27. Relationships Matter

Contagious Conversations  /  Episode 27: Relationships Matter





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 the Centers for Disease Control and Prevention save and improve more lives.

Joining me today is Dr. Mysheika Roberts, health commissioner for the city of Columbus, Ohio. Dr. Roberts leads a team of more than 500 public health professionals who are focused on neighborhood-based approaches that address the social determinants of health from safe, affordable housing and education to jobs and violent crime in order to decrease the health disparities that exist. Dr. Roberts has a 20-year public health background at the local, state and national levels. She built a solid foundation in public health early in her career by investigating outbreaks in Ohio for the Centers for Disease Control and Prevention and leading an STD clinic and hepatitis prevention efforts at the Baltimore City Health Department. Welcome Dr. Roberts.

Dr. Mysheika Roberts: Thank you. Glad to be here.

Claire Stinson: We're glad to have you on the podcast today. So, let's talk and start today by talking about your background and your journey to becoming the health commissioner for Columbus, Ohio. I know you're not originally from Ohio. So how did you become interested in medicine and end up in Columbus, Ohio?

Dr. Mysheika Roberts: Yeah. Well, great question and one I always enjoy sharing. I grew up in a healthcare household. My mom is a nurse and my dad is a physician. And growing up, I knew I wanted to go into medicine and I wanted to be a physician. And I told my parents all the time, I want to be a doctor like dad, but I've got to do it different than he did. Because my dad had his own private practice, back when physicians had their own private practice, and he saw his own patients in the hospital as well. And my parents were divorced. And so on weekends with my dad, my sister and I would spend a lot of time waiting for my dad to see his patients in the hospital. So we would spend many hours in waiting rooms in hospitals, waiting for dad to round. And I just knew that wasn't the lifestyle I wanted. And there had to be a different way of doing medicine without spending so much time in the hospital with sick people. And how could I deal with well people. Fast forward, went to college and was pre-med and got introduced to public health really two ways. One is I grew up in Los Angeles, so I was a huge Laker fan. And dating myself, I was in college when Magic Johnson announced to the world he was HIV positive. And that really spurred my interest in public health, through the HIV movement. I took a class, fell in love with it, and really the rest is history.

Claire Stinson: Well, that's a great background story. And you also have experience with the EIS program through CDC, correct?

Dr. Mysheika Roberts: Yeah, correct. So that's how I got to Ohio. I was working in Baltimore at the STD clinic and my boss at the time asked me what I wanted to do when I grew up. And I said, "Well, I want to lead a health department." And she said, "Well, I think the best way for you to do that is to do the EIS program."

So she introduced me to the program, I applied. And when I applied, they said, "You're in, but you have to go to Columbus, Ohio, and work for the state health department for two years." And so I came to Ohio kind of kicking and screaming and ended up falling in love with Columbus, Ohio. And as my two years with EIS were ending, I got offered a job here at the local health department as the medical director that turned into a wonderful career. And then eventually, I became the health commissioner.

Claire Stinson: Wow. That's great. Well, thanks for sharing that. And we should mention that EIS stands for Epidemic Intelligence Service program with CDC. That's a great background story and it brought you to Columbus, Ohio. So in your role as health commissioner in Columbus, you lead a team of more than 500 public health professionals, like we spoke about in your introduction. And they're working on approaches that address the social determinants of health from safe, affordable housing and education to jobs and violent crime. Talk to us about this work.

Dr. Mysheika Roberts: Our work is so important. I always believe that real public health is at the local level. And so we're dealing with people every day in their lives. And so, whether it's someone who is recently diagnosed with HIV and needs treatment, whether someone has an STD, whether someone wants to prevent their pregnancy, or wants to be sexually active but is not ready to start a family yet, we provide family planning services. When we talk about infant mortality work, that work is so important. And there's so many different aspects that we can be involved in to help them with safe sleeping, making sure they're connected to prenatal care, making sure they're connected to WIC services or good nutrition once the baby is born for both mom and baby, and for the whole family. We've gotten into drug overdose work and the opioid epidemic. We have really gone head first in that and providing NARCAN training and treatment for those who are dealing with the disease of addiction. We've even gotten into the work of violence.

