184: Advice for PH Officials

Dr. Lisa Piercey, Tennessee’s Health Commissioner, reflects on her time in office as she prepares to leave her position at the end of this week; Dr. LaQuandra Nesbitt, Director of the District of Columbia Department of Health, says her department...

Dr. Lisa Piercey, Tennessee’s Health Commissioner, reflects on her time in office as she prepares to leave her position at the end of this week; Dr. LaQuandra Nesbitt, Director of the District of Columbia Department of Health, says her department created programs to address vaccine access and hesitancy by listening to community feedback; and ASTHO’s Dr. Kim Wyche Etheridge and Wisconsin State Health Officer Paula Tran talk about health equity in a video conversation now online.

Washington Post – Live: Health Equity Vaccines

ASTHO Q&A: Health Equity, Minority Health & COVID-19 – A Conversation with Paula Tran and Kimberlee Wyche-Etheridge

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This is Public Health Review Morning Edition for Monday, May 23rd, 2022. I'm Robert Johnson.

Now, today's news from the Association of State and Territorial Health Officials.


Vaccine equity and a plan to improve dental care in underserved areas of Tennessee top the list of accomplishments Dr. Lisa Piercey is thinking about this week. She leaves the job as Tennessee's health commissioner on Friday. Piercey reflects on her time in office and offers a bit of advice to our colleagues in today's morning conversation.

As you leave your position at the health department, what are you most proud of during your three and a half years there?


That's a great question. I'm glad you ask because, you know, I think about it in two separate buckets: I think about COVID work and I think about non-COVID work—because there was a time before COVID and thankfully there is a time after COVID.

But during the pandemic, when I think about what I'm most proud of, we had a strong, almost singular focus on vulnerable populations, and that encompasses a lot of things. You know, for us, it was long-term care, it's the incarcerated population, it was the socially vulnerable communities using the SVI—particularly with vaccine distribution, it was overcoming or trying to eliminate disparities amongst minorities but amongst also our very large rural population here in Tennessee. And taking care of the vulnerable population was always the first thing we talked about and was always top of mind, and I'm really proud of that. And I think our outcomes show that; as compared to the overall mortality rate, our long-term care mortality rates what are the lowest in the nation. And so, I'm really proud of that as it pertains to the COVID work.

Now, when you think about the non-COVID work—which there was some of that, too—I'm very, very proud of what we did in the dental or oral health space. And that's not something that gets a ton of press, or it might not even be top of mind for a lot of folks; but we are one of, if not the largest, safety net dental provider in the state. And what we realized is we don't have enough dental professionals. And even if we did, the state at large doesn't have enough dental professionals—not only in public health, but in the state as a whole. They are over a million Tennesseeans without access to dental services. And then, we've got this large, you know, deficiency in oral health professionals, and it's going to grow over the next 5–10 years with upcoming retirements.

And so, over the last year or so, we got a $94 million package passed that is a five-year effort to expand the dental professional pipeline, to recruit and retain dental professionals to underserved areas and to safety-net populations, and to enhance some of those wraparound services for the uninsured, like orthodontics and elderly case management for oral health services. But one of the biggest things is as that was moving through the general assembly, it also became readily apparent that we need to expand TennCare, which is our Medicaid program for adult dental services. And so, I'm very, very excited and proud to say that we're soon going to be bringing 600,000 Tennesseeans on the roles of adult dental TennCare.

And so, those are the two biggest things I think when I think of legacy and think of the things I'm most proud of. That's how I think about it.


You've dealt with the pandemic for most of your time in this position. How does an event of this magnitude shape your thinking as you move to the next stage of your career?


I probably can't think of a better answer other than the biggest lesson I learned—and I started learning it very early in the pandemic and have kept it in mind throughout—and that's simply the notion that facts don't change people's minds. And when I first had that realization early in the pandemic, I thought, "Oh, well, maybe I'm not saying things clearly enough or simply enough. You know, this is complicated scientific material, maybe I need to break it down." Then I thought, "Well, maybe I need to say it a little louder or a little harsher to get people's attention," and that wasn't it either.

