Share Public Health Transcript: We Need to be the Group that Speaks for the Community. An Interview with Brian Castrucci.

Season 1 Episode 16

Laurie Walkner Welcome to Share Public Health, the Midwestern Public Health Training Center’s podcast connecting you to public health topics, issues, and colleagues throughout our country, highlighting that we all share in public health. Thank you for tuning in to these series of interviews with public health leaders as we learn about different perspectives on current and emerging public health issues. Share Public Health will be taking a break the next two weeks. Please tune back in January 7th for a 10-part series on health equity. Today Suzanne Hawley from Wichita State University talks with Brian Castrucci, CEO of the de Beaumont Foundation about the importance of telling compelling stories, building strategic skills, and tearing down silos to help communities achieve optimal health.

Suzanne Hawley Hi, welcome to the public health leadership series. My name is Suzanne Hawley and I’m with the Midwestern Public Health Training Center. Today we have an opportunity to talk about leadership skills and knowledge areas from a personal perspective. So I’m very happy to be with you today. I’m wondering if you can tell me a little bit about yourself.

Brian Castrucci Sure, I’m Brian Castrucci. I am the president and CEO of the de Beaumont Foundation. I am a public health guy. I started in public health departments, and worked a decade in Philadelphia, Texas, and Georgia. Back in 2012, I had this amazing opportunity to help shape a new philanthropy and that is de Beaumont. De Beaumont is really concerned about the people, the policies, and the partnerships that are needed for communities to achieve their optimal health. That’s a real dedication for us as staff. None of us are philanthropists, we all have some public health background to us, which I think makes us unique in the philanthropic space, and I think able to really meet the needs of our constituencies. What is there that you can do if the community is not healthy? You can’t go to church, you can’t go to school, you can’t go to work. We’ve never framed it in that way. Umair Shah down in Harris County has started this hashtag Invisibility Crisis, but is almost wearing it like a badge. It’s like we’re there, we’re the silent warriors.

Suzanne Hawley Which is better.

Brian Castrucci It is, but most people have never been mugged. Most people have never had interactions with the police apart from a speeding ticket. I have a lot of those. Most people have never had a use for the fire department, but for some reason we value those services. You try to cut fire, you try to cut police, then there’s a community reaction. We did a poll and police and fire were some of the most important services you could have in a community. Public health polled with parks and libraries. It’s the same idea, why do we not have that same understanding that “I need the police because inherently even if they’re not serving me today, they are providing a safety service to my community.” We’ve not translated that with public health for some reason.

Suzanne Hawley So what do you think are the actual persuasive communication skills to get people to say “Okay, I’m listening.”

Brian Castrucci Well, let’s even go further back.

Suzanne Hawley Okay.

Brian Castrucci Okay? Let’s go back to childhood.

Suzanne Hawley Alright.

Brian Castrucci So I have a seven and nine-year old, so it wasn’t that long ago that they were three, four, five. What did they read? My dad is a cop, my dad is a firetruck, my dad is a fireman, my mom is a doctor. There were no books about public health. When my daughter got her Melissa and Doug Dress Up Doctor, set I took the stethoscope I gave her a notepad and we did a disease investigation of her dolls. She knows what an epidemiologist is. She knows the difference between a physician in clinical care and an epidemiologist. Even when you finally get introduction to health in high school it’s about cleaning your private bits and going to the doctor. So when have we ever acculturated anybody about community and how the community impacts your health? I mean, starting from a communication standpoint, you’re maybe finding out about the concept in your 20s right? Everyone knows what a fireman is, everyone knows what a police person is, everybody knows what a doctor does, everyone knows what a nurse does. Because we acculturate those roles – teachers is another. These are roles that are acculturated from birth and then you you get to public health. So then everyone that you meet says “I don’t know what public health is” right?

Suzanne Hawley And I don’t want it to be horrible things that have to happen for us to even think about it and then see somebody in the front of a news camera being a communicator, but we don’t know still what public health is doing. It’s just “let me report an update on something, you know, measles or Zika or disasters.”

Brian Castrucci It’s interesting. We were working on this PHRASES project, Public Health Reaching Across Sectors, and we’ve done interviews with folks from housing and education and we’ve not even built a communications toolkit for public health. We keep saying social determinants of health, knowing it is like the worst messaging in the history of the world and not done anything about it. Actually, what we heard back from these sector leaders was that when you say determinants it sounds like I can’t do anything about it, so it turns me off.

Suzanne Hawley Mm-hmm.

Brian Castrucci We need think about pivoting our communication to conditions of prosperity, conditions of economic development, conditions of hope, conditions of worship. So when I’m talking to a priest, I need to say listen, if you want more people to worship and have a full life in their faith, they need housing, they need better education. Now I’ve – without saying public health, without saying social determinants – I’ve given him a reason to join my team, right? This is like basic salesmanship 101, which we don’t teach in schools of public health. So what PHRASES is gonna hopefully do is be that communications toolkit for the chief health strategist so that they get some ideas on how to better talk to other sectors with some real tools. When you think of all that we have to master as public health leaders now, it starts with the housing people, the education field – it’s daunting. Many of our public health leaders were trained as clinical providers, so they don’t even know that literature. This is a way with PHRASES that we can provide some tools to help people communicate better, but we have to tell better stories. Soledad O’Brien has said that in a blog and in an ASTHO talk. Stories change emotions like data never can, right? You need that emotional hook. Ultimately good stories plus good data equals power, and power equals change. We’re missing the story

.

