The Kids Are NOT Alright with Dr. Anthony Iton and Leslie Campos

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I'm your host, Dr. Alex Salazar. I'll say it.

Alone, secluded, and with nothing but a screen to connect you to the outside world. If this defines your pandemic experience, you're not alone. The pandemic tore millions of people away from the things they know and love.

Forced us to quote socially, distance from the very thing that's probably most important for our mental health, other people. For me, I was lucky we sheltered in place with family.

Moving in with my in-laws, who helped care for our then two-year-old, while we struggled to work from home. At one point, we had eight people in the home. Don't get me wrong, I missed all my friends and family whom the pandemic kept from me, but I wasn't nearly as isolated as folks stuck in an apartment alone.

The impact of the pandemic was particularly bad for folks in the most social period of their lives. In their youth. So much of the experience of being young is dictated by our interactions with other people. And the pandemic hit just as the spring of 2020 came in.

The social landmarks that define the average American young person's experience prom, graduation, summer vacation. But while it's on Vogue to blame the pandemic for the rise in teen mental illness, it's been happening for a lot longer than that.

Between 2008 and 2017, the percentage of teens experiencing depression jumped 63. Rates of teen suicide nearly doubled in the two decades between 1999 and 2019. Here, I want to pause and remind everyone that if you or someone you love is struggling, make sure to get help again. That's 988, please.

So it's not just the pandemic. These trends preceded the pandemic by at least a decade. So what's up? Well, it has a lot to do with an announcement from the surgeon general that we talked about last week.

But like most of my friends, I had a flip phone the iPhone wouldn't come out until I graduated college in 2007. Laptops were a luxury, so while the Facebook was a nice distraction from getting work done when you were at a computer, it wasn't. At the palm of our hands and the top of our minds. Fast forward a decade to 2013..

Social media isn't relegated to the Facebook anymore, which, by the way, now has 1.

23 billion users, but a plethora of new sites, all competing for our eyeballs and eardrums. More than half of American adults have a smartphone, putting wireless internet and social media in their pockets, making that competition so much more vicious. Already, social mores are shifting around this new normal, more of the interactions we would have had in person are shifting online.

And that was 2013, a decade ago. And that's also the point at which experts track a disturbing trend rates of teen mental illness start to climb. There are lots of reasons for this. FOMO is a big one.

Fear of missing out? In case you don't know what FOMO stands for, think about it. Social media feeds are basically a highlight reel of other people's lives. By comparison, they make our mundane lives feel well mundane with a perfect latte.

Art is so much better than the boring cup. I just drank. Why wasn't I invited to that lit party? On Saturday? I netflixed again.

And because it's designed to be addictive, we lose our sense of boundaries. Teens are sleeping less because they're scrolling more, and it's not just the time spent scrolling. It's all that blue light that keeps us awake, too, tricking our brains into thinking we should be awake.

And then there's the fact that those corporations who intermediate so much of our lives on the internet understand that. The single most important thing they can do to keep us scrolling is to scare us or piss us off. So they've devised algorithms that show us the worst of each other, to keep us enraged or afraid, which, of course, leaves us enraged and afraid. And rather than reassure ourselves that the world is not, in fact, an evil, scary place. By spending time with the people we love. Social media displaces in real life interactions with the online versions of one another, sending us through the doom spiral one more time.

We watch TikTok for folks right around my age or older. We spent the most formative years of our lives outside the bounds of social media. We built the social muscles to live offline, even if they've deeply atrophied through so much time online. So it's easy for some of us to think of social media as a choice. But for younger folks who've grown up in the era of social media, ubiquity defines their social environment.

It's so built into the social infrastructure of their lives that opting out becomes nearly impossible. It means simply walking away from the platforms that intermediate so much of how they even live and interact. Which is why the Surgeon General's advisory last week is so critical. It recognizes the crisis of teen mental illness for what it is, and one of the most important circumstances that's driving it. Late last year, the California Endowment did a benchmark poll of young people to understand the crisis from their perspective.

The findings were staggering More than three quarters 75 of the young people surveyed reported anxiety. more than half reported depression. A third one in three of them reported suicidal thinking. Those numbers would have been unfathomable a few decades ago.

