 Welcome home. We are so excited to have you back in Wild Hall, welcoming our current students, faculty and staff, but also our alumni who are back visiting with us. Welcome home, we're so excited to see you. Tonight's policy talk is really gonna be an exciting one. I've been waiting to talk to you and I am, first of all, let me introduce myself. I'm Celeste Watkins Hayes. I'm the interim dean at the Ford School of Public Policy. I am also the founding director of our Center for Racial Justice and I'm a professor of public policy and of sociology. And I'm so excited for this conversation. Social policy is health policy with my colleague and friend and predecessor in the Associate Dean for Academic Affairs role, which I had last year, Paula Lance. But first I wanna welcome some special guests tonight at our fireside chat here. First to those here from the Ford School classes of 2020 and 2021, we are so happy to have you back on campus. We're so proud of your achievements, accomplishments and I know that you are tired of hearing this word but it must be marked and acknowledged your resilience given what we experienced in the last couple of years. We celebrated your two classes on Zoom, you and your fellow 40s will forever be bonded together through this experience throughout the pandemic and throughout that first year and I can't tell you how great it is to see you today and to be in person with you again and I say welcome back and congratulations on behalf of the Ford School. I'm really, and I'm really looking forward to connecting with you and we are after the talk today we'll be having a reception out in the courtyard following this conversation and to hear about all of your endeavors since you were last with us. And I know we have some Ford School alumni from other classes in the audience tonight. Welcome back, welcome back and thank you for spending some of your homecoming back at Wild Hall. And a big welcome to our alumni board members. I had the pleasure and honor of spending some time with this group today for the fall meeting and I know you've had a busy and productive set of conversations and I'm grateful to all that you do on behalf of the Ford School. And now before we kick things off I'd like to turn things over to Naomi Goldberg the alumni board chair to share some greetings. Thank you so much Celeste. I'm really excited to be here to welcome home all of our alumni, especially those from the class of 2020 and 2021. It's wonderful to be able to gather here together in person and virtually to engage, to connect, to catch up and most importantly to celebrate your accomplishments. On behalf of the Ford School alumni board folks raise your hands. We are excited to welcome you back and meet you. As Celeste mentioned you graduated during extraordinary circumstances and we couldn't be more proud of you in your accomplishments. You are now part of the Ford School alumni community and we are a great resource to one another. I encourage you to be an active alum. Join events, volunteer to meet with current and prospective students. Hire an intern, show up by showing your support for the Ford School and follow us on social media. And that can start later today at the reception that Celeste mentioned. Connect with our current students who are here who are eager to hear about what you're doing now and network with us as alumni. Welcome home again and go blue. Thank you so much. Thank you so much. So tonight's event puts us at the intersection of health policy and social policy because in fact health policy is social policy and explores the devastating structural inequities that were exposed during the COVID pandemic. We'll leave some time at the end for questions and we wanna hear what you're thinking about this space. Our attendees in the room can simply raise your hand during the Q and A and those tuning in virtually can post questions using hashtag policy talks. To talk more about why all policymakers must now be equipped with a toolkit for navigating pandemics, I'm joined by my colleague, Professor Paula Lance. Paula is the James B. Hudak Professor of Health Policy here at the Ford School and the director of our BA program. She also holds an appointment as Professor of Health Management Policy at U of M School of Public Health. As a social demographer and social epidemiologist, she studies the role of public policy in improving population health and reducing social disparities in health. Some of her current research on how COVID-19 is exasperating existing social, economic and health inequalities in the United States is particularly fitting for today's conversation. So I'm so excited, welcome Paula. And I wonder if you would start by telling us a little bit more about your work at this intersection and why this conversation is so very important. Sure. Well, first I wanna welcome everyone today as well. It's really great to be seeing some of my former students already and looking forward to catching up some more with the rest of you. I'm also really excited to be here because this woman is so busy that we never have a chance to talk. And so we're gonna catch up on some more things in front of a lot of people publicly, but that's okay. It'll be a fun conversation and of course we welcome your insights and input as well. So I'm a population health scientist. I'm trained in, as you said, social demography and social epidemiology and I have been drawn to health related research my entire career because I've been compelled for a long time and I remain compelled in a bad way by the just shameful social inequalities we have in health, any measure of health status in the United States. I'm also drawn to policy because as a population health scientist I see public policy as, first of all, unfortunately one of the drivers of the inequalities that we see. But also public policy reform is what needs to happen to address health issues at a population level. It's the most efficient way and we'll talk more about this, but we're not gonna improve health and health disparities at a population level one person at a time with medical care or healthcare. We need public policy reform on many, many levels, including social policy reform to make those shifts in populations. And it's so interesting that you say that in terms of the importance of public policy in responding to these issues because as a sociologist who also focuses on inequality and really started my work focusing on economic inequality and my kind of foray into doing health research came when I was working with women who were trying to transition off of public assistance and one of the women that I interviewed happened to also be living with HIV and trying to understand her social network, her healthcare network but also her social support and economic network in terms of how she was surviving really led me down a path to understand all the way up the chain, the role of public policy and specifically the Ryan White Care Act in creating a context of resource distribution that would give her access to healthcare and medications and also create a kind of health safety net that became so important. So really I think it's so important to think about those micro level experiences funnel up to the institutional level and then funnel up to the larger macro structural policy level. So I appreciate your kind of perspective on that. Exactly. I think our friends here would love to hear more from you about your new center for racial justice at the Ford School. It certainly fits into our conversation. Absolutely. So part of what I think is crucial about this policy perspective that we're talking about and policy as sometimes a driver of inequity and then also a tool that can respond and confront inequity is the really important legacy of race in this country. The historical legacy but also its contemporary manifestations. So when I came into the Ford School and this was a vision that I know you shared and Michael Barr shared and the faculty shared in terms of we can't properly educate our students unless they have that a level of historical knowledge and a level of kind of contemporary understanding of the role of race in shaping public policy. And when I talk about race I should emphasize that I have a very intersectional perspective on race. So I'm thinking about the ways in which race and class and gender and sexuality