Building a Culture of Health and Social Justice with Dr. Richard Besser
How to (Truly) Change the World
Changing the narrative on opportunity and public health
Dr. Richard Besser, president and CEO of the Robert Wood Johnson Foundation, discusses his Foundation’s efforts to build a culture of health in America, why that effort requires a national shift in mindset, and why he still believes that working in public health is really about working to change the world.
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 (CDC) save and improve more lives.
Joining me today is Dr. Richard Besser, president and CEO of the Robert Wood Johnson Foundation, a position he assumed in 2017. Dr. Besser is the former acting director for the Centers for Disease Control and Prevention, and former chief health and medical editor at ABC News. At the Robert Wood Johnson Foundation, Dr. Besser leads the largest private foundation in the country devoted solely to improving the nation's health. The Foundation's work is focused on building a comprehensive culture of health that provides everyone in America with a fair and just opportunity to live the healthiest life possible.
In this episode, Dr. Richard Besser shares his career path, some takeaways from his CDC leadership experience, and the Robert Wood Johnson Foundation's vision for building a culture of health.
Dr. Besser: Oh, it's great to be here.
Claire Stinson: To start, your career path has been quite interesting because you started as a pediatrician, then you were a CDC leader, then you were chief health and medical editor at ABC News, and now you're president and CEO of the Robert Wood Johnson Foundation. Can you tell us more about what led you to this point in your career?
Dr. Besser: It's interesting if I think back to the start of my career, when I was in medical school and thinking what I was going to be doing, I thought I'd be spending my entire career doing global health work, living overseas in a variety of different countries. And I've been incredibly fortunate to be able to have worked in as many sectors as I have.
The big driver for me going back to college was wanting to be involved in changing the world, in making the world a better place, and I've kind of used that as the filter as I've looked at opportunities that have come my way.
Claire Stinson: Well everyone wants to change the world. That's an amazing goal. I love that you had that at a young age. Did you have any big influences in your career path?
Dr. Besser: Yeah. Along the way there were a number of people who were really important, and mentors play such an important role in people's lives. When I was in residency at Johns Hopkins, the chair of the department, a guy named Frank Oski set a really high standard for us. He wanted to make sure that in our roles as pediatricians we weren't just providing good care, but we were challenging the type of care that was being given. We were thinking about how to answer questions that hadn't been answered. We were always keeping in mind the role of the pediatrician, not just as the provider of healthcare for a child, but as an advocate in the broader system for the overall health of kids.
Frank Oski had a really profound effect on my career in many different ways. He was a gifted researcher, clinician and teacher. I came out of my residency thinking that I wanted to do the same. I wanted to do research, I wanted to teach and I wanted to take care of kids. And I've been able to do that throughout my career. Not always at the same time, but frequently at the same time. I've been able to continue to practice pediatrics in every one of the jobs that I've had. A half day a week, but it's kept me in touch with the issues that were most important to me. Issues around social justice. Issues around inequity. And by staying clinically active in community clinics, it's been able to keep me close to the problems that I wanted to address.
The second person who I would say had a profound effect was someone else I met during residency, but it was on maybe one of my first rotations as an intern on the floor. I think it was on the infant floor at Hopkins. The attending. The attending is the chief doctor who oversees care, and oversees the residents. He was from the School of Public Health. His name is Dr. Mathuram Santosham. And he was doing work all over the world, as well as on Native American reservations looking at improving health. And I had gone to Hopkins for my residency because I wanted to connect with people at the School of Public Health, and here in my first rotation I'm meeting him.
And I approached him and I said, "Dr. Santosham, when I finish my residency, I'd love to come work for you." And we got to know each other, and I did. As soon as I finished my residency, I got a job with him working for a year in Bangladesh. Learning how to do research. Learning about diarrheal diseases, and their impact on children's health. And he has stayed a friend and mentor over the entirety of my career.
Claire Stinson: They sound like wonderful influences, and I believe we gave Dr. Santosham an award, if I'm remembering that correctly. I believe the CDC Foundation gave him the Fries Prize for Improving Health, so I know he is an impressive individual.
