I say is really going to be golden. And Covid, and it didn't just start with Covid, but Covid was a big, you know, really a big reckoning point. I think, for a lot of us in public health. And realize that we don't have that type of plot that we thought that we did.

And that people are looking beyond the affiliations and the accreditations to say, what else are you about? And the other piece here that I think weaves all this together is think about this idea of relatability. So when you are operating as a clinician, you go out. For the most part, I don't speak for you because I don't know what you're thinking in your head. But in general, you probably say, most clinicians don't enter into a clinical space and think, I wonder if this patient thinks I'm relatable or not. They're probably more thinking, Does this person think that I'm credible, right? do they think I'm qualified?

But the type of insecurity of whether or not I'm relatable is not something that really exists in public health. The way that it does in other spaces, where we actually do, care a lot more in those other spaces. About the extent to which the people who work for the organization are actually looking like and reflecting the population or the public. And another thing I'll mention, I'm kind of thinking about this idea of experience. So if you think about your typical store, let's say, like your Fortune 500 companies take something like Apple, right? Steve Jobs was hugely, hugely into design from the whole 360 type of experience, right? Both with the product, how the product is packaged, not to mention what the product does and how it's designed. But those little minute details are really important to him.

And then, furthermore, if you go into an Apple store, that is a very unique experience, right? That's unlike any other store that you'll likely go into. Like a best buy. Or, back in the day, something like Circuit City. So he recognized that, and granted, we shouldn't expect public health to go out and get super fancy buildings with all glass. But there is, or could be a more subtle things to improve the spaces, right? And I think this happens in two ways.

It's kind of those little gestures that communicates to clients or patients in that setting that they actually care about our experience here, right? I'm just walking into a space that feels like a mental health ward from the 1910s. I'm going into a space where there's a little bit of music playing or something like that, right? And there's some flowers up, or there's some paintings or artworks and things like that. Little things that signal that we're aware that you're here, we're not taking that for granted.

And we also want to make a connection with you, right? We like the same things that you do. And we're not operating from this Ivory Tower, which is one.

They're just bureaucracies that care a lot about how they're perceived. The second, though, is that I think about the canonical government. Good guys and gals, and they're fire people, right? The firefighters got a lot of swag. There's no question that if somebody walks by.. ..

And the way I think about swag is when a kid interacts with them, either a teenager or a toddler. There's just a sense of awe, right? And the reason that they got a sense of awe is because those people run into burning buildings. And I wonder if a lot of the way we do public health has been about curtailing the implicit risk that people face in their lives. And there is something about risk that is, I think that is foundational to having charisma, right? It's like, when you see a rock star up there on stage, there's something about you. Thinking, Man, if that was me, I think I'd die, right?

If you see an incredible athlete, right? They're doing what they did and you're like, man, that is like putting yourself out there like that. And then you think about firefighters and they just run into burning buildings, which is insane, right? It's incredible that they do it, but most of us wouldn't willingly every day sign up to run into burning buildings. And I would argue that most people in public health say no, I do that every day.

And they'd be right, but it doesn't come out the same way. And I guess I'm wondering. For a profession that has, in some respects, framed itself around telling people not to do risky things, it's almost like the anti-swag, right?

Yeah, well, if you think about public health broadly right now, we talk a lot about innovation. This has been a big thing for a long time. We're talking about AI and things along these lines. There's a sense from the perception of public health leaders that we are innovative, right?

We're developing new treatments, we're designing new ways to engage with our patients and our communities. But this is speaking to the product, right? It's speaking to the product, but it's not speaking to how the product is communicated. And, as you are aware, there's a whole field for public health communications, right? But it really does not signal this interest in making that relatability connection, right?

There are a lot of studies out there which you're also probably aware of, right? That they have like really cool names they'll put. Like, you know, like the delayed study or something like that. Like things that are obviously pandering to a certain population. But they're not really making this case for how we, as public health workers or practitioners, are similar to you. We're just trying to speak your language, but we're not trying to say that we have this sort of, you know, comparability. And if you take somebody right now, think about like people who have been regarded as cool in public spaces, right?

