Susan Polan, associate executive director for public affairs and advocacy with the American Public Health Association, talks about the decline in trust and the politicization in public health in America and the work health experts are doing to keep communities happy and healthy.
Polan joinsΒ Lynn Schmidt, columnist and editorial board member with the St. Louis Post-Dispatch. The conversation spans the rise in vaccine skepticism, the closure of rural hospitals, suicide prevention, opioid overdoses and combating βdeaths of despair.βΒ
Episode transcript
Note: The following transcript was created by Headliner and may contain misspellings and other inaccuracies as it was generated automatically:
Dr. Susan Polan is an associate executive director with the American Public Health Association
Lynn Schmidt: Hi, my name is Lynn Schmidt, and welcome to the what keeps you up at night? Podcast, the show where we discuss the big issues and worries facing America and the world, and then begin the conversations about how we can go about solving them. I am a columnist and editorial board member with the St. Louis Post Dispatch. I will be interviewing experts and politicians from across the country, from right to left, on the political spectrum as well as spanning the generations. It is my pleasure to welcome today's guest, Dr. Susan Polan. Dr. Polan is an associate executive director for public affairs and advocacy with the American Public Health Association. She oversees the association's departments of government relations and affiliate affairs, communications and membership. Prior to joining the APHA, Polan worked as the Director of Government Relations at the Trust for America's Health, a, public health advocacy organization. Dr. Polan earned her Bachelor of Science degree in psychology from the University of Illinois, Urbana Champaign. She later earned a Master's of science in health psychology from San Diego University and a doctorate in social ecology from the University of California, Irvine. Welcome to the podcast. Dr. Susan Polan.
Susan Polan: Thank you so much. It's my pleasure to be here.
Lynn Schmidt: Thanks.
One of the big issues is how public health is going to survive
Lynn Schmidt: So my first question to you is what keeps you up at night?
Susan Polan: There are a variety of things that keep me up at night. I think that one of the big issues is how public health is going to survive, both because of the attacks that are happening on the field of public health, on the people in public health, as well as the long term issue with funding for public health. We are seeing, opportunities for public health diminish because of concerns and feedback and pushback after COVID. But it was happening for years and years before that, the lack of recognition for what public health and the field of public health does for people and for communities every day. And so, because things are going well, people think we don't need funding to continue things to go well. And that has been an ongoing issue of concern.
Lynn Schmidt: So maybe you could share with our listeners what exactly is public health, or what do public health professionals do in our communities?
Susan Polan: So public health is the idea that you can keep people happy by keeping communities happy and by focusing on the issues that are upstream to illness. The idea for public health is to prevent disease, to keep people well, to keep them out of the doctor's office, away from the hospital. And we do that by focusing on creating healthy communities, by creating streets and communities that are walkable and safe, by assuring that people have access to fresh fruits and vegetables, by assuring that there is a good education system so that people can be literate and graduate from high school and be healthy in their life. We, assure that there's health by offering access assuring there's access to health care, or by making sure that there are wellness programs in communities, or tobacco free communities, or access to vaccines, and also making sure that there are things like clean air and clean water. It really does run the gamut when you wake up in the morning to when you go to sleep at night. Public health is there, like an umbrella over you, keeping you healthy in ways that you don't see, because it is based more on you as a part of a population rather than you as an individual.
Lynn Schmidt: So trust in almost all of America's institutions are at an all time low. And they started that decline, before the COVID-19 Pandemic, which I guess was a set up for a disaster, especially for public health. going into the pandemic, can you think of ways to increase that trust in our public health while we wait and see if we can restore trust in our institutions overall?
Susan Polan: So all of public health work is based on evidence and research. And I think one of the things we need to do is be more transparent about that. We understand what we understand today because of where science is. But tomorrow, there might be a new understanding, a new opening, a new research project that tinkers with and maybe is more nuanced in terms of what works, in terms of creating health and what does not. And so one of the things that we need to make sure people understand is that when a public health professional tells you something today and then tells you something that's maybe a little bit different in three weeks, they're not lying today. It's that we have new data and evidence through the course of time that helps us better understand what works to protect health, and create health and well being. So, transparency, I think, is going to be a really important part of regaining trust. And part of transparency, again, is not just telling us what we know, but also helping people understand the process of gaining access to more information. I think another piece, that's, going to be important, is that we also say what we don't know. We tell people that this is the information we have. And if there are questions, we make clear that we're doing additional research to understand those questions, and hopefully we'll be able to have more information. Now it's the issue of, are eggs good for you? Are eggs bad for you? Data has changed over the course of our lifetime to help us understand better how to be healthy. And the same thing is true in understanding how to create clean air, or what vaccines work, or what physical activity is necessary to create health.
