I think most of us, we like to think about things on a human scale that we can intuitively understand.

But the most complicated problems that we face, to my mind, are almost always problems where you have to be able to think across scales-- from the smallest forms of life to the superorganism of a city.

And in public health, that kind of thinking is the standard, crucial, conceptual toolkit, which often means moving across different disciplines.

From microbiology to epidemiology to sociology to urban planning, all these different disciplines have to come together to solve health problems.

If you think about something like the COVID crisis, you're going literally from the actual genetic information in that virus all the way up to the scale of nations and the entire planet.

We needed to be able to understand how it was actually affecting physical bodies, but then you also had to zoom out and think about transmission patterns and where people are going to be most vulnerable.

And that is a very complex and very modern form of thinking that goes against our basic instincts of the way that we perceive the world.

The way we deal with pandemics depends on more than just whether we have vaccines or masks or drugs.

It really comes down to this question-- What do we value?

Whom do we value?

What do we feel we owe to each other?

Pandemics are a collective problem.

And you cannot get out of them by thinking about yourself alone.

You need to be thinking about your community.

♪ ♪ ♪ ♪ ♪ ♪ The new internal report from the CDC warns the Delta variant is spreading much faster than previously thought.

We have begun to see an increase in the numbers.

The younger folks are now becoming people who are now ending up in our hospitals.

These guys started at 8:13.

They have a few more minutes.

Looking good so far.

Oh, dear.

And they have a positive staff member at the school.

So, isn't school almost out?

Friday is their last day.

And our other goal the last couple of months has been to keep kids in school.

Okanogan County is in North Central Washington.

We border Canada on the north end.

The whole state of Connecticut could fit in our county, just about.

We are not just rural.

In fact, we call it frontier.

We're only listing 37 deaths, which I don't remember the last flu year that we had anywhere close to that.

However, the beginning of the year, I started looking at deaths.

I have a pending.

I have a suicide.

I have a suicide.

I have an OD death, OD death, suicide, one pending toxicology, another suicide.

During the pandemic, we saw our suicide rates increase.

We saw our overdoses increase.

I think it's due to mental health.

Especially now when people who are isolated anyway because of their geography, and then to have all this COVID stuff isolate you even more.

Here, you may not have a neighbor for miles.

So you already have a county that is a service desert, as I refer to it, and now you've decreased those services further.

So, for example, we do have a behavioral health organization with substance use disorder counselors.

They have done no in-person visits.

So we're well over a year without that face-to-face contact.

I think it's taken a toll.

2020, the year of the pandemic, was also a year of calamity in the opioid crisis.

The National Center for Health Statistics says the United States set a record-- drug overdose deaths rose dramatically to 93,000 people.

The number of people who died from opioids a year is bigger than the peak that we've ever had of people dying from car accidents here.

More the number of people who die from gun violence every year.

It's much higher than HIV deaths at the peak of the HIV epidemic 30 years ago.

And what is, I think, saddest about it is that, fundamentally, it should be preventable, right?

It is about taking of a drug.

The opioid crisis is a crisis of despair.

I believe we're suffering from an epidemic within a pandemic.

In the U.S., we have seen stagnation of our life expectancy, and most recently, beginning in 2017, a decline.

Not a big one until COVID, but a decline.

Now, this should have been taken really seriously.

For year on year since the last flu pandemic, we have expected to see life expectancy increase, and every year it does.

Although probably since the 1950s, it's slowed down, but every year it gets better.

When it starts getting worse, not better, that is a bad sign for our society.

It happened in the Soviet Union before its collapse.

It happened throughout Africa with the AIDS epidemic.

But it doesn't happen very often.

And we ought to take it really seriously that it's happened to this country, and ask ourselves, what are we doing that we need to fix?

White, non-Hispanics in America in middle age are dying in large numbers.

That was certainly a huge surprise to me.

Economic studies by Case and Deaton in 2020 showed that mortality among a certain group of white men was actually increasing.

The main drivers for overdose-- liver disease, presumably due to alcohol, and suicide.

So they coined the term deaths of despair to capture the fact that for many of these men, the future wasn't looking very bright.

The deindustrialization, the loss of good factory jobs, the loss of hope.

Deaths of despair really reflect a social fracturing.

They reflect harm that come from economic insecurity and social insecurity.

When we have poor economic functioning, when we have no jobs, when people do not have opportunity to advance, that is when you see more drugs.