Suzanne Hawley Okay, we need to really find a way to understand what Apple does, what Google does, what Amazon does in terms of persuasive communication and marketing, to get those skills before we actually have the data that’s three years old or whatever it is. To know how to even communicate that when we understand what public health is. There needs to be some entry level ways of really having a more comprehensive discipline, I think.

Brian Castrucci Well, and it’s being comfortable telling stories and engaging in this way. It’s the zoom-in, zoom-out, right? So I can tell you about housing and asthma, but I can also start you with Billy who was in the ER last night, who has mold in his house. Then I gotta zoom out, right, because no one starts zoomed out. The hook is the zoom-in. You get that hook and then you zoom out and say listen, this is how we help Billy. We help Billy with rental inspection policy. PEW did this brilliantly with the Food Safety Act. They found a kid who I believe passed away due to foodborne illness, and that kid was the poster child of a very complex food safety policy. This kid died because of foodborne illness. Foodborne illness doesn’t have to happen. We’ve made that choice. You need this law so that there will be no more of this kid. That’s what we’re not doing a good job. We have public information officers in any number of health departments who won’t engage media. They’re reactive, they’re not proactive. We have to change that kind of perspective because the opportunity to talk to media is a chance for us to tell them something, but it’s that they’re gonna get you with a gotcha question.

Suzanne Hawley I got all kinds of thoughts in my head from what you’re saying. The media thing is . . . here my sister was a tutor in graduate school and she tutored football players at a very big university. They took classes on how to talk to the media. They had all of these things to prepare them for professional life. This doesn’t happen just magically. I think those are some of those things that we need to do.

Brian Castrucci It’s the revamping of public health education. Public health education is all about specialized skills and not about strategic skills. I remember taking a course on cardiovascular disease epi. Why in the name of God did I take that class? Why do they even offer it? It should have been how to present, how to not have death by PowerPoint, how to really construct slides, how to get on message, how to deal in different frames, how to talk to different people, but those are not the skills that we’re being taught. It’s not the skills the faculty have. So how do you add communication skills?

Suzanne Hawley True, True.

Brian Castrucci And I agree with you. I think there are athletes who as part of their training – how do you answer the media? Well there are any number of new health officials who are engaged in the media for the very first time on their very first day, having had no media training. The amount of control you exercise in a clinical setting, when that person then moves to the public health setting, it’s totally different. It’s not an ER doc where I can say go do this, go do that, go do this. It’s more collaborative. This really gets to how we pick our leaders in public health, which I think is really important. I think there are fabulous physicians who are public health leaders. I don’t think it only has to be a physician. I think we’ve made a mistake there. Literally before I walked in here I had tweeted yesterday that one way to achieve health equity is removing the physician requirement for health officials. I said San Antonio has done really well with that. In 2015 they did a charter revision and they took away the physician requirement. Colleen Bridger is there now and she’s killing it. She’s passed policies, she’s improved the health of San Antonio. A preventive medicine doc tweeted back at me “Chapter xxi of the Texas health code says only the health authority can quarantine. Physicians must lead health departments.” I was like wow, so in one hand you’re talking about equity, but now you’re talking about exclusivity because you want to keep the handle in that job. If health is housing and health is planning and health is architecture and health is food, then there are so many people it’s going to actually take to lead a health department. To lead health, it can’t be boiled down to one particular role.

Suzanne Hawley I agree and I think leadership and public health is about being able to tell a good story, tell an important meaningful story. That’s everybody and that really fits in with my definition of leadership. I think leadership is not a position of authority, it’s an action. It’s an action that happens anywhere with anybody. It begins with you. So if you can tell your own story even about your own life and what’s important to you – I don’t know if I could talk to anybody and just say “tell me about who you are.” I have no elevator story for who I am. I have my role or my title and does that sound important enough that you’re gonna keep talking to me. This is about leadership in a sense of it beginning with everybody. To tell a story and – just to go back on your policy examples – I think you’re on to something. I’m like okay, in Kansas, the two bills that I was very familiar with that didn’t pass and it took a couple of years to pass. It was when they were able to bring the person with the issue who could say this happened to my child, this is my real life, with all of the data and it changed the story. It changed what happened in the legislature. So that’s not a coincidence.

Brian Castrucci The story by itself, you’re just some singular person that had a bad experience. We can write that off. If you have the data, again, there’s no emotional bind to that data. They don’t make someone move to action. It’s when you have both. Think about child death review, think about the stories that we tell in child death review. You aggregate enough stories together and then it’s okay, we’ve seen these seven deaths at this intersection, we need to change the traffic light. Something’s wrong here, but getting that traffic light change is gonna be telling the story of the mom who doesn’t have her kid anymore because of a traffic accident at this intersection. Actually, there have been 37 accidents at this intersection. What are you going to do City? Now, that’s the question, but it’s a compelling story. We’re administering our grants, we’re implementing our programs, we’re developing our interventions. When do we have time – and especially when it’s not a priority and no one’s making it a priority – when do we have time to learn and hone these communication skills and tell our story? Academics tend to do it. They’ll try to tell stories, but it’s often very academic and doesn’t really get to those they’re the heartstrings.

