Episode 44. Seeds of Doubt - The Politicization of Public Health with Matthew Jacob and Dr. Brian Castrucci
Michelle Rathman: Hello, one and all, and welcome to a new episode of The Rural Impact, the podcast that works hard to connect the dots between policy and rural everything. I'm Michelle Rathman. Again, thank you so much for joining us. We are so glad that you could be here today because today's episode, we are talking about misinformation and disinformation and how these things are connected to public health and policy.
You know, in fact it needs to be said that misinformation and disinformation have become a most pressing public health crisis in America, and we know that rural America in no way, shape, or form has been spared, been able to escape its impacts. I want to share with you that in September of 2023, just to paint a little picture here, the KFF Health Misinformation Tracking Poll Pilot, examined U.S. adults’ use of and trust in different media sources, and their exposure to and belief and a series of health related misinformation claims, including false statements related toCOVID-19 and vaccines, reproductive health and firearm safety. Three, as we know, hot button subjects.
Now, while the report is extensive, one key finding that I think was important for this conversation we're about to have is this. Reflecting the partisanship of adults and rural communities, rural adults are least trusting of the health recommendations from the Biden Administration with one third, 35 percent of rural adults saying they trust the Biden Administration, including just 8 percent who say they trust the administration a great deal. An additional third, that's 36 percent say they do not trust the health recommendation from the Biden Administration at all. Rural adults are split in their trust of the former President Donald Trump's recommendations. One fourth say they trust Trump to make the right recommendations when it comes to the health issues a great deal.
And a similar share, 28%, say they do not trust him at all. Fast forward, we are now heading into 2025 with a return to a Trump Administration, and as of this recording date, facing the confirmation of a potential head of the Department of Health and Human Services, who has no medical background, but more than that, has made his views on anti-vaccination well known, which has many in the public health field quite concerned.
And of the potential appointment of Robert F. Kennedy Jr, Dr. Richard Besser, and you may know the name, President of the Robert Wood Johnson Foundation, wrote the following opinion, which appeared in U. S. News, and he also shared it on his LinkedIn profile on November 17th, and I want to provide you with more context.I'm going to read some of that from Dr. Besser, and it goes like this.
Regardless of which party controls the White House or Congress, the hard work of building back trust in public health that plummeted during the pandemic is going to take time. It must be ongoing. I've devoted my career to medicine and public health more than 30 years as a pediatrician, 13 years with the Center for Disease Control and the past seven years leading RWJF.
I have served under both Republican and Democratic administrations and as acting CDC director, I worked with selfless public servants dedicated to advancing health in America every day based on the best available evidence. A person's politics did not matter when it came to facts and following the science.
Dr. Best goes on to say, indeed, the reason to oppose Robert F. Kennedy Jr.'s nomination is not because of his politics or even the politics and priorities of the incoming Trump Administration. If he's permitted to use Health and Human Services as his soapbox to promote dangerous and unfounded conspiracies, Kennedy will literally threaten countless lives across America.
So that was again from Dr. Richard Besser of RWJF. And before I introduce my guests, let me also share this. Fortunately, data does also tell us that rural adults continue to trust their doctors. In that KFS study that I referenced earlier, rural adults are more than twice as likely to trust their own doctors a great deal on health recommendations than to trust government sources.
All right. This is a conversation I've been wanting to have for quite some time, and I've been having this conversation with many of my colleagues. And so, I'm grateful to be joined today by Matt Jacob. A public health consultant who offers strategies to help nonprofits, health agencies, and other stakeholders raise their profiles and communicate with impact.
And I'm also joined for this conversation by Dr. Brian C. Castrucci. Brian is the President and Chief Executive Officer of the de Beaumont Foundation. He is an epidemiologist, public health practitioner, and fierce advocate for the public's health. Okay, listeners, now that I have painted the big picture for this conversation, it is my honor to have you listen to my conversations with Matt Jacob and Brian Castrucci.
We're talking about misinformation and disinformation in public health and policy. Are you ready? You know, I am. So, let's go.
Matthew Jacob Interview
Michelle Rathman: Hey, Matt Jacob, welcome to The Rural Impact. I mean it when I say we are so glad that you could join us for this conversation. These are some important times we're in.
Matthew Jacob: Well, thanks, Michelle. It's a pleasure to be with you.
Michelle Rathman: Well, I've let our audience know why we've asked you to be here and so I'm just going to jump right in, Matt. First, I want to remind our listeners, first and foremost, that we are recording this on the 20th of November. And as you know, news is happening super-fast with respect to the future of America's federal institutions focused on health and other things.