Dr. Besser: Yeah, you did. And when I was at CDC, after the year I spent in Bangladesh, I came back to Hopkins for a year, and then went to CDC, and joined the Epidemic Intelligence Service, which is an amazing program that trains people in field epidemiology. It trains you to be a disease detective. And that program at CDC was totally career changing. It showed me the power of science to answer questions, the thrill of solving a mystery and trying to help a community. And on my first outbreak investigation, I also met the woman who I married, and that changed my career trajectory in really big ways.
Claire Stinson: Well that's awesome, so that was a win-win situation. I love that. What is your favorite part about being a pediatrician?
Dr. Besser: I love children. I love interacting with children. I like the role the pediatrician plays in translating complex information to parents. It's something that I've done as a general pediatrician. It's something I did at CDC when I was in leadership. It's the role that I played at ABC, translating science and health information to the public. And it's something that I always keep in mind here at the Robert Wood Johnson Foundation when I think about how we talk about our work, and the importance of making sure that it's in plain language that anyone can understand.
So much of what we do is about prevention and is about helping children get on the right path to reach their potential. And that's really pretty exciting to think that you can have some impact early in a child's life that could affect their entire life course. It ties in with the mission of public health. It ties in with the vision I have, and what excites me about health and health equity is this idea of opportunity for people to experience health and well-being to their fullest.
Claire Stinson: I love thinking of things in that way. Tell us more about the Robert Wood Johnson Foundation's approach to building a culture of health. What are some of the guiding principles as you work to improve health and healthcare for everyone in America?
Dr. Besser: The culture of health is a journey we've been on for our history, but it's something we defined about six years ago. And what this is is a recognition that while healthcare, and access to high quality comprehensive affordable healthcare is so important to health. If you really want to think about what it takes for people to have the opportunity for health, it goes way beyond there. It goes to what takes place where we live. Whether we are living in housing that is safe and affordable. Where we work, whether we have jobs that pay a living wage, so that we've got time to spend with our families, but also the resources to be able to buy healthy food, and do those things we know that it takes to be healthy.
Where we live in terms of neighborhoods, and whether we live in neighborhoods that are safe, and afford people access to jobs, access to the environment, to places to play. And where our kids learn, our schools. Do our kids go to schools that provide them with a good education? With high quality food? With physical activity? With the opportunity to set forth in life on the right foot?
So the culture of health is a recognition that health isn't something that's given to you by the healthcare system. It's something that has to do with the opportunity that society provides. We ground all of our work around a culture of health in health equity. And what we mean by health equity is the idea that it's about opportunity. Everyone needs to have a fair and just opportunity for health and well-being.
We talk about personal responsibility being part of health, and it's really important. People have to make healthy choices, but often times we don't reflect on the fact that for many people they don't have healthy choices. And the choices that we make so much depend on the choices that we have, and we want to make sure that everyone has those healthy choices to make.
Claire Stinson: Absolutely, and it sounds like your background as a pediatrician has really helped inform some of that culture of health work as well. Going back to what you were saying earlier, would you say?
Dr. Besser: Oh, incredibly. In every clinic that I've worked I've seen examples where parents know what their kids need, but they're not able to provide it for reasons outside of their control. I remember a grandmother in Harlem at the clinic I was working, she was the primary care giver for her grandchildren, and she'd traveled about two hours to the clinic to be seen. And I was going through the CDC recommendations on physical activity. The CDC recommends an hour five times a week for children.
I said, "What kind of physical activity are your grandchildren getting?" And she said, "Well they're spending a lot of time sitting around the house." And I said, "Well in terms of their health, that's really not a good idea." She said, "Well it's not safe for them to go outside in our neighborhood to play. And so I don't have a choice."
And the idea that all it takes is educating people around what the guidelines are, and what the science says for health without reflecting on people's lived experience, and their ability to follow through, that's a lot of what we're talking about. It's something I saw in clinics all the time. A mom whose child had severe asthma, and lived in an apartment with dust mites, and had a landlord who couldn't care less, and wasn't going to clean it up. The ability for that child to have a full and healthy life was severely impacted by their housing, by their living conditions.
