Public Health Connects: A Conversation with Dr. Judy Monroe

There's so much we can learn from the world to really adapt those global learnings to really advance health in our communities. We're doing that at our agency about Global One Health and I'm just curious about how you see that adaptability. Not everything in the world is going to work in our communities across the U.S. but there are a lot of things that can and could so talk about that a little bit. Yeah, no I think we need more exchange, right? I think the U.S. all of us here in the U.S. should be open to learning from other countries. There's a lot of innovation taking place in other countries. Some of its on the ground work innovations and just how you reach communities as I mentioned all the way to you know high-tech and science. So we've got to embrace that and I think setting the table for that having the exchanges being able to learn is super important. CDC does some of that. I mean I've had and I've had you know with delegations come over from other countries they say exactly what you said they're always like we want to learn from the U.S. but we have a lot to teach. We spend a tremendous amount of time collecting the dots. We need to spend just as much time in connecting those dots. That's what Public Health Connects is all about. My name is Dr. Umair Shah. I'm the Secretary of Health for the great state of Washington. This is Public Health Connect. I am so so so pleased to have this conversation with my friend colleague Dr. Judy Monroe. Dr. Monroe is the present CEO of the CDC Foundation currently and what that means is that you have had so many career paths and journeys to get to where you are today. Judy thank you so much for joining today. Thanks for having me. Such an honor. Well let's start off with just I just mentioned the journey. Tell us about your journey. Sure so my journey actually started in medicine. I'm a family doc and I practiced in Appalachia. Thought I would just practice in a rural community and help folks that needed help. I was wrong that wasn't the end of my career. I ended up getting into academics. My husband took an academic career so I followed him. Okay. And from there I got a call one day from the governor of Indiana asking me to be the health commissioner. So I know about those calls. Yeah you get those calls. You don't expect them and the next thing you know you're going one day from being a practicing doc to leading the health department and leading the in my case the state of Indiana for their public health. It was a great leap. Big steep learning curve but I loved it and found a real passion for public health. From there I went to CDC. Was a deputy director of the CDC and I helped support all the health departments. My job was over state, tribal, local, and territorial support and from there I found myself being recruited to be the CEO of the CDC Foundation. And what is the CDC Foundation? First of all I was gonna ask that question but I should say originally from Ohio. Ohio you have an Ohio connection. Otherwise Ohio and Indiana have some rivalry so I just want to just kind of put out but it should be about cooperation across state lines and all that stuff. But you from Ohio right? Yeah I grew up in Dayton, Ohio. Okay Cincinnati. At least one person does. All right we're good. CDC Foundation what exactly is it? What do you all do? Yeah so CDC of course Centers for Disease Control actually authorized by Congress to be an independent nonprofit to help forge public-private partnerships on behalf of CDC and public health. So our mandate is actually very broad to support public health and actually some of our key work right now is supporting health departments. We've hired tons of staff particularly during the opioid crisis and then during COVID we ended up hiring over 5,000 people. 5,000? 5,000 people that were embedded. We literally had CDC Foundation field staff in every single state health department, large cities, tribes, territories. It was you know work that just needed to be done because folks were having trouble hiring and we got called and tapped to do the job. Yeah yeah so let me ask you a little bit about more about the CDC Foundation because there's also an interesting agency or organization because not only do you do domestic work you also do global health work and I find that intersection fascinating because we've had trouble, I've had trouble finding agencies that are really doing good jobs in both or trying to find some inflection points if you will. So can you talk a little bit about the global health piece? Well I love our global work let me tell you and the part of the reason we do global work it's because of CDC. Folks may not realize the reach CDC has around the globe so they have country offices, regional offices now all across the globe and if you travel to other countries, you go to Thailand, you go to Vietnam, you go to Africa, many of these countries you'll find that their top leaders were trained by folks at CDC. They either came to CDC for some training or they learned about CDC so so that's part of the connection. For us again public-private partnerships we've done work across the globe for decades now in tobacco control data. We've got a great program funded through the Bloomberg Philanthropies and it's data for health using iPhones you know or using using those to be able to collect critical data to be able to make good public health decisions. Where do you put your resources? How do you message? You know all of those questions that we have in public health. And are you seeing themes just to kind of, sorry to follow this thread a bit, but are you seeing themes across different countries about how they're using technology or mobile phones or what-have-you or do you see it as like this is this country you can't really learn with this country it's completely different? Yeah no most countries are using