40. Tomorrow's Public Health Professionals

Contagious Conversations  /  Episode 40. Tomorrow's Public Health Professionals





Judy Monroe: Hello and welcome to Contagious Conversations. I'm Dr. Judy Monroe, President and CEO of the CDC Foundation and host of today's conversation. Every episode we hear from inspiring leaders and innovators who make the world healthier and safer for all of us. 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 are Anna Heilers and Dr. Antoine Denis. Anna is currently an MPH candidate at the Indiana University, Purdue University, Richard M. Fairbanks School of Public Health. She works at the Indiana State Department of Health as a Covid-19 Epidemiologist 1 on the CDC reporting team, and has also served as Tobacco Cessation and Prevention Division Graduate Governor Summer Intern at the Department of Health. Dr. Denis is currently an MPH student at the Columbia Mailman School of Public Health. In 2022, Dr. Denis launched an effort to improve health safety in New York City by strengthening a network of hand sanitation stations in subway stations and other transportation nodes around the city. Welcome to you both.

So, I'd like to start at the beginning and hear from each of you how you first became interested in public health. So, Anna, tell us a little of your story.

Anna Heilers: So I was one of those very nerdy children that always had her nose in a book, and when I got into middle school and high school, I started getting really interested in infectious disease. I started using historical outbreaks for my class projects and then when I took my first dual credit class, I was reading in our textbook and there was a chapter on public health and in there it had a definition of epidemiology and I just pointed to my textbook and I shouted, "Oh my gosh, that's what I want to do!" And so shortly after that I started looking for epidemiology undergraduate programs, which are pretty rare to find. And I came across the IUPUI, Richard M. Fairbanks School of Public Health where we had a program in the works that was also an accelerated program. And so I just knew once I started talking to the faculty, that was where I was supposed to be.

Judy Monroe: I love that. What a great story. And Antoine, same question to you.

Antoine Denis: Yeah. Well first of all, thank you so much for having us. I would say my passion for public health really stems from family roots. Growing up, my father lived below the poverty line and really my grandparents had to move mountains to make ends meet. So really the family faced food insecurity. And when my grandfather passed away from lung cancer, he made my father, at that point 17 years old, promise to persevere through adversity and really to help lift our family out of poverty. When I was born, my father really kept his promise, I'd say, in part by instilling in me the values that helped shape my thinking and really this desire to help others led me to apply to med school.

And throughout med school, I did feel compelled to be of service to vulnerable populations including disadvantaged youth like my father and the elderly facing extreme social isolation, especially during the pandemic. And I also realized the importance of addressing and understanding the root causes of illnesses, not solely their pathophysiology. And really through these initiatives in the hope to address some of those barriers, I really felt a strong connection to my family's origins and it really gave me a confirmation that public health was for me the obvious next step forward.

Judy Monroe: That's a really compelling story. Dr. Bill Foege has told students over and over that if we lift folks out of poverty, we'll overcome so many of our public health issues and challenges to health. So thanks for sharing that. So why do you all think it's important to engage in public health work?

Anna Heilers: I think that there are a lot of reasons that we should engage in public health work, but I would say that one of the most important reasons is because in public health we have the power to champion health equity. In public health, we have the capacity to assess gaps in healthcare through opportunities in the realms of public health informatics, through epidemiology and biostatistics, and we're able to assess who is more affected by certain health outcomes. And then through community-based research and community-led and evidence-based interventions, we can work to address these issues.

Judy Monroe: Antoine, back to you on that question.

Antoine Denis: I think public health work is vital for improving betterment of our society. I really do feel privileged to be part of this field. And while it's true that the successes of public health initiatives may and often do take years or even decades to manifest, I think the potential to save lives and really to prevent suffering is just immense. One of the most inspiring aspects of public health work, I think, again, as I mentioned previously, is to focus on addressing the root causes of health problems rather than just treating symptoms. It's also about thinking outside the box and being innovative.

