The Check Up: Brian Castrucci of the de Beaumont Foundation

Brian Castrucci of the the de Beaumont Foundation joins the Check Up to talk about lessons learned from COVID-19 and what needs to be done to prepare for the next pandemic.

MH: Hello, I'm Matthew Weinstock, managing editor of Modern Healthcare. Thanks for tuning into the latest edition of the Check Up. The COVID-19 pandemic, as we know, put the nation's public health infrastructure under a microscope. And now as the nation slowly begins to recover, attention is turning to what lessons the healthcare industry and policy makers and Public Health experts have learned from the pandemic. I'm pleased today to be joined by Brian Castrucci. He's president and CEO of the de Beaumont Foundation which works a lot with communities and stakeholders and providers to address community and population health efforts. And we're going to talk about what changes public health may be in store for to get us ready for the next pandemic. Brian, thank you so much for being with us today.

Castrucci: Thanks for having me.

MH: So let's start, before we delve into some of the lessons learned from COVID and the public health infrastructure. Maybe you could talk a little bit about what de Beaumont has been doing in communities. Obviously you have a long history of working with communities on community health, population health. But in particular to COVID, what are some of the efforts you guys have undertaken?

Castrucci: Well, we're very fortunate to be the home of the Big Cities, Health Coalition, and that's really where the pandemic started. It started in some of the nation's largest cities. And so having an opportunity to work with them through their executive director, Chrissy Giuliano, has been really important and I encourage everyone to check out the Big Cities Health Coalition. There's a lot to be learned there from that group. We also worked with ASTO and the Public Health Labs to support them through their response efforts. And then for us, we really focused on messaging. We worked with Frank Luntz to figure out what are the words that work. We believe that the right messages from the right messengers can save lives. And so we started working with folks in all different kinds of populations. Then as the pandemic wore on really honed in on Republican voters, because they were a group that had the most concern about the vaccine.

MH: Yeah, it's interesting. We talk about vaccine hesitancy and there's been so much attention at the early stages on minorities and populations of color and hesitancy there. But there has been a lot of data now showing that it cuts across political beliefs, urban, rural as well. Right? So maybe you could talk a little bit about what you've found in messaging and what's worked.

Castrucci: It was super important to start with communities of color. They were bearing a disproportionate burden of both disease and death. But once we started to see more communities of color go from concern to confidence, we then pivoted into Republican voters and really helping to understand what was motivating them. And I think unfortunately COVID has been politicized from day one. And so, we're really not having a conversation about a health issue, we're having a political conversation. And so when Republican voters saw manipulation or indoctrination, their walls immediately went up, this is why we still say we probably shouldn't mandate vaccines. When you mandate vaccines, it stops being a health issue. And again, becomes an issue about liberty and freedom and government overreach. And so we have to really provide the facts. We need trusted messengers. So physicians, pharmacists, other healthcare providers, pastors, and other religious leaders and peers and parents. These are all people who are trusted messengers on the frontline and that's who we need to be talking to. And that's who we need talking to people who are still a little concerned about taking the vaccine.

MH: And so along those lines, I want to jump into guidance that you released. I think early May, right? That really targeted the physician community. So as we've seen vaccines sort of level out, we're starting to see that shift towards primary care physicians, take the lead in talking about it. So maybe you could talk about how those primary care doctors can get into their communities and talk about shots in arms.

Castrucci: Yeah, every day we get closer to the immovable no. And it becomes a little harder to take people from concerned to confident. And this is where our strategy has to change. We needed to change in two ways. First we do need physicians talking about the vaccine with their patients. We have a toolkit on changingthecovidconversation.org, but what it really comes down to is leading by example, telling your patients that you've taken the vaccine and you did it as soon as you could. Really making COVID vaccination of vital signs. So every visit every patient, every physician needs to ask, have you had the vaccination? If yes. Great. If yes, but I'm waiting, make sure they know where to get it and that they have the information they need. And if it's no, then we have to have a conversation and we need to figure out, what are some of the challenges or the concerns.