And of course, things may have shifted by the time you listen to this. However, I'm certain the discussion will have relevance no matter what the date is on the calendar. So, let's start there. Matt, from your vantage point, with all these moving parts and these uncertainties, what will be the hardest challenges for public health leaders going forward into 2025 and given where we are?
What do you have to say about that?
Matthew Jacob: Well, I'd say there are two challenges that stick out for me. First and foremost, RFK Jr. 's influence at the federal level might encourage some governors and legislatures to muffle the voices of public health leaders. And that concerns me. In many states, this could take the form of an unofficial gag order on health departments, restricting what they can say or post on their websites about vaccines or other topics.And it would really undermine the public's access to accurate information.
Because health departments may increasingly have their hands tied. It's a very real prospect. Health foundations have to be poised to step up. I think foundations should begin now to identify and fund nonprofits in their states that are on standby that can step into this vacuum and fulfill the role of public health communication if that opens up, if health departments are gagged. And I hope my suspicion is wrong about that, but I always believe in being prepared.
I'd say the second challenge is, kind of an oldie, but goodie. And that is every sentence, every paragraph matters and in a tough environment like this even more so. So we've got to really strive to be better communicators in public health.
You may have seen it, Michelle, the Pew Research Center just released survey data showing that only 45 percent of Americans view scientists as good communicators. So, from the public's perspective, public health leaders, in my view, fit into that category of scientists. So, I think we need to own some of this and accept it as a critique of how we communicate.
We've got to look at it positively and really redouble our efforts to, to be effective communicators.
Michelle Rathman: I echo that. I really do. And you know, this leads us to the next point I want to bring up, which is about data and sources. I mean, at the end of the day, public health and scientists may not be the greatest communicators. However, their research is essential. The data that comes from their research is imperative for forming policies, for example.
So, let's talk about data and sources specifically. What about some strategies that help to, I mean, we're already crawling ourselves out from a hole that started during COVID, okay, so how do we even begin to regain, maintain, and dare I say, build trust in public health while we anticipate these major headwinds?
I mean, messaging is one thing, but trust is not just about, messaging. It is about relationships. So how do we square with data and resources and then connecting with people to the level that they begin to have trust again, even their local health provider?
Matthew Jacob: Right, right. Yeah, I, I think, I think public health leaders have to encourage clinicians, dentists, physicians, behavioral health professionals, others, nurses, to step into this role a little bit. Given diminished trust in the public health sector, some of the, some of the attacks that we've seen and experienced, I think we've got to lean a little more on the people around us in, in that community.
We know, and I think you've seen the data, things have gotten very partisan and yet at the same time, people's level of trust in their own doctors is still pretty high, and that doesn't shift much at all based on whether their affiliation is R or D. So, I think, I think we've got to lean on others to carry the message because they are trusted if, if we, if we kind of, leave say “It's all up to us and this is kind of our, our challenge. We've got to tackle it on.” I think it's going to be very difficult.
So we, we have to find messengers who already have a reasonably high trust level in their communities, parents, civic leaders, community activists, and others. And these can be very simple. This can take simple forms of just people. You know, Instagram had a big thing during the COVID pandemic with people taking photos of themselves having just gotten vaccinated.
That went very viral, right? And give people a sense of ownership over it too. I mean, I think as public health people, we have this tendency to be very structural and go, okay, well, let's get this approved. And we've got to kind of, okay. And stamp this and that. But sometimes letting it be as authentic as it can be and letting people kind of own the message a little more you know, people, a mom using her smartphone to just record a video of herself explaining why she's gotten her child vaccinated for HPV, you know, something like that could go viral. Health department could share it.
I think, I think there's no real easy way out of this hole uh in rebuilding trust. I think we've just got to work on multiple, multiple fronts. I do want to throw out a caveat though. One thing that I hope doesn't happen. And that is feeling that lack of trust, feeling pushback.
I don't want public health leaders to be afraid to correct misinformation when they see it. And I do see some timidity out there and here's one reason why. Many years ago, you're probably familiar with it. There was an analysis of a CDC leaflet about vaccines that led many public health leaders to start worrying about what they called the so called backfire effect.
The fear was that if you correct misinformation, do people end up remembering the misinformation more than the facts that you've laid out? Here's the reality, though, that I think should be reassuring to public health leaders and hopefully help them as they work and build trust. That analysis was never published in a peer review journal.