Suzanne Hawley The field of public health is changing. You’ve kind of talked about several things that would help in terms of persuasive communication, but I’m wondering what other types of things do we need to do or public health professionals need to do to handle change management? I mean what you’re saying is you got to change your game, so how do you manage this change and then the future of public health?

Brian Castrucci It’s getting those skill sets to people. Change management, systems thinking, it’s so easy to think I’m coming to work on a disease. It’s much harder to think about I’m coming to run an organization.

Suzanne Hawley I’m gonna ask you to break that down just a little bit. How do you define change management and systems thinking?

Brian Castrucci These are broad terms. Fortunately, in our new Public Health Wins survey in 2017 we did break those down. We did the training needs assessment and got to policy development, budget, systems thinking, change management. That was actually the reaction we got from the workforce. What about change management, what about systems thinking? So now, each of those has a breakdown of different competencies within the broader umbrella so that we can be much more specific about what skills we need to develop. We’re continuing to look at those data to try to provide the information that training centers and others can use. Recognizing that there are strategic skills that we need and that’s only a couple years old, this conversation in public health. The huge shift in HRSA’s public health training center . . . we want to you to focus on strategic skills. Now juxtapose that where they were with the last cycle where folks were like “I’m going to be the Preparedness Center, I’m gonna be the MCH center” – still very much our specialized skills. So the fact that HRSA has made this move, we now need to really struggle with what are the set of competencies we need in systems thinking, in change management, and how do we deliver those skills to a workforce who in all likelihood will not have it.

Suzanne Hawley So from a personal storytelling perspective, how would you in your own life, in your own work as a public health leader or professional, dealt with change management?

Brian Castrucci It’s always about knowing where you’re going. If you don’t know where you’re going, you’ll never know when you’re lost. I don’t think we often have the idea of where we want to be in mind when we start projects.

Suzanne Hawley Do we need to know the end or do we just kind of need to know we’re going in the right direction?

Brian Castrucci I still think you need you need direction. The more specific you can be, the better off you’re going to be. I’ve done organizational changes, I’ve done new org charts, I’ve redone whole organizational structures. You have to buy people in with why are you doing this, why are you upsetting the applecart right? If you can give them the idea like listen, this is where we’re going and this is why we’re making the changes. I don’t believe everyone has to agree and I believe through a change process sometimes people have to go, but right now for public health, I would argue that we have to make a major change. One from doing programs and interventions and being health educators to being advocates, to being the community health strategists. What public health has done extraordinarily well is set a goal post. Public Health 3.0 is kind of tantamount to putting out a party invitation and it’s the best DJ, best food, and the best party of the year, but not putting the date, time, or directions on the invitation. You’ve given us this goal but no one knows how to get there. What does that behavior look like? We don’t even have best practices per se to what public health 3.0 looks like. This is the conversation that we’re not having right? So, change management, we maybe know where we’re going – Public Health 3.0 – but what does that mean? Right now, the basic fundamental challenge to Public Health 3.0 is our funding doesn’t support it. It’s not about moving the health of the public forward, it’s about disease-specific siloed funding. That’s our biggest challenge with change management. The money is not aligned with the goal. So how do we do that? What I talked about in today’s plenary is this plague of individualism, which I also think is kind of critical in this conversation because by making everything either medical or criminal you abrogate the need to have community. You got sick, you went to jail, you failed, you failed us, you failed your family, you failed yourself, you failed your community, with no conversation about how the community has failed you. Austin, Texas is a great example. In Austin, Texas, Dell came in, other tech firms came in, housing prices went through the roof. All of a sudden they noticed that all the good teachers were leaving the Austin Independent School District because they couldn’t afford to live in that area. So the developers actually built low-income housing for teachers, professionals who have college degrees. No one ever thought of it, no one took a second to say as we develop this community, with all this building, how does it serve us all? The developers made a pirate’s ransom just building everything. Predator lending, predatory buying, moving people out. And no one said this is not okay. We’ve lost that and this is why I think our health is struggling. This is why life expectancy is going down. It’s because we’re all out for the individual. We’re in a spot in our culture right now that even as hospitals are taking on social needs, you only get your social needs addressed when you cost the health system enough money that it’s advantageous economically for us to deal with those. So your hunger is only important as much as it’s driving my health care costs.

Suzanne Hawley So we have focused siloed funding, we have the focus on the individual. When you think about change, I think about well, we ultimately have to meet people where they’re at. We have to address where they’re at, where they’re business it at. So how do we do that? Because we do need to figure out how is this individualistic focus gonna shift even one note over on the piano key? How is that beneficial to move from . . . well we also have to move from determinants to prosperity . . . this aspirational place you know where we are going as a public health professional and leader.