I mean, a great question to ask is just to say, listen, I understand you have concerns about the vaccine. What questions can I answer for you? Far too often, we're blaming and shaming and ridiculing. And I don't think there's any health behavior that has been promoted by shaming and blaming people. We don't get there by saying, you know, don't smoke, it's bad, wear a condom, it's really bad not to. I mean, that doesn't work. And so it doesn't work with COVID either. And so we need to tell people that we cut red tape, not corners when it came to getting these vaccines to the American people. That tens of thousands of people have been part of the phase three trials. And that we can save hundreds of thousands of lives if people get vaccinated. And then with folks, the space to make the choice that they want to make, but give them an opportunity to come back and ask more questions.

MH: So that messaging conversation is obviously one, that's been a challenge for public health experts throughout the pandemic. As you said earlier, it's been politicized. But also we're seeing even in the most recent guidance from the CDC on masking some challenges in the way that this is communicated to the public. So talk a little bit about where you think we could have improved that process.

Castrucci: Public health communications has to be seen as a leading crisis for the field. The pandemic in a lot of ways stands as a monument to poor communication. I will suggest that we probably spoke with a little too much certainty at the start, which then meant we had to undo things we said previously. That was challenging. We allowed the initial debate around COVID to be framed as a binary choice. Are you either going to die from the, from the virus or you're going to die from the economic fallout from the lockdowns. And that's that wasn't the right way to frame it. We needed to focus on the anxiety that all Americans had. We needed to not use the word lockdown, right? Where do you have a lockdown? You have a lockdown in prison. I know my kids talk about it when they do shooter drills. But that just wasn't good language.

And so we didn't start out with the right language, our language fed in to the politicization. And honestly, you had health officials throughout the United States who all of a sudden found themselves at a podium talking to the media about a novel virus. And no one stepped up to get them the messaging that they needed to have clear, concise communication. And Public Health has never particularly been good at delivering simple, relatable and reliable communication. And that's what we need to focus on going forward.

We also need to really think about social media because I'm 47. So I was in school before social media, and I'm thankful for that every day. But there was a guy in the court who held a sign. It said, the world will end tomorrow. Well, that dude now has 25 million Twitter followers. And we have to figure out what that means when there are people in white coats, when there are people who seem to have credibility, who are scientists telling you that COVID is a hoax and don't listen to the government.

This is something I don't think we've ever really confronted on this level before. And we're going to have to think really hard about it.

MH: And so what would you like to see, or what would your recommendations be to health system leaders who have put their clinical experts out in front of cameras to talk about it?

Castrucci: Well it can't be during the crisis, right? That's not a good time to introduce yourself. I think throughout the nation, there were some health officials who were meeting with some leaders of Chambers of Commerce to say, Hey, we're shutting you down. That's a bad first date. I don't care how you cut it. Right? Resilience is built in between the emergencies, not during. And so we need to make sure that moving forward, we're talking to businesses, we're talking to health systems, we're talking to Public Health departments and we're creating plans and procedures so that when another pandemic hits or something else that we're ready to work together and we know our roles and that we can mobilize quickly.

So I hope that every health system, every community in the country has that pandemic plan. And they learn from this experience with COVID. So that next time they're stronger. The challenges, of course, public health has been systemically underfunded. And so we need to refund and rebuild our public health infrastructure. If we don't do that, if we don't address the vulnerabilities that created the conditions that allowed COVID to devastate our nation, if we don't address those vulnerabilities, they will remain. And next time it might not be the same kind of pandemic with a not inconsequential, but low mortality rate. And we need to look not just at Public Health, but at our policies. We knew that people were rent burdened. We knew that we weren't paying a livable wage. We need to address those issues. COVID was the match, but decades, if not centuries of social policy and decisions by elected officials provided all the kindling that COVID needed to have the devastating effect it did in our country.

MH: And yet, as we know in the current debate over the infrastructure bill, that president Biden has put forward, they're starting to strip away some of the things that, the very things you're talking about. So how do you get to that conversation with policy makers to really start talking about reinvesting in issues of Public Health and social determinants, how do we make that connection?

Castrucci: So, public health often gets tagged as being more with one side of the aisle than the other. What we need to keep saying to folks, it's not about one side of the aisle or the other. It's about the ground on which the isles are built. That's health. And we need to find Republicans and Democrats and anyone else who wants to help us understand that, think of everything that you want to do in your community. You want to get good grades in school? You need to be healthy. You want kids to read on grade level? Healthy. You want kids to not drop out of high school? They need to be healthy. You want employers to really do a great at work? They need to be healthy. You want to be able to go to work or go to worship on Sunday? You need health.

