Public Health Connects: A Conversation with Dr. Este Geraghty

When you talk about this real notion of precision public health, and I said this earlier about our tagline about collecting connecting dots. Yes. So, could you talk a bit about not just collecting those dots, but how do you tell them the story? Storytelling for one is so important because, you know, our business is about context and storytelling is about context, right? And so it's not all location, but it's all of that information that brings an issue to life. But I will also say that people are not moved or motivated by a graph. Dots, right. Yeah, I mean, it tells them nothing. So you really need to put all of that information together in a way that compels people toward action. 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. Dr. Garrity, thanks for joining today. Pleasure. I'm always glad to talk to you. Amazing to see you again. You are the Chief Medical Officer at Esri. You have had a distinguished career in so many different facets and aspects. One was an incredible amount of time that you spent at the California Department of Public Health. And so there's a lot to unpack about your career. I'm not the best person to unpack it. So why don't you unpack your career and then we're going to talk a little bit more about Esri. Okay. Well, my favorite topics. My career started in internal medicine and I spent about a decade in practice. Yay, go internists. And then a colleague suggested I apply for a position at California Department of Public Health. I sure didn't think I was qualified, but I was so glad to go there. It was a terrific position and I ran the Center for Health Statistics and Informatics. And I should also mention part of my training beyond my medical degree was getting a master's in health informatics and in public health. So after having all of this experience, I caught the attention of Esri because I had gotten interested in public health informatics with geographic information systems. That is a mouthful. So let's say it one more time, public health informatics with geographic information systems. We can shorten it and just say GIS. Okay. There you go. Thank you. So Esri took an interest. I had done teaching in spatial epidemiology in my academic career. I used GIS at the Department of Public Health and they offered me kind of the world to come and talk about the value of using location. You might say context to the environment around us to understand and take action for health concerns. And so I said, yes. So I've been at Esri for a decade now. Wow. Okay. And a lot's happened in that decade. I guess. Right? So the way we thought about GIS, the way we thought about informatics 10 years ago, five years ago, but let's say 10 years ago is very different than how I assume, this is my question to you. I assume different than how we think about it today. And in between we had a pandemic, which may have evolved things as well. So talk about that journey. Yeah. I would say when I first started at Esri, I mean, public health has been longtime users of map-based information, which is great. And shortly before I came to Esri, there was an evolution of what GIS could do. So it went beyond making maps to really thinking about entire workflows that use location as a basis for decision-making. So calculating things like access to care and doing analytics to really understand where there were health disparities, using GIS as a communication tool with story maps and things like that. So all of this evolved in the first few years before I was at Esri and my first maybe five years at Esri. And public health had to learn that GIS is more than a map. And that took some time. So there was that evolution. You mentioned the pandemic and I would say before the pandemic, but certainly evolving from the pandemic and inspired by the pandemic was the data integration needs that public health recognized. I mean, I think everybody knew that maybe there were too many systems and some legacy systems that weren't talking together. And so you would have your data siloed in all these different places and you couldn't use it to answer the questions that were really pertinent. And so other places did answer some of those questions like Johns Hopkins and were able to create surveillance applications that took public health a little while to catch up to. So I think that it really showed that there is technology and innovation right at the forefront, still available now. But we have to prepare our systems to use it because they're not all ready. So our systems and our people. Totally. Right? True. We're talking about the tools, technologies and the people, yeah? Yeah. I mean, look at, I've been participating in that large ONC grant, the Office of the National Controller, and they have a grant for educating the public health workforce, $80 million, I think they gave out over the last several years. And so getting that modernization going, as you said, it requires the same thing we always say, people, process and technology. You got to have the governance, you need the tech, but you've got to train the people. Got