Claire Stinson: Sounds like you're the right guy for the job at the Robert Wood Johnson Foundation.
Dr. Besser: Well thanks very much.
Claire Stinson: Rich, going back to the fact that you were former acting director for the Centers for Disease Control and Prevention, what are some key takeaways from your CDC leadership experience that have shaped your views about health?
Dr. Besser: There are a lot. I mean CDC was... is so important for me. The years that I spent working there I just loved. There are a number of takeaways. I'm a big believer in government, and the power of government to do good, so when I hear people talk down government it really gets me mad. I've never worked at a place where people were more committed to improving the life of those in the United States and around the world then at CDC.
One of the things that I take away from my time there is the importance of good science, and the importance of debating that science in ways that are respectful and open. We have as one of our guiding principles here at the Robert Wood Johnson Foundation, something that was also a principle at the CDC, and that's the importance of rooting our activities and the change we're working on in the best available evidence, analysis and science, openly debated. And that was true at CDC. We would have knock-down drag-out debates all the time.
Another thing that I learned especially in leadership at CDC was the importance of clear and honest communication. During the swine flu, the H1N1 pandemic in 2009, I was in the position of acting director of the CDC. When we got together and planned our strategy for addressing that pandemic, communications was a central part of that, and we made a pledge that we were going to let people know what we knew as soon as we knew it. We were going to tell people what we didn't know, and what we were doing to try and get answers, and we were going to give people the best information we had at the time of actions they could take to reduce the chances that they would be adversely impacted by the pandemic.
And those principles are principles that I used after CDC, during my years at ABC News. They're principles that I carried through and use here at the Robert Wood Johnson Foundation as well.
Claire Stinson: Would you say that the H1N1 response was the most meaningful part of your CDC experience?
Dr. Besser: I don't think there was a time that I was prouder of public health. Of governmental public health at the federal, state, local, territorial, tribal levels. It was a time where we were visible to the public in a very positive way. Public health has an identity challenge. Most of the time what takes place in public health, especially governmental public health is invisible. It's not something people see. They see it when there's a breakdown. When there's an outbreak of measles like is taking place right now in places around the country. When the water that they're drinking isn't safe to drink.
Those are times when people say, "Oh, why is this happening? Why isn't public health doing more?" During H1N1 people saw public health responding, and providing information that was of real value. It helped people deal with their fear. It helped people think about what they could do to protect the health of themselves and their families, and that was to me a really rewarding time in my career.
Claire Stinson: We'll be right back with Dr. Rich Besser.
Since this is a show about Contagious Conversations, we want to hear from you. Each episode we'll ask you a question, and this episode's question is what does public health mean to you? Just email email@example.com to answer. That's firstname.lastname@example.org. And if you share your thoughts with us, you'll have the chance to win some CDC Foundation merchandise.
And now back to our conversation with Rich.
Any other defining moments from when you were at CDC?
Dr. Besser: Early in my days at CDC, I was involved in starting a program called Get Smart: Know When Antibiotics Work. This was a program that was designed to try and address a problem that's still a major global health problem, and that's antibiotic, or antimicrobial resistance. The fact that microbial organisms are mutating faster than we're able to develop drugs to treat them. And the part of the problem is the use of antibiotics for conditions for which antibiotics have no value. Using antibiotics for viral conditions.
And we had very little money. I think we had about a million dollars to run this program across the entire nation. That's not a lot, but what we were able to do was harness the passion that we found around the nation, layout a vision, and work together to really change how many people thought about antibiotics, and how they should be used.
I worked on that program for about seven years, and during that time we saw a dramatic decline in the prescribing of antibiotics for colds and flus. We did the science to track it. We really built coalitions that involved business, that involved the public, that involved schools, all different kinds of sectors. And the experience from that is very similar to some of the work we're doing around culture of health, and thinking about who needs to come together to address this issue. How do you make this issue real? How do you change mindsets so that people think about a health problem, or a situation in a different way?
And that experience at CDC of leading Get Smart: Know When Antibiotics Work was a real highlight for me.