intersect to shape life experiences and how people navigate institutions and how they navigate public policy. So what we're trying to do at the Center for Racial Justice is come into the very conversation that you've so beautifully framed for us in terms of how can public policy be mindful of the historical legacies of race? How can it think about its role in correcting past injustices? And how can it set up rules of engagement, if you will, so that people have the opportunity to live to their full human potential without the barriers of racial antagonism, animosity and discrimination and prejudice? So the Center for Racial Justice is really trying to set the stage and create a context that we can have these conversations here at the Ford School. We're so lucky to have you in the center. I'm happy to be here. Good, I'm happy to be here. Thank you. And you know, it's really interesting because whether you're thinking about housing, healthcare policy, immigration, labor market policy, our historical obsession with racial inequity shows up in all of these policy domains. And therefore, when we talk about how resources get distributed, how decisions get made, who sits at the table, that kind of understanding is really, really critical. I hope to see a day where it's not, but until that work is done, we'll continue to be here and to make these and help shape the conversation. Excellent, yeah. So let me ask you this. I know you've been spending a lot of time thinking about COVID-19, a lot of time. As a public health scholar, I know it was something that on a day-to-day basis, you were thinking about as associate dean. And one of the things that I commented to you when we sat down was there's a interesting disconnect where we went from this period where all eyes were focused on the pandemic to this moment where there's a feeling that we've quote-unquote moved on, but it depends on who you are and it depends on your experience in terms of whether we've in fact moved on. So the question I think about is, how do you fight a pandemic that many people think is over? And this comes up in my work on HIV because it's a perennial question that HIV researchers face in terms of, how do we continue to fight against the HIV epidemic when many ask me still, is that still a thing? They remember the 80s and the 90s and then it's off the evening news, it's off the front pages, but the fight rages on. I worry that COVID is basically experiencing and following a very similar path in terms of moving from the evening news and the front pages to this pandemic experience where people say, is this still a thing? And I feel like we're moving in that direction. So what do you think about that? Is that a good thing? Is that a bad thing? How do we address it? How do we think about it? What's the landscape right now in a conversation around COVID from a public health expert? Does anyone have a shot of bourbon or anything? I'm sorry. So with all due respect to President Biden who declared, I think kind of off the cuff the other day the pandemic's over and then kind of backed away oh the acute phase of the pandemic is over, it's not. It is not by any sort of metric. And yes, it is the case that, people who are vaccinated or fully vaccinated and have the privilege in their lives or they can avoid a certain amount of exposure on and can work remotely or have other resources to avoid exposure. If they get it, they'll have really good care. Immediately, yeah, let's move on but there's so many people who can't move on. And I'm a walking set of the metrics. I have a friend in neighbor who said she didn't want me, she didn't want to get together for dinner anymore unless I promised to not talk about COVID and what the reason is, I'm sorry. She's usually the one who brought it up, not me but because I like a break from it too. But just say for today, today, where are we? The United States, now data on the incidents of COVID is super hard to get because most cases aren't reported. The best guess in the United States is that we have 10 times as many cases as you're seeing on the dashboards for whatever state or county or university you're looking at. So the levels, because it's not a reportable disease and lots of people aren't even getting tested, et cetera. So the metrics that the CDC and other people are looking at are hospitalization rates and mortality rates. Hospitalization rates have been going up through the middle to the end of the summer. They have started coming down, which is very good news. But we are still in the United States at a level of around 400 deaths a day from COVID. That is the level of the peak of a really bad influenza season. So the comparisons to influenza, they're just wrong on so many levels. I'm sure many of you saw the recent report that came out that life expectancy in the United States dropped by, I mean, as a demographer, it's astounding. If we wiped out all of cancer and heart disease in the United States, life expectancy would drop by like 3.8 years. And so the levels that we're seeing, and of course the drops in life expectancy are much higher for communities of color, life expectancy dropped for American Indians and Native Americans was six years. So this has put us back like three decades in terms of where we were with that really important measure of population health. And we are, if you look at graphs mapping just the number of COVID deaths at this point, end of September this year compared to last year, we're the same, it's the same. We're not, we're not, we're not out of this. And as long, we're not gonna go into whole discussion about viruses, but it's just pretty basic to understand the more there is a virus circulating within communities, the more people are gonna get sick and also there's more chances for a mutation. And there's new variant you've heard of, B.A. 2.75, I'm worried, I'm worried. The early suggestions are it is more contagious even than Omicron, which is more contagious than, I mean the virus mutates a lot and there's some mutations that are attenuated and not as worrisome, but the ones we hear about are the ones that are worse. So B.A. 2.75 looks like it's more easily transmissible and also don't really know yet, but if it's escaping the vaccine protection, that's gonna be bad. So I'm sorry, I'm Debbie Downer, but I feel like I'm being realistic. And it's so interesting from a sociological perspective, one of the things that I, if I had time to do a study on this, I would investigate this. The social dynamics of public health precautions and how they have changed over time. So first it was the tension in terms of the lockdowns and the masking and kind of tracking along ideological lines because it got politicized so heavily. And now it feels like there's still some of that, but there's also this tension of community norms. And I hear all the time I go into the grocery store, I'm the only one that has a mask on and people kind of navigating the social pressure and the social conformity and the dynamics that even when we sat down, we kind of had to talk about like, so how are we gonna navigate? Oh, I just had it two weeks ago and blah, blah, blah. So this idea of the beginning of the school year, I'm out with COVID. So talk about from a sociological perspective, this relationship between public health and community culture and kind of interpersonal dynamics and the role that that may play in people's willingness to embrace or not embrace public health measures. I think it's so interesting as people kind of figure out what their comfort level is and how to navigate these situations. Yeah, and I'm probably, I'm gonna talk about it more like a social epidemiologist probably, but so in any epidemic or pandemic, if you wanna control it, you need a vaccine is what you're gonna need really to think about polio and smallpox and even measles and vaccine preventable childhood diseases. Vaccines and treatments for people who get it are very helpful, but we're never from a community perspective going to get rid of that virus circulating unless we add to the arsenal what epidemiologists refer to as non-pharmaceutical interventions or NPIs. So these are things that hit populations rather than individual treatments and like vaccines are one person at a time. And so when especially if a novel virus hits a community, you need of an array of non-pharmaceutical