it. Have we made progress in this sort of getting people prepared to be able to use? Let's go back for a second. I mean, there's so much that's evolved, right? Not just the health issues and the challenges and all the opportunities that are there, but there are also these tools that have really advanced, right? So you cannot go anywhere without somebody saying something about AI and- Data science. Data science and technology and innovation. How do we, one, make sure that the workforce is able to utilize those tools? But number two is, how do we make sure it's not a buzzword? That's one of the big challenges that I always feel like when we say, and we're going to talk about these cornerstone values, when we say innovation, we don't want that to be a buzzword. We want that to be a way of doing our work. Yes, exactly. How do you unpack all that? Well, I think you're very right. I mean, in the conversations I have, I hear a lot more than I see the actions. And I do think part of that is capacity. I also think there's a lot of just human nature following the shiny object. And sometimes the shiny object is a little too advanced, right? We should be starting from a foundational data integration and management platform before we try to move on to data science and AI. But that's sexy. But we don't always. Yeah, yeah, yeah. That's what people wanted. That's where people are going. That's what people are talking about, right? So that's where- Programs pop up. And I do have hope that people are starting to develop the training. I mean, just over the last week, I have been getting tons of requests for, how can we learn more GIS and informatics and be able to use this stuff? And so from our perspective, we recognized the need years ago, and we developed a health GIS curriculum. And that curriculum- I'm sorry. A health GIS curriculum at Esri? It's Esri-based, but it's free for everybody. Oh, I see. I see. Yeah. And it's really- For the field, not academia. Or I guess it could be both. It could be both. I mean, part of that ONC grant, my part was teaching summer courses or internships using that curriculum to train students in GIS as a part of their informatics training. But it's available and freely available to anyone in seven languages. So that public health and ministries around the world can start to learn GIS skills in bite-sized chunks. So that was what we heard. We did a lot of interviews with educators and with public health professionals to say, what do you need? People have to incorporate this into their job. It's not going to be their job. Right? I mean, an epidemiologist might use GIS, but they're not going to become a GIS professional like me. Right? They have a day job. So I think we have to think about high value and reasonable medium or low effort to get to the next step. So training courses, in my opinion, should be continuous but small bite-sized chunks. So you just mentioned seven languages and you talked about, you just alluded to international and global. Yes. So that speaks to me. So I wanted to just maybe tease that out for just a moment. So are there other nation states or international geographic areas where you see that they've really got this going? They're really advanced in the way we, maybe in the US, maybe you say, no, no, no, it's not, it's here. We're doing it. We're the most advanced. But are there some places where there are some examples that come to mind that really you're appreciating the integration of technology, AI, data science in the actual work? Right? So it's not theory, but it's really practice. So does anything come to mind? And if you say, no, nothing comes to mind, that's fine. We'll go next. Yeah. And I mean, we see spotlights of brilliance, but I wouldn't say- Spotlights of brilliance. Can we use that? Spotlights of brilliance. Feel free. Okay. Yeah, there you go. But I couldn't say that I can point to an example where people are doing everything that they could be doing at a level that we all would look to as pioneers. There's just a lot of small to medium-sized successes. But there are places around the world that are doing some pretty amazing things. I mean, I've recently been in Switzerland and they're doing great things in health and GIS, and actually even just their medical care is pretty impressive with the speed and the scheduling and the pharma. It all works really well. I mean, there are places that are doing great stuff. Oh, in Sweden, we're supporting the ECDC and they're doing a lot of- ECDC. You're going to have to- Sorry. The European Centers for Disease Control. Oh, okay. That's right. So they're using GIS for surveillance work and really trying to pull in lots of information, text-based information, news feeds to do good surveillance. So there are projects more. But what I'm looking for is kind of, you and I were talking about this earlier, that this is an integration of a philosophy, a way of doing things. It's not a keyword or a buzzword. It's how we do things from now on. And I think what we're trying to create is the good type of muscle memory, right? Equity is not a project. Equity is how we do the