We just have to look at public health successes like the eradication of smallpox or vaccines or the recognition of tobacco use as a health hazard. All of those have really saved millions of lives and really the benefits of public health work are far-reaching and also they're cost-efficient. I think public health work also allows us to collaborate with community stakeholders, establishing trust and communicating effectively to again, promote healthy behaviors and also prevent illnesses. And also, I must add that it is incredibly fulfilling and also rewarding, which makes it a lot of fun along the way.

Judy Monroe: That's great. So, the issue of schools of public health supporting the work of health departments and the practice of public health is a pretty hot topic these days, and both of you really typify that outreach. What do you believe is driving that?

Antoine Denis: I do think that the driving force is the increasing recognition of the crucial role that public health plays in our society. We've seen this especially during the Covid-19 pandemic, where the measures taken in public health have been vital in both reducing the spread of the virus, but also by saving lives. But it's not just pandemics. Public health challenges like obesity and climate change do require this collaborative approach that really involves all key stakeholders, whether that's government agencies, healthcare providers, those community organizations, and also academia like schools of public health.

They all play, I think, a vital role in it. And what I think is exciting is that public health schools are recognizing more and more the importance of engaging with the community. And I think by involving those community members and the planning, implementation and evaluation phases of any real public health interventions, I think we can better understand what their needs are, what their challenges are of diverse populations, and really to develop strategies that are more effective to address them. And maybe lastly, I'd say that public health is becoming also increasingly complex and interdisciplinary like pretty much all other fields. And I think the schools of public health are perfectly positioned to lead this change, this shift, by providing their research, the education and also the training that's needed to develop those evidence-based policies, which hopefully can achieve our shared objectives.

Judy Monroe: Anna, what would you add to that?

Anna Heilers: Yeah, so I completely and totally agree with what Antoine said. There are so many different reasons that there are collaborations between schools of public health and health departments. And I think one of these is that there's a great need for workers in the field of public health. And if we can get our future workforce exposed to the work that we do day in and day out, they're going to be better prepared to enter our organizations and be able to enact change to be able to carry on the torch once we've laid it down.

Second, like most professions, there's always a learning curve. So, in the classroom we'll learn about healthcare disparities, but when we actually get into public health practice, I think our understanding of those disparities deepen when we actually meet people from the community who may be living with some of these social determinants of health. Collaboration also between schools of public health and state and local health departments are very mutualistic. Schools of public health have a better research opportunities and are better able to gain experiences for their students. And then health departments are able to gain future workers from the experience that those students gain. They're also able to engage in different research opportunities as well.

Judy Monroe: Yeah, so both of you bring up some excellent points of what's driving this and why the need is so great. And I think the reference to the complexity of the problems that we're facing, we can't solve these problems alone. So, Antoine, you and your colleagues from the Columbia University Mailman School of Public Health launched the RISE Project in New York City last year. RISE stands for re-Imagining Infection Safety Engagement. Can you tell us more about this project and what the goals were?

Antoine Denis: Yes, absolutely. Really, really proud of the RSCE project. So, this was launched basically by myself and Adam Snyder, MHG student at Columbia, and also a very good friend of mine. Our main goal is to fill a gap, which we identified in the primary prevention measures that are in place in New York City. And that is specifically the lack of hand sanitizer in high traffic areas such as metro stations, bodegas, restaurants and also local churches. Our team is made up of grad students from various departments within Columbia's Mailman's School of Public Health. And we're really lucky to have the support from world renowned experts in the field of epidemiology and healthcare management like Dr. Robert Fullilove and Professor Heather Butts. Advisors help us look at the projects from three different angles and make sure that we're taking a well-rounded approach. And so that's our big mission, which is pretty ambitious.

So, to achieve it, we really take a three-pronged approach. So first we conduct research. After all we're in academia. We want to understand really what is driving people to use hand sanitizer, and we want to track also where dispensers are made available to the public in the city. So that's the first approach. The second one is really to take action. So ,we literally walk around our neighborhood, which is Washington Heights, and we engage with the store owners. We try to offer them hand sanitizer dispenser and really try to understand their perspective. And lastly, we try to raise awareness to promote healthy behaviors in the city.