Lynn Schmidt: Yeah, I think that's what we saw, particularly in the early days of the pandemic, where our public health officials were providing the best information that they had at that time. And then when it changed, people are using it against them. Right?
Susan Polan: Right. And as we learned more about COVID-19 and, the underlying transmission process, that idea of do we need masks or do we not need the masks? Became more clear. As we understood it, the idea of physical distancing became more clear. And so it was an, understanding of transmission, of the disease, of the infection that really changed over time, not what scientists were saying to help protect you.
Lynn Schmidt: Right.
Eric Schmitt, junior senator from Missouri, tweets attacks on public health
Lynn Schmidt: So, speaking of attacks on the institution of public health, and specifically, maybe on COVID-19, the junior senator from Missouri, Eric Schmitt, tweeted or posted the following on X, which is the new name for Twitter. He, posted the following on X on September 5, Senator Schmitt posted no vaccine mandates, no vaccine passports, no mask mandates, no lockdowns. then on September 7, why the fight against COVID tyranny was and is a fight for freedom. On September 9, Fauci lied. September twelveTH, COVID fear mongering. And then again, on September twelveTH, do you trust the CDC? Which, Senator Schmitt posted a poll.
Lynn Schmidt: Under his account, in which 91.8 of the respondents of his Twitter poll responded that they do not. all of these posts seem to come at a time where COVID-19 cases are back on the rise. but I want listeners to be clear. There are no max mandates currently. There are no vaccine mandates. the new boosters have just been, approved and released, and I got mine this week. but those are personal choices.
Public health officials say COVID cases are still here, people getting sick
Lynn Schmidt: So maybe could you speak a little bit about these attacks and what the public health community can do to do some counter programming, if you will?
Susan Polan: I want to reinforce that nobody is talking about mandates right now. Nobody is talking about lockdowns. I also want to make really clear is that we don't even have a really good idea of the numbers of cases right now, because the only time we really find out about cases at this point is when someone gets to the hospital with no emergency declaration. Much of the tracking of ongoing cases has gone away. So we don't know how bad or how well we're doing right now, but we do see an increase in cases coming to the hospital over what we've seen in previous months. So nobody can deny that, COVID cases are still here, that people are getting sick, that people are dying from COVID This is still going on. And because of that, I think what we in public health need to do, and somehow what we need to get through is some of this incendery language to make clear that it's not fear mongering. It really is about trying to offer the most up to date data and information that's available and offer ways for people to keep themselves healthy. And in that process, as a community, we need to recognize that what works well for one person might not work well for another person. But that doesn't mean we shouldn't give a person access to all of the tools available to keep themselves healthy. So that means we should continue to allow people to get vaccines. That means that people, if they want to, should still mask, and they should be able to walk through the streets without getting harassed for that. They're taking care of themselves and their needs in a way that allows other people to live their life freely. And I, want to make sure that we figure out and this is way bigger than what public health can do, but how do we respect individual choices at the same time we respect the choices that are best for the population at large.
Lynn Schmidt: Right? absolutely.
Dr. Anthony Fauci lied about COVID
Lynn Schmidt: So, in those posts, I think the one that really stuck out to me, and is particularly damaging is where, Senator Schmitt wrote, Fauci lied. And of course, he's referring to Dr. Anthony Fauci, because he's attacking an individual, who I don't believe lied. I believe that Dr. Fauci gave the information that he knew in a timely fashion. And if that changed, like we talked before, it changed, and the data was showing something new. Right. how are our public health professionals, dealing with these attacks to their, and some of them maybe to them personally? Right.