mobile phones in one way or another and most countries many countries are really advancing even AI now as well and they a lot of countries like to build their own so as example Vietnam I was just there in the spring and they're doing some incredible work with tuberculosis because they have multi-drug resistant TB but to hear how they've embraced technology to do that they do they're doing using AI to read chest x-rays. Oh wow. 40% increase in the diagnosis of TB over the radiologists. You're kidding. No it's very impressive. And then the other thing they do is great photographs they showed us to get the x-ray machine out to the most remote areas. The poor x-ray machine is like out in the middle of the ocean on a boat. I mean they transport the x-ray by boat so they talk about equity I mean the going to Vietnam seeing this marriage of technology with with a real drive to reach everybody regardless of where they live really incredible. Oh my gosh so I recently was in Taiwan and had that same experience I know you've had that yes that same connection as well and so you've seen how they are leveraging AI and technology as well and trying to look at that so there's a lot to learn from the rest of the world and I and I I'm always fascinated by this question I'm just gonna pose it to you sometimes we're we're we're thinking we're in the US and we're going to teach the world remember that old song that was like I want I'm not gonna sing it but I want to teach the world to sing right but there's so much we can learn from the world to really adapt those global learnings to really advance health in our communities and we're doing that at our agency about global and one health and I'm just curious about how do you see that that adaptability not not everything in the world is going to work in in our communities across the US but there are a lot of things that can and could so so talk about that a little bit yeah no I think we need more exchange right I think the US all of us here in the US should be open to learning from other countries there's a lot of innovation taking place in other countries some of its on the ground work innovations and just how you reach communities as I mentioned all the way to you know high-tech and science so we've got to embrace that and I think setting the table for that having the exchanges being able to learn is super important CDC does some of that I mean I've had and I've had yeah you know when delegations come over from other countries they say exactly what you said they're always like we want to learn from the US but we have a lot to teach exactly it's bidirectional absolutely absolutely well let's talk a little bit more about I know you you mentioned that you were the previous Commissioner in Indiana and you also were re-asked to come back to Indiana and help us with you know an initiative their governor was putting together can you talk a little bit about that yeah I was actually in the middle of a pandemic so it's it's July of 2021 we're still I think and I get which very busy and I get a call saying that Governor Holcomb would like to invite me to co-chair the Governor's Public Health Commission and so Indiana took on the issues of public health starting in the middle of a pandemic and it was such a privilege to go back to Indiana I know the state well yeah it was great to go back and I co-chaired along with Luke Kinley who was a 25 year veteran of the State Senate so Senator Kinley was my co-chair and it was a great marriage between you know someone that like myself that had a career in public health and someone that really knew the legislature and the politics and knew how to manage and then we had a tremendous Commission and we spent a year studying we there was an executive order by the governor so we had to address certain things like data equity you know there were a number of things outlined which we did but one of the key things was the listening sessions so we went around the state and listened to communities and got their input on what the Commission and what kind of recommendations we should make and that was a fascinating experience and that's that's I'm so glad you said that because we oftentimes in our field talk about community but we really don't always reach out embrace or are humble enough to listen to community talk a bit about either what you're seeing in the field with with that conundrum yeah and also what learnings you had as you were going through the aha experience of hearing community where people in Indiana for example there were some things that they said that you would have never brought to the table you you know it was surprising to you how does that play out yeah yeah well first of all it was during the pandemic sure and so there were some that would come to the listening sessions and we're quite angry right they were upset over mass policies and so forth and we listened very respectfully and we listen hard for those ideas that they had that would could translate into the recommendations one of the things really important to Indiana is home rule yeah they want to be in Washington Texas yeah exactly so they want the decision-making to be at that local level and the cool part about this is that got translated into the recommendations and then ultimately into the law which is it's now called health first Indiana is the name of the implementation okay but every single county got an increase in state funding at the tune of 1500 percent state 1500 percent increase in state funding to the local health departments and the local health departments have and their communities a lot of community engagement are responsible for their priorities they want to select I mean there were some parameters there were some things that were standardized and then others you're free to decide what what's most important so when you saw that kind of 1500 percent increase was that because it was