But frankly, they're unsurprising today. I wanted to understand a bit more about what's driving them, so I reached out to Dr. Tony Aitken, senior vice president at the California Endowment. And true to form, he suggested that it wouldn't be enough to get his perspective.

We needed to hear from the young folks at the heart of the crisis, he suggested. I speak to Lesley Campos, a youth organizer and entrepreneur, about the work they're doing together to address the crisis, too. Here's my admittedly lovely conversation Lesley Campos and Dr. Tony Aitken. Okay, can you introduce yourself to the tape?

I got my first grant through the Biztube and it was a beautiful opportunity. And I was able to start my own project, which I'm also the founder and executive director of. Soyhood and Soyhood is a social enterprise and streetwear brand that focuses on uplifting black and brown youth through creativity. I also work with the teenage population during the day and work with housing. So I work in the L.A. area and do work around problem solving and prevention and evictions with youth in the community.

In your colleagues.

It's easily shut down, right? So how do we start shifting the conversations? And I think now, like, just looking back in our community and just working with our youth now, like, how do we provide safe spaces, right? So I think a lot about that, like the stigmatization around mental health.

And I think about how our resources, right lack of resources within communities of color, I see us working in housing.

Lack of resources within housing programs and how housing is tied to a lot of mental health as well, right? And being in the frontline, I see a lot of that being tied into stability and how stability also impacts our mental health as individuals. And I've seen the process of how our youth who come from the streets and survival mode, right? How? When they get housed, or like, they get their basic needs met, it does help a lot and shift a lot of the mental health, right? And just seeing that, like, I see a lot of like housing, just like basic rights and creating more cultural spaces for youth specifically as well.

That's very important, I think. Oftentimes, like when we look at therapy or solutions for youth, we also have to provide cultural background right, also appropriate therapy right. So making sure our youth, black and brown youth, are connected to the right resources that are culturally appropriate for them.

It was really quite astounding. And we had to recognize the fact that in our society, we create stress incubators. Places where young people are basically bereft of all of the resources that they need to be able to manage their healthy development. The infrastructure for youth development has been absolutely obliterated. The boys and girls clubs, the police activities leagues, the pop Warner football, Little League baseball, all of that stuff literally doesn't exist in many parts of the State of California and other parts of the country. And nevermind access to things like summer camps or music programs and the like, people can't afford that.

So what we were seeing was that young people, they would tell us from 2.

15 in the afternoon for the rest of the day. They had literally nothing to do. And when that's the case, they found essentially the youth development was happening in gangs and other kind of organized activities that the youth themselves would pull together. So we felt like we had neglected this. A generation of young people, particularly low income young people in our rural part of the state. In the Central Valley and in the Inland Empire, but also in Oakland and L.A. and San Francisco. And our feeling was that this was already in crisis before the pandemic.

Then the pandemic hit, and that coupled with young people being pulled out of schools, being on Zoom for their education. The social media bullying that was happening and continues to happen. All of this just basically synergistically and cumulatively, created enormous stress in the lives of these young people.

So we started talking about suicidality and talking about, in some cases, acted out in violent ways, so you couldn't confront this problem from just one angle. You saw it being impacted by so many different things that were happening in society. And it wasn't just a youth here or youth there. It was the bulk of young. People were telling us day in, day out, about the trauma that they were having to navigate in their daily lives.

And we just couldn't look away anymore.

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And you all did a landmark poll to understand what the impacts really are. And I'm gonna dig into the stressors a bit, in particular with you, Leslie. But what were the broad take-home top lines for you? You know, when you put that poll in the field, what did you expect to find, and then what did you actually find?

And so we decided we were gonna have a summit in California. And so we had the U.S. Surgeon general, we had the California Surgeon General and a number of officials from the state. And then we brought in young people and we wanted the young people from across the state to just inform the surgeon general about what their day-to-day realities are like and the solutions that they had seen work well, and we can talk about that a little bit later.