Brian Castrucci So, we’ve been really fortunate with our City Health Project. The city health is a package of nine policies that are bipartisan, generally budget-neutral and doable. We rated the 40 largest cities in the country as to where they had these 9 policies. Now these policies aren’t typical public health. There’s some of that, there’s Tobacco 21, Clean Indoor Air, there’s also inclusionary zoning, paid sick leave, healthy vending, and complete streets. So, it’s a mix of policies and we’ve had 24 policies change since we launched the project. So people got it.

Suzanne Hawley Can you say more about that in terms of what you mean by policy change?

Brian Castrucci They passed the policy. They didn’t have it, and now they do.

Suzanne Hawley For cleaner streets, for example.

Brian Castrucci Or any one of the 9. So, we rate the 9 policies individually. So, you can get a gold medal in complete streets, but then you’re gonna get maybe a bronze medal overall. We look both across the 9 policies and within the 9 policies. We’ve had 24 individual policies change because we went and said look, this is incumbent upon this community to be healthier, so that you can have better economic opportunities, so you can have economic prosperity, have people engage more fully in their lives, you will recruit businesses better, people will want to live here. These cities are competing against each other all the time for businesses and people. You want to start to create an environment that supports health rather than antagonizes it. So, the city of San Antonio is a great example. They passed Tobacco 21 and paid sick leave. Kansas City, Missouri, working with their Chamber of Commerce have said about trying to get a gold medal in city health. The Chamber of Commerce was able to say look, healthy employees is a good thing, early pre-k is a good idea, and Tobacco 21 is a good idea. It’s the conversation about how do you see yourself in these policy changes. We designed city health not as a health promotion activity, not as a public health program, but as an economic development program, as a community development program. We spoke to leaders in those communities, not just the health commission, but using that health commissioner’s chief strategist, how did we leverage some of the relationships to say okay, why don’t we have this?

Suzanne Hawley So not only are you in the business of health, you’re in a business for health.

Brian Castrucci Oh, absolutely.

Suzanne Hawley Literally a business model to do this. I’m hearing housing, infrastructure, different ordinance, Tobacco 21. What do you think in general . . . are there other partners that we need to engage to really further the dialogue – and I mean an actual dialogue to make progress towards this health community end point.

Brian Castrucci Yeah, it’s the business community. I believe that firmly. I think that most health officials know the top 3 reasons, the top 3 causes of death in their community, but they often don’t know the top 3 employers. If you’re a health commissioner and you don’t have a relationship with those top 3 employers, there’s a problem. When there’s an Ebola outbreak, you need to know that. When you’re trying to get something passed through City Council, you need to know them and you need to help them understand, sit with them, and help them understand how public health and better community health is in their economic best interest. That’s what it comes down to. I mean, it’s simple, what’s in it for me. If I asked you for 20 bucks, you’re gonna say why. It’s a natural reaction, why. Well, if you give me 20 now, I can go over to buy this new video game. I’m gonna sell it for 40 bucks, okay? Then, I’m gonna give you 30 back and I’m gonna take 10. Oh, okay, I get it now. So, I’m gonna make 10 bucks, cool. Here’s your 20. But if I just said cuz I’m cute, because you like me, because I’m trying to do God’s work, like all the public health kind of things that we way, why would I give the money? So if we can figure out a way to work with the business community and have them understand their economic interest in promoting better community health, then we can start to move the needle. It’s the next frontier. There was a time in this country where worked killed you, right? Radium girls, Sinclair’s The Jungle, black lung. There was a real time when that was happening. Then we got the National Institute for Occupational Safety and Health, we got some actual real laws in place that protected workers, and then that evolved as workers took on health care to needing to do employee wellness. Now that most employers have an employee wellness program, whether it’s evidence-based or not is besides the point, they have it. There was a time they didn’t, we worked to get there. So now the next frontier is helping businesses understand their role in community health. They didn’t do employee wellness because they thought it was cool or fun. They did it to control healthcare costs. Now I’m going to tell you can’t control healthcare costs just working with your individual employees.

Suzanne Hawley So I’m thinking I need to really not only know who my top 3 businesses are, but what are the 3 top priorities, vision, mission, of those organizations. I’m not even sure I might know how to do that, but the only reason why I feel like I wouldn’t be overwhelmed by that idea is that if it’s in my community, I can do that actually. The newspaper tells me probably every week a little bit about how I could do that and how we all can do that. These exciting projects you have are looking at communities that have their own story, that have their own priorities. Do we want to do this or not? Do we want to be healthy? Do we want the bronze medal? Now, I’m kind of curious about what your thoughts are related to the aspirations of de Beaumont or public health in general from your perspective of that community change versus federal policy. Is this where we think we have our skill set and then we can kind of build from there to go up or?

Brian Castrucci Federal policy is great but public health is the domain of the states. I’m perplexed at how Mitch McConnell just said we’re going to do National Tobacco 21. I’m not quite sure the mechanism with which he will do that. The only way that we got the alcohol age to increase is we tied it to funding. That’s what the federal government has, they have funding, but ultimately the policy work is going to be done in local communities and in states. What I believe public health is, is changing the community conditions in which people live. So listen, if government’s not regulating business, then business will manipulate you to the nth degree. Our challenge right now, and one of the things that we missed with the transition from acute to chronic disease, is that right now our health and achieving our best health is running counter profits because there are any number of corporate entities whose profits are predicated on us staying fat, addicted, and afraid. The food industry, big food, and how we’re marketing unhealthy things to kids . . . I use it in my talks, there’s a Barbie Pop-Tart.