Susan Polan: there are a number of personal attacks. There have been people who have been harassed off of the job after years of good public service because someone did not like what they said. And this has been a big problem, in the public health field, but also in the related fields that were trying to deal with these issues during COVID School board attacks were on the rise. People came off of school boards, off of local health boards, because when you are offering information that not everybody agrees with, it opens you up to attacks. And COVID actually opened us up to attacks unlike anything we had ever seen. And that's just not fair. You're not going to find public health professionals who are out there offering information that is to their own personal gain. It really is about the community that they're involved in, the community that they are trying to protect. And again, just because people don't agree doesn't mean that anybody has a right to attack them personally, to attack their family, to put them in danger because they put their address or phone number online. And all of these things happened to public health professionals during COVID And so, again, this is not something that public health can solve alone. But we in public health need to continue to offer the most up to date science to acknowledge when things change. Dr. Fauci didn't lie. Dr. Fauci learned more throughout the course of the process because he was working with experts from around the world who were all learning more at the same time. And so we really need to try and hold people accountable for what they are doing right and what they're doing wrong. And I think the same thing is true with public officials, elected officials who say things like this. We need to hold them accountable and responding and respond with the truth and with transparency and with humility. Because, as again, we're always learning and things will always change. And so, what I say definitively today might not be the same nuanced conversation that we have in three months. And we just have to acknowledge that and not be challenged for that, but be rewarded and applauded for being willing to say things have changed.
Is there a change in how citizens view vaccines in general?
Lynn Schmidt: Is the public health community seeing, a change in how citizens, view vaccines in general? I mean, is there increased, skepticism about getting other vaccines as well?
Susan Polan: Well, that's always been there as well. We, unfortunately, have been dealing with the, MMR autism hoax for many, many years. And so there was always a small and vocal minority of people who believed that vaccines were dangerous. And the truth is that for 99% of the population, vaccines are not dangerous. I have a son who, when he was young, was allergic to eggs. So many vaccines, we had to address that in a certain way because many vaccines were grown in eggs. But it wasn't that. When we had all the information, they were not dangerous to him. They were protective. And that's what we know about vaccines. I think the vocal minority is growing a little bit. And unfortunately, it's been seeded by legislative process, which are changing the rules for kids who go to school. Making vaccines no longer making vaccines mandatory in a lot of places when what we are trying to do with that is protect the population. So we've had cases of measles from people who are not vaccine, who do not have vaccines. We've seen people die because they have not been vaccinated and they catch measles. We see all sorts of unnecessary illness and disease because people do not receive the vaccines. Vaccines are preventive. They keep people healthy. And we need to just continue to reinforce that. I'm afraid of what we're going to see in the next few years as we have more and more kids entering schools who are not vaccinated. And unfortunately, what we might see is a dramatic increase in some of these preventable diseases. Whooping cough? polio.
Lynn Schmidt: Right?
Susan Polan: Polio. These are all things that we know what happened before we had the polio vaccine. I think that for many of us, those visions of people in iron lungs are seared in our brains when we've looked at history. And we can go to other countries and see where polio has not been eradicated and see the implications for people in those countries. So I'm really hoping that this is a short term kind of rebound effect and we will get back to where we need which is recognizing the value of vaccines for long term health of individuals and populations.
Lynn Schmidt: I hope so as well.
September 15 was National Suicide Prevention Week
Lynn Schmidt: we are recording this, podcast on September 15, and this week is National Suicide Prevention Week. Pew Charitable Trust reported this week that the US. Suicide rate increased 30% during the years, 2000 to 2020. Their report also showed that suicide was the 11th leading cause of death in the country in the year 2021. the suicide rate among American Indian and Alaska Native women grew 135%, and the rate for men rose 92%. would you mind speaking to the alarming, rise in suicides in the country and what we as citizens or the public health community, can do to, reduce the number of suicides?
Susan Polan: One of the things that we know about suicides, particularly the increase that we've seen among the populations you mentioned, among the populations of white men, older white men, all of these things are related to a couple of different factors. One is what we call deaths of despair. So it is related to the opioid epidemic, it is related to unemployment. unfortunately, there is, kind of an exponential increase in suicides. When there is somebody high profile who commits suicide, there's this, copycat effect of a better term that is really horrific. So there are a variety of things that we can do. The dramatic increase in suicide among men is related to a variety of things. But one of the things is that men are more likely to use a gun when they try to commit suicide, and then they are therefore more likely to be successful, right? What people don't know is that about 60% to two thirds of the, suicide or the gun deaths every year are actually suicides, right? And so, there are things that we can do that are related to guns, like red flag laws. If we know somebody is in a place where they should not have access to a gun, then the red flag laws are designed to, allow people, law enforcement, to take those guns away. And that's not a bad thing. It is protective of the individual. But there are a lot of other things that we can do. We can focus on some of the upstream causes. The opioid epidemic is something we definitely need to do a better job on. And we can see how it has ravaged, parts of the country more than others. But it is everywhere.
Lynn Schmidt: It is everywhere.