interventions like stay at home orders, first of all, right? But masking policies regarding gathering, banning gatherings, school closures. There's been a lot of research looking at other epidemics and especially like historically the 1917, 1918 influenza pandemic. And some good research showing that cities in the United States that had lockdowns, closed churches and businesses and schools, et cetera, had lower mortality rates than places that didn't and places that lifted those maybe a little too soon given the amount of circulating virus didn't do as well as others that kept them in place. So there's a whole arsenal, if you will, of NPIs, non-pharmaceutical interventions. But they're destructive in so many ways. I wanna ask people in the audience, does everyone remember where you were back in 2020 when you realized like, oh, this is gonna be bad? Or like, oh, this is gonna be so much worse than we even thought it was. And I was sitting with Michael Barr, the former dean in the dean's conference room and the university had just announced a lockdown and all this was happening really fast and we both pretty much said at the same time, like, yeah, you know, because, but you don't have to be a social scientist or a public policy person to understand pretty quickly, like this is what we need to control the virus but this is gonna destroy the economy. And this is gonna hurt education, it's gonna hurt commerce, it's gonna hurt social relationships, it's gonna hurt mental health as well, it's gonna do so many bad things and then in our country, people who are, you know, disenfranchised, disadvantaged and more vulnerable, it's gonna sock them even worse. And so it's this horrible, horrible catch 22. But I will say that on, so on the non-pharmaceutical intervention side and it's before we had a vaccine and we're so lucky we had a vaccine for COVID as quickly as we did or I just, I can't even imagine what the world would be like. There are social policies that can be implemented to address the downsides of those non-pharmaceutical interventions and I'll just give you one example. So we know that early, so early in the pandemic before we had sort of really understood the virus and way before we had the vaccine, there's studies that show that the mortality rate and we know it was much higher among African-Americans and Hispanics, especially people in urban areas and the research has shown that one of the primary reasons it was higher in communities of color was the kind of work people did. So it was frontline workers, essential workers and the people that, you know, waited on us if we dared to go into a grocery store or delivered our food or our groceries and ran the buses and the trains, et cetera. So the mortality rate was much higher among those essential workers who didn't have, many of them didn't have sick leave. And so a social policy that will help mitigate some of the problems with then the NPIs and non-pharmaceutical interventions that you need is paid sick leave. And so, I mean, I have my list of what I think we should be doing right now in terms of social policy to keep us on better track to deal with the pandemic and paid sick leave is absolutely and important. It's really key to social policy. And tell us more of the social policies that you think are important because I'm thinking about, you know, when I've given talks on this topic, I always show a visual of a rowboat and a yacht. And we heard all of this conversation about we're all in the same boat when the pandemic hit. But in fact, we were not all in the same boat. We were all navigating the same very turbulent waters, but some of us were in yachts and others of us were in hallowed rowboats and there was everything in between. So that kind of language didn't quite capture things. So I wonder how do we think about the rowboat in terms of policy and how do we think about the yacht? Because this is another kind of interesting dynamic that we think about in policy schools. We often have a lot of conversation about what we should be doing about the rowboat and we feel good about that. But it's harder to have, I think the conversation about what needs to happen with the yachts, right? Because it confronts our kind of cultural norms around, you know, get what you can in America. It's, you know, it's land of plenty, et cetera. So how do you- And don't dare you tell me what to do. And don't you dare tell me what to do. So how do you, is you picture that yacht and you picture that rowboat and you picture everything in between. What are the policies that we need to have to think about those different vessels? And then you're gonna answer it? Yeah, and then I'm gonna answer. Okay, good. Yes. So I'm gonna focus primarily on the pandemic and we can talk about social inequality in general, but still thinking about the response to the pandemic. I think, sorry friends. I think, you know, when the community levels get high and we're high in Washington County right now, there should be indoor mask mandates. There should be. And it's more, it's for equity reasons. There's so many people who are immuno-compromised who are at high risk for COVID. They're not out and about and they're not contributing to our economy and they're not able to live their full lives because they live in fear. Masks are not perfect, believe me, but there's fairly good research suggesting that probably at a minimum, they could help reduce community transmission if you're at a high rate by 10 to 20% and that's not nothing. I mean, anything we do to reduce transmission is important and if we don't start reducing transmission, we're never gonna get it more under control. So, you know, I'm not going to the football game tomorrow. I'm sorry, I'm like not gonna be around that many that many people, there are things and I spent some time last year on on sabbatical nicely in Spain where you had to show that you were vaccinated or had a negative COVID test before you went in a museum before you went indoor at a restaurant. And so again, I think we only need that when we understand community transmission levels to be pretty high by hospitalizations and death rates and the really fun dinner time conversation of a wastewater surveillance. I don't talk about that at dinner parties. Don't worry. Improved ventilation in indoor spaces, especially our schools is so important for kids. That will really make a difference. And I said paid sick leave. And then also thinking about, and these are things right out of, there are pandemic preparedness playbooks. We've had them forever. My friends who are infectious disease epidemiologists for years have been talking about it's not if we're gonna have a pandemic, it's when. And there really, there are all these playbooks and ways that we need to prepare, did we? No, did we invest in the resources we needed, the community involvement in the preparation or preparedness? No, we didn't do that. But in those playbooks are things like digital equity. So important. Just think when we were all on lockdown. Think about people who didn't have internet access at home, kids who were in school. People, first of all, there are people who don't have bank accounts, but there are people who don't have electronic access to their finances and don't get paid that way as well. And just for education, for commerce, for work, there's so many reasons we need to do a better job on digital equity. Water infrastructure. If I just say Jackson, Flint, on the hundreds of other communities in the United States who do not have the infrastructure for consistent, high quality and affordable water is important too. And then public health infrastructure. We have underinvested in public health and the infrastructure we need is particularly at the local level in this country for decades and it just bit us when this came. One of the things that I think about in this question of yachts versus row boats is all of those policies I think are so critically important and I think about the overlying piece is we have lost this sense of kind of community ethos. Like I felt like if this pandemic didn't bring us back to a level of care for each other and protection for each other then I'm not sure what else will. Because it was a place where we all were forced to stop, from our very busy lives and very busy existences and it really showed the power of leadership in