Think about somebody like President Barack Obama, right? He was considered very cool from the outset. That was a big part of his appeal. Worked for him, worked against him in other cases, but by and large was considered a really cool president, right? Think about somebody like Jay-Z.

Now we don't expect someone like you or Dr. Fauci to have that type of swag and that type of personality. But that doesn't mean, again, that's kind of the extreme of it. So the argument is that when we talk about swag, that you have to be, you know, decked out and Prada and Gucci and things like that. It's just to say, can we focus a little bit more on relatability and create an experience for people recognizing that the experience is a big part of healthcare, right? It's not just about what you're getting, it's very much about how you get it.

And that's a part of public health that's really been lost, or arguably was never even there, so there's also that argument that it was never really there. And we're kind of just catching up and picking up on trends in other spaces. But one place where we really don't innovate in public health is communication, something we really do poorly in. And you probably, I mean, I don't think there's any public health program for NPHs where they teach you about marketing, they teach about communications, and that is slightly different from marketing, right?

There's kind of like this thin margin between them, but there is a distinction between those two, so it's really complicated. And I want to try to wrack my brain and think about who are the folks out there who are really recognizable, who are known by the public. When it comes to public health, there aren't many, right? And that makes sense in a way where you just don't expect scientists to be very cool, to be like a Bill Nye, the science guy type.

But what if that changed, right? what if that was a paradigm that we sought to change? That I think could be really?

I think that in the 70s, 80s and 90s, public health turned inward, rather than being the folks who are willing to take on the powerful to protect the public. We became ornery about individual risk factors, and as we individualized, we went from being the folks who step up to those who are more powerful. To the folks who wag their finger at you to tell you, don't eat this, don't smoke, click it or ticket. And not to say that those things aren't important, they're very important.

And I don't want anybody listening here to be like, Well, wow, okay, Abdul's encouraging. I'm just saying that. When we stopped being the folks who thought about the environment writ large and started being the folks who are a lot more focused on individualized behaviors. We lost a lot of our risk and I think that there is a way for us to regain it. When we talk about things like air pollution or enforcing on that major factory, that's polluting in those kids lungs. Or it's taking on the major corporations that spilled opioids out into our communities, or it's being willing to step up to policymakers who are clearly right on the take from a large corporation that's more interested in their well-being than yours. When we advocate for something like universal health coverage, that is the kind of thing that people look at and say, Okay, all right, there's an edge there.

There's a risk there. Those folks are putting themselves on the line for me rather than just telling me not to eat stuff. And I think that is a.

Philosophical regression to what was safe. That then made us look like people who aren't willing to actually pick fights that matter. And until we start doing that, I think we continue to move out and this is an issue. I know you're from right outside Flint and you've done a lot of work on the Flint water crisis. And when I think about somebody who's got a lot of charisma, I think about Dr.

Mona What did Dr. Mona do? She stepped up to the State of Michigan when they wanted to deny that there was a water crisis in Flint that was poisoning thousands of kids. She stepped up and said, You need to pay attention to this data and you need to come to grips with what you've done to these children.

And I think there was a moment where folks were like, Well, damn, she got it. So I wanted to ask you, as you think about where we go from here, what does it look?

MONA Somewhat, because I still actually do work in Flint, is that she was one of very few who was willing to say the things that she said right now. Maybe it wasn't one of these really dramatic cases where 10 years from now, they make a biopic about her, but it was enough to say there were some consequences for her decision. And one thing that I found, as I was talking with various people in Flint is. There's actually a considerable amount of jealousy for what she did. In part because she really broke that paradigm of we are scientists, right? We pay attention to data, we are not advocates.