And four years ago, a review by researchers at Harvard and Northeastern University was unable to validate the backfire effect. In fact, these researchers wrote that public health people can, quote, rest assured that it is extremely unlikely, unquote, that citing and correcting misinformation will increase the public's belief in the misinformation.
So, I, I think that, you know, I think that people should feel comfortable continuing to identify misinformation, making a correction and, not, you know, feeling so much like we're, we're digging a trench, right? And we're hiding. We, we feel kind of, we're being assailed and it's so easy to feel that way given what we've been through over the past several years.
Michelle Rathman: I mentioned the word headwinds. So, you know, here at the end of the day we sat at the top of the show, we talked about some statistics about you know, how things are different today. So, the politicization, not just in this country, it's in other countries as well, although we're here and we're feeling the heat of it right now, of public health is dangerous, very, very dangerous territory. And it has been building for a long time.
And so as in particular, from a rural lens, more under resourced than, than any other sector that we have, I mean, public health and urban and metropolitan and suburban areas looks very different than in rural areas where it might just be one or two people, you know, at a county level, and there's, there's some limitations as to even what they're able to do today.
So whether it's the next outbreak of a highly contagious virus, routine childhood vaccinations that you mentioned, HPV, fluoride in the drinking water. We recognize that that is, you know, county and states, but we are talking about kind of the potential for public health organizations to be depleted of their resources if they don't comply with the politics that's happening in Washington, D. C.
It brings me to wonder about how rural communities can really convene groups of stakeholders that are influential because people are listening to the, to those who they trust, whether it's their faith-based organizations. We ran a campaign called Shop Talk. Show them you care as much about their health as you do their hair, which is really to equip, you know, beauty shops, salon owners, and so forth.
Not with health information to dispense advice, but rather gentle nodding and nudging people towards seeking information from their own provider. So, talk to us a little bit about, you know, as a communications expert, what can be done if you take a look at it as a community level and say, with the resources we have, and the influences that we have in our own community, recognizing also that media outlets are sources of media in rural communities have diminished significantly. If you have a, still a local paper or a local radio station, you're lucky. It depends on who owns it and runs it. So, can you give us some advice about how we can build coalitions from a rural perspective to help address this at a local level while all the other noise and chaos is going on around us?
Matthew Jacob: Yeah. Yeah. No, it's a, it's a very important point. I mean, I think, I think part of it is, is sort of what you said in parenthetically, which is, you know, about that, that program, that initiative you mentioned where the goal wasn't, okay, here are the three things I'm going to tell you, you should be doing to improve your health.
And I think sometimes with public health, we need to step back and realize that this is simply a first conversation. And my goal is not in the next six minutes to completely persuade somebody to do three things to improve their oral health or their behavioral health, right? Or their systemic health.
It's to help them pivot and, at least encourage an openness to wanting to learn more, digging in a little more, having a conversation with their physician when they visit them the next time. So, I think we've got to think about the objective a little differently. We've got to break it down and realize that there's an iterative element to this, right? That it's not like, okay, I'm getting ready to talk to this person. And in three minutes, you know, I need them to believe blank. And so, we have to be very patient. And that's something that doesn't come easy to me. I don't know about you.
Michelle Rathman: Yeah. Right. No, I mean, and it is, it's important to ask questions and, you know, without, yeah, I've said before, we have to get to a point where when we're asking a question, those before us don't believe that we're questioning them, but rather have a genuine curiosity about how they arrived at their conclusion.
Matthew Jacob: Right, right. And I think language is huge too. I think we have to consider whether the language we are using is perceived as partisan, right? Most of rural America is red America. I mean, we know that to be the case just in terms of data. So, and we have to just tell ourselves as public health people, it's not what we say, it's what they hear.
And I'm not suggesting that we discard dozens of words solely for this reason, but I do think every county and state health department needs to have an internal conversation about this. Now, let me put my cards on the table. I have never been fond of the term intervention to describe a wide range of public health practices.
Why? Because when some conservatives or libertarians hear that term, it suggests that government is taking an aggressive step, moving into a certain area, playing a role it wasn't playing before. Surveillance data is another public health term that just is likely to be heard a little differently by people, right? Based on their political views.
And that's a term we hear all the time internally, right? When you're talking to your colleagues in public health. There's no you know, deplorable intent involved in that. Right. But we know we are living in this, and operating in this larger environment where words can matter and they can really push the wrong button.