terms of how the message gets framed in terms of what this moment means and what this moment calls upon for us in terms of a sense of community care and community ethos. And I think we had a really big lost opportunity there to help people understand if you're in the yacht you are tied to the row boat and if you're in the row boat you very much understand how you're tied to the yacht because you're the one checking out the groceries as you're sitting in your row boat for and doing the food deliveries and all of that for those who are in the yachts and everything in between. So this sense of community connectedness as it relates to how do you develop the political will for policy is something that I think is really critical because it strikes me as just even listening to the set of policies that you talked about we have good policy prescriptions. We've got evidence based solutions we know what works and what doesn't we've got reams of research to demonstrate it but in a very corrosive and divisive political environment and when there's not a strong incentive for leadership to be collective as opposed to divisive it all kind of goes by the wayside. So one of the things that I think about particularly in the Ford School context is how do we train students to not only be able to do the policy analysis but how do they also communicate not just the importance of the policy but the power of the policy implications for the policy for the kind of collective community. How can we be, how can we train students to be better communicators around those issues? That's a good question. Yeah. Because we're not gonna be able to convince everybody. I mean, there's a lot of diversity of thought but to be able to break through the noise is something that I think policy thinkers are gonna have to get increasingly savvy about. And then this is bigger than COVID. This is something I've been working on my entire career but I think one of the things that also made the pandemic harder for the US is this ongoing conflation between health and healthcare. And the notion that any problem we have with health we have to solve with a healthcare medical sort of solution. It's not true in a pandemic as we just talked about but it's not true for any health issue we're gonna think about. So healthcare is super important but it's one of many drivers of health at both the individual level and the population levels. So housing matters for health, economic security matters for health, transportation matters for health. I mean, every area of social policy matters for health. Inequality in any of these areas drives inequality in health but I spend a lot of time talking about this issue, this conflation and this conflation of what we call the social determinants of health with individual social needs, they're not the same things. The individual social needs like living in poverty and not having affordable housing and not having food or affordable clean water are symptoms of these upstream sort of drivers. Policy needs to address both. And when I talk about this in healthcare settings, I usually, at some point the people wearing white coats with stethoscopes around start going like that and get really mad at me but it's really not debatable in my mind. So I'm not saying healthcare is not important and boy do we have problems with healthcare in this country, right? And health insurance is the really messed up terrible system but if we don't start thinking about social policy as health policy more and moving some of the huge amount of investment we have in healthcare in this country. I know everybody here knows that the US is an outlier by a huge margin of any other country on earth of how much we spend on healthcare per capita and part of our GDP and however you wanna measure it and our population health metrics are not good compared to that but there's so much money going into healthcare we've gotta figure out a way to make different kinds of investments. It's so interesting that you say that because it very much ties to my research on women living with HIV and in my book and I've talked about this at the Ford School and my book Remaking a Life I tell the story of the opening line of my book. Which is from a woman named Dawn who I interviewed who said to me if it weren't for HIV, I'd probably be dead. And how do you unpack that kind of statement, right? How is it possible that an illness responsible for over 32 million deaths around the world is credited by Dawn for helping to save her life? And throughout our interview I, Dawn talked about her history of poverty, her experiences with homelessness, her experiences with childhood sexual trauma, her incarceration history and all of the different ways in which structural factors trickle down into her life that set a context of limited opportunity and limited resources that set her on a path for her to have a series of struggles. And what she said about the HIV safety net though was there's a way in which I got access to housing, I got access to healthcare, I got access to support groups so I can talk to people who are also living with HIV and also dealing with recovery because she had substance use issues. And I also got a voice to be able to use my story to politically advocate for other people like me. And all of that came through her involvement in the HIV safety net. So what she was saying was if it weren't for the HIV community, I'd probably be dead. She didn't say if it weren't for the HIV healthcare, it wasn't about, although that was important, but really what she was talking about was a much more comprehensive and holistic set of resources that she was able to get access to. Yes, healthcare medications being one of them, but also these tangible resources like housing and these intangible resources like social support and training on how to become a politically active HIV advocate that ended up saving her life. And that's what she means when she says that. And it so connects to what you're saying because it raises the question of why did it take a life-threatening diagnosis to give her the set of resources that she needed all along? Why was it the HIV status that opened up this suite of resources? Like why was the fire raging before we installed the fire extinguisher? And HIV, as you know, has its own political history in terms of a very, very strong advocacy community that has fought for decades to be able to build up an infrastructure for people living with HIV that Don was plugged into. This would not have happened without that advocacy. It would not have happened without that advocacy. And there's a way in which it highlights the importance of that kind of holistic approach. It highlights the importance of addressing things upstream so that we don't have to then address them downstream, but it also highlights just how far off we are for the general population to be able to have that same level of access if they are in marginalized situations. And I appreciate the HIV story. It's really powerful. And I'm gonna push it though even further because I think still having the Ryan White Care Act and other policies that provide these fundamental material conditions needed for health is really important. I still see that as downstream. It's very downstream, exactly. It's still downstream, so let's back up. It's the fire raging. Now let's put in the fire extinguisher. Yeah, yeah. Because, okay, so housing. There's no housing market in the United States where a person making the federal level of minimum wage can afford a two-bedroom apartment. That's where we are with housing affordability in this country, and I could go on and on. And so it's like dealing with these upstream macro level, including public policy, drivers of social inequality and the inequality we have and the basic necessities that we need for full and happy and healthy lives that cascades downstream. So I'm not opposed to giving people resources downstream. And actually the California Medicaid is launching this huge experiment. They are getting in the business of housing in a way that no other Medicaid program has. And so that'll be really interesting to watch. I was just interviewed for a podcast about that and people asking me what I think what I just, my refrain always is it's necessary but not sufficient. It's that healthcare is necessary but not sufficient. Dealing with people's