Claire Stinson: Sounds like it, and that's such an important topic. I know that we work on that at the CDC Foundation as well, and it's one that resonates with a lot of people as well.
Dr. Besser: Yeah.
Claire Stinson: Here's a question I'll bet a lot of our listeners are interested in. Who is the most interesting person you ever interviewed while you were at ABC News?
Dr. Besser: That's an easy one. I was able to interview quite a lot of people, but my favorite interview, and the most interesting one for me, was President Obama. I was able to interview him kind of late in my career at ABC News. It was nearing the end of his time in office. I was only given five to seven minutes with him, and so there was a big flurry of activity at ABC to figure out what I was going to be asking him about.
Claire Stinson: I'm sure.
Dr. Besser: And it was really terrific. He talked about one of his daughters having asthma. The interview was focused around climate change, and we talked about how worsening air quality is so hard on everybody, but in particular people who have breathing, respiratory problems. Children and adults with asthma. We talked about the fear he'd experienced when one of his kids had an asthma attack. But I was also able to ask him about what has been viewed as one of the biggest health... public health problems in the nation, and that's gun violence.
And we talked about Sandy Hook and the failure to implement any kind of gun control activities following that. And he said that that was the biggest disappointment in his presidency. That he thought that the nation was going to be able to rally around just some simple measures, background checks, some simple controls. And the inability to treat that as a public health problem is something that was very concerning to him, and still persists around the nation.
Claire Stinson: Absolutely. And what an amazing experience for you to interview President Obama. I bet that was incredible.
Dr. Besser: It really was. It was an honor to be able to interview him, and it was really a terrific experience.
Another interview that has really stuck with me was in 2014, during the Ebola epidemic in West Africa. And I had the opportunity to travel to Liberia twice during that, once very early in the epidemic. And I met a physician there, his name was Phillip Ireland, who was working in the emergency room in one of the large hospitals in Monrovia, and he had contracted Ebola himself. And I interviewed him on his front porch. He had recovered, but he talked about his experience being cared for in his own home, where people would bring food to the window. The fear that was instilled by those who were around him, and this life and death struggle that he had as someone who was a healthcare provider who had Ebola.
And it was just a very moving interview. It was inspiring to hear him talk about his desire to get better, so that he could go back and care for some of the patients who were suffering so badly.
Claire Stinson: Let's move on to a question about partnerships. What have you learned about partnerships since taking the role as president and CEO of the Robert Wood Johnson Foundation?
Dr. Besser: Philanthropy for me is a new sector. I've been working here now about two years. It's very different from governmental public health, where we'd be directly implementing programs, and we would be looking to see their impact on people. Philanthropy does its magic through the grants that we make, and the partnerships that we have. We look to partnership as a critically important part of our work.
I was saying before how important health equity is to our work, and for us one of the things that we're trying to do is figure out well who are some of the key partners who can carry that message of health equity, of opportunity, forward? People or organizations that may be a little unexpected. One of those organizations is the national Y, and we've been partnering with them for quite a while. And people may ask, "Well why are you engaged with the Y if you're focused on health?" I guess it makes sense because that's where a lot of people learn to swim, and that's where people go to use the gym and play basketball.
But the Y is about so much more than that, and for them partnering with us is partially about expanding how people think about the Y, and what its role is in communities. For us we see the Y as an incredible way to reach people in communities across the entire nation. There are more than 10,000 Ys. And the Y is so much more than a swim and gym. The Y is the largest provider of daycare services in the entire nation. It's one of the largest providers of diabetes education. They're also incredibly important in terms of the social fabric of communities.
They released a video that looks at the different experiences people have based on zip code, and how your life experience, just change one number in your zip code, and your entire life trajectory could change. Well that comes out of data from work that we’ve funded, that shows that your zip code and your life expectancy are highly linked.
We're here in Princeton, New Jersey, and life expectancy here is about 87 years. The clinic I work in, in Trenton. Same county. It's about 14 miles away. Life expectancy there is 73 years. Fourteen miles, fourteen years. That's incredible. Hearing it from people at the Robert Wood Johnson Foundation, and health people is one thing, but hearing it as well from the Y. That's one of those unexpected messengers.
