Thriving and Resilient Communities

Driving Strategic Efforts to Advance Health Equity with Dr. Lauren Smith

Contagious Conversations  /  Episode 18: Thriving and Resilient Communities

Towards a North Star of what's possible in public health

After a career in pediatrics and both public and private health leadership, Dr. Lauren Smith is now stepping into the new position of chief health equity and strategy officer at the CDC Foundation. In this episode, she discusses the perspectives on health equity, systemic racism and community resiliency that she's bringing to the role.



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Below: Dr. Lauren Smith speaks at the Making It Plain: Minority Health Professionals and COVID-19 Vaccine Dissemination town hall. (view recording)





Claire Stinson: Hello, and welcome to Contagious Conversations. I'm your host, Claire Stinson. Every episode, we'll hear from inspiring leaders and innovators who make the world healthier and safer for us all. Contagious Conversations is brought to you by the CDC Foundation, an independent nonprofit that builds partnerships to help CDC save and improve more lives.

Joining me today is Dr. Lauren A. Smith, chief health equity and strategy officer for the CDC Foundation. In this new role for the Foundation, Dr. Smith will partner with the Foundation's senior leaders to develop and drive strategic efforts to embed health equity across the Foundation's COVID-19 response activities with an explicit focus on addressing systemic racism and its impact on vulnerable populations resiliency during the pandemic.

Dr. Smith joins the CDC Foundation after five years at FSG, one of the world's leading social impact consulting firms, where she served as co-CEO and led the firm's U.S. health practice. Her previous leadership roles have included serving as the medical director and then interim commissioner for the Massachusetts Department of Public Health. In this episode, Lauren discusses the importance of health equity with an explicit focus on addressing systemic racism and its impact on the ability for vulnerable populations to be resilient amidst the COVID-19 pandemic. Welcome, Lauren.

Lauren Smith: Hi, thanks for having me.

Claire Stinson: We're so excited you're a part of the conversation today and we're really excited that you're a part of our team at the CDC Foundation. So, let's start by talking a little bit about your background. You started your career as a pediatrician and you've mentioned that working with children is a practice that involves a community level focus. What drew you to this specialty in medicine and how has this really shaped your career?

Lauren Smith: Yes, well, it's funny you said I started my career as a pediatrician. In my heart, I still consider myself a pediatrician. And what I mean by that is that once you start caring for children, you recognize that their well-being is directly related to their family and how their families are doing and their parents and their siblings, how their community is doing, how their broader community is doing.
So it's really—caring for children forces you to have a broader understanding of what contributes to health and well-being. And so, I think that broader focus, that understanding of the connections, from an individual all the way out to their community, really is what has had a big impact on how I've thought about my work.

Claire Stinson: That makes so much sense. And a pediatrician does have such an impact on so many facets of a mom's life, a child's life. I'm a mom of a toddler. I certainly understand that and appreciate that. I appreciate that so much. So, do you still practice pediatrics?

Lauren Smith: I say that I practice on friends and family. I'm not seeing patients anymore. I wound that down during my time at the department of public health. It was really pretty all encompassing. I said that I went from having 20 or 30 patients at a time when I would be on the inpatient unit at Boston Medical Center to 6.5 million people I was thinking about, and caring about, their health. This was all encompassing, so I did shift then.

Claire Stinson: I love that. That's a little bit of a change, right?

Lauren Smith: Right.

Claire Stinson: So Lauren, you've worked in both federal and state government roles, including serving as the medical director and interim commissioner for the Massachusetts Department of Public Health. As we listen to the stories of frontline workers during the COVID-19 pandemic, we don't often get the chance to hear about the behind-the-scenes efforts of public health departments. How would you describe the importance of local public health leaders, especially in the midst of a pandemic like COVID-19?

Lauren Smith: Oh, it's such a good question, and really the irony or the tricky part here is that when public health officials do their work well, it's invisible. No one knows about it and the rest of the public have the luxury, really, of going about our daily lives not thinking about it, because the public health officials are thinking about the safety of their water. They're thinking about the safety of the X-ray devices that may be used on them when they seek out healthcare. They're thinking about monitoring and surveillance for outbreaks of infectious diseases. They're doing all sorts of testing and inspections for food safety, and all of that happens in the background without anyone really paying attention or knowing.
So because of that, I think the general public can sometimes not fully understand the full breadth of what local and state public health officials do to protect their safety in the background. And then, they may not value it because they don't know that it's even happening. And to be honest, I don't think public health…we're not good at singing our own praises or describing and pointing out all the ways in which the work is crucial, but it's absolutely essential to functioning communities, but unfortunately many people don't know about all the things that public health does.