acute immediate needs is necessary but it's not sufficient. The housing problem in California is big. It's huge, yeah. Medicaid's not gonna solve it. So it's not, again, it's not sufficient. So while, yes, I'm pleased that those things are happening and helping, happening within a healthcare sphere, there's so much other work that needs to be done. Absolutely. So I'm encouraging the audience to start to think of your questions because we're gonna turn to you in just a second. And I wonder before we turn it over, Paula, if you can talk about the 21st century public policy education with all of these different challenges. She's so off script. None of the things she's asked me. I know, I know, hold on a second. I didn't really over prepare anyway, but. Let me go through my notes. You see, this is what happens when we haven't spoken, we haven't had a chance to sit down and do drinks and talk. I'd like lose my mind when I get in front of you. Like, what do you think of this? What do you think of this? What do you think of this? So I do wanna talk about public policy education but let me ask about that's fine, just go with it. Okay, cool. Sorry, I had a little fit, but. I know. And it's so funny because, you know, I'm a qualitative researcher and I spent all this time creating interview guides and then I get into the conversation and I'm like, so, and I just, but it turns out to be so generative. It turns out to be so generative. So weave in whatever thoughts you wanna add cause it's a broad question about policy education and helping us understand why all of us need to have a better understanding of pandemics and public health, no matter what our policy area because I think what we've learned in the last two years is we cannot be siloed. This touches national security policy. This touches immigration policy. This touches education policy. So do we all need to have some level of understanding of public health in order to be strong policy analysts? I might, so I might go along with that a little bit, not pandem, I'm not advocating and not just cause I might be the one who would have to teach it, but I am not advocating that every foreign school student has to get training in pandemics now. But I think in understanding, I don't think health is, you know, that it's not special. I mean, it's one of the, it is special, but it, let me back up a minute. When I first came to the Ford school, it's been eight years now, meeting some of my new colleagues here. And one of the reasons I transitioned from being in a school of public health to a fabulous school of public policy was that I wanted to learn more from my colleagues here who were experts in education policy and transportation policy and labor policy and et cetera, et cetera, environmental policy, cause I've moved so much more of a stream with my own research and thinking and teaching about health. So I would say to some of my colleagues here who said to Sue Donarski, oh, well, you know, you're working on health cause you work on education policy. She's like, who made health, the king of everything? I was like, okay. But I think having students under, you guys who know Sue Donarski know that that's how that would go. She probably doesn't remember it. But I think having an understanding of how, in general, inequality in any of the things we care about, social inequality, which is primarily in our country driven by education and economic inequality, intersected with race on the experiences of, you know, instead of thinking about people's intersection with race and gender and all these other aspects of identities, it's really important to think about inequality drives everything else that we care about. And I'm doing a lot of introductory teaching right now. I always started on my classes talking about, well, the public sector's really interested. There's four core pillars in the public sector, economy, effectiveness, efficiency, and equity. And our students need training in all of those things, but equity's hard, but it's essential. And one other quick little point on that. So I think, and it's hard to teach about things like structural racism and systemic racism. And many of us are trying, we're trying to learn along the way how to do it better and we're learning from our students how to do it better. So that's a very important work in progress. But I have to say one of the things that I'm most concerned about in this country, among the many things I'm concerned about is the pushback and the legal response that we've seen in so many states that is banning the discussion of structural inequality, structural, you can call it critical race theory, but what critical race theory is really about thinking about these issues from a structural perspective and racism and inequalities are transmitted not just person to person, but through policies and institutions and systems. And that is against the law in many states right now, including at the college and university level. So it's the epitome of structural racism to use the power of law to ban the discussion of structural racism and sort of where we are in the country. Like I don't know how we get forward in this without tremendous pushback against that. Right, right. And I think so our series through the Center for Racial Justice, Racial Foundations of Public Policy and all of the talks are available online looks at these very issues in terms of what are the kind of historical foundational elements of how racial inequity has informed a particular policy area, whether we're talking about health or housing, immigration, et cetera. So I encourage you to check out that series. We just had Melissa Murray from NYU Law School on reproductive access a week or so ago. And the other thing that I think is really interesting for our conversation and useful that I wanna pull out is the fact that so much of this activity is happening at the local level. Right, school boards. School boards and curriculum committees and city councils and a lot of this kind of response to conversations around inequity are happening at the local level, which I think creates an opportunity particularly for our students in terms of what's gonna be your plug-in point and where are you going to get involved? And yes, there's a lot of interesting things happening at the federal level and at the national level, but really a lot is happening at the local level. Oh yeah, I almost saw this is at the state level. At the state level. So there is opportunity for people who are earlier in their career to be able to get a seat at the table in some of those conversations. And in fact, I think we had a four school student who's on the Aaron Arbor City Council, right? If I'm not mistaken, I'm looking out to the audience. I think so, but I think that that level of engagement is possible and I really wanna encourage our students to think about, like you don't have to wait 20 years after your degree to be in a very, very impactful conversation, so. We did follow this, I just moved around a lot. Okay, so I wanna open it up to the audience. This was so helpful and enriching, Paula. It's just such a pleasure and joy listening to you and hearing from you. You as well. Thank you, thank you. So we have audience microphones floating and then just to remind you, if you're watching virtually, you can use the hashtag policy talks to send us something through the Ford School channels and we are open to questions. And if not, I'm just gonna keep asking stuff. Hi, Celeste, hi Paula, it's Barney. Good to see you guys. So my question is this. So the World Health Organization devised an ethical framework for the distribution of vaccines. This includes transparency, inclusiveness, consistency and accountability. How well do you guys think that the federal government and state governments met this criteria and why? That's a good question with respect to COVID, Brittany. Yeah, COVID vaccines. COVID vaccines. Terribly. But one issue, God, I could go off on this too, but one issue, so when the vaccine was first made available, there were a lot of discussions about how can we distribute this and how can we distribute it in a more equitable fashion. And there had been a lot of research going on, including here I was part of a research team led by some fantastic junior faculty at the medical school looking at what's referred to as social vulnerability