That's when you see more suicides.

Folks don't see a bright future ahead, right?

They think that the situation that we are in is really the end result for them.

And so it's quite alarming to us in public health.

We see this across racial and ethnic groups, in white populations, as well as in Black and Brown populations.

When I think about Case and Deaton, I wish that they had acknowledged that it's not just the white working class that is experiencing despair.

It's much broader than that.

For other groups, there's been a loss of hope for a very long time.

In the 1980s, in New York, we're dealing with an epidemic which was an epidemic of despair and poverty.

I'm someone who grew up in the '50s when a high school diploma was enough to not only get you a good job, it would basically give you the wherewithal to have a middle class life.

By the 1980s, we were slowly but surely becoming a service-dominated nation, where, in order to get a job, you had to have, at the very least, some college training.

Many of the pressures on poor communities that had depended on unskilled labor as a source of income suddenly found that the most useful thing that they could do to pay the bills and maintain some sort of semblance of a pleasurable life was to turn to the person who was dealing drugs.

Because, at the very least, they appeared to have a brief answer to much of the misery that people were experiencing in communities at that time.

South Bronx in New York, where 1 in every 5 men suffer the AIDS virus along with 1 in every 10 women.

The figures are worse than parts of Central Africa.

AIDS is flourishing here against a backdrop of vast poverty and crime, mainly drug dealing.

I was born into public health because of work that I did on HIV/AIDS under the leadership of Mindy Thompson Fullilove.

Mindy Fullilove and I began our work as part of the founding members of the Center for AIDS Prevention Studies at the University of California at San Francisco.

Acquired Immune Deficiency Syndrome, or AIDS, started as an exclusively gay disease.

Fight back!

Fight AIDS!

We know so little about AIDS, but what we do know is how it is transmitted.

My training as an educator included doing a dissertation that was pretty fancy with respect to the use of multivariable statistics.

When I heard many of the data that were coming out about HIV, even back in 1986, it was clear that it was going to be one of those conditions that would be especially prevalent and problematic in communities of color.

My father worked with sexually-transmitted diseases.

So when we went back home to Newark, New Jersey to do the usual family visit, part of what I got to say was, Dad, look at what I'm doing.

Good afternoon, ladies and gentlemen.

This press conference will be devoted to the subject of AIDS, in which an area there is, of course, important news.

In 1986, Margaret Heckler, then Secretary for Health and Human Services, made the announcement that HIV was the causative factor for AIDS.

We now have a blood test for AIDS.

With a blood test, we can identify AIDS victims with essentially 100% certainty.

We also believe that the new process will enable us to develop a vaccine to prevent AIDS in the future.

We hope to have such a vaccine ready for testing in approximately two years.

My dad says the following-- beware of the language of the cure because it is not the way in which we're going to get past the crisis that HIV is ultimately going to present.

He said, you have to understand that when I started treating gonorrhea and syphilis in the 1930s, I didn't have very much I could do for folk who were infected.

In 1948, I had penicillin.

I had a cure.

Son, I'm going to remind you, gonorrhea is what helped send you and your brothers to prep school and to college.

Which means that ever since the 1940s, I continued to see a condition that I can cure, but which is present in the community not because I lack medication, but because the social factors that are driving it are still present.

The talk of the cure has to be secondary to everything that we do to make sure that we are dealing with the conditions that make our struggles with HIV so problematic.

Do you suspect that it's possible that this disease could be spreading from the gay population in San Francisco to non-gays in San Francisco and thence on to other cities?

I suspect it is spreading, and I suspect it will continue to spread to other areas of the country.

The use of contaminated needles has led to over 200,000 drug abusers in the city contracting the virus.

Women seem to be more vulnerable than men.

New York wide, 700 women so far have caught the virus from sex with male drug abusers.

In 1987, roughly 29% of AIDS cases were in African Americans.

Well, in 1987, African Americans were 13% of the U.S. population.

Their overrepresentation amongst those who are living with HIV/AIDS meant that there was a problem that was not just biological, but related to the communities where HIV was found.

The devastating fires in the South Bronx, destroying 80% of the housing in some neighborhoods, was a driving factor for HIV.

What happens when someone who's lived in a building for a generation suddenly has to move to a completely new neighborhood?

Rapid movement of people from one neighborhood to another broke up almost all of the social connections that we know are essential to good health.