And I think what's really unique about RISE is that it's a community driven initiative and that we believe that it's important for institutions like Columbia University to better engage with its surroundings. And we think that initiatives like RISE are a way to do just that. And ultimately, I think the RISE project is about bringing our community together and really promoting better public health outcomes for all.

Judy Monroe: Well, I love the initiative coming from you and your colleagues and faculty. It's really fabulous. Have you had any big surprises? What's been the greatest surprise doing this work?

Antoine Denis: Yeah, absolutely. I would say the first thing is that launching it was way more challenging than I would've expected it to be. When you just think about it from a fundamental standpoint, we want people to be able to wash their hands pretty much anywhere they go, where there's a risk of transmitting either the influenza for example, or diarrheal diseases. So, getting the funding was really, really challenging. On the flip side, engaging with students and offering opportunities for students at Mailman to engage with our program was really fun. And the response from students was extremely positive. Most of them wanted to participate, and we're really now at a point where we're filtering applications and because all of them, that's really what they want to do. They want to engage with the community in a meaningful way and hopefully make a difference out there.

Judy Monroe: I have to tell you, I directed a residency program years ago, and I was also surprised at how the residents really wanted to engage and do volunteer work above and beyond the work they were doing in the residency, but we needed to make it user-friendly for them. So, it sounds like you put the structure together, you gave the students the opportunity to engage and be involved, which is really terrific. We'll be right back with Anna Heilers and Dr. Antoine Denis.

Public health professionals support the work of health departments across the country. As the need for public health workers grows, learn more about the role of public health in our global health infrastructure. Visit the CDC Foundation website at cdcfoundation.org/what-public-health to learn more.

And now back to our conversation with Anna Heilers and Dr. Antoine Denis.

Antoine, you are also the founder of a nonprofit organization in Canada called Academic Immersion in Healthcare with the mission of sparking interest in advancing the presence of underrepresented populations in future generations of healthcare professionals. Talk to us a bit about that organization as well.

Antoine Denis: Yes, absolutely. So AIH is a nonprofit that I founded in 2018 in Montreal. In my first year of medical school, I noticed that low SCS groups were still severely underrepresented in my program. So I must say my head was really pulled out of the sand, and it also motivated me to take action. So what I did is basically I began by visiting high schools in underprivileged areas of Montreal. The goal was really simple; to help break down the perception that medical school was unattainable for them. We received immense support from Nicole Li-Jessen at McGill, and also Sami Chergui, a very close friend of mine. We provided hands-on teaching of suturing. We displayed anatomy in real time using ultrasound machines, and we gave motivational talks on healthcare career opportunities. And again, the goal was very simple. It was to inspire them and make them believe that they could reach whatever goal they put themselves on.

While engaging with those students, I really discovered how many of them were facing significant barriers such as food and housing insecurity. And it reminded me of my father's story, who back then had to move mountains to make it past even high school. And I would say that this experience motivated me to create AIH with the goal, again, of boosting their confidence in achieving their full potential. And today AIH is offering mentorship, acute simulation events and also an interactive digital platform to support students from low SCS group. And I would say that through this work I've definitely grown both personally and professionally, but most of all, I've developed a passion for promoting EDI and addressing barriers in access to higher education, one of those social determinants of health.

Judy Monroe: Listening to your story, I can only imagine how proud your father must be and how proud your grandfather would be of you for taking on these issues.

Antoine Denis: Thank you so much.

Judy Monroe: It's really, really terrific. So, Anna, like Antoine, you have also been very engaged in the work of public health, even as a student. You worked at the Indiana Department of Health in several different roles over the past few years focusing on public health needs like tuberculosis, tuberculosis outbreak in Indiana, and you've collected data on youth tobacco use. So, tell us about your experience at the Department of Health and tell us more about your current role as a Covid-19 epidemiologist on the CDC reporting team.