measures at the community level, both at the county level and then zip code level. So measuring communities, social vulnerability, because we already knew that we showed that rates of COVID incidents and mortality were higher in communities with more social vulnerability and the things that go into these indices are things like what's the poverty rate, the unemployment rate and some other things. Now some of the indices, including one that was used in Michigan includes what proportion of the population in a community is of racial and ethnic minorities. And so in Michigan and some other states, the idea was to use these indices for vaccine distribution. And there were people in the legislature that said, you can't consider, we have a law in the books, you can't consider race or ethnicity or gender or national origin in our state in the distribution of access, in the distribution of our access to any public resources. And so it's like, no, we're not gonna distribute the vaccine using measures of social vulnerability that include race. Now there are some other measures that don't use it, but it was this huge scramble in a bunch of states, including Michigan, like okay, well, how can we measure, how can we think about equity and get the vaccine targeted, especially we were really worried about having enough supply versus demand. And it just, it derailed the process in ways that I thought was unfortunate. And it also speaks to this question of how, and it's a question we think about in education, in healthcare, if we can't talk about race, how are we gonna deal with the inequities? Right, right. So thank you for that question, Brittany. I really appreciate it. Okay. Oh, I see that. Hi, hi, I'm James. It's great to be here. I have another vaccine question, which is I wanted to know if you could talk a little bit about the commercialization of COVID, NPIs and the vaccine moving forward and what that will mean and whether we're, we've shot ourselves in the foot by turning this over to the private market or what is your perspective on commercialization? Thank you for that, James. That is a great question. And I don't feel like I have a particular expertise in it. The fight between Moderna and Pfizer is really unfortunate. Patent fights and yeah, I mean, there's money to be made in every market and for every kind of thing. So it's been disturbing in a lot of ways to see the people sort of pouncing on making money. I've got crappy masks and other kinds of things. And then the stories coming out. I'm from Minnesota. I was so disappointed to read in the news about the big bust of people who misuse the COVID really funds in a big scam. So it's a great question. I don't have other than a really sort of human, like, oh my God, sort of response to that. Yeah, I would say it's an ongoing problem for sure. Yeah, yes, Mel. My voice usually booms. I wonder if you could be a little comparative. So having been a former diplomat and several international boards been around the world and seen different systems. So I would say maybe I'm not sure I'm right, but for most of the world, the government has quite an active hand in the healthcare system and in health and general insurance, et cetera. I think of Germany, for example, if you have some complaints about people, they have a sore leg, they send you to a core art for two weeks, this kind of thing. And so there's some violations. But what do you think would a system that had more government involvement in the United States actually fly within the American political process? Because it certainly might open up, well, but it certainly might open up in a sort of, something that conforms to democracy, in other words, more availability to the citizen, a much better record in healthcare in the country. Is it, you think it's completely impossible that the government would have a bigger role in this? Are we just too ruggedly individualistic to have this? I was hoping earlier at the beginning of the pandemic I was like, COVID is laying the faults and the cracks in so many aspects of our society, but including in our healthcare system, just laying them wide open. Surely, now is the time, we're gonna try to respond to that, but no, everything is so political right now, but there's- And you even think about the Affordable Care Act. Yeah, I mean there are people pouncing to repeal the entire Affordable Care Act. There are many states who haven't gone along with the Medicaid expansion for the Affordable Care Act. There are people who voted against, trying to deal with the costs of insulin for seniors. So I don't, I'm not optimistic. I mean, we'll see what's happening politically after the midterms, but yeah, I don't know, Mel. Yeah. Hi, sorry. So I was kind of wondering if you guys had thoughts on how do we, in the sense of equity, and also just understanding human value, how do we help communities that don't want it? We saw red states and red neighborhoods had significantly higher mortality rates than those of their blue neighborhoods. Like, do you guys, as you look at this, as we look at the health of a society, how do we, do you think it's better communication, better messaging, better empathy? Like, where do you guys see the wiggle room for trying to help people who for right now would say like, we don't want it, we don't believe you? So much of this, I mean, there are a number of reasons, I think, for it. First, I think it's cultivated distrust in the system. I mean, and I think that there's all kinds of political incentives to fan the flames of government mistrust and to essentially kind of hunker down in our ideological bunkers. And I also think that there have been things that have happened historically that have also made people distrustful of institutions and of government. And I think that during the pandemic, we very rightly focused on medical mistrust within communities of color to explain vaccine hesitancy issues. But, and James has been involved in the American Voices Project, and I've been involved in it too, looking at data, that mistrust of institutions transcends racial boundaries where essentially what we see in some of those data are people who have routinely been frustrated by the medication costs and lack of access to their healthcare system and having to use emergency rooms as their point of contact for medical care so that when the pandemic hit, there was already a level of distrust in institutions and particularly health related institutions that I think was wider than many of us realized. So part of the challenge is going to be in the absence of a complete overhaul of a system and a movement to something that represents what you see in other countries, how do we nevertheless deliver in a way that starts to rebuild that trust? And the question is, does it need to be driven at the federal level or does it need to be driven by things more at the local level where people have a little bit more trust in it but it's incentivized and resourced perhaps at the federal level. But I think what we saw was just laid bare in terms of number one, the power of ideology and who people trust and then the distrust in some of our key institutions and particularly within the healthcare system that had been brewing for decades. Hello, thank you so much. This has been such an incredible talk. In terms of prioritizing interventions, I'm wondering what the literature tells us either here in the US or comparatively about which social policies are most associated with improved health outcomes. So thinking about again sort of targeted interventions, is it income maintenance? Is it universal health insurance? Is it early education? Housing interventions? And again, ideally these things, it would be yes and yes and but in a world in which we have to prioritize, I'm curious what your thoughts are. Yeah, that's a great question. And I don't think the, it's hard to answer with it's hard to do that research, but I think where the research does push us is first of all, thinking about kids, right? But thinking about poverty prevention for children, income security for children and including things like universal pre-K are really important. So start caring about kids very early on. Universal health insurance would help. That's again, it's a necessary but not sufficient investment as well. And then there's a, those pretty much everyone agrees on those