community saying to the the ones who are listening to say this is important to us so as a legislator policymaker listen to us because we are your community so listen to us we're saying you need to invest more in in a system or public health or what-have-you or was it something else yeah no that was there was much of it in fact it was an opt-in so the counties didn't just they just weren't given they had to actually opt in to take the funding so the first year of funding it there were some outliers there were a handful of counties that said we're not taking the money and so it was like 92 or 93 counties in the state and 88 or 89 took the most of the money at all the second year 100% took the money because their communities the ones that hadn't taken why didn't you they all were like but we have needs we have public health needs and we need the resources to be able to take care of it that was really cool so now they've got Health First Indiana across the entire state it's all been opted in you've got the Hospital Association that pledged to support Health First Indiana so now at the local level that translates to the local health our local health departments working with the hospitals the business community Chamber of Commerce got up and this was all at a big second rally at the Statehouse a year after the legislation passed we had this fantastic rally the first year to try to get it get the momentum to pass it but in the second year you've got your business community and your hospital standing up saying we pledge to do all we can to help support Health First Indiana that's all being translated now at that local level that's incredible yeah it's amazing I know you and I had had some conversation about the things that we're doing in Washington foundational public health services and the funding our transformational plan and activities related to it so there's a lot that seemed the similarities in terms of you know how some of that that plays out I'm curious then what are lessons that you would say are for all of us across all systems across all states or all parts of our country when we look at this right so not just in Indiana not just a you know a particular state but what what's a lesson and I know you mentioned business community and I know the speaks to you because you and I've had a conversation about how do we get to the people who really have a lot of the purse strings in our country but don't always think about public health or health or health and well-being in the same way we think about health care delivery but we don't think about prevention so how does that all play out for you right yeah well on several levels and I'll actually start with trust I'd love to outline there's a great book called the four factors of trust they came out in the last year or so I've really been applying this to public health in the work that we do so what what the book says the four factors are humanity transparency reliability and capability okay so your humanity and transparency tells me what your intent is if I can trust I know you you know you really care and and you're transparent I trust your intent and if you're reliable and capable I know you're competent right so that's a starting point and that's a starting point for all of us in public health that applies to businesses it applies to any organization right so I think applying those are looking through that lens is really helpful we all need and then if you take that and think about it we all need to be listening more intently that's a common theme we need to listen with humanity and and with the intent to really understand what the other saying because that's transfer you can translate that into some really great things that you may not have thought about so so that's a lesson in humility but also yeah the listening I think that's super important I think we also have to break bread more often I think we need to I think that's I'll give you an example a hard example when I was at CDC we were in some meetings with our tribal advisory committee this now at the national level right and we were having some difficult conversations and and folks were upset and I remember thinking what can I do because I was leading the the office at that time and at a break I went out and I asked some of the tribal leaders I said what are you doing for dinner tonight would you mind if I joined you just me just would love to join you and I said sure that'd be fine and so we so we met at a restaurant and guess what you know what the first part of breaking bread is you're talking about your children you're talking about your family you're talking about illness you're talking about things that bond us as humans right once you have that breaking bread moment whatever that looks like now you can talk about the hard things and you understand one another you're gonna find the common ground you're gonna find the middle ground you're gonna find solutions much faster it doesn't solve it all but it certainly makes it easier it sets the so I've so much to unpack here our transformation plan EIE values equity innovation engagement you've talked about engagement you've talked about innovation you've talked about equity I can't you've operationalized these so let me not ask you about that specific I'm gonna ask you a different question okay I throw you a curveball here I know you love sports and baseball so here's a you've had a career where you've seen so much and you've been a part of so much do you feel at times that we are having similar conversations that we had five years ago ten years ago 15 years ago and that we are making progress in in resolving or solving issues or do you feel maybe it's not it's not an either or it's an and what do you feel like we're still having the same conversations just in a different way what's your take on that so I first of all I have to tell you during it throughout the entire pandemic