And so we had a two-day session and it was shocking the level of distress that the young people were describing, and particularly when I say distress, I'm talking about levels of suicidality. And folks that were acting out in ways that you or I would act out. If we were under that amount of stress, they didn't have the resources to cope with it, and they were just facing stressor after stressor after stressor. Including being on the verge of homelessness or being actively homeless and lacking basic resources like food.

So we decided to do the poll to just get some numbers around these issues. And so that's what you saw. And Leslie can talk about that as well.

We're providing a survey to our community of our care network, which is also California Youth Rising, and that's a small care home. Project of the Vistoop. Where any youth ages like 18 30. Because then we expand what youth really means, if you think about that idea that 18 is like into adulthood, but that's not the reality of life. I feel like youth is expansive and I love that the Vistoop has been able to expand what youth looks like.

But with that, we've been able to really do surveys for youth in our community to do these surveys, which we created. That really centered the voice of youth in the community and what they want and what they looks like. So programs that take ideas and take all these numbers and all these ideas and try to create right what the solution looks like for. Just like in the future. And a lot of what I found, yeah, like, I think what Anthony was saying, like loneliness, like, I think with capitalism, like. We've really shifted away from community and like, I think now with the pandemic and just like with us dealing with all mental health. And I think with the age demographic, we've seen a lot, like, at least in my experience, 18 to 24, 18 to 25. We see a lot of heightenings of mental health symptoms coming up. That's like the prime age, where we see a lot, because that's when we're going into adulthood.

That's when we're dealing with, like, daily life, we're supposed to have housing, all of this, right? So there's a lot of pressure coming. But yes, a lot of that, we've seen a lot of that in the studies.

My own like, Yeah, like, being in this field, I think there's like a lot of at individual level. Like, we have to really do a lot of inner work too as well. To come from a trauma-informed perspective when it comes to youth and dealing with folks with high mental needs. Instead of criminalizing them and being like, Oh, like, when things pop off, how can we come as a community, right? How can we shift that narrative? But yes, that's a little bit of a kind of what I'm saying.

But I came up in a time where I feel like I share a lot more life experience with younger folks than with older folks. Especially considering how much has changed in the course of our shared lifetime.

And the way that we manifest and intermediate social experience through it, problematically. And we'll talk a little bit more about that. But I think about my generation, and you know, we had the 90s and the 90s were pretty glorious. Not gonna lie, right? So you talked about stability earlier and the stability that came in that, right?

I turned 13, sorry, 16, in the year 2000.

And most of my youth had been behind me, and that's when things started to get pretty rocky, right? I remember 9-11 like it was yesterday. And you know, I'm a Middle Eastern young man, so that really created a social milieu that changed my experience.

And then I graduated college into the Great Recession.

I raised my first toddler in the midst of the pandemic and all that was pretty bad. But then I think about the fact that I was 22, right?

You were born into the post 9-11 era. For most of your life, our country's been at war in two different places. The great recession was when you were a kid, and the number of people who lost homes and the instability that came with that. In childhood, watched their parents lose jobs is pretty immense. And then you think about, you're trying to, you know, get your first job out of high school or go to college? In the midst of the worst pandemic in a hundred years, that's some kind of instability, right?

Your perspective on the role that our national experience has played in shaping the experience of young people? Because before this, the going, I hate to say, joke was like, you know, if somebody grew up in the depression, it scarred them, it changed the way they thought about things, right? And I think for a lot of this generation, we're gonna be like, Oh no, they came up in the recession or they came up in the pandemic. And you know, when your great grandchildren are like, you know, why do they do that?

They'd be like, Oh, it's the pandemic kid. I'd love to hear a little bit about that instability and the ways that that shapes the experience of, you know, trauma and challenge that people in your generation face.

More conversations. I've noticed a lot, and at least in the youth that I work with, the youth directly in my life. Like, I think, me coming from being a social worker, me being in the front lines, me being trained to come from a trauma-informed lens. Like I've seen a lot of our generation start having these conversations around mental health, start having these conversations in our families. I, from my own experience, have started these conversations and creating a space where our youth.