And even the people who are offended in some way. They're not even necessarily so conscious that that's the word they heard that kind of set them off, right, or made them distrustful. So, I think this is all very tricky, but I think we have to kind of do a little bit of an internal audit on what language do we use.
And I think, you know, uh, part, we talk about finding messengers outside of the public health sector. And diversity is very important on that level. I think political affiliation is another form of diversity we've got to consider. So, after RFK Jr. made his negative statement about water fluoridation, a national reporter contacted a Republican congressman from Texas who happened to be a dentist.
The congressman said he didn't understand why somebody would oppose fluoridation. His hometown had fluoridated water and his kids were all the, his kids were all the healthier because of it. So, you know, there are people out there who are conservatives, who are Republicans, who get public health. In all the noise when you're on X or on Facebook, it's easy to lose sight that, oh my gosh, they're all against us, they're all this.
Um, I, I think we, we've got to really rise above that and challenge ourselves to find these messengers. And also give them some coaching on how to talk about the issue, right? I've been around some dental professionals who I've heard say, “fluoridation is a no brainer. Every community should do it.” Well, here's the problem.
When you tell somebody that something they are skeptical of is a no brainer, it's a little bit like saying you don't have a brain.
Michelle Rathman: Yeah, you're discrediting them. I mean, Matt, it brings me to my very next point, which is about the work as it relates to making assumptions about our audiences. I mean, we really do work in our, in my day job. We do work to help health organizations, rural health organizations, in our case, understand developing personas, because that is how we reach people. Not because we want them to, not because we want to shove a message in their face, but rather we want to open up opportunities for them to receive.
And so, let's talk about that through a rural lens, you know, making assumptions about the audience and what can you share with, with our listeners about how they can kind of put that on a shelf and recognize that we have a bigger mission.
The picture is, the mission is bigger than just making a point in front of the person in front of you.
Matthew Jacob: yeah, yeah. We, in the public health field, we generate hundreds of fact sheets, and web pages, and news releases every year. And when we write this content, we tend to make assumptions about the public, right? What they already know, what they need to know, and we've just got to do a better job of learning all we can about our target audiences.
And I think I think there's a tendency among people living in urban suburban areas to kind of tag all rural people as sort of thinking this way or being this way. And we've got to pull ourselves out of that shell and realize if we haven't lived it, if we haven't grown up in those communities, we're not in a great position to make any assumptions, right?
We really, so I think we need more community liaisons. We need more people from the community who are really having conversations with, whether it's, just grabbing coffee with them on. These don't have to be formalized, you know, focus groups, but we've got to have those avenues where we're somebody's keeping us honest and kind of just holding us accountable.
And, and those assumptions can be, it can really be difficult to overcome. I'll give you a quick example. So public health people, understandably, we're very excited when the covid vaccine came out. But we overlooked a reason why some Americans might be more nervous than excited. Some people wonder understandably if the covid vaccine was safe because it seemed to be developed in such a hurry and
Michelle Rathman: warp speed, I think was the name of the project. So
Matthew Jacob: Yeah. So, the media used that term, the government used that term and I'm like, folks, I don't think this is really how you want to frame it. And so, most of the public health leaders who were interviewed on TV that I saw said little or nothing about the decades of research that had been conducted already on earlier Corona viruses.
And that research gave us a huge headstart to develop the vaccine. And you know, if we had told that story, I think we could have lowered the anxiety level and probably made it a little harder for anti vax people to exploit the situation.
Michelle Rathman: I believe you are correct. And because we are a society that doesn't have a lot of patience, and everything, and with all the outlets we have, we're not communicating any better. We just have a lot more outlets to spread information. All right. So Matt, let's talk about my next point, which is something that you talk about, is communicating with passion.
I communicate with passion. That's why I do this. And I recognize when I'm working, you know, in other spaces, I have to temper that because we, we may not share the same passion, the same sense of urgency. So, talk about how we can, from a public health perspective and all the uncertainties with policy, how can we temper our emotions and passions and how will that make us more effective communicators about really important public health matters?
Matthew Jacob: Well, I'll be quite honest with you. I think that, that, the real challenge is, I see people on kind of both ends, right? I see people who are very passionate and it can come across, for better or for worse, as aggressive, sometimes contentious, right? We don't want that. But I don't think we want the other extreme either, right?