And we have a great relatively new partnership with 4H that reaches young people all around the nation looking to identify the health issues in their communities, and bringing together coalitions to address those. We're partnered with the American Cancer Society, which is moving forward on the health equity message. The NAACP. These are all groups that are so well respected in their communities, and for us we see those partnerships as essential to accomplishing our mission.
Claire Stinson: I did not know that the Y is a source of diabetes education.
Dr. Besser: Yeah, isn't that incredible?
Claire Stinson: Absolutely. And I have to say one of my favorite projects that I've worked on here at the CDC Foundation is the 500 Cities Project, which is a partnership with the Robert Wood Johnson Foundation. And that project identifies and reports on 27 chronic disease measures, focused on conditions, behaviors, risk factors, that might have an effect on people's health at the census tract level. And it was so fascinating because I believe the Robert Wood Johnson Foundation did bring up their partnership with the Y as part of that.
Dr. Besser: One of the things that we love to do is bring together our various partners, so that they can then work together. We view the CDC Foundation as an important partner, and being able to connect the CDC Foundation with our other partners is absolutely terrific.
Claire Stinson: And so important. You have now been at the Robert Wood Johnson Foundation for about two years. If you could accomplish one key initiative above any others, what would it be?
Dr. Besser: As I think about my time at the foundation, and what would success look like when I'm ready to retire from this job, if in America we have a different understanding of health, and what it really means to provide people with an opportunity to lead a healthy life, I will feel that my time here has been really well spent. It is a change in mindset. It's a change in narrative.
We've done a lot of work around childhood obesity, and a lot of that work has shifted the focus from obesity being all about personal responsibility, to obesity being the result of the social context in which a child or an adult lives. And if we can continue to work on that mindset shift, so that we're thinking about who needs to come together to truly make opportunity there for all, that would be success.
One of the things about the Robert Wood Johnson Foundation that I've always loved from before I joined the organization is the focus on investing in people, in leaders. When I was at CDC, I had a joint project with the CDC Foundation and the Robert Wood Johnson Foundation, and it was on something called Meta-Leadership, which is training people to lead across sectors. It was all focused around emergency preparedness and response, but it was this idea of how do you get people to work together and lead across sectors, lead across organizations that may not report to you?
And it was absolutely terrific, and it's something that's been in the DNA of the Robert Wood Johnson Foundation from the beginning. This idea of invest in leaders and they will identify what the key problems are to solve. If you help give them the tools and the skills to address those problems, you will truly change the world.
And we have four new change leadership programs here that are helping people gain the skills to work across sector, to be able to identify and solve the problems in communities across America. And it's one of the things that really keeps my hopes up. It keeps me optimistic that we're on the right trajectory.
Claire Stinson: I love the idea of investing in people, and you're a very inspiring person. You're making me want to get out there and change the world, so thank you for talking to us today.
Dr. Besser: Thanks very much.
Claire Stinson: This is my favorite question to ask our guests. What career advice do you have for future public health leaders of America?
Dr. Besser: My advice is if you got into public health because you believe in working to change the world, to make it a better place. If you believe that coming together you can make a more just society, you can ensure that everyone has that opportunity to experience a job that has meaning, that pays a good wage. Living in an environment, and a community that supports health. Raising a family or connecting with loved ones in ways in which you're respected, and a democracy in which you feel you can participate in, and really affect the course of your life. Don't let anyone tell you that you can't do it. Don't let anyone tell you that public health isn't about making the world a better place, and shouldn't hold that out as its overarching goal. I think that working in public health is a true privilege. Don't let anyone tell you that that's not worthwhile.
Claire Stinson: Really powerful. Thank you so much for sharing your story with us today, Rich. This has been very inspiring. You've had such an interesting career path, and I really enjoyed talking with you today. And on behalf of the entire CDC Foundation, we want to thank you for your partnership.
Dr. Besser: Thank you, Claire. It's been a lot of fun talking with you today.
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