Susan Polan: It's in rural areas, it's in urban areas, it's in suburban areas. And we need to be much more conscious and conscientious about trying to help people, offer them the services that they need, access to the care that they need, and assure that we truly have parity in mental health care so that people can get the services that they need. If you are trying to find a therapist who takes insurance, it's almost impossible if you're trying to pay out of pocket. It is exorbitant. And so we need to make sure that these things are readily available to people who need them. But, the other thing we need to do is work on assuring that there is hope and opportunity in communities, because so many people who try suicide once do it because they're in this moment of despair. But in two or three years, they have been able to rebuild a life. And that is what we want to do, is want to make sure that everybody is able to build a healthy and active and life where they are able to access the services that they need, so that they don't get to that point where they are contemplating suicide.
Lynn Schmidt: I recently met, a veteran who was suffering from PTSD, who, is a gun owner. and he realized that he was really struggling with depression and was suicidal. and he knew enough to bring his guns to a neighbor and ask them to lock them up for him until he was in a better place. And then he was able to receive mental health services through the VA. But, there's so many more people in our country like him who don't know enough to ask someone to help them, or don't feel like they can reach out to someone and share that they're in a bad place or able to access, those services.
Susan Polan: I applaud him for being so self reflective and thoughtful and taking action. For a lot of people, they are at a place where that they just don't have the capacity to do that. And so it's important that we support those people as well. And, I'm really glad, also, that he's able to receive services from the VA. But the VA is another place that we need to make sure has the staff and funding that it needs to offer services to our veterans, so many of whom are suffering from PTSD. And so, he is an exemplar, and I hope that there are more people like him, but I also want to make sure for those people who are not in that same place, they're able to access the services that they need.
Lynn Schmidt: I almost got emotional talking about him, and I realized that if he hadn't taken the steps that he did, I probably would not have met him. and there's so many, people in our community, and I think that's one way that we all can help the public health community in just providing, relationships within our community, reaching out to our neighbors and friends and strangers, honestly, right? Just with kindness, because we have to figure out a way to rebuild our communities.
Susan Polan: One of the kind of standing tenets for public health is that you don't want to meet your counterparts or your partners in times of emergency. You want to have relationships. So when emergencies arise, you're able to pick up the phone and not have to build that relationship. It's true with our neighbors. It's true in our communities that we need to reach out, we need to support and engage in community activities because it, makes communities safer, it makes communities healthier. When you have this integrated community where people know each other, they watch out for each other, they're able to check on their neighbor if they haven't seen them in a few days. All of these things are really important. it's the famous saying, it takes a village, and it does take a village to keep people healthy.
Dr. Polan: Public health professionals are your neighbors
Lynn Schmidt: So, before we wrap up, I was hoping maybe you could, just say a few words about the public health professionals, in our communities. It seems to me that they are just people who care, care about the other people that live where they live, whether that's a town, a, county, a state, or the country. Can you speak to that a little bit?
Susan Polan: Yeah. The public health professional, these people are your neighbors. They're the people who do their job to assure that, the air is clean. So they're people who make sure that the neighborhood doesn't have the sanitarians, who assure that there's no blight in your neighborhood. They're the people who test water to make sure that it's safe to drink your drinking water, or who are in a public health clinic, or, the community health center, offering health care, offering vaccines, offering tobacco prevention activities, who go into schools and work with kids to teach them about the ravages of drugs to an individual. They're also the people who you will never see, who work in a lab, when your child is first born, and who test them for all of those different things to make sure that there are no birth defects. They are the people, who are out in the streets and trying to engage people to offer condom them and clean needles so that we don't have HIV. so there are people who are doing things that you see and things that you don't see. And maybe some of these things are things that individuals don't agree with. But again, the goal is to keep the community healthy. And so these are tools that are available to people to keep the community.
Lynn Schmidt: I'm I'm recording this from Missouri. and I know that there are many hospitals in our rural areas that are closing. And so, it might just be that your public health official may be the only one in your area, in your community that's there to help you and keep healthy and can help direct.
Susan Polan: You to a place where you can access the services you need if perhaps they're not available in your community.
Lynn Schmidt: Yeah, great. Well, thank you so much, Dr. Poland, for joining me today. I hope listeners enjoyed this conversation. please subscribe on your favorite podcast platform, so you won't miss an episode of what keeps you up at thank you again, Dr. Poland.
Susan Polan: Thank you. I really enjoyed this time.