We are not political and there's no way to talk about the water crisis without getting somewhat political about it, right? You have to start singling out specific politicians who were doing right or wrong. But there was something inherently political about what she did, and there's a lot of resistance to it. Because the idea of what a clinician should be is very much antithetical to what she was doing. To be out there, to be, you know, like, you know, really, kind of on a press tour circuit, having these conversations was very new, right?

It's very novel, it's not something that we've ever really seen, especially not in the context of a place like Flint, right? Another thing that I'll mention, in terms of this kind of lineage of public health advocacy, is thinking about those truth ads. Do you remember those related to smoking? Yeah.

So TRUtH ads, I think came out maybe like 15 or 20 years ago, and they'd be these ads. Where you have people who were typically like former smokers, with some pretty grave, you know, consequences as a result of smoking. You remember those, right? Yeah? So they come on from time to time and people would watch them and you know, they would be kind of freaked out by it, right? This person's lost their teeth because of this, right?

Like, it was pretty provocative, pretty much, you know, in people's faces. Now, I don't think that there's probably strong empirical evidence that shows well, people watch these ads. They started to stop smoking. But the fact that Public health came out and said, we care about this, we think this is important for us to acknowledge. And we're going to put it out there in this really raw way. That's very provocative, right? That's very powerful. And I think even those people who were smokers, they have to look at it and say, like, Yeah, your point? Like, dang, that's something, and that's not something that we really do anymore.

We're much more tame and it's hard to look at something like Covid and say, Oh, maybe we could apply that model to Covid. Because there's not a direct kind of Apples to Apples comparison there. But we didn't engage in ways that made the public feel like we were relatable, right? We were in the ivory tower, we were wagging that finger at them, right, and we were being super paternalistic.

And, you know, in this day and age, and arguably even before this day and age, people don't really respond well to that. So when I start to think about what are the solutions to this, I think there's a couple different paths that you can go now. On one level, you would just say that we just need to think more about relatability as a genuine question. When you are in a clinical setting, when you're in a classroom, as I am right with students, to what extent are those people looking at you as relatable and what does relatability get you? So, another thing that sometimes I talk about is this idea of equity clout.

So it's very similar to swag, you could say that it gives you more of this swag. But equity clout is thinking about what is your level of authenticity, how trustworthy are you, and then, as a result of that, how much authority do you have?

So to really amplify those types of things, we have to ask those fundamental questions, right? And it's not just the patients or the students we're engaging with. It's like, you know, when you go to Walmart and you're in line and checking out, right? What about that cashier? Do they look at you and think you're relatable? And not just because of how you dress and your race or ethnicity, but in terms of how you engage with them.

Because there's this huge buffer that I don't think existed 50 to 60 years ago. Right? Where you went in, you knew your PCP and you had some sort of connection. That feels very gone now, I mean, it feels very much gone. And part of it, I think, is because medicine is very much politicized now, in ways that it probably wasn't 50 or 60 years ago, right? So operationalize that.

We have to ask that basic question, Am I relatable or not? And we have to stop avoiding some of these more complicated conversations about people's backgrounds and the politics. Not saying, you know now, that we need, when we do our intake forms, to have questions all there about people's politics. But we have to start thinking about people more holistically, because that's how they look at us, right?

On one level, when you go in that clinic, they see you as a physician, but on another level, they see. This person probably has some politics. They may or may not agree with mine. They may feel this way or that way about these social issues, so we really have tried to be agnostic to those issues.

And it's very much to the detriment of public health. So the way I see it, I think it's a long road. It's not something that I think is being prioritized, but I think we are getting to a point of at least recognizing that. There's a huge gulf between us and the public. And having credentials is not enough to make them trust us or want to engage with what we have to offer.

We don't have to be so serious all the time and know when you're going in to get tested for chlamydia. You don't want to have a rollicking time. But there is this argument that we can kind of rest a little bit, we can be ourselves a little bit more. And that may be just enough to get a person to see us as more than you know, the institution and the man. So, yeah, get the vote out if we can.