So I mean, public health, and I share this all the time, the work is so important, but it's also so diverse. We had a conversation with some of my leaders within my department just yesterday, all talking about our journeys to public health. And we all got here a different way and with different backgrounds. But that's the beauty of public health, it's so diverse. And there's so many different things you can do in public health, from the clinical work that I described to restaurant inspections, pool inspections, body art inspections, all things to keep our community healthy and safe.

Claire Stinson: It does sound like a really rewarding job. And I do agree that so many folks that we've interviewed in this podcast didn't seem to set out originally looking for a career in public health, but they ended up in public health and are all the better for it. So I love that that's a story for so many out there. So, let's pivot to COVID if we can. Many, if not all, health departments in this country have had to address stark inequities during COVID, in terms of mortality, hospitalization, vaccination and more. How did you and your team approach dealing with or working to prevent these inequities?

Dr. Mysheika Roberts: Well, first I think we just have to recognize that these inequities existed before COVID. COVID just ripped the Band-Aid off of them and really made these inequities visible to everyone, even those outside of public health and outside of the individuals who've been living with the inequities for decades. Early on, I always tell this story. The first case of COVID-19 we had here in Columbus, Ohio, was an African American. And this person had traveled. So at that time, that was a high-risk activity for COVID-19. They had traveled outside the country. They later shared with me that they had to beg the healthcare providers where they were seeking care to test them for COVID-19. Now, keep in mind, testing was very limited early on in the pandemic. So you had to meet certain criteria. But this was the second time this person had sought healthcare and they had to beg the providers. And finally were able to convince a nurse who then convinced the rest of the treatment team to test them. And they tested positive and ended up being our first case.

So clear indication of some of the inequities that we had experienced during this pandemic. But I think one of the first things that we did when testing became more readily available here in Columbus, but really across the country, is we knew that our Black and Brown residents, and our residents who were not connected to healthcare, so they didn't have a primary care provider and they didn't have the resources, the financial resources, to go to an urgent care or someplace like that to get tested, would be lost. And they would not be able to get tested and they could further spread the virus in our community. So we set up a testing program with all three of our adult hospital systems, where individuals in our community could call the health department. And if they wanted to get tested for COVID-19, they could come to the health department to get tested.

And we had a hospital of the day, so to speak, that was providing testing for anyone in our community who wanted to get tested on that given day. That worked out very well. It took away a lot of the red tape. You didn't have to have a healthcare provider. You didn't have to have access to the internet. All you had to do was have a phone number and call us. And to that effect, we even took walk-ups. So we had people walk up, ride up, and it was drive through. So that was one of the first things we did to really address some of these inequities and try to have a level playing field for everyone to get tested in our community. And that process worked out very well. And to some extent, we've continued it today. It's just no longer happening here at the health department, but you can call us and we will get you tested.

Claire Stinson: Wow. What a success story. That's incredible that you were able to get that off the ground. And I'm sure it benefited the community immensely. What was it like for you being the health commissioner during COVID-19?

Dr. Mysheika Roberts: Well, I can't deny the fact that it was hard. There were a lot of restless nights. There was a lot of stress. But I was fortunate that I had a tremendous amount of support from my staff to elected officials here in my community. And to the business community, our partners, as well. Particularly, the hospitals really helped out a lot. But being an African American and being a woman made it challenging, especially knowing the disparities. I mean, early on what we saw were Black and Brown individuals were more likely to be infected and more likely to die from COVID-19. And so much of that was because of the work that so many Black and Brown people do. Black and Brown people didn't have the luxury to work from home. If they were working in the food industry or in the transportation industry, those were jobs that could not be done remotely.