That's what we were seeing in the South Bronx.

It was a way of understanding the ways in which health is a function of those neighborhood connections.

So that when they're broken up, the factors that typically keep widespread needle use, widespread drug use out of neighborhoods are no longer there.

The structures that maintained neighborly community life had been destroyed.

32 years later, these communities are also the neighborhoods that, with COVID-19, had the highest rates of infection at the very beginning of the pandemic, the highest rates of hospitalization, and the highest rates of mortality, including the highest rates of people dying at home because they couldn't find access to medical care.

It was déjà vu, you know.

It's really important to understand history, especially because if we treat what we're dealing with now as if it's totally new, as if we've never seen it before, all the lessons that we're in a position to learn from 1990 will be lost.

Our poverty level is quite high.

It always has been.

Our unemployment is concerning.

We used to have a lot more job opportunities.

We are looking at what remains of the mill that employed a lot of workers for Omak over the years and was devastated by fire.

It gave good-paying jobs to a lot of the people in our county.

People lost their homes when they didn't have a steady income, or had to relocate.

We haven't ever recovered.

It's just heartbreaking.

With unemployment, what do people do?

What motivates them?

What gives them hope?

The status quo?

What brought us the opioid and overdose crisis was not just individual decisions.

About 25 years ago, the culture of medicine changed and a lot more opioids were prescribed.

The goal many doctors had was to treat their patients' pain, but they created a public health crisis.

There isn't anyone that ever said when they were younger, I'm going to grow up and stick a needle in my arm.

- Mm.

- Can't wait.

There's a level of fear in the community.

We need to respond to that and meet that with, hey, we have solutions.

Absolutely central to public health is the concept of prevention.

How do you reduce the chance that people will die from overdose?

We offer a variety of syringes.

Most of our current clients are using either a 29 gauge half inch, or even this small-- very small--31 gauge syringe.

Harm reduction, to me, is looking at the needs of the individual to help the community.

I can't change your behavior.

If you're going to stick a needle in your arm, everything I say, every piece of education I give you isn't going to keep you from doing that.

What I can do is use empathy.

I can be non-judgmental.

And I can provide you a safe, sterile syringe instead of you getting, besides your addiction, getting a chronic disease.

I was actually at CDC when Scott County, Indiana had their big opioid epidemic, which led to the HIV epidemic.

In less than a week, the number of HIV cases in Southeast Indiana has gone from 55 to 79.

And the governor says the number of cases could climb into the triple digits.

The virus is being spread exclusively through IV drug use.

I do not support needle exchange as anti-drug policy, but this is a public health emergency.

And on the recommendation of the Centers for Disease Control, I am authorizing a focused, short-term, limited needle exchange program if local officials deem that to be necessary and appropriate.

That epidemic was stopped because of the syringes.

These are amazing preventive tools that we have at our fingertips.

The challenge is in this current environment, we're seeing politicians close down needle exchanges.

Could you imagine if someone took penicillin off the shelf?

Imagine the immediate outrage that in the middle of an opioid crisis, we're closing down needle exchanges.

It's the politicization that's killing us.

We started our Syringe Services Program Harm Reduction in 2006.

And we've been going ever since, unfunded.

Sometimes we are the first step in referring people to services.

Once they feel comfortable that we're not judging, we can then suggest and encourage, and say, do you have stable housing?

We know that housing is part of treatment.

Building that trust, sometimes it takes years.

There are thousands of studies that indicate that syringe exchange programs work.

If science is going to help us get out of this mess, the fact that we're culturally blind to potential solutions is a significant problem.

This, this is crack cocaine seized a few days ago by drug enforcement agents in a park just across the street from the White House.

It's as innocent looking as candy, but it's turning our cities into battle zones.

Who's responsible?

Let me tell you straight out-- everyone who uses drugs.

What I recall most about being in New York in early 1990 and working in Washington Heights was a real understanding of how much that community was being transformed by crack cocaine and understanding how much of that transformation was probably exposing people to HIV.

And then the final factor, the notion that we were going to deal with this problem, not by creating treatment centers, not by doing what we could medically understand the challenges of substance use disorders.

No, what we decided to do was take the problem of crack cocaine and the health impacts that it had and turn it over to the police and to the courts.

While it seems as if it takes the problem of crime and puts it out of sight and out of mind, what it does instead is create reservoirs of infection.