Health is the foundation of our society. And right now like the foundation of your house, our foundation is cracked. So everything is in jeopardy, our economy, our education, our way of life. And this is the message that we have to deliver every single time that we talked to elected officials. Because it was their choices to defund Public Health, that put us in this very vulnerable situation. We lost 600,000 plus Americans, we've also lost 100,000 businesses. And we spend $700 billion a year, each year on defense. But you can't show me a foreign country that has taken that many American lives on American soil. We spend a lot of time getting ready for a coming war. We were just preparing for the wrong adversary. And we need to recognize that the virus, this virus, future viruses have as much ability to disrupt our economy and our way of life as a foreign nation. And we have to invest appropriately

MH: Well. And I imagine Brian, one of those investment areas has to be on data collection, data analysis, and just getting better data in the public health system, right? That's always been kind of a weakness for that sector of the healthcare industry.

Castrucci: Yeah. I have more information and data when I go to buy a couch than I do when I have to make public health policy. I mean, when you look at COVID, we have spotty, but some, race ethnicity data, but that's not nuanced enough. You know, if someone told you you had cancer, your first question is where is it? What is it? And if the doctor said, I don't really know, I'm just going to irradiate your whole body and see if we get it. You would find another doctor, right? That's not the right solution. We need nuanced data. We need to know not only race ethnicity, but income and occupation. And it could have really changed our messaging, but we've not invested in the data systems. Now, interestingly, we found $27 billion back in the Obama administration to modernize medical records. I want my 27 billion for public health.

I won't even charge interest, but I want the 27 billion now. I want us to invest it in public health infrastructure. I want us to invest it in public health data so that we have interoperable data systems that allow us to monitor the safety of our nation. And it's not all predator drones, right? It's about health data and understanding that our health is just as important as monitoring foreign threats. And so just like, what's the cost of a predator drone? Can we let put that into our public health infrastructure? I mean, that would be a good first step.

MH: Right? And there was a piece in that, in the initial Meaningful Use legislation, that try to address exchanging of public health data. We clearly haven't gotten there yet. I kind of want to leave it Bryan, where I'd like to leave it with you is how optimistic are you that we'll come out of the pandemic and have policy makers understand some of the messaging you're talking about? Are you optimistic that we'll be able to make some headway?

Castrucci: You know, I mean, it was always a hard question cause I always sound like I'm public health Eeyore, and I'm just not optimistic at all, but I'm not. Right? Because someone asked me once, you know, Brian, are you confident that people, elected leaders will listen to Public Health going forward? And I said, no, they're not listening to us now, in the middle of the pandemic, they're not listening. We had states that were trying to hire contact tracers at the same time, they were opening up movie theaters in bowling alleys. Right? We've had policy that has been repeatedly the antithesis of good public health practice. And we're seeing this over and over. And so my biggest fear is that once we are through the pandemic, once we have enough people vaccinated, when people aren't dying or going to the hospital, we'll just go back to the way it was. We'll go back to sleep.

I don't know that we're going to learn our lessons from COVID. And, and what concerns me is that if we don't learn these lessons, then one, we do a complete disservice to the 600,000 plus people that we've lost. And we remain super vulnerable to continue threats in the future. And mother nature threw a pretty significant warning shot across our bow. I wouldn't be so sure to say, well, you know, we'll worry about it in the next a hundred years. And I hope that we actually make the investments that we need, and that includes pursuing better health equity and social justice. But I don't know that we have the political will to do it because we've always known how to solve many of our problems, homelessness, hunger, we just lacked the political will to do so.

MH: Right. Well, it's obviously a conversation that's a huge challenge for policymakers, for healthcare as well. Something we could talk about for quite a while on this, but we're going to leave it at that. We'd love to come back to talk to you, maybe as we find ourselves at the other end of the pandemic and see what other solutions might be out there for the industry. Brian, thank you so much for taking some time and sharing your insights with us.

Castrucci: Thank you!

MH: And I'm Matthew Weinstock with Modern Healthcare. Be sure to come back next Monday for another edition of the Check Up.