So they were on the front line. And at that time, masks were not recommended for people who were not in healthcare. So they were constantly exposed. They didn't have healthcare and they didn't have insurance. So if they got sick, they were not likely to take time off because then they weren't going to get paid because they were hourly employees. And that was hard to watch and to understand and to explain to people what was going on and why we were seeing this disparity, particularly in mortality, among our Black and Brown communities. And so as the pandemic progressed and as we got to be able to offer vaccines to certain groups, I was a huge advocate in my state that I thought minorities should have priority in getting vaccines, especially those working on the front lines. And I wasn't able to successfully get that passed through the state. But what we did do is we started offering what we called an opportunity clinic. So we took neighborhoods in our community that we've identified as opportunity neighborhoods. These are neighborhoods that have a high population of minority individuals, low income, low educational rates. And we made them a priority. And we had a special clinic just for them to come get the vaccine clinic. As long as they lived in those neighborhoods, they could come and get the vaccine from us through a special clinic once a week where we vaccinated 150 people. And so that was really rewarding that I could say we did something like that for our community who was in great need.

Claire Stinson: We'll be right back with Dr. Mysheika Roberts.

The CDC Foundation is convening a National Summit Series on the future of public health in collaboration with the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, Big City Health Coalition and other public health partners to advance recommendations for a modernized U.S. public health system. The Lights, Camera, Action Summit Series includes virtual convenings, leveraging recommendations across a variety of research. Learn more at futureofpublichealth.org.

And now, back to our conversation with Dr. Roberts.

Let's talk a little bit about community partnerships. I know you've mentioned a few examples, but talk to us about your experience with community partnerships and multisector partnerships in Columbus.

Dr. Mysheika Roberts: Yeah, well, I'm a huge believer that relationships matter. And so I've been working for the local health department now for almost 16 years. And I've had the opportunity to build relationships during that time. But during the pandemic, I really got to see the benefits of those relationships and the need to even form more relationships. As the really only noticeable physician that works for the health department, I was viewed as the voice of public health for this community. And so I found myself stretched really thin early on trying to spread the message about COVID-19, and then moving forward to spread the message about the COVID-19 vaccine. But I really relied on those relationships. And I realized that if people needed to hear from me, and if that made a difference in them following the public health guidance or getting the vaccine, that was something I was willing to do and needed to do. So I did countless numbers of round robins and community forums, all virtual of course, to just talk to residents and constituents about what was going on, what we knew, trying to be as transparent as possible about what we knew at the time about the virus, about the effectiveness of the vaccines, when the vaccines became available, about testing, about everything. And sometimes my staff would say, "Oh, I don't know if you should do that. There's only going to be 20 people on the call."

But those 20 people could make a huge difference if they talk to 20 other people, and then they talk to another 20 people. And I remember vividly, they asked me to do a call on a Saturday. And it was a group of moms who had kids that had Down syndrome. And these were African American moms with Down syndrome. And this was a group that my staff said, "At most, there's going to be 25 people on the call, Dr. Roberts, are you sure you want to do it? And we can't get someone else to do it." And I said, "No, I want to do it." And if you could see the reaction to those moms, when they had an hour to ask me any questions they could. And there was a sense of relief at the end of that call, that they felt good about vaccinating themselves and their kids. And so that makes all the work that I do, my team does, it makes it worth it. And sometimes it's not the number of people, it's the connection you make. It's that relationship. And it's the trust that people have in you. And I realized that many people that I didn't even know had a tremendous amount of trust in me. And if they heard it straight from me, they were more likely to follow that guidance.

Claire Stinson: Wow. That's really powerful. You have so much experience with this community partnership angle. And it sounds like your voice of public health in the community was such an important and trusted voice. And so again, the community just benefited so much from your leadership here. Tell me more about community engagement in Columbus in general. How is Columbus moving along the spectrum of community engagement?

Dr. Mysheika Roberts: Yeah, well, it's something that we had been working on before the pandemic. Which I'm grateful that we did because when the pandemic happened, not only did I have relationships, but others in my department had relationships and had been engaging the community. With COVID, there was a different type of engagement, obviously. You couldn't see people face-to-face. We were accustomed to going to community events and churches, which weren't really happening. None of those events were taking place during the pandemic. So we found ourselves at a challenging point when vaccines had been readily available for about six months, but there was still a pretty sizable disparity between Black and Brown individuals, who'd been vaccinated, and Caucasians, who'd been vaccinated. And so we wanted to see how we could close that gap. And so many people, particularly from the state level and other leadership levels were telling us, "Have what they called a pop-up clinic. Go to this corner and provide the vaccine for four hours on this today. And do this and do that."