work that we do. It's instilled. Innovation. We're always looking forward. We're learning the next technology because it's out there, right? As soon as you stop lifelong learning, you're legacy. Yeah. That's right. So it's interesting you were mentioning that. I know we've talked about this before, that in medicine we have this term precision medicine, right? Yes. Precise precision. We want to know where the MRI and the PET scan, the nuclear, is going to be precise about what's happening. There's also that term, that notion of precision public health. Yes. What does that mean to you? Precision public health? Well, as you can imagine, in my business, I'm always thinking about location. So precision is about using location to target the way that you understand populations, allocate your resources, select a site for a new program. I can give you an example. Maybe some people say that your zip code may be more important than your genetic code for your health. Absolutely, yeah. Right? And precision public health would recognize that. They would target in on this neighborhood or this census tract or zip code, whatever it is, is maybe experiencing more overdose deaths. What can we do? Well, we can use GIS to look within that neighborhood and find a place for a harm reduction vending machine. We can put in drug drop-off locations so that they can take their unused and expired prescriptions and put them there. We can collaborate with the public safety teams, the police force, and the hope teams and make sure that they're outreaching in that area because we know where people are experiencing the disparity and we can start to unpack what are the causes and then address them. Got it. That's precision. Because otherwise, what I've seen is that people are taking a countywide or a statewide approach and it's too expensive. We don't have the resources. It's not efficient. Yeah. And it's not going to give you the greatest impact for your effort. Yeah. That's great. I wonder if when you talk about this real notion of precision public health, and I said this earlier about our tagline about collecting connecting dots, so could you talk a bit about not just collecting those dots, but how do you tell them the story of community? I know this means a lot to you because I've heard you talk about this in several presentations about it's not good enough to just have the information and the data and all the things that we want to have, but we have to tell the story of what it means and how it's meaningful for communities. How does that? Yeah. Did I summarize that well? Beautiful. Because I've heard that from you. Yeah. And I've stolen your connecting and collecting dots because it works so perfectly for what we do. No, I mean, storytelling, for one, is so important because our business is about context and storytelling is about context, right? So it's not all location, but it's all of that information that brings an issue to life. But I will also say that people are not moved or motivated by a graph. Dots, right. Yeah, I mean, it tells them nothing. So you really need to put all of that information together in a way that compels people toward action. And we do that. And I told a story recently that really shows those connections where I was talking about how GIS has been used to address mental ill health and the different ways that we can support improvements in that area. And then substance use disorder, what we can do there. And then I was talking about using GIS to address homelessness. Things like automating the homeless point in time count and other kinds of interventions. And then I was saying, okay, but those are all related. And we, I call those diseases of despair. And diseases of despair are super complicated and they're interconnected. And so my example of that is in San Diego in, I think it was 2017, they had the largest hepatitis A outbreak in the United States at that time. And they used a geographic approach, but they had also used a geographic approach to addressing homelessness and illicit drug use. So when they mapped their hepatitis A cases and deaths, they saw a pattern. We recognize this, right? And so they overlaid it on their homelessness maps and their illicit drug use maps. They're like, now we know. So what did they do? They had all these targeted interventions. One was because hepatitis A is spread via the fecal oral route. They mapped all the public restrooms that people may be using and put them on twice a day cleaning schedules. They looked at at-risk sidewalks and sanitized them. They put hand sanitizing stations in the homeless encampments so people could protect themselves. And they used GIS to send out mobile and foot teams to educate and vaccinate the population that was at most risk. So all geographic, all connected. And yeah, it's a good way to connect the dots. So I love that. So let me ask you this question, this last question about technology and innovation and the other piece is about the barriers. So I don't want you to give me like 1,000 because we don't have time for 1,000, right? Oh, come on. But yeah, yeah, yeah, it's going on, right? Tell