We, we, we, sometimes people come out of, of graduate school, they've got an MPH, you know, I, I'm, I'm into public health, but my, my purpose is to be calm and just passionate, let the evidence speak for itself. There, there's some value in looking for that sweet spot in the middle. Right? I think that, you know, we, we don't want to, to talk in a way that almost encourages somebody to think, “Oh, I can get into a food fight with them. Right? If I just push this button, you know, they'll react negatively. And then we're kind of in this very contentious, angry, um, debate. Right?”
By, by contrast, though, I think if we avoid any emotive language, it can make us seem unrelatable. It can put more distance between ourselves and the public. And those are the people, right, that we're trying to build a relationship with.
You know, Mandy, Dr. Mandy Cohen of the CDC was talking about the COVID and flu vaccines to a news media outlet in Dallas. And I loved what she, how she handled it. She said, as a mother, she would never recommend something for the American people that I wouldn't recommend for my own family. Now, she didn't yell that, she didn't, it's not filled with fury or passion per se, but what I appreciated was she kind of took the white coat off and said, “you know what, I'm a mom. I'm not just a scientist.”
And I think that humanized her without undermining her professional credentials. And it showed people she had some skin in the game. And I think it gave credibility to what she was saying. Yeah,
Michelle Rathman: it could go both ways, right? And so that's where, that's where turning to already trusted sources that you have a relationship with. All right, Matt, I ask this the end of every, before any guest leaves, it's kind of our, your parting gifts to us, I should say, and it is related to policy and advocacy.
This will never stop. Our advocacy efforts to improve population health and public health in rural communities must continue regardless of those headwinds that we are facing. What is in your advocacy toolkit for our listeners, whoever they are, and they, they span from all walks.
We are going to have a new Congress. We are going to have to communicate needs. We're going to have to ask for resources and sound policy that keeps those resources coming to those rural communities. What would you say would be one of the first kind of repurposing or retooling in your advocacy toolkit to make sure that those resources continue to come to public health departments and rural communities in those counties that, that, that rely, I mean, they are dependent on those federal dollars coming into their state, coming into their county.
So how do we communicate with our policy stakeholders of the importance and why we need to continue?
Matthew Jacob: Yeah. So, I think it's, it's, we really need to come in with a good circle of people around us, right? So, when we're having conversations with a state legislator or a member of Congress, we, we really want, we want the hospital administrator. We want the manager of the FQHC. We want a small business leader in that community and other, other business people who understand, right, that if that rural hospital closes, guess what's going to happen to restaurants and drugstores and other businesses there.
They're gonna get hit hard.
Michelle Rathman: The food processing plant. With the, with thousands of employees we know what happened, right?
Matthew Jacob: And Michelle, you're great about pointing this out that hospitals are such a hub in rural communities. And really, it's more than just the things we know about, right? That they really are kind of a cultural and identity anchor. They tell rural people that, that your community matters.
There are people in this building here that are ready to serve your needs and provide care when you urgently need it. And so, I think that's, that's really important. I would say in terms of tech tactics and strategies, one thing I just kind of want to leave you with is my thought is we live in such a tense and turbulent time, and public health people are pretty serious people.We take our craft very seriously.
Look for ways to throw just an element of humor or levity into some of the initiatives that we launch. So a little spoiler alert here, I'm going to encourage people to look for a campaign that the Maryland Department of Health is going to launch soon about trying to encourage people just to increase water consumption and move away from bottled water, that they can enjoy tap water and how it's actually tested more rigorously than bottled water.It doesn't have a negative effect on the environment.
But they're not just throwing those facts out there. They've developed a device that I think is really clever and and really reaches their target audience, which is Gen Xers and Gen Zers to, to, uh, to encourage them to do that. Right?
And sometimes we forget that there's kind of this whole psychological hurdle. We need to leap over before people are ready to accept our facts.
Michelle Rathman: That's a great point to leave us with. Oh my gosh, Matt, Jacob, I am so, I mean it, grateful. We met full disclosure, you know, we met on LinkedIn, so, and it's just been wonderful to follow your work and and your wisdom and your experience and your words, and let's stay in touch because we are in for, I would imagine a perhaps a bit of a bumpy ride ahead of us, got a lot of work to do.
Matthew Jacob: absolutely.
Michelle Rathman: All right. For the rest of you, don't you go anywhere because we're going to be right back with this very special Rural Impact extra episode. Sit tight.