Suzanne Hawley/strong> Oh, I haven’t seen that.

Brian CastrucciYeah, a Barbie Pop-Tart, I don’t think they’re made from real Barbie’s, but they’re Barbie-endorsed Pop-Tarts, so that’s okay, but Joe Camel was marketing to kids and we want to take that away.

Suzanne Hawley Like, we see other countries actually doing sometimes an incredible job with just addressing things in terms of prevention and things like that. I’m thinking, what can we look at, what can we learn?

Brian Castrucci We can learn that the single most impactful public health intervention is voting. If you go back to 2016 when Trump won and everyone’s kind of reacting to that, down ballot, it was a really good public health election cycle. It really was. There was minimum wage and soda taxes they were passing. I mean, that’s a way that we can combat the money that goes in. Berkeley, California is the greatest example. Coke, Pepsi, and ABA, American Beverage Association, dumped tons of money, but the voters said this is what we want. Then, when we can tie it like they have in Philadelphia to something like early pre-k, because if voting is one of those 2 tactical public health interventions, early pre-k is right behind it. We know the data are clear, the evidence is there that if you can provide early care and learning to children they will have a greater likelihood of success. So again, if I had a cure for cancer but I only gave it to some people, we would see this as a moral atrocity, but I have that. I have the cure to incarceration, I have the cure to poor learning, I have the cure to some of the racial and ethnic inequality – with access to universal pre-k, but we’re not doing it.

Suzanne Hawley So, you’re able to provide a really good story with these examples of how to kind of reframe some of the ways that a lot of us have been thinking about things in our silo in a way that focuses maybe too much on just data and how we can really go more to the root cause. You’ve covered a lot of different areas and it’s exciting to think about. I’m wondering what excites you most about public health? You know, we talk about a lot of things. What do you feel like you’re most hopeful about?

Brian Castrucci So when I think about public health . . . the thing that’s always attracted me to public health is the ability to change community conditions and serve a community, not an individual, but a community, move a community forward. In my practice, getting more and more interested in policy change, the real opportunity that we have to make change and just implement what we know works, being serious about the choices we’ve made. Homelessness is a choice that we’ve made for people. We could build more low-income housing stock, but the developers would lose money and the property values might suffer. We’re in a closed system and someone has to win and someone has to lose. The problem that we have is we’ve decided that the poor are gonna lose right? I love when we talk about the tax stuff with Congress because when you listen to like Ocasio-Cortes, she’s talking about a giant tax on your 10 millionth and $1 and that’s not acceptable? Because what we’ve convinced everybody of is that in our hyper individualized culture that that’s okay. You made that money. You earned that money. That’s your money. None of us got anywhere alone. It really should be called the individualism lie of American right? You got to America and you by yourself can make a million, but you’re never you by yourself, right? I mean, we are organized into communities and we have so deprioritized our community identity. I want to see a community health worker organize a candidates’ forum, bringing people to the polls, talking about the needs of the community, not the individual patient, but the needs of the community, and how we can remedy those, right? But we continue to make every conversation about health devolve into pills and procedures, instead of policies and partnerships. Until we get that fixed – I mean, look at TV at night. Can you watch a show without seeing an ad for a pharmaceutical diabetes? My diabetes – I’m a Type 2 diabetic – and my disease is well-managed. When I got to my provider, I even bring him like “Oh I saw this one, I saw . . .“. He’s like, “why do you . . . you don’t need those“. But the pharmaceutical company told me that I need this to control my disease. You know what I need to control my disease? I need a place to exercise. I need a place to eat healthy. I need time to care, to do some self-care. We’re not building communities to do that.

Suzanne Hawley I don’t know that we expect, you know, that the average person – whatever you want to call that, someone who’s able to be gainfully employed – does expect some things from their employers, but they don’t expect it from their community.

Brian Castrucci Right.

Suzanne Hawley Some, I guess, unique perspectives is why does the business person have all the burden, have all the community burden? They’re trying to make a profit when it might be more . . . you know it could be a business model actually. Now I’m kind of even coming around to thinking about how you might even be able to focus this. The public health professional who really needs to know about the business, who needs to be knowing about politics, who knows what bills are being voted on in your district.

Brian Castrucci If we’re going to be the chief health strategist that’s not just the chief health strategist in our silo, alone in a corner. That’s for the community. That’s for the business community, the education community. It’s saying how do we achieve health across all of our sectors? But it has to be a community-first perspective, and that’s just not where we are. Even to the point where you listen to the – I believe at this point – 87 Democrats that have announced to run for president. Every one of them was talking about Medicare for All, like it’s a solution. Medicare for All has potential to bankrupt the country. If we’re not doing housing and education. All we’re doing is building bigger and bigger buckets. Medicare for All is just a big bucket to take all the downstream issues.

Suzanne Hawley Yeah, yeah.