me about why. Why we can't get there. And this is, I mean, this is respectfully coming from my experience, your experience, collective experiences of our practitioners, right? Which is we know that we have to tell a story. We know we have to collect dots. We know we have to connect the dots. And yet, we're not. I know. We're not in the way that we can or should or must in order to tell the story. So what's holding us back? What is that? Yeah, well, I think probably some of the excuses, which I say excuses realizing that they're real. You know, there's not enough funding. There's not enough workforce. Yeah, I get all of that. But what I think is maybe the biggest barrier is fear of change. I think a lot of people look toward and want change. I mean, everybody wants change, but nobody wants to do it. And they perceive a level of difficulty and a newness for something they don't necessarily know how to do right away. And so it's easier just to do it the way we have been doing it, right? We only have so much time. We only have so many resources. I'm a busy person in my job. I don't have time to learn this. So I'll do it the same way I've been doing it because that's worked. So I think what people don't necessarily understand or can't get to in that model is once you do it, if you put in the upfront effort, everything gets easier. And so some do it. Right. But it's not as common as we would like. So I think it's partly that fear of change and just I don't have the time that I need to really dig into this. There's a perception it's all harder than it needs to be. It's interesting. I was having a conversation with some colleagues about this very issue. So I'm glad you brought it up. This is completely, I had no idea you were going to say that. And the concept or the conversation really turned from, we talk about, and this is where the buzzword comes in. We talk about innovation, but we don't want our work lives to change. And there's got to be a reconciliation there. So either we don't want to be innovative, or we've got to have change. Yeah. But we can't do both and say, well, we want innovation. We want to be state of the art. We know the world has changed around us. We have to be state of the art and the latest, greatest, and we don't want to do those things, but we also don't want to change or see our work lives change. I said that was my last question, so I'm going to ask you a second. This is the last question on that. We'll see. How do you reconcile that? What's your advice? Maybe that's a better way. What's your advice to the group that's really saying, innovation, yeah, it makes sense, but it's not for me, it's for someone else? Yeah, I think maybe part of it. I don't know, but the thing that comes to mind is some of the fear may be, what if this project fails, and what will my leadership think? Will I lose my job? Will I be demoted? Will I never get any resources to do another project? So I think my advice would be, there's got to be room for some experimentation. And I think you choose as wisely as possible what your priorities are and different projects, knowing that not every project will work. But people need to be reassured that that's okay. Otherwise, they're not going to be innovative. So let me flip that to you. Okay. Do you worry about that for yourself? When you've gone through your career, you've been in public health, you've been at the state level, you've been working as a practitioner, you've done big things. Do you worry about that? Do you worry about, gosh, if I do something, it's all going to come. It's going to be, it's all going to fall apart, or maybe even not now. But let's say previously, did you have that fear? And how did you overcome that worry about, it's all going to come crashing down. So the inertia, I'm not going to be able to move forward in a different way. I can't think of an example where I had that much fear. I think I'm very much a person driven by passion. And in some ways, like when I was at the public health department, I worked on open data, and open data was like a bad word back then. I was like, no, we can't have a breach. So there was a clear risk of failure. I mean, I was literally asked, how can you make absolutely sure that you will not embarrass the administration? And I'm like- 100%. Right. So I thought about those things, but my approach was not fear-based. My approach was, okay, I'm going to look it up, see if anybody's done this before. I'm going to talk to people, and what is possible in creating a governance model so that doesn't happen? And that's the only reason that open data got approved and put into practice within eight months of my idea of doing it. Wow. Yeah, which we know in public health, that's a big deal. And it was because I took every question, I researched it, I answered it, and then moved forward. And then we all felt comfortable that it was going to be okay. It wasn't just me. So you were methodical around the way you leveraged those experiences. And democratic in bringing people in. But then didn't say stop, you said you leveraged all of that to hedge the bets to give us the best