To talk about depression, to talk about the realities of life and how we experience this in our everyday life. And, you know, oftentimes, like, our parents could be a little harsh when it comes to, like, dealing with depression, you know, I think something I've seen a lot. And it's like our youth coming together and like creating spaces for us to have dialogues, right? And it's important to have, like, also like programs that are youth-led and youth-focused. But going, yeah, going back to your question, there's been a lot more conversations around what healing looks like.

And I think that's what's really different now with our youth. Now is they're understanding the tools and finally realizing that they have the power to heal themselves and connect. And take therapy. And really, like, even like when you think about therapy, I know growing up for me, like therapy was something. Was like, not accepted, or like, it's always, at least in, like, a lot of Latino cultures.

But it's like, no, it's what is needed, it's like we need to tap into ourselves. And I think there's a lot of push with this generation trying to focus on healing, and I think that that's a lot what has changed. And also, like, social media has had a great impact on that as well.

We sort of the chasm between us is, from a generational standpoint, like all the things that have changed. My sister is so much more versed in the language of mental health and the conversations about mental health. And I think you're right that social media played a really big part of that, the other part of it, and I wanna get both your perspectives on this. The other part of it is that I feel like social media has also, in so many ways, gobbled up a lot of the means of healing, right?

It creates this place where you can have a conversation about mental health. But the things that really sustain us tend to be in-person nurturing relationships, right? And I feel like the corporations that manage social media, they've realized that their real competition wasn't just each other, their real competition was all the time. You spend actually looking somebody in the face and talking to them. And so they made more and more of your or our social interactions.

Mediated by their companies so that they could sell us stuff via ads, right? And so we're having a conversation, but we're not doing the thing on the other end of the conversation that has to fix it. And I think about this because I was a freshman in college when the Facebook came out, right when it first started, it was a Mark Zuckerberg production.

We were like, This is amazing, what a better way to connect with our friends, and then soon enough, right? We weren't connecting with our friends. But it wasn't the same conversation that we'd had.

And so it's odd. I kind of lived through that transition and watched my younger siblings work through it, and so it's had both upside and downside. So I'll pose this question to you, Tony, and then I wanna get your perspective on it too, Leslie.

Thinking about your youth, Tony, and the nurturing relationships that you had, and then reflecting on the ways that this generation interacts. What are the qualitative differences that you see, and how do you see them playing out in terms of the way that you might manage the bumps and bruises of life?

Well, let me just start by saying that. Part of the reason that I have no doubt that this is a serious issue was looking at the polling data.

75 of young people felt that this, that mental health, was a serious issue in their lives, and a majority of them felt like they didn't belong. And belonging is something that when I was a young person, I felt. Despite being a Black kid, growing up in a largely white environment, there were institutions that essentially helped us develop.

Our interests? There were places to play sports, there were places where you could gain leadership. This was all part of the milieu that I grew up with. And what was critical in those institutional settings were that they created a platform for deep relationships, both with people that were your age, but also with adults.

And this is one of the things that we measure in youth development.

With adults who are not your parents and opportunities to exercise leadership. And somebody who believes in your future, believes that you have a gift or a talent, or a skill that can be developed and contribute to the wellbeing of society. And so I think in my generation, and I grew up in the 70s and 80s, that stuff was just more readily available when we spent time in the Central Valley doing the work that we're doing now. And, as I mentioned, young people would tell us that after 2015, they had nowhere to go.

Gone was all that infrastructure, we just couldn't find it and it was so bad. In fact, in a place called Merced in California, Central Valley, young people were saying, You know, in the middle of the summer, the temperature gets up to 106 degrees.

The city of Merced had closed the public pools because they felt they couldn't invest the resources in lifeguards for the pools. So they shut the pools down in 106 degree temperature. And this is the difference between when I grew up, where you had infrastructure. You had opportunities as a young person to forge those kinds of meaningful relationships with others, and that helped you develop a sense of belonging.

People knew your story, you knew other people's story, you were seen, you had a voice. This is a fundamental human need, and we have essentially stripped the infrastructure for that kind of youth development from our society and replaced it with a cell phone. Where there's an enormous amount of diminution of people's self-esteem in that setting. Through bullying, through judging themselves against the lives of others who are portraying their wealth and their existences. And so I fundamentally recognize that we have a deep problem in this society. We have to rebuild, you know, starting from the ground up, a sense of meaningful belonging for young people in this society.