Brian Castrucci If we’re willing to do Medicare for All and we’re willing to make that payment, why aren’t we willing to pay for better housing? One of the easiest ways to resolve a lot of our health issues is fund education more equitably. My kids are going to go to a great school. We have great, really high property values, so we’re gonna benefit. But because you were born in a neighborhood and a zip code that doesn’t have the same access to education, you’re not gonna have as good of an experience, you don’t have access to the computers. Then we wonder why we have disparities – because we’ve allowed them to happen. We know the solutions. This is not new. We know what works. We’re choosing not to implement the solutions that we have. Someone – de Beaumont, public health – someone needs to be the annoying thing in the corner. I think we need to change and have a public health logo that’s the Lorax, like we need to be the group that speaks for the community. We need to bring community members in and empower their voices in election processes, in regulatory processes. Jerry Maguire is about a sports agent who says we should have fewer clients and better relationships, right? Maybe the health department doesn’t even need to be the health department anymore. Maybe we have a health person at the Transportation Department and a health person at education and we infect everyone that way. Maybe we don’t need 800-person organizations. I don’t know, but we need to be able to do is start asking and questioning our norms and our institutions and how we do things, right? I’m so proud of San Antonio for, in 2015, changing their charter to allow physicians and other people to apply for their health commissioner position. Their health commissioner right now is a PhD. She’s passed policy, she’s tore it up. I mean, that’s progress, but we have to find . . . we have to find our North Star. We have to start moving there. We talk a lot about the North Star. We talk about the framework around the North Star, but we’re not really moving there. I think that’s where – especially young people in public health – need to push our practice to policy and not programs and interventions. Take something like redlining. Redlining should be in the policy hall-of-fame.

Suzanne Hawley Say more.

Brian Castrucci Did it not like do what those folks wanted it to do? Did they not pass a policy that has continued a legacy of segregation far after segregation had ended? I’m not saying it’s a moral policy, I’m not saying I like it, but I’m saying you sure as heck need to put it in the Hall of Fame and say this policy did exactly what these people wanted. It’s shaped society for decades and we’re still paying that price. So, we need to understand that 50 years of racist federal policy is not going to be undone by a program or intervention. 50 years of racist federal policy will only be undone with thoughtful, inclusive, progressive policy. We can kind of dabble around the sides and feel good about what we’re doing. “I did this today in my health department. I talked about this intervention. I gave 17 people group prenatal care“. But ultimately, every bit of their health is shaped by the policy environment in which they live. For a long time that policy environment did not work for people of color and people who were poor. So it’s a simple choice right? What are we hearing recently – that 2 families own the wealth of the bottom 40% of America? These are choices we’ve made and hopefully public health can be the conscience of this society where we are now.

Suzanne Hawley Yeah, it sounds like we have to be really creative and innovative to address some of the things you’re talking about. When you talked about the commissioner not being an MD, then I thought, well, this t-skill that you talk about with cross-cutting skills and then also your area of specialization, we need to promote public health lawyers, public health businessmen. They happen to be in these different sectors, but there are actual positions or they’re how people can get trained with that. Because really, it’s kind of branching out those individuals to be more bicultural within that, to kind of come up through those rather than like you’re saying, just the traditional . . .

Brian Castrucci Yeah, why can’t an urban planner run a health department? Why can’t a housing expert run a health department? Because if you just came out of clinical practice, you don’t have any more skills to run public health than the housing guy or the urban development person. It’s a different skill set. But these are hard, like we need a big room where we can have hard conversations and really start to define what the future of public health is and align the funding appropriately, right? So CDC needs to give money to states to do social determinants and infrastructure development. Half of our public health workforce says they’re out of here by 2025, so what are we doing with that? If that was physicians – imagine if half the physician workforce was going to leave in the next five years. There’d be congressional hearings. Public health? It’s like well, you already lost 58,000 people in 2008, you can lose some more. But the bill’s gonna come due. That’s the truth. Sooner or later this bill will come due and we won’t have people in low-paying jobs who can be there because they’re unhealthy. We won’t have people at work as frequently as they need to be because they’ll be dealing with issues of health. So, it’s all really like a Jenga game and we’re getting dangerously close to pulling the wrong cylinder out of the Jenga game, and then it all falls down. I think we are that precariously perched at this moment in our cultural development. The economic inequalities can’t continue to grow at this pace and there not be a solution. I think public health is at a critical moment where it can start to lead social change. If we believe we’re the social justice warriors – I don’t know – I don’t know that we’re warring that well these days. So, we need to figure out the strategies that actually will get social change and social justice.

Suzanne Hawley Yeah, absolutely. There’s a lot of things you’ve talked about today, I mean, really multiple ways to drill down and some really heavy concepts.

Brian Castrucci We are fortunate in philanthropy because . . . we can always say we can speak truth to power, but they never finished that sentence. You can speak truth to power and lose your job. You can speak truth to power and have your wife leave you. You can speak truth to power and etcetera, etcetera. Philanthropy is very blessed in that we can speak truth to power without consequences, right? The governor can’t really do anything, if Coke gets mad at me, that’s fine. So we, I think, need to lead in a different way and philanthropy needs to ensure that the voice of the broader community is engaged in a thoughtful, useful way to change election politics. Now, I don’t think that means electioneering. I think that means creating spaces where we can have real conversations and not soundbites. We can actually bring a lot of depth to our sound bites. Even something like “you know, your zip code is more than important than your genetic code“. It’s a soundbite. It’s a cliché. Now, unpack that. Let’s really talk about what that means and how do we fix it, because that’s the thing. Genetic code is hard to fix, zip code, not so hard to fix, but God knows we put a ton of money into cracking the darn genetic code, but how much have we done with the zip code? So, it’s a hard road. This is not an easy profession and it’s not an easy time to do it, but I don’t think anyone gets into public health for lucrative, easy jobs.