opportunity for success. Yeah. Wow. That's so much about leadership that's in there. You've got to be brave. Yeah, yeah. Brave. Yeah. Okay. I actually forgot that I even had questions because I think I just riffed on a number of different things. But let me close with a couple of things, and I wish we could go longer. This has just been the theme of all of these Public Health Connects is just never enough time to really unpack everything. I want you to maybe think about this from the standpoint of where we are today with uncertainty about the next several months. But also recognizing that we will be in 2025 very soon, very quickly, regardless of whether we want it to happen or not. It's going to be here. It will. What gives you hope as we go into 2025, in the next year? What's that feeling of optimism or hope that you want? I want to end on a positive note here. What does that look like? For me, this will maybe sound very practical, and maybe it's even simple. But my experience in academia and in public health has been that a lot of the work has been research-oriented. We need to better understand this problem before we do anything. And what I think has happened, particularly with equity as a highlight, and other things that we've been shining a spotlight on very heavily, is that everybody is thinking action-oriented. That gives me hope. Because I think the research is important, but we can get mired in analysis paralysis and not take the steps to do something about it. And so I feel like I'm starting to see a lot more action-oriented conversations and actions themselves that give me a lot of hope. I love that. That's so much to really talk about, about how it's not perfect, must be the enemy of. Let's really try to figure out how we can make something actionable. What did they say? Ready, fire, aim. Yes. So you readjust your aim if you miss on the firing. Or is it drop, roll? Anyway, I'm not sure I got that. Okay. I am going to close with this. I am holding our BeWellWa apple. And as you know, we talked about this. This is our new initiative on health and wellness. It has four pillars of movement, nourishment, emotional well-being, and social connection. We're asking people across Washington, 8 million people, find your apple. What's your apple? What gives them their health wellness journey? Some say it's singing. Other people are like, hey, it's dancing. Some people are like, it's just sleeping. What is it that, as I give Dr. Garrity this apple to you, I am going to ask you, what is your personal apple? And I'm going to hand the apple to you as you answer that question. For inspiration. That's right. Well, you know, but maybe most of your audience doesn't know, that I live my life nowadays, last two and a half years, as a digital nomad. I do know that. Yes. I have no home. I literally live out of a suitcase. I travel the world. And I'm kind of a fast traveler, a week here, a week there. And I love that. So that's great for, you know, life goals, my spirit. I love travel. But travel can be challenging. Yes, it can. And I'll tell you, in the last two and a half years, I've gained a little weight. And it just can be difficult to manage your weight, to eat healthy, when you're always in a new place, a new country, trying to figure out the food landscape and all of that. And your schedules are all off then, especially internationally. So it can be crazy. Still fun, but crazy. So I think my apple has sort of been something I've been thinking about recently. And I thought, I need to get back on a program and be my best self. Okay. Now you're building up to this. Now I'm like, okay, what's this apple? Wow. No, this is literally six weeks old for me. But I gave it serious thought because I need to be highly motivated. I've got to apply my internal OCD to my health and wellness. And so I decided I want to run a marathon. Okay. Yes, I've run half marathons. And I once trained for a marathon, but I got injured halfway through. So I've never completed it. Always a dream to complete it. But then I started thinking, well, where am I going to run a marathon? Because it's got to be an inspirational place. So I'm going to run a marathon. New York? I don't qualify for Boston. Seattle? Malta. Okay. Yes. Wow. Didn't see that coming. So, you know, thinking about your pillars, I mean, I have used online resources to design a running strength training and stretching program. I have been modifying my eating. I use an app. I track what I eat, throw in some protein shakes as I'm building muscle. And I actually joined an online runners over 50 community. Okay. And they're very good about giving me positive feedback. And if I need advice on things, it's been very helpful. So I've got that social pillar as well. I love that. That is so fantastic. Now, I will tell you, the over 50 part, I mirrored. The running part, maybe I won't join the group for that reason. But thank you, Estie. Thank you for your time today. Thank you for spending this energy with us. And thank you for the story about the apple. I love that. Thank you very much. That was fantastic. Dr. Garrity, it's been a pleasure.