Anna Heilers: Definitely. So, I started working with the Indiana Department of Health in 2019 as an E-vaping Associated Lung Injury intern during my sophomore year of undergrad. And then when Covid hit, it was about the same time that data collection on e-value was wrapping up, and so I asked my supervisor if I could go ahead and hang out a bit and help out with Covid. I bounced around for a while doing different tasks, just trying to help out with the immense workload that was pushed on to our epidemiology resource center at that time. And then I later accepted a position as one of our CDC reporting team student workers. At the close of that program, they then asked me to help with some contact entry for the FiberCel TB investigation, which was a great opportunity to learn about extra pulmonary TB transmission. And then I started searching for my graduate internship.

I was referred back to the Indiana Department of Health to the Indiana Youth Tobacco Survey internship, and I got to help out with the 2022 partner exchange, which was a wonderful educational opportunity that I will never forget. After that, I was asked to go back to the CDC reporting team and join them as one of their new EPI1s. In my current role, my work involves a lot of data cleaning. For instance, when we pull case investigations that have mismatched race and ethnicity in our systems, we work to correct those so that we have accurate race and ethnicity data, so we're better able to assess healthcare disparities.

And additionally, our EPI1s on our team are allowed to engage in research opportunities, and several of us have been able to take that on as well, which is very exciting as students to be able to engage in real-world research. And then additionally, I'd like to just suggest that all public health students work to try and gain experience within a state or local health department. It provides you with so many different opportunities. You can attend events, you can attend conferences and you can gain practical exposure in the field.

Judy Monroe: That's a terrific answer and great advice. And corollary question to that is, can you share from your wisdom and experience, how do you balance the workload of study versus engaging in active public health work or volunteerism?

Anna Heilers: I would say that it definitely takes a lot of discipline and no one ever has it figured out on their first run. It's something that takes a lot of trial and error, and it's definitely a balancing act. Many of my classmates I know are married with kids, and so they're trying to balance school, public health work and family responsibilities. As someone that does not have to balance that extra family responsibility, it is a little bit easier for me, but it is still definitely difficult and students do have to try and find what works for them in terms of managing the workload. It is definitely tricky, but I think that it's a very rewarding process as well because in that process you learn a lot more about yourself and who you are as a student and who you are as a public health worker.

And then also I think that it also helps students find their organization system that works for them. So ,I know at Fairbanks, a lot of us have multiple calendars. We'll work with one paper calendar and one Outlook calendar, and then we will coordinate the two back and forth. And when we decide to hang out with friends, we send each other calendar invites rather than just normally texting people. So, there's a lot of different ways that we can try and balance that workload, but it's definitely a balancing act and students have to find what works best for them.

Judy Monroe: Yeah, I love the emphasis on developing organizational skills because those are skills that are lifelong skills that will benefit greatly. So, when it comes to providing public health students opportunities to connect with their communities, to carry out actual public health work while in school, where are schools and public health departments doing a good job? And where do you think organizations could do a better job? Are there opportunities being realized? Antoine, I'm going to toss that one to you.

Antoine Denis: What a great question. And I think it's one that is more relevant than ever. I do think it's crucial for schools of public health to engage students in hands on work because it helps them become more invested in the field and prepare to face some of those real-world challenges. For example, at Columbia, MPH students are required to complete a practicum or an internship in public health. And I do think that it gives them some practical experience, lets them work on meaningful projects and also lets them have the opportunity to apply with the learning class to real-world situations.

However, I would say that most of those internships come in just too late. I do vouch for another type of learning method, which is to get your hands dirty and then look for tools to solve the problems you face. Going back to Einstein who once said, if you're given an hour to solve a problem, you'd better spend the first 55 minutes thinking about the problem and then leaving the last five minutes to think about solutions.

