It’s impossible to definitively measure how many lives were saved or prolonged, or how much illness or disease prevented or made less severe, as a direct result of public health initiatives. Douglas Brugge, chair of the UConn School of Medicine’s Department of Public Health Sciences, joins Dr. Anthony Alessi to explain the “invisible” benefits of things like policies that regulate toxins in our water or pollution in our air, and discuss how COVID changed the perception of public health (and lessons learned from that).

Listen now:

 

Submit questions for “Healthy Rounds” to healthyrounds@uchc.edu.

Support comes from UConn Health Orthopedics and Sports Medicine and Coverys.

---

Transcript

Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery and a grant from Coverys. It is not designed to direct your personal health care, which should only be done by your physician.

I’m your host, Dr. Anthony Alessi, and it gives me great pleasure to welcome as my guest today. Dr. Doug Brugge, who is professor and chair in the Department of Public Health Sciences here at the University of Connecticut. Doug, I really wanted to have you on the program today to talk a little bit about public health initiatives.

You know, it’s been public health initiatives that have provided what are among the greatest contributions to humanity and medical sciences in general. When we think of sanitation, water purification, vaccines, these are all things that make people safe and healthy. And yet I don’t think a lot of people understand and appreciate that these are public health initiatives.

Dr. Brugge: Yeah. Thank you for that. And I certainly agree with your introduction to public health. Public health is, I think frequently does not get the attention it deserves because the benefits are more invisible to people. If you have an illness, if you have a heart attack, or you have cancer and you go to a hospital, and you receive treatment, and you get good treatment and it makes you better, that is really tangible.

You know that somebody has saved your life or improved your life. If you don’t get cancer or don’t have a heart attack because someone, as you said, regulated toxins in the drinking water, or in my field, the pollution in the air, it’s invisible. You just don’t know that it happens.

And so, I think we in public health work in a bit of a obscurity and underrepresented the impact we have now. That said, we have a really nice department here at UConn Health. We’re a very, very vibrant and enthusiastic department within the medical school. We have over 30 faculty. We have over a hundred students in our graduate programs and we represent a very broad range of approaches to research and education, as well as topical foci, in terms of public health, including those you mentioned, but others, substance use, diet, and nutrition, many, many other things as well. And so, I’m proud of the department that I chair. I’m really privileged to sit here and be in this position.

Dr. Alessi: Yeah. What’s interesting to me is actually your background and your background was in biology and chemistry. You got a PhD in biology and then went into industrial hygiene. Can you tell us about what pointed you in that direction personally, to go to industrial hygiene?

Dr. Brugge: Yeah. From third grade onward, I wanted to be a biologist, basically.

And in third grade I thought it was a naturalist, but I didn’t know the difference. But, and I pursued that all the way through college. And at some point in grad school, I began to realize that there were aspects of laboratory science that were not right for me. And the two main ones were one, that it was very far removed from real world impact.

You’re doing basic science. Someday, somewhere down the road, someone might use it for good or even not for good. You don’t know. And I wanted to have a more direct impact on the world. The other thing was I found working in a laboratory socially isolating, and I preferred to interact with people. This department is great in that regard.

There are all these wonderful people and I’m interacting with them all the time. But, so I had a choice to make. What was I going to do? And I did the degree, it’s a public health degree in industrial hygiene at Harvard School of Public Health in order to shift my emphasis over into public health and do something that was both science, and more directly impacting real world problems. And so that, so it solved a problem for me, and I wish sometimes that I had known about public health in third grade, but no one introduced it to me until much later in my life. So, you know, it’s worked out okay.

Dr. Alessi: You mentioned before that, you know, people in public health are relatively anonymous and in the background, but that’s not the case anymore since COVID.

Dr. Brugge: Right, yeah.

Dr. Alessi: I mean, let’s face it. In the headlines today, right? Canada is going to lose their measles free designation, right? In 1998, they were a hotspot. In 2000, their cases were rare. COVID took away your veil of anonymity.

Dr. Brugge: Yeah.

Dr. Alessi: And now to the point where there are attacks, there are threats on public health professionals.

Can you talk to us what it’s like from the public health side? I know what it’s like from the medical side looking at this, but from the public health side, is there fear? Do people not want to go into public health because of these changes?