And I kept saying, "I don't know. I don't know if that's what the community wants." So we hired a company that had good relationships with the community to really go door-to-door and find individuals and survey them about what they wanted and needed. And what we heard clearly from the community is they wanted consistency. They wanted to know that if we were going to provide the vaccine, we would be there every Monday afternoon at a certain location. They wanted a location that they knew about, that they felt comfortable going to. So community rec centers, community-based agencies that they were familiar with. And so we had a neighborhood approach where we went into their neighborhood, set up shop by providing the vaccine where we had a schedule. So if someone came on a Monday to get the vaccine, they could go home and tell their neighbor, "If you can't make it this Monday, they're going to be there every Monday. So go back the next Monday or the next Monday."

And that is what we heard loud and clear the community wanted. And it was clear from the way they turned out that that's what they needed. And so we did that. It was place based, it was consistent. And then to top it off, we also started providing $100 Visa gift cards for people coming to get their first dose of the vaccine. As a result of that program and those relationships and that community engagement, we actually got rid of the disparity and actually found that Black and Brown individuals in our community by January 2022 were more likely to be vaccinated against COVID-19 than our Caucasian residents.

Claire Stinson: Wow. Well, congratulations on that success. And what a powerful example of the work you're doing on the ground in the community. And it does sound like you're such a trusted voice in the community. So let's pivot to multisector partnerships. They do occur on a regular basis in public health departments, including with partners like businesses. Why is it important to engage all parts of communities in public health work?

Dr. Mysheika Roberts: Well, we can't do our work alone. Really, no one can do their work alone. And that's what our mayor preaches all the time. Government cannot do this alone. And so it's important to have partners that believe in you, that are willing to carry the torch, that understand the message and the information and what needs to be done. And that can assist you in spreading the word. Just yesterday on the conference that I participated in with CDC Foundation, someone said that second to an individual’s healthcare provider, it was their employer who they had the most confidence in the information that was shared to them. So when it came to COVID, second to your healthcare provider, if you heard something from your employer, you were more likely to believe it and follow it. And so, Columbus has multiple employers. And so it was important, whether you're a food service industry, whether you're a bank, whether you're in housing or whether you're in healthcare, that we provided those entities with accurate information, accurate resources, to help us to partner with us to co-brand things so that we could effectively reach our population.

Claire Stinson: Sounds like Columbus is a shining example. How do you envision this work changing post COVID-19?

Dr. Mysheika Roberts: Well, what we do is what we call the “Columbus Way” and how we work together. It's known that if you're in Columbus, it's the “Columbus Way” and we partner and work together. So I see this, post pandemic, as we move into an endemic stage, those relationships will continue and there'll be even more relationships. And we've already started to brainstorm of, what else can we do? How can we work to reduce violence in our community? How can we work effectively together to reduce homelessness in our community? How can we work effectively together to reduce food deserts in our community? And I really think in many ways the pandemic has brought us closer together. Even though we couldn't be in the same room with people, there's this relationship and this connection that we all have now.

Claire Stinson: We've heard that many times in this podcast that working together is key, working with the community is key. And that COVID-19 has kind of served as a catalyst to help shine a light on so many other issues that were in existence before COVID, but have been maybe more brought to light because of COVID-19.

Dr. Mysheika Roberts: Many people outside of healthcare, and who aren't a minority, were unaware of the health disparities that we have in our community, whether we're talking about infant mortality, whether we're talking about violence, whether we're talking about obesity, diabetes. I think it's really helped as a catalyst to bring more partners to the table.