And I think this quote raises a fundamental question about how much we value delving right into the problem and figuring out on our own by engaging with the material. And I think that one of the ways public health schools can do a better job is by supporting student led initiatives like RISE, for example, where students can work through real world scenarios and figure out solutions on their own. I think schools should follow also the lead of “B” schools, of business schools, who have to allocate funds, discretionary funds, for student led projects. And I really think that this would encourage more innovation, entrepreneurship, and learning, all of which I think is really essential for creating this next generation of public health leaders.

Judy Monroe: I think taking lessons from the business schools is a really great advice for public health. That makes a lot of sense to me. So, I want to move to a couple of future questions here. Anna, I'm going to start with you. How do you think your experiences will shape your future career in public health?

Anna Heilers: So for me, I know that my experiences in public health have already started to shape my career. My experiences have allowed me to ask more direct questions when I'm in meetings. They've enabled me to work in an interdisciplinary fashion through my AHEC Fellowship and with fellow students at IUPUI. I think that my experiences have helped me to have a focus specifically on healthcare disparities. In the classroom we can learn about these disparities, but when we actually get into public health practice, we actually gain a better understanding of what's actually going on in those situations. When we start engaging with the community and start listening to their concerns, I think that's what makes us better public health workers and healthcare workers.

Judy Monroe: That's really good. That's good. And Antoine, how about yourself? Where are these experiences going to shape your future career?

Antoine Denis: I must disclose that I've had an amazing time in New York this year, and I really think that my conversations with–whether that's healthcare professionals, administrators–they've all really been enlightening and eye-opening on so many fronts. I've realized how much potential there is for more collaboration like Anna just mentioned, and to shift the words ‘more preventative care’ and really to unite communities at all levels. More specifically, through RISE I have met some amazing people who were dedicated to making the world a better place, but also through initiatives like RISE, I realized how much sometimes difficult it is to move the needle.

So as for my future career in public health, I'll be starting a five-year public health and preventative medicine residency at McGill University, which is going to start on July 1st. To be fully honest, I'm still exploring different sub-fields in public health, but there is one thing that is for sure, and it's that I want to be a public health physician who really uses innovation and technology to address some of the most critical healthcare challenges. And really my time here in New York has been very inspirational on that end. And I really want to bring communities together and promote preventative care, and I'm really, really excited to keep learning and growing as well in this field.

Judy Monroe: So that's a great segue to my last question, again about the future. So, Antoine, what do you see as the biggest challenges ahead in public health?

Antoine Denis: Well, I think the answer that everyone would agree with is that there are so many challenges that are facing public health right now, whether that's ranging from climate change, antimicrobial resistance, non-communicable diseases like diabetes, emerging communicable diseases, but also the need to provide healthcare in really vulnerable settings all across the globe. I think those issues are complex and require, again, the collaboration of people across sectors and really to come up with innovative solutions. But really, I think that one of the biggest challenges is simply getting people to care about public health in the first place, not just during times of crisis.

I think it's difficult to convince individuals, communities and sometimes politicians too, to invest in measures where the benefits are not always immediately apparent. So I really think that sustainable funding for public health units must be provided to ensure that it's going to continue in the long term. Again, not just in times of crisis. And at the end of the day, I think it's all about being more and more creative, innovative, open to collaboration. There's so much potential for public health work to really make a difference out there in people's lives, but we need to be willing to really roll up our sleeves and get to work because the best, but also I think the worst is yet to come.

Judy Monroe: Then Anna, over to you. Biggest challenges ahead in public health.

Anna Heilers: I would say that one of our biggest challenges ahead in public health is just tackling misinformation. I think that with Covid we all saw the ease at which that misinformation can spread, and then once it's out there, it can be very difficult to manage. And with mistrust in government, and there's something always out there in the world that are contradict us, it can be really difficult to make a case that people are willing to listen to.

Judy Monroe: So I'm going to thank both of you for a fabulous conversation. Thank you for your dedication, and we look forward to hearing about some tremendous impact that both of you will have in your future careers on public health.

Antoine Denis: Thank you so much.

Anna Heilers: Thank you.

Judy Monroe: Thanks for listening to Contagious Conversations produced by the CDC Foundation and available wherever you get your podcast. 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.