things. And then it's just this big smorgasbord of lots of the and this and that as well. But in the US context, there are a lot of people talking about we have to address the legacies of residential segregation in this country where they came from and the incredible impact they've had on housing and wealth accumulation in the US. And if we don't figure out policies for undoing that, we're gonna have a really hard time dealing with racial inequality in every level, including health. Right, including health. And both in terms of how inequities impact health, but also when crisis hits, whether people can withstand of health crisis financially. Right. Yeah. Okay. Hi. Is there someone else next? I can go. I'm over here to your left. Paula, I'm right here. I was waving. You were looking the other way. Okay, got you. My words are so gross. Hi. I'm Grace. Paula, I was interested in your note earlier about California's Medicaid system investing in housing and would love to know the podcast that your interview is going to be on. Trade-offs. Trade-offs. Thank you. My question is about the healthcare sector, both public and private's acknowledgement of non-healthcare interventions is critical to health and that representing one example of a move in that direction. What other policies or ideas should we be thinking about at state and federal levels that would incentivize public and private healthcare actors to do more work in that space? Big question. It's a very big question. I haven't spent a lot of time doing work on that the last few years. So incentivizing, pay for it, right? But I personally am a little worried about healthcare, medical care delivery systems getting into the, they're not designed to address the social determinants of health. And so I worry greatly about this actually. But I think there is some movement in certain kinds of housing supports could be really important. And then I do think it is important for healthcare systems. I don't know how many of you have been to see the doctor going to healthcare lately and then top of all the forms that you seem to have to fill out every time you go and they ask for the same information. Have you had to fill out something that asked you, do you have trouble paying your utility bills and are you worried about where your next meal is gonna come from? And again, screening for social needs. There's a basic saying in healthcare, don't screen unless you could do something about it. So I'm going around talking to the health system, tune saying, don't screen your patients for their social needs unless you actually can do something about it. And it's not sufficient to just then refer them to the beleaguered social safety nets that exist in their community. So I personally think the best thing that healthcare systems could be doing is investing in the community and find out from the community, what do you need? What do you need that's not related to healthcare? Can we help build, do we need a community center? Do we need different transportation systems? Do we need investments in our schools? That's where I think the healthcare system is gonna have the biggest sort of impact. There are a few systems in the country that are actually investing in building more affordable housing in their patient catchment areas. So think, again, more upstream. Thank you so much for this talk. It's been really delicious to listen to. So there's been more and more focus, both domestically and internationally, in addressing misinformation, combating misinformation intentional or otherwise. And I wonder what your thoughts were on what needs to happen to address misinformation that has to do with public health issues, both from an education standpoint, but also from efforts to sort of actively combat those who may be intentionally involved in misinformation. Yeah. That's a great question too. It's not in my area of expertise. So anybody here answer that? But it's certainly a problem. And I would just say it hasn't helped. I'm sure it's a hard job being the head of the CDC during a pandemic and working on these issues, but there's been an unfortunate series of miscommunications that just hasn't helped create trust. So yeah, it's incredibly important. Yeah. And I think, I mean, there's a whole conversation around the role of the tech industry and the struggles that have, that legislators have had around regulating tech, largely because of just a lack of understanding and fewer staffers who really understand the issues that also can compete with the lobby that has developed around that industry. But one of the things that, you know, I imagine in a kind of blue sky, wouldn't it be great perspective is when we think about some of our largest technology companies having people on staff who are knowledgeable about some of the biggest issues facing us, health, election integrity, and a whole host of issues that can really help to steer the conversation within the organization around how do we respond to this and how can we be proactive in helping to guide the conversation and helping to program the algorithms in a way that respond to this. And what struck me just listening to the whole conversation around technology was there just didn't seem to be the level of expertise on the subject matter in a lot of the firms around, say, health issues. And you also need expertise of communication specialists and like political psychologists and social psychologists and communication experts because correcting misinformation is not an easy thing. You don't correct misinformation by going, oh, you're wrong here. You know, here's the right stuff. And some cases has what's called the backfire effect and it makes people even more resistant to the messages you're trying to give them. So you need people with content expertise, but you also need people who really understand the incredibly difficult thing about correcting misinformation. Absolutely. I didn't, yeah. I just wasn't sure if there was anyone else before me. Hi. Yeah, we'll come in next. Do you think the federal structure of the US government aided or exacerbated the politicization of COVID measurements here and what strategies do you think could be taken to try to move away from the politicization that happened because it happened more here in the US than probably anywhere else in the world and that divide was super strong? I just wondered what do you think could be done about that? And I think it's kind of related to the misinformation and how you address that. Guys are asking amazing questions and they're just, they're so big. I feel the weight of them. Yes, I think both the Trump administration and I also think the Biden administration has fueled the politicization of COVID and lots and lots of ways and it's not clear how to back out of it. I think there's a lot of worry about the midterms. I mean, there's always elections coming up and like in our country every two years there's a big set of elections. I just think there's just too much worry about, oh, let's just wait till we get past the election because we don't want to piss off whoever. And then we're worried about the next thing and then it's just, it's so politicized right now. I don't know how we get out of it. I just don't. Yeah, I don't have any ideas on that either. I think it's just, it's really, we're at a really difficult point as it relates to that. To the point that people select who they want to hear based on that kind of ideological divide. Yeah. Okay, well actually the two questions earlier comments actually triggered my thoughts about this. It's a big country and we have a unique system of governance, right? The federalism idea here. And it's interesting, Paula, that you were talking about some things that you do you would not do for instance, you didn't want to go to the big house this weekend. But if you look at China for instance, I mean just to carry that argument a bit further or another country that my colleague is traveling to, if you test positive for instance, you're mandatory that you go into lockdown, right? We would never do that here. Can you imagine? No, but is it the question? I guess the question that I'm posing to you is that a lot of this discussion about who's right or wrong doesn't come down to who gets to say what you could do. Isn't it really about our governance that's coming to four year and I'm not sure