Claire Stinson: That's such an important point and it's certainly come to light this year with COVID-19. Would you say that it's been a total change in 2020 with COVID-19?

Lauren Smith: Well, I think what's shifted, among the many things that have shifted more recently, is that if people don't have a full understanding of why public health officials…how they go about making their decisions, what's the evidence that they're using, they can potentially jump to some conclusions and not have a full understanding, and unfortunately, I think that has happened in many locations. The public health officials have been targeted with discomfort and dismay within communities over having to adjust their daily lives or what they're used to doing. And so, that frustration, I think, has been kind of taken out on public health officials who are trying to do their job based on the science and the evidence and I think that's been really hard on our public health colleagues.

Claire Stinson: A really important point. And trust is so important with public health leaders in a community, and so it's at the heart…would you say it's really at the heart of what public health folks do?

Lauren Smith: Trust and credibility and a sense that I am working in the background while you're asleep, while you're focused on all the things that you need to focus on in your daily life, I'm working in the background to make sure that you and your family and your community are safe and have the opportunity to be as healthy as possible. So it's both that trust and that expectation that I would be doing that as a public health official and that I'm going to be basing and making whatever decisions or recommendations I develop based on science and evidence and what the best practice is.

Claire Stinson: Very true and that invisible, powerful force working behind the scenes is so important right now. So Lauren, you recently joined the CDC Foundation as the Chief Health Equity and Strategy Officer. It's actually a new role for the foundation and an incredibly important one. Health equity is a critical part of our work, especially as the COVID-19 pandemic continues. Can you tell us a little bit more about health equity and how this has impacted your work?

Lauren Smith: Sure. I think the basic premise of health equity is really pretty straight forward, which is that everyone has a fair and just opportunity to be as healthy as possible. The follow-on to that though, is that in order to have that be true or to come true, it really requires removing obstacles to health and promoting the building blocks of health. And as we have seen this pandemic play out in ways that have made it more obvious to many people, some of those obstacles are structural with roots in our history and continuing to the current day. So, if we want to make health equity a reality, we have to think about what it would take to identify and remove those obstacles to health and promote the building blocks of health.

Claire Stinson: That's a really important explanation. How has health equity impacted your work?

Lauren Smith: Well, it's really intrinsic and underneath all of the work I've done over the past 25 years because as we started off talking about thinking about kids and families, having that idea of who has the opportunity to be as healthy as possible and being able to see and observe populations of kids who don't have that full opportunity, that really galvanized me to be looking out into the community, and the state, the nation, the broader context to identify, well, what are those barriers to health for kids and their families and how might we dismantle those?

Claire Stinson: Absolutely, and again, so much more important this year amidst a pandemic. So, in addition to developing and leading the CDC Foundation's strategic vision around health equity, you will also be focusing on systemic racism and its impact on vulnerable populations. As someone who has worked on these issues throughout your career, do you think there is greater awareness about the role racism plays in public health than maybe before the pandemic?

Lauren Smith: Well, I do think that the way the pandemic has had disproportionate burden and impact on populations and communities of color I think has, again, brought it to the fore for folks who may not have been aware of it before. But for those of us who are in public health or in healthcare who have been working in this field, we could have predicted that the pandemic would have the effects it's had on the Black, and Latinx, and Native American communities because of what we were just talking about, those structural and historic obstacles to achieving health. And so, I think that there's a greater awareness of it now and I think our opportunity is to seize on that and to help people understand how we got here.
I'm a big believer in understanding our history and understanding what came before, so I think that's really important. And I think that we're beginning to be able to have conversations about race and racism that allows folks to understand that it's not about individuals being a racist if it's about what are the patterns, and the policies, and the underlying structures that exist and how they put up obstacles for some folks.

Claire Stinson: Thank you for that explanation. I'm so glad you're a part of this conversation. And a theme that has come up in other interviews during COVID-19 is that COVID-19 has kind of served as a catalyst to bring these issues to the forefront. Do you agree with that?