Dr. Brian Castrucci Interview
Michelle Rathman: Hey, we're back. And if you just joined us, today's episode of The Rural Impact is focused on public health and policy. And it's my pleasure now to welcome Dr. Brian Castrucci, President and CEO of de Beaumont, where you all are doing amazing work to advance policy, build partnerships, and strengthen public health to create communities where people can achieve their best possible health.
Brian, thank you so much for joining us on the Rural Impact. We're really glad to have your voice and your wisdom on this topic. Welcome.
Dr. Brian Castrucci: No, totally happy to be here. Thanks for having me.
Michelle Rathman: All right. So, here's my lead question for you, Brian. On November 20th, we are recording this on December 2nd, but on November 20th, it just seems like so long ago, but it wasn't. You, along with former Governor of Ohio, John Kasich, wrote a commentary for U. S. News with this title, What the Senate Needs to Hear from RFK Jr. and Dr. Oz. Senators Have a Duty to Vet Nominees Who Affect Every American's Health and Well-Being.
So, let's start there. For those of our listeners who did not read that piece I encourage you to do so, but why don't you just give us kind of the essence of, of why you developed that and your position on this matter.
Dr. Brian Castrucci: Well, I think right now there are a lot of people who are upset at the nominations, and you have folks, you know making it, attacking RFK Jr., attacking Dr. Oz, attacking the nominees. And those attacks don't necessarily yield anything except expected disapproval. I don't think Trump went into this thinking, oh, everyone's going to love RFK Jr.
I think he knew the, the concern he was stoking. And so, I think for the governor and I, the issue really is about the Senate. That's where we get to investigate and determine where these nominees are in terms of vaccine and other health issues. I mean, there's a lot that we can debate. There's a lot about health policy that is perspective.
But then there's also a lot that's just basic science and vaccines work. They are safe. Fluoride has been in our water and has been one of the 10 great achievements of public health. And so, we do want the healthiest country possible. We're nowhere near the healthiest country. It's going to take some strategies that may be different.
It may take some outside of the box thinking, but let's not go backwards, in an effort to go forwards, and I think that's what the Senate's going to have to tease out.
Michelle Rathman: You know, um, we, you, you write in the, in the piece, you talk about healthier communities means stronger economies. You cannot unlink those two in my view. And I'm glad to see that you wrote that as well. So, less strain on health care systems and a brighter future for all.
You know, Brian, no secret. I mean, this is The Rural Impact. So we focus on rural, America's rural hospitals. Again, over the weekend. I'm reading how many more hospitals are vulnerable of closing. Our health systems continue to struggle in rural areas, both in workforce recruitment. You know, I'm talking with hospital CEOs right now, and [their biggest concern is workforce, losing their physicians, losing their nurses, their, their phlebotomist, techs, what have you.
So, with that said, their financials is tied to that. There are so many external forces. How do you foresee these already vulnerable, not all of them, but many of them organizations, and their abilities to respond to any number of public health crisis born out of a policy that, for example, might restrict or make less available vaccinations? Because we are seeing this in Idaho, uh, which I talked about with our previous guest, Matt Jacob, where an entire health department is saying we're not going to do COVID vaccines any longer.
So, what is your, you know, kind of like, like, connect these dots for us? What happens when we have a public health crisis and a weakened, uh, health system in rural communities?
Dr. Brian Castrucci: Well, we're more vulnerable now to pandemics than we were at the start of COVID. And that's a threat to our economy. It's a threat to our safety and our security. And so any person who's leading the country needs to be sure that our country is safe, whether that's safe against viruses or safe against foreign countries, you have to ensure that we're safe.
And right now we, when we look at the electoral map, we see that rural America is mostly red. And so, it is on the Republican party now to ensure that rural America is healthy. Now that might not mean that the economic model that we currently employ for hospitals works. Maybe rural hospitals are going to lose money.
Maybe they won't have the census. Maybe they won't have the ways to be profitable. But profit shouldn't outstrip the need for people to be healthy in this country. You shouldn't have to relocate to a city and exacerbate the death of some rural communities, because people can't get care. Right. It's really hard to say, I'm gonna move to this place to get a job knowing I don't have any access to OBs or I don't have any access to cardiac care.
I think that limits who can live in rural communities. And we shouldn't be in a in a world where only people who are willing to ignore their health care needs or don't have health care needs are the only people who can live in rural America. Rural America is, is critical for the success of all America.