The majority of these young people are recognizing fundamental issues with their mental health, and we cannot sustain this kind of status. It will erupt in ways that we can't even predict.

I was like, I can't believe they're friends with a machine anyway. Tell me a little bit about what it's like to have come up in a time when the internet is so ubiquitous that you don't remember a time without it. And you know, as you think about your reflection on Antony's generation or on mine, how does that show up? In the way that you all think about, the relationships that you share, the interactions that you engage in? I want to talk a little bit about BizTube because it seems like, you know, and I see this in your generation, really pushing back against it. But tell me about a little bit about kind of your reflection from the younger generation looking older.

Yeah, I just want to emphasize what Antony was saying. Yeah, I think it's very important to provide spaces for community and building community. I feel like now, with our generation, a lot of youth do get stuck to their cell phone. Or get so obsessed with being liked and being part of the social media community. And, you know, especially growing up in L.A. Now we see a lot of influencer life and all that, right?

So I think it's very important to also create spaces. I think for myself, right? I reflect on a lot in the work that I do. How can I create a space where our youth understand their individuality and the importance of their uniqueness? Which is how I started Soyhood, which is? We focus a lot on storytelling and the importance of our individual experiences, and how these experiences can create mass movements. How with each conversation, each dialogue that we have, we are planting the seeds for our youth.

Not social media, where we want to be able to provide our youth creative opportunities, right? So, yes, I think, just reflecting, yeah, it's been, it's kind of so. I kind of grew up in the age of where, like, yeah, I was. I remember Myspace coming up, everything coming up, all that that's like, and it just being TikTok, everybody. Just that culture is like. We have to learn to also practice keeping our community alive, too, outside of social media. So that's been my reflection in the past year.

Is how do we do work outside? Just social media? But also creating spaces where our youth are able to have community, where they're able to show up. And authentically. And just again tapping into their inner selves.

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I remember talking to a friend of my younger brother.

And we had met. And he was like, Yo, you're like a real-life version of your Twitter. And for a minute, I was like, Nah, man, my Twitter is a Twitter version of me in real life. And it was one of those things where I was like, Oh, wow. There are a lot of people who know me as a character on social media, it's almost like we're all performing our own avatar.

Then I had another interaction with a friend and he was like, Oh, you know.

On Insta or whatever. And it makes me feel like I'm not out there fighting the good fight. And I was like, the good fight doesn't happen on my Instagram. If that's where you think the good fight is, we're missing this. So I've tried to be a lot more conscious about what I put out there and the ways that it shapes, the ways other people think about themselves. Because FOMO is real, and rarely does anybody be like, Hey, I woke up this morning and my back kind of hurts.

And then I went to work and it was rainy and I got to work and I got yelled at by my boss. And then I sat there for a while, trying to work with it to get my computer going. And then I read some emails and answered some emails. And then I went home, hung out with my cat and watched Netflix, which wasn't that great.

And I went to bed because that's most of our days, right? And nobody ever posts that. It's like, Oh, look at my perfect coffee, look at my amazing trip that I took, right. And then you're sitting there, you know, and answering emails, being like, why am I on an awesome trip?

Why is my coffee not perfect? And, you know, and it shapes the way that people interact with the world. And I got to imagine that if more and more of your life is intermediated that way, the ways that it makes you feel both absorbed by that comparison and disconnected from those people. Experiencing those things has to be like, devastating.

You are actively taking this on, both of you are solving this problem in different ways. Leslie, I want to start with you. Tell us a little bit about Soy Hood and Bizstoop and the kinds of venues. The space that they give you to be able to create that meaning and that connectiveness, and that community.

That is so important and so many folks are missing.

And they'll fund your idea and then you'll be like, there's a lot of really dope opportunities here. So I went ahead and basically applied for this and pitched soy hood, and that was the first time I ever.

I just was like, Okay, I'm gonna think of an idea, what am I gonna think of?