Dr. Brugge: Those are all very good questions, and probably the basis of several hours of conversation between us, Tony.

Dr. Alessi: Absolutely.

Dr. Brugge: But anyway, let me see if I can be brief. I agree with you that COVID was an inflection point for public health. Maybe before COVID we were somewhat obscure, but largely, more largely respected. Maybe people didn’t know how polluted the United States was in 1970. Maybe they didn’t appreciate how much public health measures led to clear skies and much better health.

Again, to focus on my field of environmental health. But, they weren’t against it. They weren’t angry about it. They weren’t resisting it, I don’t think. COVID was a crisis, and it was a very intense national and global crisis. I remember the early months, it was very hard to tell what was happening, how great the risk was, and what to do.

It was a very scary time in my opinion. I remember driving from Hartford to Boston, ’cause my wife and I have a place outside Boston, to hide away for the early month or two of COVID, and thinking how surreal it was that I was running away from this infection that was spreading wildly.

So, I think one thing that gets lost in all of this, and some of it is exacerbated by the media and by politics, in my opinion. The media plays up the conflict. That’s what they want because it gets clicks and views.

Dr. Alessi: Sure.

Dr. Brugge: And politicians play up conflict and accusations in order to get elected and to pursue their agenda.

And so, we have this really scary situation that’s exacerbated in the media and the political sphere. And I think it got really, instead of sort of a level-headed public health approach, it became something more than that. And I think public health image was tarnished in the process.

Now, I think the biggest problem was the resistance to public health, the pushback, the politicization, the media exaggeration, and drama. But I also think the public health field fell short in communicating well in that context also. And, let me just speak for myself. I’m not speaking for anyone else.

Dr. Alessi: Sure.

Dr. Brugge: But, I do community-based participatory research where we bring the community in and we have them as partners in our research process.

And what I think I’ve learned from that is that if you engage people, and you talk to them, and you respect where they’re coming from, and even if they disagree with you or they have misconceptions, you work with them over time, you can form a good relationship and mutual respect. And maybe it’s partly just things were happening at a national level and really fast, but I feel like public health failed to reach out and engage people who were scared, and then felt that they were being commanded to do things that they either didn’t understand or that they doubted were effective. And so I think that it’s the lesser of the evils, but I think public health could learn something from this experience and hopefully do better in the future if there, hopefully there isn’t another one of these, but if there is, I would hope we’d learn some lessons from the past experience.

Dr. Alessi: You know, unfortunately, Doug, I think people don’t realize that as we’re kind of going through this process, people are dying. I mean, right now, I was reading where there are over a thousand state bills in this country addressing public health. Over 400 of them are designed to weaken our protections on vaccines.

Right, fluoride, milk safety. Okay.

Dr. Brugge: Yeah.

Dr. Alessi: I mean, I think a lot of people are confusing ideology and science. And, how do we get past that? I know you’re talking about communication, but as we’re communicating and trying to reach out to these people, people are losing their lives.

Dr. Brugge: You’re absolutely correct. And we should be pursuing evidence-based public health measures that are protective and that save lives or improve the quality of life, absolutely. I think where it becomes challenging is when the evidence is not fully convincing at a causal level. Now, in the COVID situation, it was almost impossible to come up with that because it was evolving and happening so fast.

This is a question of science and evidence. It should be possible to discuss it.

Dr. Alessi: Well, I think some of that comes from the sudden lack of scientists in the CDC in places such as that.

And I think to have that health discussion, that’s where we get into politics, right?

Dr. Brugge: Yeah. Well, maybe, and that is going to exacerbate it certainly.

I feel like we in public health, we need to be more willing to engage with ideas that do not conform to our public health orthodoxy and to examine the evidence fairly and engage in discussion about these issues that are potentially politically and in the media controversial in a way that is transparent and informative rather than trying to shut them down.

That’s my view.

Dr. Alessi: Let me shift gears a little bit and give you a real world example that a pediatrician came to me with. And that was, had a student whose family did not want them to get the MMR vaccine or the second dose of the MMR vaccine. So, naturally, here in the state of Connecticut, they could not attend school.

So, the family went and got a note. It was a stamped note from a doctor in Texas.

Dr. Brugge: Wow.