There is no success for America without success for rural America. So we have to make sure that we're doing something that may not just be well, let's open a new hospital and hope it stays afloat. There might have to be economic subsidies from the federal government. There could be, you know stronger loan repayment programs or expanding loan repayment programs to get people to move to those areas, but when it comes to you know not providing COVID vaccinations. That doesn't even make sense.
Now, whether they're required or not, that's a policy discussion that we can have, but their availability should be universal. And if you are living in a community and you want to get a COVID vaccine, and that is your choice, you should be able to get it. Restricting choice is not typically a Republican ideal.
We want people to make individual decisions about their health. And then we need to talk about how to ensure that we are protected against COVID as a, as a nation, as a community. But taking away the right to, to have that, that choice, that's just not right.
Michelle Rathman: Well, and of course, we are talking about one candidate in particular. RJK Jr. who has been, you know, it's no secret of very anti vaccinations. And so that that I think is something that to your point, the Senate needs to really ask some hard questions. And with that in mind, in your piece, you touch on prevention and health equity.
You know, equity is a word that, you know, as I'm reading through Project 2025, I'm seeing, you know, kind of the call to strike equity out of the conversations, but you do talk about these two things and, and I ask you this question, what, what are the questions you believe need to be asked and answered during the vetting process, uh, for these critically important positions for with respect to prevention and health equity?
Dr. Brian Castrucci: I think the nice part here is that RFK Jr. and Dr. Oz, and the other nominees are all on the record with some ideas that definitely kind of go against established science. So, let's talk about them. Let's actually have a conversation. Let's bring up what was said. I don't believe that the Senate is going to rubber stamp every single nominee.
Let's have the conversation. And what we need to talk about when it comes to health equity is, is how do we actually get there? And what's the threat of having a nation that, that does not have strong health equity? The COVID pandemic was in a lot of ways fueled by our disparities in this country, our educational disparities, our income disparities, our racial disparities.
Disparities fed that fire in the U. S. And so, we know now that it doesn't just, you know, health equity and disparities don't just impact one group, they impact all of us. And so, a commitment to reducing health disparities, I think, needs to be on any person's mind who is serving as an agency head in the Trump Administration.
Now, how we go about achieving health equity, that may be different between different people, they may have different perspectives, but a commitment to the outcome must be there.
Michelle Rathman: I love that. You know, with the disparities, as I think about it, we have to have these conversations where we are connecting the dots between all these things and to your point, rural America can't be successful. The rest of the country can't be successful if rural America isn't, let's, let's focus for a moment on medical misinformation and public health turnover and research.
I've been doing a lot over the weekend, a lot of reading about the potential nominee for NIH, for example. And kind of ending research for preventable diseases and so forth. So medical information is harming patient health. Focus on key findings and policies that can reverse harm. Is there a MAHA solution for that, that MAHA, Make America Healthy Again that, that, that new, uh, acronym that we have?
Dr. Brian Castrucci: So, I am hopeful that rhetoric and policy are not the same.
Michelle Rathman: Mm hmm.
Dr. Brian Castrucci: And I don't believe that we are going to tear down the NIH to ensure that, or, let me say that again, we're, we're not, I believe that we're not going to tear down NIH because it is really the leading biomedical research institution in the world.
Michelle Rathman: Mm
Dr. Brian Castrucci: And so it would be to our own detriment to limit what NIH is doing. Now again, there may be tweaks that are made. There may be ways to limit the authority of scientists so that they don't have another instance of a Tony Fauci who was speaking out at times ahead of the administration, or maybe there's not going to be gain of function research if it was even happening.
But let's not, let's not chase every single bit of rhetoric and assume that that's the end of the world. I want to see policies change. I want to see what actually happens. RFK Jr. said on, on the day after the inauguration, they're going to fire 600 NIH staff and then bring on a new 600 NIH staff. That just shows he has a misunderstanding of how government works.
That's not going to be possible. So, the bureaucracy that exists is in some ways going to protect the agencies and, and unfortunately, this is the outcome we have. The president gets to pick his, his nominees. He was very clear about who he was going to pick and he has done that. Right that he said, we're going to let RFK jr run wild on public health.
He said these things.
Michelle Rathman: hmm.
Dr. Brian Castrucci: What I think it's going to take our business leaders, and religious leaders, and people outside of the health and public health ecosystem standing up for health. There are very few things you can do in this country if you're not healthy. If you're not healthy, you can't go to school and get good grades.
You can't graduate. You can't necessarily go and worship the way that you want to. You can't go to work and be your best self. And so, health is the foundation of our country. And we're going to need people to stand up and stop anyone who has an idea to take a jackhammer to the foundation of our country.