How can I intersect me being first gen Latina, growing up in L.A. single mother, being a kid, an immigrant, being Oaxacan, right? And how do I build in all my community and the youth that I work with? So that's how Soy Hood came to be. I pitched it and then I got funded and that was the first grant I ever received.

And honestly, to this day, that is a life-changing moment that happened in my life. Because once I finished, I went through the process. It was like eight to 10 months process. Where I learned a lot about writing a grant, I learned a lot about creating my first report. I've never done this.

I've never had spaces to be able to learn about financial literacy and just having desiree and the whole network of this dupe. I've been able to really network with folks. After I finished my first grant and we did the eight to 10 month cycle, we had our first retreat.

And in that retreat, I just remember meeting folks.

Online. But getting to meet them in person, it was just amazing. It was life-changing and getting to meet other like-minded people who are doing work, community work, organizing with youth and just providing space. It was beautiful to see in person and just continuing to build relationships.

Where I've been continuing to build relationships, and with the Bestube specifically, I've been able to be part. I actually, in the past couple of months. I got accepted to the Young Funders Committee, which is a committee built by the youth for the youth, where we review grants, which was the first grant I received. So now I'm on a chair and we make the decisions. And it is an amazing opportunity because I've never thought I would be in a position to do that.

Also, being part of the Youth Mental Wellness Group, where we're doing research on how to create spaces for ancestral healing, how to center youth voices. These are things I never thought I would be doing, and now that I am, I love what I do and I think just learning a lot. Everything, even from when we had our youth, mental wellness, everything we do. We had weekly meetings and we would talk about topics, right? And I will take that back to my personal life.

And how can I implement that in the community of youth that I work with, right? So it's always constantly learning and providing space for us to be one safe. Coming from a trauma-informed perspective, I think it's very important and just learning what it is right and having conversations about healing.

And it's a revolution to have these people in our lives. And yeah, I'm very thankful about the work that I'm doing with Biztube and with Soyhood. I've been able to in the past year because Biztube was my seed. And it was the foundation of where I started I am now. I had started as a project, but now I what a year and a half now. I am a streetwear brand, I've been tapping into other communities in L.A. where I got funding.

I'm gonna work in our first merch. And that one is dedicated to youth growing up in L.A. And each individual who I had modeled are youth who I've impacted through my work and sharing their stories and the impact that they've had. And just, you know, and just uplifting youth. So, yeah, it's been that was the seed. But now, just watching it evolve and staying active in the community and making resources accessible to black and brown youth has been rewarding.

And you can see, we talk a lot about the broader quote upstream determinants of health.

And what you're describing isn't.

Traditional treatment for mental health, but what it is is it's addressing the things that are lacking in society that allow mental illness to take hold. Right? And it's exactly that self-actualization in community that I that is, that you're describing just so beautifully and that work is amazing. And you know anyone who's interested in Soyhood streetwear, where can they go to find it?

Soyhood. And then the website is going live in a couple of weeks as well.

The, you know, the work that we're doing is trying to essentially raise the profile of this kind of innovative work that organizations like Leslie's are doing. You know, California has taken this very seriously. The governor has proposed $4.7 billion for a children and youth behavioral health initiative in California. And, you know, what we're trying to do is help guide the implementation of that initiative. And you spoke to it earlier. The traditional mental health approach is, you know, somebody in a white coat, you know, sitting in a, you know, in an office, you know, in a 30 or 60 minute kind of you know session. Where they, you know, presumably dispense some wisdom or insight and help people manage their mental illness through therapy.

Knocking that, that's absolutely important and necessary, but it's a model that doesn't really fit as well for young people. And what we've discovered from listening to young people and looking at innovative models across the state is that the peer-to-peer models seem to be more effective for young people. They really do benefit from having somebody who's similarly situated culturally, you know, understands them, maybe even identifies with the same culture or ethnicity. Has been through the same kind of experiences that young people are going through, understands social media, understands our education system, understands the economics of being a young people in this day and age. And so we're trying to showcase those kinds of models across the state. So that a significant amount of this investment that the state of California is making to building out infrastructure for peer-to-peer mental health work in California. In schools, in communities and even in clinical settings.