It may not be worth the money, but it would, right.

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And we're back with more of my conversation with Professor Jarrell. Ezell. There are a couple of things that you shared that I really want to pick up on. The first is that we tend to think of our communication as episodic, meaning we only show up when we got something to say. And when you talk about relatability, right? The first piece of that word is relate, and sometimes you just got to build a relationship with folks.

And it's just showing up in the mundane moments to talk about the things that people are thinking about in getting out in the community. And I think there's this sense that sometimes we only need to show up in a crisis. And then we wield our credentials over folks and they shall listen to us. Rather than having been out there and having conversations that really focus on the issues that exist in the nitty-gritty of people's lives. And I think there's also a true elitism problem. In just the way that we talk, we use words that I don't think we think through, but feel intentionally.

Elitist? That they are big words to describe small ideas that feel like we're talking down to folks. And when we're engaged in a discussion about something as critical as people's health, nobody wants to be made to feel stupid. And unfortunately, that's kind of how we talk and then when people challenge us, rather than trying to explain ourselves in more simple language. And having the humility to engage and to recognize that. The only value of our work is that other people pick it up and do something with it. We tend to fall back on our laurels and try and statistic the hell out of people, and it's just not effective.

And then the last piece is. I'm thinking a little bit about how we engage in the challenges that are a problem to people, but don't feel like a problem to us. And that's, I think, one of the biggest challenges I've always seen, in terms of the way we communicate. You think about the vaccine campaign, and we've talked about this before on the show. But the number one thing that undercut the vaccine campaign is the fact that a lot of the folks who did not get vaccinated for COVId-19 were folks who did not have health insurance. So imagine when we deny them access to healthcare, meaning you cannot come to this clinic or hospital and get the care you need. And then all of a sudden we're like, but here's some care for something you don't even know you obviously need, because you're not even sick yet.

So imagine you're somebody with diabetes, you've had to rational your insulin your entire life. And they're like, I know you won't give me the medicine I know I need, and now you're coming to me with some medicine that you're telling me I need. But didn't exist last year. So, and we don't have the empathy to step into somebody's shoes and be like, I wonder how that would make me feel, and I think that really. I mean, when we think about inequality, we think about in this grand sense of like, the extremely rich and then extremely poor, but we don't think about the inequality of experience.

And the fact that what seems plainly obvious to someone with a P.h.D. in epidemiology or another public health field is obviously not plainly obvious. Because it took you how many years to get that stupid degree? And then you can't sort of climb down your Ivory Tower ladder and put yourself back in the life of somebody and be like, I wonder how this seems to you, or how you're experiencing it? And what can I say, and how can I say it in a way that explains it to you? In language that is not the one I took seven years to learn, right, but is language that I walked into my college knowing, right?

Because that's the reality of the majority of people that we're trying to support and empower. And I just think that part of this is this notion that we think we're smarter than other people. When, really, more than anything else, it's a privilege gap, and then we just exploit that privilege gap in our discussion and wonder why people on the.

I couldn't have said it better myself. There's a huge set of presumptions that come with the work that we do. We have, and granted, you know, when you have knowledge and expertise, it is hard to look over, I'm sure. And you know, I had a patient who doesn't have the same competencies that you do. And say, I'm going to listen to you and let you kind of articulate what your condition is right and what you think is the best way to approach it.

But that really is the essence of shared decision-making. But to really kind of suspend that, that clout that we have, that is a really difficult thing to do, right. And it's not restricted just to public health, it's a universal thing. Anytime that you have more power, capital of other people, you think I've got something, you don't.

So I'm really not in a position where I should be listening to what you have to say. And yet these are what people are screaming out. Saying is essential in order to make that connection with them. So, you know, the question of what does it take to get there on one level comes back to this idea of evaluation. So everything that we've talked about here, I think people could be listening to say, Well, how do you measure any of that, right? How do you measure a person's equity clout, right?