You just can't do that. It'd be like taking the, taking a jackhammer to the foundation of your house. No one does that. And if you do, you put everything else in your house in jeopardy.
Michelle Rathman: Mm.
Dr. Brian Castrucci: So I, I need to hear, we need to hear, not only from, you know, Senators, but from business leaders, because I think, I think Trump will hear from business leaders.
I think he'll listen to that. And so to say, like, this is employee health, this is health care costs you're talking about that many of these employers have to shoulder. So, I think there's a balance that has to be struck and it's going to be time for us to be more aggressive in extolling the virtues of a healthy population.
Michelle Rathman: You said we, we talked earlier, you had said, uh, you know, we have to be at the table because we know what happens when you're not, you're on the menu. And so it's really important to keep the dialogue going. Brian, before we close, I just wonder what advice would you have for public health officials related to advocacy for policy that protects public health, considering the, you know, we're going to have headwinds. There's no doubt about it.
There's fundamental differences in ideology. So what do we say to, you know, a small rural public health department? You know, some of these rural health departments maybe have one or two people, maybe five people. And how do you make sure that their voices are heard and make that they advocate for the resources they need for their rural community?
What advice do you have?
Dr. Brian Castrucci: Well, I don't know that they should necessarily be the advocates. This is time for other people to stand up for public health because they understand the value of it. When you engage in advocacy and you're a public health person, any anyone who you are advocating to is going to know your position. Right?
When you have someone who comes in who is, you know for the safety of animals, you know what their advocacy position is going to be. That's not shocking.
Give me someone they don't expect. Again, if you know, as a health official, you know the three leading causes of disease in your community, you need to know the three leading employers.
You need to talk to those employers. You need to mobilize them. You have to mobilize your religious community. You need to mobilize people in the community who aren't necessarily from that health ecosystem to advocate for health.
When, throughout the pandemic, there were health commissioners who were losing their jobs and they were at public meetings and they were being terminated, there was no one there to speak for them.
Where were all our colleagues? Where were all our friends? Where were all the people that we were engaging? And the challenge is that we, our job may be to run the health department, but we need to be out there engaging people at every Froyo opening. I think every health department needs a business council of business leaders so that you're talking regularly to make sure that they understand that health is an economic indicator.
Unfortunately, much of the work that we have to do is not acute. We find ourselves in a moment where we need very rapid action. And the fact that we don't have some of these relationships already is going to be challenging. We have to start reaching out to people today. This can't just be the health commissioner advocating for public health.
If that's the formula, if that's the algorithm, we lose.
Michelle Rathman: Yes. We're in trouble.
Dr. Brian Castrucci: It needs to be a lot of people advocating for public health. It needs to be everyone understanding our value. It's, it's a, it's a tragedy that we're, you know, uh, nearly 150-year-old profession and no one knows our value proposition. That's on us. We need to start articulating that value proposition, what we do, how we're making people's health better, and the with them, you know, what's in it for me.
You need to talk to people, not about the good of public health, but how public health impacted them and their lives. We do this because it's a public good and we know that everybody should be healthy. That's not how everybody thinks. And so, we have to start engaging people and prioritizing what is important to them, and how health facilitates that.
Michelle Rathman: My goodness, I hope our listeners really heard this advice. I think it's great advice, Brian. I believe in courageous community conversations. I'm with you 100 percent on that. It takes a room full of thought leaders, influencers, not just one voice. Because then you're just kind of talking to yourself, an echo chamber, and we know how well that goes.
You're welcome to come back anytime. You've got some information or news to share that yo think is relevant for our conversations with respect to public health and rural America. Brian Castrucci, also Matt Jacob, who joined us earlier. Thank you so much for joining us again for this conversation. We know it's not light subjects, that's not what we do here, but we do hope that in some way you've been enlightened.
To start off your week. For more of these conversations, folks, be sure to subscribe wherever you like to listen, we're everywhere, every platform you can think of, and you can also tune into us on YouTube. We sure do appreciate it when you rate us, share your thoughts and tell your friends about us. And if you're making a rural impact, we want to hear from you.
Go to our website at theruralimpact.com to get in touch with us. And a really quick note to thank Brea Corsaro and Sarah Staub for their wonderful skills to help us make these episodes happen. So,
until the next time, please take good care of yourself and everyone else around you. You're the best at that.
We'll see you again on a new episode of the Rural Impact.