Suzanne Hawley Absolutely. Have you had any weird experiences in this journey in public health that are funny or just things that are kind of part of your own story? You know, public health is everything, so I’m just wondering if asking you that question strikes anything?

Brian Castrucci Yeah. I mean, I think there are so many great stories, both mine and other people. I always get amused by Jonathan Fielding, who was in Los Angeles County forever and his conversation about attending the Adult Video News Awards because filming of pornography happens in LA. He’s the health commissioner. He was there talking about safe4 sex. I think that’s always the fun of public health. That’s why I got into public health. You never know where it’s going to bring you. I was putting together an advisory panel and tweeted to Soledad O’Brien and said, “Hey, I’m not a stalker, I’m in a health foundation. Could you help us? I think you tell great stories“. I thought okay, she’s never going to write back and in 10 minutes she wrote back and said “I’d love to talk to you“. And now we’re doing a documentary on the homelessness crisis in Seattle and the undoing of the tax that was levied against large businesses there. Soledad and de Beaumont. So you know, any number of times we site around at de Beaumont and just kind of wonder how we got here – I started out as a public health worker in Philadelphia Department of Health and now I’m working with politicians and media people. That’s the beauty of public health, as it is everything, which is its beauty and its challenge. But there’s not a table I can’t sit at as a public health professional because everything ultimately is health.

Suzanne Hawley I love that story because I think okay, here’s the Brian to Soledad kind of bucket list experience and it happened. I’m thinking okay, this is what we’re doing right now. It’s the Suzanne to Brian kind of thought. Like hey, I want to hear what you have to say. It allows just for more discussion and more growing for me. So, I think that’s a great aspirational thought for people who are coming into the field, really. You know, anything’s possible. It may actually be the unique innovation to kind of move the profession forward. We think about who do we need to have at the table.

Brian Castrucci I think it’s just – for people coming into the field – it’s being brave and courageous. PH WINS didn’t exist and we built it. We all sat there after we put out the survey the first time in 2014 and held our breath because there was a nonzero probability that no one would answer the thing.

Suzanne Hawley So, for those of you who are listening and don’t know what PH WINS is, we will provide that information at the end of this talk.

Brian Castrucci Yes. We did a Practical Playbook 1, which was integrating primary care and public health. Practical Playbook 2, which comes out in May, is building multi-sector partnerships that work. So, let me be really clear for folks. My job is the camp director at public health fantasy camp, right. I’m a public health nerd who gets to hang out with Jonathan Fielding, John Auerbach, Karen DeSalvo, Rishi Manchanda, and all of these folks who I grew up-

Suzanne Hawley Well, nerd camp has book clubs.

Brian Castrucci Yes, but all these people have written for the second edition of the playbook, but it is an amazing author list and we do want to share it and let people . . . we’ve done work to keep the price down, we don’t just do these projects for fun. We do these because we’re extraordinarily passionate about it. The whole playbook movement started for us because IOM did what IOM does really well- now the National Academy of Medicine, but back then still the Institute of Medicine – is they say public health and primary care should work together. Thank you and goodnight. And it’s like wait, how? How do we-no, no, no questions, thank you, we’re leaving. IOM sets a goal post, but they don’t really give any of the plays to get there. It was Lloyd Michener from Duke, Denise Koo from CDC, Jim Sprague, our founding CEO, and myself, and we just worked together on how do you convince public health and primary care to work together. No one knew who de Beaumont was at the time. It was a harder road. The second book – again we have amazing authors that are sharing their expertise in how to build multisector partnerships that work, what perspectives do we have to think about, what framings. It’s amazing and I hope it’s a worthwhile read.

Suzanne Hawley So, in our conversation, you’ve brought up way more questions for me than solutions, but now I’m hearing the solution is in reading that second book, at least the first step to the solution.

Brian Castrucci The playbook, PHRASES, these kinds of tools that we create at de Beaumont. We have a very clear model where we ask, then act, and then evaluate. So PH WINS was our ask. We now have a workforce center. We did the national call on the public health workforce that kind of established strategic skills in that vein. Now we’re actually working with the trade regional training centers, with HRSA trying to fill the gaps, because we’ll never have as much money as HRSA, but we’re gonna be more nimble and quicker to market then HRSA could ever be. You need all kinds of ships in the fleet. You need the destroyers and they kind go slow, but you also need the little frigates that can dart in and out and really make some quick impacts. That’s what de Beaumont has become. It’s amazing, 7 years ago we were 3 people in shoddy office space in this creepy building. So do go from there to being a real public health partner and providing tools to help people do the thing that we value most is a real mission-driven experience for us.