Lauren Smith: I do. I think that's the exact way of describing it, as a catalyst. And I think that it's not only the pandemic, but I think that there's been a confluence of events. We've certainly seen protests, the social and political protests, around police violence that have also galvanized folks and for some folks it's an awakening, for others it's an intensification of their focus. But I think that as an example, the murder of George Floyd, which was observed and witnessed in a way that was shocking to so many people, I think, also contributed to that awakening we're describing.

Claire Stinson: We'll be right back with Dr. Lauren Smith. During this season of Contagious Conversations, we want to recognize all of the public health heroes who are working behind the scenes and on the frontlines during the COVID-19 pandemic and protecting us from many other health threats. Thank you for all that you do every day to keep us healthy and safe. And now, back to our conversation with Lauren.

So Lauren, you just started in your new role at the CDC Foundation, but what are some of the other big picture items you hope to address in this new position?

Lauren Smith: I think the overarching thing that's really motivating me is to consider how the CDC Foundation can support the CDC through partnerships with the private sector, the social sector, and anyone else who is interested on what does it take for communities to be thriving and resilient. We were just talking about the pandemic, and I think one of the things that's become very evident as we were going through this is how hard some communities have been hit by this and we need to be thinking about what does it really take for communities to be thriving and resilient? And that's partially related to being healthy, but it's also so that they can be economically thriving and socially thriving, and so that's really what I'm thinking about and I believe that people are understanding, perhaps more than they ever have, that there's a deep interconnection or intertwining of the social well-being, the economic well-being, the health well-being of communities and that you can't separate them. And so, that's an important role that public health is going to play. So thinking about that, I think, will be really important.

Claire Stinson: I love that. I love the idea of making sure that people are thriving and resilient. Those are such important words to describe what we're trying to get to past 2020 in so many ways.

Lauren Smith: Right, and I guess what I think people are recognizing is that to have a thriving, resilient economy either at a local level in the community or broader at the state, or even the national level, the underlying health of the workforce and the people who would be consumers, all of that is critically important and this pandemic is highlighting that.

Claire Stinson: Again, it really just seems like this pandemic is that catalyst. It's just really made people think and be more aware about public health, but also it has really brought these conversations to the forefront.

Lauren Smith: Right. It's illuminating issues, concerns that public health and those that care about these things have been talking about and thinking about for a very long time, but again, we talked at the beginning of our conversation about how much is invisible and happening in the background. I like to say, "When public health works well, you don't think about it. If it's not working well, then all of a sudden you notice."

Claire Stinson: So important. So Lauren, public health is collaborative work and you will be addressing issues that have a long history in our nation and public health system. As you begin your role, who are you looking to as key partners?

Lauren Smith: Well, I think of everyone or I look broadly and think widely about who could be partners. Certainly people who live it, people in the community who are experiencing some of the disproportionate burdens that we were talking about a few minutes ago have a real sense of what is working and hasn't been working. People who have a vision for what could be and how this idea of this thriving, robust, resilient community that's built on a very inclusive participation in the economy and all of that. If you have a vision that that's possible, I want to partner with you. So I have a hopeful sense about what we can do. I do believe it's not inevitable that we have to repeat the mistakes or the things that have been problematic in the past and I really feel like this is an opportunity for us to get it better, to reset in a different way and not to snap back into what was comfortable or what we might have been happening in the past because we now know that wasn't working well for a lot of people.

Claire Stinson: So as this pandemic has continued, public health has become part of the national conversation in ways that it has not been before, just like we were saying. Now that there is so much attention to the field, what do you see as the key message to get out to the public about ways they can engage in the mission of public health?

Lauren Smith: That's a really good question and my first answer to it would be to emphasize and highlight the recognition that our individual fates are intertwined with that of our neighbors. I think in the U.S., we have a very strong and understandable focus on individuality and the idea of the rugged individualism and taking care of yourself and all of that, which I understand the benefit and the appeal of that. And I also recognize that in our communities and in our society, our fates are intertwined. Our futures are intertwined. So I think to the extent that we've seen play out, how the well-being of essential frontline workers to the people who work in grocery stores or who work in convenience stores.
Their health and well-being has a really big impact on whether or not the rest of us can get food or the rest of us can go about our daily lives. So I think an important part of our message to the public is that you need to care about public health, not just because, hey, you might want to care about your neighbor to be nice, but because it's really important for your own well-being that your community is thriving and resilient. I think that's really important.

Claire Stinson: Exactly. And at the CDC Foundation, we say that public health connects us all and it's never been more true. So your work has been a commitment to community engagement as well. What do you see as some of the key tools or ways to make sure important public health messages, whether related to the coronavirus or other health challenges, are communicated in an accessible way to communities?