Dr. Alessi: And, naturally, that was not accepted either. And so, the child was not able to attend preschool. And what was interesting, the pediatrician said, you know, I’ve been seeing more of this in certain ethnic communities where there’s more of a belief or whether it be rumor or whatever. How does that pediatrician get over that?

Right? I mean, the parents are kind of locked in now because their neighbors, and members of their church, and members of their ethnic community are not, they’re all saying it’s bad for you, and yet, we’re going to have a problem. I mean, we’re having a problem now with taking measles.

Dr. Brugge: Right.

Dr. Alessi: So, how does a pediatrician, how does a doctor who’s listening to this podcast kind of get over that?

How should they react or discuss this with a patient?

Dr. Brugge: Yeah, so let’s be clear. MMR vaccination is not something that’s equivocal. The evidence is very strong. It’s something that children should all get, how to convince, and it’s a very, very unfortunate outcome of the COVID epidemic in again, in my opinion, that vaccine hesitancy and questioning of vaccines has spread to other vaccines beyond just specifically COVID.

And I agree with you completely, that presents a substantial problem and an obstacle for us. I don’t know how, I’m not a clinician, so I don’t know how a pediatrician dealing with a specific family should approach this, but I would go back to my more public health roots, my approach to collaborating with communities and say that engaging, not necessarily on an in one-on-one basis, in a clinical setting, but in a broader community way, engaging the community in a mutually respectful conversation, in which they can ask questions, they can express their views, and we who have our knowledge and evidence can express ours. And people in public health who are behavioral experts, who are social scientists, can take what they’re hearing and think about how to address the concerns and fears and doubts that are out there.

I think it’s more of a societal population approach than it is probably one-on-one because the one-on-one conversation, even if that pediatrician succeeds, it’s just one person. There’s still the rest of the community. So, that would be my thought. Now, vaccine hesitancy is not my area of expertise.

Dr. Alessi: Sure.

Dr. Brugge: So I haven’t tried to convince people, but I tend to fall back on sort of the public health community roots of my perspective.

Dr. Alessi: Let me ask you another question. You know, you’re a department chairman, Doug, so you should be able to predict the future, right? That’s what you guys do, right?

Dr. Brugge: Right. I didn’t see the current financial crisis coming, Tony.

But anyway, go ahead.

Dr. Alessi: Well, I mean, are we going to get confidence back? How’s that going to look? I mean, how does that look in the future in terms of when do you see that? How do you see that developing?

Dr. Brugge: Yeah, my success in predicting the future has been almost zero, but let me give it a try anyway. I think we will get confidence back.

I think that these things go through cycles for one thing. I also think there is a whole new generation of public health professionals. We’re training some of them and they’re going out into the world there. There are some people who are hesitant to go into public health right now. I think we’ll get past that, and I think public health is resilient.

I hope, as I said earlier, I hope we make some corrections and improve our ability to relate to and communicate with the public, especially parts of the public that are not immediately in agreement with us. But I think we’ll get there. And I also, you know, working with community partners has given me a deep respect and faith in regular people. And I feel like most people, most of the time, if you approach them and talk on a, you’re not through the media, not through political politics, but you’re just having a conversation with them, they’re very reasonable, they’re very open-minded. They’ll listen to you. You can learn from them, they can learn from you.

And I think we need a lot more of that, frankly.

Dr. Alessi: Well, let’s hope this podcast helps us in that respect and we’ve reached some people with this and with the benefit of your knowledge.

Doug, listen, thank you. Thank you for spending time with us today. I really appreciate you taking time for this.

Dr. Brugge: It was a pleasure and I enjoyed the conversation, Tony. Thank you.

Dr. Alessi: We’re going to be doing it again soon ’cause we didn’t even get into environmental stuff, which is your strong point.

Dr. Brugge: I could talk to you for hours about that too.

Dr. Alessi: Sounds good. Many thanks to my guest today, Dr. Doug Brugge, who is chair of the Department of Public Health Sciences here at the University of Connecticut.

If you have questions or ideas for future programs, you could reach out to me at healthyrounds@uchc.edu. Jennifer Walker is executive producer of the Healthy Rounds podcast. Chris DeFrancesco is the studio producer for the Healthy Rounds podcast. Until next time, this is Dr. Anthony Alessi. Please stay healthy.