A substantial portion of outbreaks that we saw in many urban areas were a result of sex work that was done under the influence of crack.

So we're locking people up instead of treating them.

So if you're in a setting that is now a reservoir for a virus, you're there just long enough to yourself becoming infected.

By the time you get out into the community and try to resume normal life, you've now been one of the vectors that creates the community pandemics.

In 1990, 85% of the prison population in the state of New York was Black or Latino.

And 75% of that prison population was from seven neighborhoods in New York City.

And if you look carefully at those seven neighborhoods, what did you notice?

That they were not only the source of that prison population, they were also the neighborhoods that had the highest concentration of HIV.

We were looking at the creation of an urban pandemic that was so rooted in places that had been abandoned by public resources.

You were putting people in jail instead of figuring out how to deal with the challenge that crack cocaine was presenting.

And understanding that, to this day, the highest concentration of HIV in the United States is in state and federal prisons.

I really believe the whole war on drugs, in the first place, was a joke.

And it's kind of been proven so.

And we created our mess and we're not willing to clean it up.

Hello, Laurie Jones from public health.

I have a meeting with Chief Ruiz.

OK, I'll let him know you're here.

- Thank you.

- Just a minute.

OK.

So far, this year, we've had multiple ODs in the county.

The last one, I think, is being investigated as a fentanyl.

Well, I know the cause of death was fentanyl, which is kind of spooky, in the Omak area.

You know, it's always something you heard about in Spokane or Seattle.

It's been in the area for a while.

It's just becoming a lot more prominent now.

I though it was now a good time that we revisit Narcan training for your staff.

In a nutshell, what Narcan does is it temporarily stops the effects of anything opioid.

It temporarily blocks those receptors in the brain.

And so that's what it looks like.

And my concern from what I've seen is making Narcan so readily available, you're going to bring the overdose-- the single, every-so-often overdose in a private house-- out in public.

At the bathrooms of Walmart, McDonald's, the casino, which we are now seeing because, oh, if I OD, someone will call me, all the cops have Narcan.

I'm not saying if someone was to OD outside right now that we wouldn't administer Narcan to them.

I'm not saying that.

I'm just saying it shouldn't be an easy out per se.

Then, what do we do as a society?

Yes, you're right.

Because public health was founded on primary prevention, totally.

We're going to lose a generation, you know, over time to overdose.

And so, what are we doing to try and prevent that from the get go?

It's almost like we're putting band-aids on systemic problems that we're not willing to spend the time and money on.

So, there.

We continue to have this kind of ER mentality in the streets.

We need a public health perspective to really deal with the whole person and not their immediate medical crisis.

We'll tell people to take Narcan and use Narcan to stop the overdose, but did we give that person job training?

Did we do anything to make sure that they're employed?

Have we done any of the things that fix what got them to that moment of that overdose?

There's a whole tradition in public health when we feel like we can't prevent disease of trying to reduce the harm.

But it's become less of a exception to the rule and more the rule itself.

Since the Reagan administration, there's been less and less emphasis upon really trying to figure out how to deal with real big problems.

It's also, we're going to reduce the harm, we're going to find ways of dealing with it without really dealing with it.

You don't cure these diseases.

That's the problem we're facing.

Many of our most contemporary problems in at least the United States are literally incurable.

And we have to figure out new ways of addressing the problem.

The solutions are often outside of health care.

The solutions are making sure that kids succeed in school and have access to good jobs.

Those kinds of changes will actually prevent catastrophic health consequences later.

There's nothing like a global pandemic to wake us up to all the factors that really can impact upon our health.

And this is the moment where we need to do a postmortem, really understand what happened during this pandemic, what worked, what didn't work.

I think, in many ways, COVID has been a referendum on the soul of the country.

And I'm not sure looking back that we're going to like what it revealed about us.

In March of 2020 in this country, we all realize COVID-19 is a threat, and we said, everybody stay home.

Well, everybody stay home, depending on whether you could stay home.

People who were bus drivers, people who worked in restaurants, people who cleaned our streets, they had to go to work every day.

They had to be around others.

We as a society go on our merry way without thinking that many communities do the jobs that actually we take for granted to keep our society functioning.

If you were working at a chicken factory or you were working as a truck driver, these folks needed to continue to work or we weren't going to eat.

Our high-risk jobs were lower paid jobs predominantly that were overwhelmingly being done by persons of color, people who make lower income.