How do you measure their swag? Those are very difficult things to articulate, right? And certainly, like, there's no clinic that has, you know, form that patients fill out to say, Hey, you know, how much swag do you think your doctor has today?

We track patient satisfaction. But it's not really along the lines of like, when I talk with this clinician, like they are respectful of my race and ethnicity, right? That's not a question. When I talk with this clinician, they're respectful about my politics, right? Or they ask about my politics, all these different facets.

That would give us a sense on the other end, as epidemiologists, as healthcare administration. In terms of connections, we don't really capture, right? We have very antiquated metrics for looking at that patient experience. And that's why people are starting to tune out, and that's why we're having these deep, deep, deep, persistent disparities, because people don't trust us, right?

They don't feel in connectivity with us, and it seems, at least to me, very obvious, that that's a problem. Obviously it's less clear what the solutions are, but it seems like it's kind of hiding in plain sight.

And I wanted to ask you.

Why do you think we keep doing stuff like this? It's just everybody knows it's ridiculous and yet we do it. And then not only that, but in public health, we're like, here we are, right.

And in your talk, you cite that famous meme of, like, How are you, fellow youths? It just feels so absurd. Why do you think we do that, rather than just showing up authentically as who we are and respecting that many of us are in this field? Because deep down inside, we really love numbers and we're super nerds, but there's a way of communicating that love of numbers. That's authentic to who you really are and that people will respect and appreciate. But you can't show up and try and be something you're not, why do you think we keep doing this?

You're talking about swag, what is that about? And that's the point, right? That when you introduce something new that's silly and fun, but also you look at it and say, that is possible. You could have a lack of this one thing.

Then that becomes interesting to people right now. Obviously you have to go in and deliver and make it compelling, but at least on the surface, that's not something that we do. So when you think about what's been done historically, I think one part you would say, and I'm not trying to make this something that's ageist. But it is a generational difference. So if you kind of spend your life on the fringes of the millennial culture. And you're paying attention to the news from time to time. And you see TikTok is a big thing, you're going to say, let's go to TikTok. And that's where we should recruit for our study, right? Meanwhile, you're going to get a very specific type of person from there.

That's not going to be totally representative. So people in public health are kind of grasping onto whatever they're hearing. Certain words that are being used by youth, saying, hey, let's do that. Because then once they see those words, they're going to want to jump into that study, right? And these things aren't really happening.

So the other part of it, you know, we've been a bit cynical about these folks. You would say, well, you know, they're well-intentioned, and I do think that's very true, right? Because I've certainly had studies where I've been pwned at, but they're well-intentioned, right? But still, there's this very obvious dimension of if you want to connect with these groups, you need to learn what their pain points are, right.

Or what their touch points are? And we also don't do that. Like, how often does a public health department or a clinic go out and say, Hey, we're going to, you know, try to educate you around prep. Or we're going to talk about, you know, getting screened for HIV Aids. What sort of things would you like us to talk about? how would you like it to look?

The other thing that I'll say just quickly here is that. One thing we've done, I think well, is like we are a little bit more inclusive in our advertising. So when you see commercials for different types of medications, like, you'll see a fairly diverse group of people, right? That is a fast improvement. Because 10, 15, 20 years ago, only people who appeared to be getting any of these medications or interventions were pretty much, you know, white people. So that is an improvement. So it's not all bad, but the disconnection comes from the fact that we don't talk to people to say, what would you like to see?

And we don't do that because we're looking at the evidence and saying, I don't need to ask you because I've already read this lit review about it. So, you know, I'm just going to rely on that. And that is kind of being, you know, really linked up and chained to evidence as opposed to experience. And those are pretty significantly different things. And potentially at least.

It's a new album coming out, I'm just trying to take notes, I've been taking notes on this.

And how do you do it in?