So this is a very, very fundamental aspect of this work. De-medicalizing behavioral health care is absolutely critical. De-stigmatizing behavioral health care in general is huge, particularly for communities of color and non-English speaking communities. And working to bring the care at the right place at the right time. And so if kids spend a lot of time in school and they spend a lot of time in community. And these are the settings in which they need these kinds of resources available to them. When they either are having crisis or having an issue that's flaring for them, they can't wait three weeks to go see some therapist in an office.

They need to be able to deal with these things early, and the evidence suggests more effectively when we have a trained peer in the right setting in which they feel trust in that human connection.

Really, really appreciate you both coming on, sharing your perspectives on such a critical issue and for joining us for today's show.

She's a general internist by training and comes to the role with government experience in several different agencies. She served in multiple roles at the departments of Health and Human Services and Veterans Affairs during the Obama administration, as well as a stint as health secretary in North Carolina. Under a Republican governor. Through the pandemic, government is, well, it's a beast. And the CDC director has to be able to manage both the fast-moving politics at the top and the slow-moving bureaucracies at the bottom at the same time.

That job can prove exceedingly challenging. And that's exactly what vexed outgoing director Dr. Rochelle Walensky as she attempted to navigate the Covid pandemic. That said, Walensky was asked to walk into a nearly impossible circumstance a pandemic raging. Public trust at an all-time low, and I credit anyone willing to serve the public in those kinds of circumstances.

And all of us owe her a debt of gratitude. Mistakes and all. Cohen's role, though, will look a lot different. Her job is to help shepherd the C.D.C. into what it was always supposed to be.

A dynamic organization designed to meet the moment in the midst of a public health crisis, rather than the lumbering pseudo-academic agency it's become. She's got her work cut out for her, but if history's any tell, I think she's up to it in other government news.

It also could have robbed more funding from critical, future-focused things like next-generation vaccines, long Covid research, and efforts to shore up our broken pharmaceutical supply chain. Which, fortunately, it did not go after. But here's the bad part. It takes about $10 billion away from the Public Health and Social Services Emergency Fund, literally taking away from pandemic preparedness. Which you might think we'd want to invest in, given what we just went through. The C.D.C will also face about a $1.5 billion cut. It also cuts about $3 trillion over the next 10 years in domestic discretionary spending.

That includes the budgets of the National Institutes of Health, America's biomedical research engine, the CDC and the FDA. That's not great. It also cuts funding for critical housing and education programs. If you're a regular listener, you've definitely heard me talk about the quote Social determinants of health, those are things like, well, housing and education.

And, make no mistake, while we don't usually count those against national health spending, that's a failure in how we account. These cuts will reverberate through our society in ways that make people sick. Especially folks who've been marginalized by public policy like this throughout our history, low-income Black and brown folks in particular.

A new C.D.C report found that 40 of foodborne illness outbreaks at restaurants begin with sick workers. I want you to think about what that means first. That sign that requires people to wash their hands is there for a reason. But more broadly, this speaks to the way we do labor policy in this country. Remember the social determinants of health.

Well, sick people shouldn't have to go to work, but in this country, where low-wage workers so often lack paid sick leave, they do. And when they have to go to work, handling our food, well, guess what happens? It's another reminder that health is a lot bigger than healthcare. That's it for today.

On your way out, don't forget to rate and review. Guys, look, I tell you this every week, but not all of you rate and review. So please, please do that. It goes a long way. Also, if you'd love the show and want to rep us, I hope to drop by the crooked store for some American dissected merch.

American Dissected is a product of crooked media. Our producer is Austin Fisher, our associate producers are Tara Terpstra and Emma McFrank.

Production support from Ari Schwartz. Our executive producers are Leo Duran, Sarah Geismar, Michael Martinez and me. Dr. Abdul El-sayed, your host. thanks for listening.

The views expressed in this podcast reflect those of the host and his guests. They do not necessarily present the views and opinions of Wayne County, Michigan, or its Department of Health, Human and Veteran Services.