that that is something that do we actually want to fix that is a question. Because as a practitioner, the kinds of issues that you're dealing with and I practice in red states and it's not as simple as right or wrong or misinformation or correct information. It's about who gets to make the call and which segment of your government gets to say and whether or not you're required to do something or not, right? And so I think all of us would agree with what you just said about masking and all of that but are we actually as a group of people willing to actually say that that's what we're gonna make everyone do the same. Which I think leads to my second comment which is at the other end of the spectrum I think there's a thread of conversation about community based engagement. So our respect for community by community needs including recognizing different disparities and health differences, income differences and just conditional differences in a certain community. The reason that we care about that is because they're different in every community. So the question of how do we kind of create a consistent policy at the macro level? I'm not sure, I'm struggling with that even after decades of practicing policy in terms of how do you reconcile the two, right? Which is our value and increasingly including for our justice community and disadvantaged communities we're trying to address them separately and more engage in a holistic way. But that means that that's a community that we're trying to address because the system has failed, right? Which is I think, so anyway, those are just comments and I don't know, whatever question that you wanna take out of that, I appreciate some thoughts on that. Yeah, and I'll just say without going into my whole lecture on federalism and where the constitution, public health law basically the way it is set up in the US is that the constitution does give state and local government a lot of power, police powers they're called but a lot of power to regulate around health and hygiene and morals even it says but the state and local governments have a lot of power and then they have emergency powers on top of it to enact policies that protect people from others which is what we wanna do in a pandemic I think protect people who can't protect themselves and that's usually children or people who are cognitively impaired and protect people from themselves, protect competent adults from themselves. And so state and local governments actually have the federal government can't do a ton about COVID and federal government can't say we all need to be on lockdown but it's state and local governments that have that power and again have emergency powers. So I think like no one in this country has just the stamina anymore for their local government or their state government telling them that you have to do this, you can't do that, we seem to be quite past that which again I think it's not serving us well in the level of the pandemic we're at right now and it's not gonna help us get it to a lower level either. Mm-hmm. Yeah. One of the things that I would encourage us to think about which I really appreciate it and what I heard in your question is also this idea of the nuance of community and that's something we also should put on the table in terms of our conversations around public policy is how do you craft policy that response to these larger kind of structural issues and then appreciates and acknowledges the nuances within communities and the particularities of communities. Yes. Absolutely and one of the things that I think is really important around that is the diversity of voices at the table they can think about if we're looking at a particular policy all kinds of perspectives on how is this gonna be interpreted, how is this gonna be implemented, how is this gonna be responded to and how can we communicate what we seek to communicate and get the implementation where we would seek it to be within that level of particularity. So one of the examples that I think about that's running through my head right now is for the vaccine rollout and we know that there were real challenges around take up and a big conversation was around communities of color and the take up. And on one of the things that the I think Michigan Department of Public Health did that was really savvy was a series of messages from different kinds of stakeholders that you heard from a whole host of pediatricians about why vaccines. Then you heard from a whole host, another commercial whole host of pastors about why vaccines and just different constituency groups represented but they were all saying the same thing but the way that they were tweaking their message and the way that they were languaging their message all kind of responded from their unique positionality in the crowd that they would probably be best positioned to represent and to speak to. So that level of, it was such a great example of how do you craft a large population level policy but through the implementation and communication around it how do you have a very targeted and nuanced approach that is likely to make sure that you appreciate and respond to the diversity and bring everyone along. I thought that campaign from Michigan Department of Public Health was fantastic. Okay. Oh, it's on me. I'm sorry. It was more, Carlos by the way, it was a question relating at a structural departmental level. I know that we should engage in community activities to nuance and to change the current way that we handle our healthcare system but I was just wondering getting into the nitty gritty of if you were to actually reform to implement this policy, right? What would you say would happen to the current departments like the Department of Health or the Department of Human Services? Would there be any restructuring in those departments by any chance? Would you say that some departments would be united with others? Some departments would have less influence of others? How would like at a federal level, how would that work departmentally wise? And I don't know if that's an appropriate way to ask it. Yeah, that's a great question. There was a movement like 10, started 10 or maybe 12 years ago to think about that very, very question because so many different things impact health. So there's this movement that's called health in all policies. And the idea was not to restructure all of government that would be hard but to have like a structure overarching structure and the federal government did this under Obama and lots of state governments have they either have committees or they have like task force where people from education and housing and transportation and labor and that every government agency comes together to think about, okay, what are we doing? How does it impact health in both good ways and bad ways? What can we do to work together to think about this cascading way in which social policy is actually health policy? I think some of those efforts fizzled out a little bit but I think the idea is good because I didn't think, no one's saying let's totally restructure oh my God, the federal bureaucracy can you imagine what that would look like? But yeah, so rather than having everyone in their silos and stay in their silos think about ways that get people talking across them. Paula Lance, I am just so grateful to you. What a fantastic conversation, helpful and thoughtful and provocative and on behalf of the Ford School, your home, I just wanna thank you so much for this. Thank you, and my friend and colleague who I respect and adore so much, thank you for this opportunity to see you and hang out with you. Thank you to all of you, it was great. Yeah, and thank you to all of you for joining us. So our next policy talk at the Ford School is gonna be next Friday, September 30th. It's a panel discussion on diplomacy between the United States, key NATO allies and Russia surrounding the war in Ukraine. That is on Friday, September 4th. And I invite you to join us for this very, very, very important conversation. Now I'd like to invite all of us to head up to the second floor courtyard to continue the conversation, catch up with one another and enjoy some refreshments as we close out our welcome home celebration here at the Ford School. Thank you again. Thank you. And thank you to the Ford School team for all of your great work with this event.