So that's an excellent question. So, in my opinion, I'm going to lean a little bit on the evidence that I've read versus what feels like something that's fairly intuitive to me at least. So I think with all this type of work, anything that's related to persuasions, persuading people. It usually falls along one or two lines. So one line is going to be, I'm going to make an ethical argument for you, right? So if you take something like diversity trainings, which is something we do, we say, you know, you should take this training on anti-racism. Because it's the right thing to do and makes you a good person.

So that's one argument, and what we know from Covid is that that does not resonate with a large number of people and, more importantly, within that. It's also kind of irrespective of race, ethnicity, class, et cetera, et cetera. Which is to say, when people hear that they don't feel like this is really a moral thing. It's not ethical for me to take this vaccine. There's something more to it.

So that's one path, the other path is a more practical one. Where we say, you should take this because it's going to offer these particular types of benefits, right? And on one level, you're kind of making the same case, but you're also extracting out that moralistic argument, right? And what we saw during Covid was really not in my mind. I mean, it was definitely resistance to vaccines and public health. But it's also resistance to people telling you what to do right. And people making it seem like you were bad if you didn't do that particular thing.

And for those of us who are pro-vaccine, we'd say, well, actually, yeah, maybe it does make you a bad person to not want to do this. But that is a very heavy-handed message. And that was the one that initially kind of came out right. And we did spend a little bit of time talking about collectivism, but we're not a collectivist culture, right? We have collectivist cultures in the United States, but by and large, we aren't that. So you're delivering a message when you are making that more humanist message about collectivism, but that's not us.

We're not really a community-driven type of country. We have our ethnic enclaves in places like Detroit and elsewhere, right? But by and large, that's not what we are. So the message was just inherently wrong, right from the get-go. Now does that mean? If we had gone with one of these more practical approaches of saying, if you do this, it's going to contribute to better health for you? Et cetera, et cetera? Maybe that would have worked a little bit better.

But in general, we went in too heavy-handed and that really just turned off a lot of people. So I think when we're in these spaces, it's worthwhile for us to think about those two avenues, right? Either. I'm going to give you that heavy-handed response for the ethics of it, and sometimes that does work, or I'm going to give you the more practical side. And then the other part of it. So folks don't end up tearing their hair out over Thanksgiving dinner is saying, well, some people, they're just not going to get there, right? If you are just adamantly opposed to this idea that you should have to do anything related to public health.

That kind of comes from this policy type, of this overarching policy type of idea. There's not going to be any number of things that you can say that convert a person. So I think for everybody, sanity is worthwhile to think about that. Probably relatively small fraction of people who aren't going to be moved at all. The other thing that I will say is people when you talk about authenticity and authority, that comes from lived experience. So again, as a clinician, or even as a researcher, when you are across from that patient or the research participant on some level. They want to know, Have you gone through this, too, right? If you're telling me that I should be taking this diabetes medication, have you taken it before?

Do you have diabetes? Does anybody in your family have it right? And we're not going to go out and try to get diabetes right as practitioners. But it's a legitimate point, right? We expect people who are told to do certain things that led to that experience, and when that doesn't happen, there's this huge disassociation. So when people during Covid were observing their politicians going out unmasked, not social distancing, that contributed more and more to that disassociation, right?

And we're all just people, right? We're all kind of slipping and sometimes cutting corners when it comes to these regulations. But those things add up, and if you're not living what you're saying you're living, then that's going to be very problematic. And rightfully so. Well, on that note, we really.

Our guest today was Professor Jarell Ezell. He is an assistant professor in community health sciences, and he also serves as the director of the forthcoming Berkley Center for Cultural Humility. Jarell, we really, really appreciate you joining us. Thank you, thank you.

Predictably, the right is labeling the move as a nanny state. Trying to tell you what you can and can't eat. But let's cut right to it. I'm not clamoring to eat propylparaben, are you? This is about protecting folks from harmful chemicals they don't even know they're eating. And forcing corporations to spend their own money to find healthier alternatives. The truth is, they've already found those alternatives.