Suzanne Hawley Well, thinking about your book. A book club and national groups and departments – if that was something that could be an opportunity to invite people to. You just talked a lot about who you want to partner with and who do we further the dialogue with across all these sectors, but really, how do we even provide a community within our whole public health to develop a way of talking to each other? Even using some of these concepts that are coming from the book, to have a common perspective or a common discussion.

Brian Castrucci I think that we are in a wonderful time of egalitarian media where social media allows people to communicate in ways they never have. I do hope that we get more Twitter chats and more opportunities to share. We’ll do a Twitter chat as part of the American Public Health Association Annual Meeting. We are also, for our book, doing an online symposium where we can introduce some of the book concepts by the authors. We’re not doing it in a fancy room in DC because only so many people can get to the fancy room in DC. We’re doing it as a Facebook livestream kind of deal so that everyone who’s interested in the information can get it. If anything should be easily accessible and egalitarian in this day and age, it should be knowledge – that’s very empowering – and perspective. Because once upon a time, the only people who could have perspective were those who brought their ink by the gallon and their paper by the ton. Now, anyone with a good idea can share that and shape the world. I think that’s a really exciting time to be alive.

Suzanne Hawley Well I hope we can also connect through all of the public health training centers to push some of your roll-out, so then we can challenge and affirm and continue the conversation.

Brian Castrucci Leadership is solely the ability to influence other people to get to a common good. So, if there’s a student who has a question, if there’s a person on Twitter who wants to learn something, if there’s someone who wants to be led and wants to engage with you, there are no celebrities in public health. There are absolutely none. I cannot find one. I don’t care who you are. There are no celebrities in public health. We should all be willing to engage with each other in an open and thoughtful way and have dialogue. I remember those folks who didn’t return my emails when I was a student. I remember those folks who wouldn’t spend time talking to students, talking to staff that’s too low on the totem pole. We don’t need that kind of leadership in public health. We are all people who got together to work on a common good. If our leaders aren’t being inclusive and . . . I mean we have to be strong and we have to fight battles that are really challenging with tobacco, with alcohol, with marijuana now. When it comes to building our profession, we need to be extraordinarily humble and extraordinarily open. I do my best all the time. I know the things that I’ve committed to personally. I don’t turn down a speaking engagement. It drives my wife nuts that I spend sometimes a day traveling for an hour talk, and then another day traveling back, but if you want to hear what we have to say, I’m gonna come. I’m gonna talk to you. I’m gonna engage in a conversation. I’ve been to Eau Claire, Wisconsin, I’ve been to the Wisconsin Dells in February, which was extraordinarily scary, but those are public health people. They deserve the same attention that those living in New York and Chicago do.

Suzanne Hawley And you family still loves you.

Brian Castrucci And my family still loves me.

Suzanne Hawley You can still be a nice person. Listening to you, I think about not only do we need to be more open, but the people you’re not saying no to are people who are Erin Brockovich, those are people . . . when I think about a professor saying “I don’t work with undergrads“, and I think you know what, people are people. Barack Obama was a freaking undergrad. He was a high school student. We don’t know where change is gonna happen and who’s going to lead that and in what sector they’re gonna be in. I’m guessing – have you had an unexpected yes? Like, hey, I really needed to be here and this meant more to me than some headliner.

Brian Castrucci There was a recent opportunity to head a policy conference that had mayors and Congress people or to maintain the commitment I had to go to a rural area and speak. I said, you know, for the brand? The brand is about going to people, not doing the fanciest and glitziest thing. I still went. One of my team did the policy summit. She did great. I went to the other place with the commitment that I had made. I mean, I can’t stress enough. There are no celebrities in public health, right? Like, why can’t I sit down and talk to Tom Frieden or Francis Collins? Why don’t we create those opportunities? Again, from a personal leadership point of view, I never say no to a talk. I always try to respond to people on LinkedIn and Twitter. I always write my own stuff.

Suzanne Hawley Obviously you’re doing everything you can to kind of keep the conversation going. So thank you.

Brian Castrucci It’s why I love Twitter because I can actually engage.

Suzanne Hawley And that’s the best way to get ahold of him.

Brian Castrucci Yeah, but I can engage in a conversation and I love the student engagement. I mean, I’m like an energy succubus. I see all these students are asking questions and it keeps me energized to doing this work. I love that authentic kind of communication. I don’t have to hide behind handlers and I won’t because I’m not a celebrity.

Suzanne Hawley Well, it sounds like you’re creating a lot of gratitude on the part of the people that you’re open to and that it’s certainly energizing you. So, I think having energy – you know, this is a long haul, this whole public health journey that you’re on. So, I just want to thank you Brian for your time here today and talking with you about your ideas. I think the listeners are going to really appreciate that.

Laurie Walkner Thank you for joining us today. We hope you tune in for the next episode of Share Public Health. Special thanks to our guests, and to Katie Brandert, Brandon Grimm, Joy Harris, Roger Hileman, Janine Moody, Mellisa Richland, Hannah Shultz, and Laurie Walkner with the Midwestern Public Health Training Center. Theme music was composed and produced by Dave Hoing and Roger Hileman. Funding for this webinar is provided by the Health Resources and Services Administration. Please see the podcast notes for an evaluation and transcript.

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