Lauren Smith: I think a key, just to pick up on part of what you were saying, is it's communicated in an accessible way and also, what is its relevance? How is its relevance identified or highlighted for communities? And there's a couple of things that I would say there. One is that we really need to follow our principles in building on assets and strengths of communities and not solely focusing on the limitations or the deficits that communities may have. I think that we can slip into that by looking at what needs to be fixed without recognizing the strengths and the assets that are there to build on, so I think that would be really important. I think it's important to also both recognize and acknowledge that communities have prior collective, as well as individual, experiences related to their own health, the health of their family members and neighbors, and those experiences are on their mind.
So as public health officials, when we come with messages, we're not working from a blank slate. We need to recognize and acknowledge that people are already coming to the conversation with experiences that shape what it is that they're going to hear and take away from what we're saying and we need to know that. And some of that we have to address. So thinking about the current focus on importance of vaccines and why some folks might be skeptical, or hesitant, or concerned about vaccine safety, as an example.

Claire Stinson: That's really powerful and that's really important to remember. I love the idea of making sure you're building on prior experiences and not starting from scratch. That's so important.
So research from CDC and other research institutions like Johns Hopkins has continued to demonstrate the disproportionate health outcomes of COVID-19 on people of color, especially Black and Latinx people. From your perspective, what do you see as the biggest challenges and opportunities to serve these populations?

Lauren Smith: Yeah, well, we were starting to get into that and I would say Black, Latinx, certainly Native American populations as well, I think what we're seeing is that the underlying situations, the underlying patterns of those opportunities for health, or the lack of opportunities for health that we were talking about, as the defining aspects of health equity. Those underlying situations and patterns were present before and they created the landscape health risk that has put so many of these communities of color at risk. And so, those are... Many aspects of that are beyond the reach of specifically healthcare or even public health. Those are having to do with housing quality and density, employment. Do people have job security? Do they have work flexibility so that they're able to stay home? Sick leave? We certainly saw that people, when they are worried about losing their job, which is the only way that they can help their family survive, they're not going to miss out on that if they don't have protection.

So they're going to go to work even if they might be not feeling well. So all of those underlying kinds of things are the kinds of challenges that folks are facing and I think that this, again, gives us an opportunity to think about what do we really need for that thriving, robust community and what does that mean for exposure for essential workers or people who might work low wage jobs without as many protections, as an example.

Claire Stinson: Really important points and it really does, going back to what we said earlier, it really does sound like COVID-19 has continued to serve as a catalyst for so many of these issues.

Lauren Smith: Right. People who never would have thought about work flexibility and sick leave all of a sudden we're like, "Wait a minute. That's really important. We don't want people to have to work in the grocery stores or the food processing plants, or what have you, when they're sick. That's actually not in our best interests." We end up having to close down a meat packing plant because there's been a spread of illness. That's in everyone's best interest to avoid.

Claire Stinson: Right. So many challenges, but again, we're talking about opportunities as well to serve these populations. So, Lauren, as effective vaccines emerge for COVID-19, what role should health equity play in how the vaccine is rolled out?

Lauren Smith: Well, I think it's an essential component. And I think to the credit of everyone who is considering this, both in developing the plans for how it should be distributed within the states as well as connecting with community-based organizations and others, to identify ahead of time where people might have concerns. What are those concerns based on? Is it around the testing or concerns that perhaps the folks that have been part of the trials aren't as diverse and so they're wondering if it's relevant for them. Those kinds of things. All of that is going to be really important because we're going to need folks to feel confident. We're going to need them to want to embrace this as an opportunity to protect themselves and their family members. And so, we have to be really prepared around, as I said before, acknowledging why people might have concerns about health system and research.
Unfortunately in the U.S., we do have a history of some really egregious mishaps in scientific research. The Tuskegee Syphilis Experiment is one example, and so people carry that. And then not only is it historic, people also have experiences within the healthcare system that we have right now where not everyone has great experiences. So we have to acknowledge and address that and be able to be upfront around it so that people don't think we're talking past what their concerns are.

Claire Stinson: Absolutely, and it's so important to acknowledge these concerns. How do you help alleviate these concerns from marginalized individuals including those in the Black and Latinx communities?