if someone had given me a multiple-choice test my answer was gonna be all of the above always be and or my answer was gonna be both and right so I'm gonna default to my answers and my answer is both and I can't I have to tell you there are many times I'm in meetings I'm like hmm that was 20 years ago I was in this meeting that's right and it hasn't changed yeah and that's a problem right we've got to move on particularly in public health right I mean that's that's we need to move on the flip of that though is that we've got it we started talking about AI and the just the technology alone we've got wastewater surveillance now we never dreamed of that right right well yeah these are like dreams of yeah we've got incredible dreams we've got communication channels we never had right and that's both the good and the bad right social media is amazing yeah and then it's got it's got challenges and so I think I'm I'm hopeful because of the innovations I'm hopeful because of young people you know I mean we've got some great it's amazing the energy here yeah yeah you have so many unbelievable right but I think we've got we've really got to be serious when we find ourselves in rooms that we're saying the same thing yeah yeah we have to really get to not just talking about it let's do it how do we get to the solutions and get to see the other piece for me is the urgency yeah right so sometimes in our field we feel like we've got time and that time then the next you know you look at your your watch or your clock and it's been five years ten years that's right the time goes so you have to have an urgency and that's right issue is that's right I heard the other day someone say that especially if you have young children the days are long the years are short so some days you might feel like you've had a long day and you're tired you turn around and it's at five years ten years so there is urgency yeah well I know you have an incredible amount of hope because you're one of the most optimistic people that I ever met not just in the field of public throughout there is this opportunity of being hopeful right we talked about the challenges what are the the real concerns the lack of investment or understanding and all those things let's put all that aside let's talk about hope about ten years from now but let's look at next year what gives you hope for the year that's coming yeah in the in the field of public health or or beyond well I'm you know I find hope first of all in coalitions I mean it's just amazing the power of coalitions if they're well-led and folks come together so I'm seeing some coalitions that are forming and are taking on some big challenges I'm hopeful about that name a coalition like that that really gives you that kind of the Health Action Alliance actually I don't know if you're familiar we actually helped start it the CDC Foundation helped started during the pandemic they took on helping CEOs so this bridges the private sector they help CEOs understand what was happening during the pandemic and translate that into what the CEO should be messaging what policies they should have yes you should let your employees off to get vaccinated you have those types of things that then was so well received by fortune 500 companies that they continued now looking at mental health and they've taken on what there's a Commission now a National Commission on climate and workforce so what should employers be thinking about to protect their employees in extreme heat right and what kind of policies does that look like what so that and that's a huge coalition of businesses but it's got great leadership through media right is the name of the company the or the kind of a social action that's great and they've got great leaders so that would be one that'd be one example a PHA has some coalitions that are forming that are that's getting getting a lot of power behind them yeah yeah yeah no that's so the hope is in the coalition the power of the collective to be able to do big things and also hopefully do them faster with an equity lens is that kind of yeah yeah that's perfect I love it okay Judy we could go on for a long time as you know but let me close with this last piece I'm gonna reach over here for the Apple okay so as you know we launched recently our be well one it should it be well Washington and this is our health and wellness initiative for pillars if you will we're focusing on movement nourishment emotional well-being and social connection so those are our four and what we're saying to people and because we're known for apples we're asking eight million people what is your Apple find your Apple and then people are saying things like oh it's you know dancing or it's playing you know Scrabble with my you know my my my friends or whatever that is so as I give this Apple to you I will ask you Judy what is find your Apple what does that mean to Judy Monroe so I have to tell you when I think about finding my Apple it's reawakening my ten-year-old self and my ten-year-old self and these and I've done this in recent the summer was a great summer where I recaptured that age and what that day will look like is a Saturday getting up and biking to the pickleball courts and playing a little pickleball going kayaking maybe taking in a swim relaxing with friends in the evening it and being out in nature just being out in nature to reconnect I love a really physically active day with a lot of variety and that's what I did as a kid and I ate a lot of apples and Washington has the best apples yet it does and not only that pickleball started in Washington or if you knew that Bainbridge Island near Seattle that's right so that's putting it out there so that is probably one of the most insightful answers that I have gotten for that question so thank you for saying that thank you Judy for joining today this has been a lot of fun thank you thank you thank you so much