Claire Stinson: Right. Absolutely. So you mentioned it earlier, but the CDC Foundation is convening a national summit series with partners that is exploring ways to build a stronger, more equitable and more resilient public health system for the future. It's called Lights, Camera, Action. And the most recent virtual summit focused on catalyzing cross-sectoral partnerships and community engagement. What do you believe are some of the key takeaways from the summit that the public health community can turn into action?

Dr. Mysheika Roberts: Yeah, so it was an excellent summit, by the way. So congratulations. I think there are a few things that we can all do. The first is there are so many community-based organizations out there that want to partner with public health and want to do more. And so I think it's going to be imperative from the federal level to the state level and to the local level that we all look at funding and how we can change the funding model that has been out there for so many years. First and foremost, and I say this as a local health department, as we get funds, funds need to be sustainable. Getting funds that just are good for 12 months is not an effective means to move the needle in the right direction. So we need sustained funding. So funding that preferably lasts at least three years, if not longer, so that we can really start to make a difference.

We also need to allow our community-based organizations, who are very connected to our communities, help drive some of that decision making. So not make the funds so restrictive. If we're providing resources to help us with drug overdose, it's very broad versus saying with prevention or with treatment. And so the community-based organization can figure out what their lane is and provide the services that best fit them for the services that they have available.

And then, we have to get rid of some of the red tape. And that not only goes for community-based organizations, but even for a large health department like mine. Some of the red tape that's expected, some of the forms that are expected to be completed every 30 days or every 60 days, really bog us down. And it gets in the way of us doing really good work. And so we really need to look at those funding models.

And then I also think as a health department and to better work with community organizations and that engagement with the community, we've got to look at our data. We've got to make sure the data that we have on the issues at hand are readily accessible to our community and understandable. So I employ over ten epidemiologists here at the health department and they do great work, but I'm always challenging them. How can we share this with the public? And how can we share it in a manner that they can understand and interpret themselves? And so, I think that is very important too. That we have to make sure we collect the data, we analyze the data, but then we share it back to the community. So they understand the progress that we've made or the progress that we still need to make.

Claire Stinson: Absolutely. Such important points and important perspective. And thank you for being a part of that summit. There are undoubtedly many challenges facing public health right now. What are some of the bright lights that give you hope right now?

Dr. Mysheika Roberts: Well, I think some of the bright lights are for the first time, I think our whole country knows what public health is. Public health was kind of under the radar for so long. And now, I think many people know what it is. And most people have a very positive perspective of public health. I think that will help us as we get more people interested in public health as a career. And so, as we go and try to recruit individuals, I think we're going to see more young individuals applying to schools of public health, graduating from schools of public health and wanting to work in public health. I think that's one thing.

I think the other thing, if I could just talk about my staff. My staff are incredible. I mean, they stepped up to the challenge. And I think even though sometimes they were beat up on in the media and sometimes things weren't always easy, I think they have this energy in them like, wow, we can do anything. Anything is possible. Look what we were able to accomplish over the last two years. And I really see this fire in them now. They're coming up with ideas and suggestions of things I didn't hear from them three years ago, presenting to me. They're being creative. They're thinking outside the box. And they're realizing that really anything's possible because during the pandemic we were trying to do anything we could to keep people healthy and safe, whether it was getting them tested, getting them into treatment or getting them vaccinated. And so I think the sparkle in their eyes about what they can do is definitely a positive and gives me hope for the future.

Claire Stinson: Well, thank you so much for sharing that. Thank you for sharing all of your perspective today. It sounds like you're an incredible Health Commissioner and I'm inspired by your work. I know others will be too. It's not a surprise that your staff are inspired by you. We really appreciate you being a part of Contagious Conversations.

Dr. Mysheika Roberts: Thanks for having me. I enjoyed it.

Claire Stinson: Thanks for listening to Contagious Conversations produced by the CDC Foundation and available wherever you get your podcasts. Be sure to visit cdcfoundation.org/conversations for show notes. And if you like what you just heard, please pass it along to your colleagues and friends, rate the show, leave a review and tell others. It helps us get the word out.

Thanks again for tuning in and join us next time for another episode of Contagious Conversations.