Lauren Smith: Well, I think that there's a number of ways. One is really to focus on what are those concerns…to hear. There's this adage about you have two ears and one mouth and you should use them in that proportion. So really listening carefully to what it is that people are concerned about and not dismissing those fears, and then also partnering. We talked about partnerships. Partnering with community leaders, community members. We want to be able to support these community leaders, community members, other folks who are credible and really legitimized members of the community to be able to say, "Hey, we understand what's happened. We believe in the results. We have confidence in the results so we think that this is a good idea for you and our neighbors and for me to be able to embrace this really important way of protecting ourselves and our families." But we're going to need significant transparency about how the trials were done, what was included, what were the outcomes and the effects.

I think having the results endorsed by other trusted members of the community, say for example, the National Medical Association, which is the group of African-American doctors, or the groups of Hispanic or Latinx doctors and healthcare providers, and Native American healthcare providers so that people really feel that they can trust both the message and the messenger.

Claire Stinson: Thank you for explaining that. And really acknowledging these concerns is so important so I'm so glad you're making these points. As the pandemic continues, the nation still must contend with existing health equity challenges that may have now become further strained since COVID-19. As part of solving these challenges, how do you see different sectors of public health coming together?

Lauren Smith: Well, I'm going to go back to what we were talking about before, which is that the primary concerns and priorities within the public health sector haven't changed fundamentally because it's those underlying fundamental issues and concerns and obstacles that we started talking about at the very beginning of our conversation that have landed us where we are. So we need to continue to focus on those very same obstacles, those structural or social determinants of health. So, that's all still there. I think that the opportunity we have now is that we have many more people who have been activated or who now recognize that there is a role for others to play in creating the kind of healthy communities we want. And our opportunity, I think, and our challenge in public health is to coordinate and to mobilize all of those folks who've been activated so that they can really contribute in a meaningful way.
I think that we also recognize the essential importance of coordination at the local, state and national level. I think that we've seen what can happen when there's not that level of coordination and alignment both in purpose, messaging, as well as an understanding of what people's different resources and capabilities are. So, I think that's going to be really important. And then, the last thing I would say is I think that it's to be essential for us to make the support of our public health colleagues and leaders a key part of what elected officials do, what community members do, so that they're not feeling so isolated or embattled frankly.

Claire Stinson: Right, absolutely. Do you see others who should also join this work that may traditionally be outside of the public health sphere?

Lauren Smith: Well, certainly I think that the business and the private sector are really...If they didn't know before, they certainly know now that their well-being and functioning of our economy is intimately related with public health and well-being. So I think that there's a tremendous opportunity for our business sector, private sector colleagues to partner and I think that folks recognize, again, it's in their best interest. It's not just something that's a nice to do. It's really essential for their success.

Claire Stinson: And at the CDC Foundation we say, "Together our impact is greater," and I think people will see the value in that now more than ever.

Lauren Smith: Right, I agree.

Claire Stinson: So Lauren, thank you for being a part of this conversation. This has been such an important conversation. As we wrap up, here's a question I often like to ask guests on this podcast. What advice do you have for the future public health leaders of America?

Lauren Smith: Oh boy, that's a big question.

Claire Stinson: It is a big question.

Lauren Smith: Gosh. Well, I guess I'm going to come back to this theme of having a vision of what's possible, not losing sight of that, having that really important North Star. I think one of the things that I know is true for those who are in the trenches in public health is that you can be doing so much firefighting, responding to the urgent and crucial needs that come before you that it can be harder to step back and say, "Hey, what are we working toward? What is our vision for what's possible?" And I think being able to do that then allows you to have that North Star so that even as you're being confronted by urgent needs and lots of competing priorities, it allows you to be able to take a breath and say, "This is where we're going. This is where we’re headed and I want to align my efforts in that direction." So I think being able to balance the need to respond to urgent and crucial crises with the need to be thinking ahead and having a longer-term view. I think that can be really hard in public health, but it's also incredibly important.

Claire Stinson: I love that.

Lauren Smith: And not to lose hope because I really do believe that people can be more motivated by a vision of what's positive and what is possible than through fear and division. So I think that would be really important part of leadership as well.

Claire Stinson: Really powerful and I love that. I love ending on a note of optimism and on having a North Star. So Lauren, thank you so much for joining our conversation today. It's really been a pleasure learning more about your new role with the Foundation and I'm sure we will benefit immensely from your experience.

Lauren Smith: Oh, well, thank you for having me. It's been a pleasure to have the conversation and I'm looking forward to diving into the role.

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