These four have already been banned in Europe, and food manufacturers have just had to adjust, albeit their costs are slightly more expensive. Here's the thing, though, they just don't want to spend the money to make sure our food is as healthy, and now they'll have to. Meanwhile, in more local leadership for health, state governments are exploring ways to reduce prescription drug prices for their residents.

Taking a page out of the federal government's playbook, many of them are exploring, negotiating prescription drug prices on behalf of their residents. Remember, right now, aside from 10 prescription drugs that the federal government will start negotiating for Medicare beneficiaries, the federal government is legally prohibited from bargaining on federal taxpayers behalf. Don't forget, almost every single one of these drugs is one that the very same taxpayers already paid to discover through grants to scientists. But state governments don't face the same prohibition, and they still negotiate for large numbers of people. So states are stepping into the gap, working out ways to address the ballooning costs of prescription drugs.

Eight states, including Maryland, Colorado and Minnesota, have created price review boards. That can limit the costs that either local government entities or, in some cases, individual residents themselves have to pay for their medications across the state. And that could be a big deal for residents. Finally, a cycle of murderous violence erupted after Hamas attacked southern Israel by land, air and sea on Saturday morning. The carnage was immense, as thousands of rockets were fired into civilian sites and civilians were brutally murdered and taken hostage by militiamen. We taped last week's show on Friday.

I haven't had the chance to say this here yet. As a physician and public health leader, I condemn Hamas's brutal attacks on civilians, and that's because civilian lives should always be off limits, because I condemn attacks on all civilian lives. And since the attacks last Saturday, the Israeli military has responded by cutting off food, water, internet, gas and electricity to Gaza. And bombarding what has been called by observers, the world's largest open-air prison, with missiles hitting targets, including hospitals, mosques and apartment blocks, as of Sunday morning, more than 2,400 Palestinians have been killed, including 800 children.

That also includes 27 American citizens. This is being justified in too many minds as Israel's response to the attack by Hamas, a known terrorist organization. But since when was collectively punishing millions of people justifiable? since when was bombing hospitals and houses of worship justifiable? What about the 800 children who died?

Surely they weren't Hamas terrorists? were they? They can't be responsible for the attack on Saturday. They were born in an open-air prison that has been blockaded economically for decades by the very government that now killed them. We can both condemn the murder of innocent civilians in Israel and in the same breath, condemn the murder of innocent civilians in Gaza. In fact, any real belief in the equality of all human life demands it.

The innocent Israeli civilian's murder does not trump the humanity of the innocent Palestinian's murder. We talk a lot about health equity on the show, and at the very basis of health equity. The most profound goal is that we value all life equally, and that's just it. It feels right now like there's a double standard. We're appropriately mourning the lost lives of innocent civilians in Israel, condemning the people who took them while using statistics to sand down the humanity of Palestinians. Numbers to be ignored as the collateral damage of a response.

They are human, they have dreams and hopes, aspirations and fears. As did the 1,200 civilians who were killed by Hamas. And today, I'm just asking that we venerate their humanity equally.

America dissected is a product of crooked media. Our producer is Austin Fisher. our associate producers are Tara Terpstra and Emma Lickfrank. Vasilis Vitopoulos mixes and masters the show. Production support from Ari Schwartz.

Our theme song is by Takas Azawa and Alex Uguiera. our executive producers are Leo Duran, Sarah Geismar, Michael Martinez and me. Dr. Abdul El-Sayed, your host. thanks for listening.

This show is for general information and entertainment purposes only. It's not intended to provide specific healthcare or medical advice and should not be construed as providing healthcare or medical advice. Please consult your physician with any questions related to your own health. The views expressed in this podcast reflect those of the host and his guests, and do not necessarily represent the view and opinion of Wayne County, Michigan, or its Department of Health, Human and Veteran Services.