And I had the realization that if you were giving a fact pattern but it causes them to go against their, quote, "tribe"—and you can define tribe however you want to: religious, ethnic, community, family, social group—if it causes them to go against those norms, the facts are secondary or perhaps even irrelevant and people would rather fit into their tribe than be right.

So, what I learned through that—not only in public health messaging, but sort of taking it out into the world as next steps—is we've always known that you have to have a trusted message and you have to have a trusted messenger, but we've got to be cognizant of sort of those tribal norms—and I'm using that with a lowercase T and in the broader sense—and we're going to have to start tailoring our message, whether we like it or not.

If we want people to hear the message and internalize the message, we've got to make it both accurate and accepted. And that's admittedly very difficult and a very tricky proposition; but if we're going to be effective, that's what we have to do.


That's good advice, whether you're in the middle of a pandemic or not.

You have a few days left in office. Any other words of wisdom for your colleagues around the country who are still going to be doing this work in a week?


Well, hang in there. You've gotten through some really hard things and you will get through hard things in the future, but I would leave you with some advice. That, when I've been thinking back—and I've been doing a lot of reflecting lately about what were the underpinnings of our administration success, and it was the ability to engage the private sector. And I don't know about others, but I've sort of always thought about public-private partnerships as more of a theoretical term. And yes, we've done it. We do it in a lot of different ways because it works and we're supposed to.

But when you're faced with really big problems, I would encourage you to get the big private sector players at the table. And I'll admit that's somewhat of a scary proposition for those of us in government who sometimes find comfort in our insulation and in the way we've always done it. And we always tend to think that the private sector is coming to us in a unilateral direction, you know, oftentimes with their hands out. But when you really engage them and bring them to the table, you're just exemplifying the concept that we all know and know works, which is, you know, diversity in thought. And whether that's in the boardroom or in a governmental committee or in some type of administrative work, getting those folks to the table with a different perspective and, frankly, a different set of resources really drives better outcomes. And so, that'd be my parting advice to my fellow SHOs.


Piercey is leaving her position after three and a half years to launch a new healthcare investment company.


How has the pandemic impacted health equity? That was the question at a recent panel discussion hosted by the Washington Post.

Dr. LaQuandra Nesbitt directs public health for the District of Columbia. She says equity should be a concern for everyone.


We really adopt this notion that health equity is everybody's business. It's everyone's job, it's everyone's work. So, I think it's critically important that when you're adopting population health frameworks, when you have patient safety and quality initiatives, any community health initiative that you have has to be done through an equity lens. It's not enough to achieve improved health outcomes for your city overall, and still have wide disparity gaps.


On the matter of vaccine access and hesitancy, Nesbitt says her department created programs based on community feedback.


We created a senior buddies programs. We did faith and vaccines initiatives with the faith-based community in our city. We did in-home vaccinations where you could call us and we come to your home so that people who had challenges with, if they were caregivers to seniors and couldn't leave the house, or they had childcare issues. We did everything we could to really make getting into neighborhoods a priority for folks.


You can watch the full conversation using the link in the show notes.


Finally this morning, ASTHO's Dr. Kim Wyche Etheridge and Wisconsin state health officer Paula Tran talk about health equity in a video conversation, now online. Tran discusses community engagement, COVID vaccinations, and what it took to implement health equity strategies in her department. There's a link to the video in the show notes.


That'll do it for today's newscast. We're back tomorrow morning with more ASTHO news and information.

I'm Robert Johnson. You're listening to Public Health Review Morning Edition. Have a great day.

LaQuandra Nesbitt MD MPH

Director, DC Department of Health

Lisa Piercey MD MBA FAAP

Commissioner, Tennessee Department of Public Health