Our farm community, our immigrant community, our seasonal workers, they were clearly getting infected at work.

When you look at those plants, those people are working shoulder-to-shoulder, next to one another.

When you think about COVID, for many of us, we sat at home.

We were able to isolate ourselves from the threat of COVID.

I mean, think about the privilege that some of us had to not have to go to the grocery store because we could pay for Instacart.

And all that Instacart was during this pandemic was paying someone else to take risk for you and paying them relatively small wages.

There is essentially a straight line relationship between wealth and health.

The wealthier you are, the better people's health is because wealth buys you access to the elements of the world around us that generate health.

We've known about this for centuries, the problem of poverty.

It's the slavery of our time.

And we've all become plantation owners.

We get our food cheaper, our travel cheaper, our clothes cheaper because there are people working at starvation wages in this country and other countries.

And they are actually subsidizing us.

We should be so embarrassed and ashamed.

It is my belief that in coming to terms with history, we need to acknowledge that the current impoverishment of the population of African descent and the desperation of Indigenous peoples is related to this appropriation of their labor, of their land, and that it needs repair.

When you enter the Lincoln Memorial, there's a giant statue of him looking down at you.

And then on the right, chiseled into the wall, is his second inaugural.

It was the last thing he really wrote or spoke before he was assassinated.

It's kind of his summary of what the Civil War is about.

And when you think about it, when he's saying, yes, there is a moral reason for this war in the ending of slavery, but we're really talking about our future and our past of who will be suffering from the systems of work that we've created and the systems of labor that lay at the heart of this whole war-- who does the work, who will benefit from the society and who will not, who will suffer for the sins of our past, and who will benefit from the exploitation of others.

And that's a theme that really is at the heart of all public health.

It's really a theme that's at the heart of trying to find ways of remedying and addressing the inequalities that are a part of our original sin.

"Fondly we do hope-- "fervently do we pray-- "that this mighty scourge of war may speedily pass away.

"Yet, if God wills that it continue until all the wealth "piled by the bondsman's 250 years of unrequited toil "shall be sunk and until every drop of blood drawn "with the lash shall be paid by another drawn by the sword "as was said 3,000 years ago, "so still it must be said, "'the judgment of the Lord are true and righteous altogether.'"

We deserve what we're getting.

So I always-- you know, I just find that, in some sense, the bringing together of every strand in American history, all the contradictions that we started our nation with-- a society supposedly dedicated to democracy, to life, liberty, and the pursuit of happiness-- that was since incorporated into its very constitution the inequalities.

There are certain conditions that are relegated to the poor.

Basically, some people are, in some sense, structurally chosen to bear the burdens of the world we create.

You know, you don't have to get rid of poverty in order to create the opportunity for health.

I wish we could, but people who are poor still can have the opportunity for health.

And we need to stop thinking about the idea that we can get in our enclaves if we're wealthy, and protect our health within those enclaves, and keep out the rest of the world.

I mean, if anything has shown us that we're all interconnected, it's a highly contagious virus.

When COVID happened, people said, oh, my God, a pandemic?

Like, we haven't had a pandemic since 1918.

Why did we say that?

The HIV pandemic is still going on.

The cholera pandemic is still going on.

All these diseases that we have forgotten about in the West, in the wealthy West, becomes ghettoized and something that only affects really poor people.

And you can go back to malaria.

We still have hundreds of thousands of people, of babies, who get sick and die of malaria every year.

Tuberculosis.

We know how to cure tuberculosis.

It's a huge problem in parts of the world.

Is it even something we talk about?

COVID is overshadowing other services.

If you take TB with even more than a million deaths a year, we have more cases now because services have been disrupted.

HIV, the same.

Of course, since the pandemic started, we tried to keep a balance.

But it was very, very difficult because all eyes were on COVID.

The potential risk of viruses and how disruptive they can be is not theoretical anymore.

We've seen it.

It's realistic.

And we need to start preparing for future pandemics now or we risk a much worse future for us and our children.

When COVID happened, we thought of it as an invasion, that this is something that's coming from afar.

It's being thrust upon us, and we are just these passive victims.

Well, what do you do if you're a passive victim and you're being invaded?

Well, you have to strike back.

We didn't have vaccines and drugs at the beginning, but we said, close the borders.

Don't let the people from China in.

That'll protect us, right?

We have to, like, keep the invaders at bay.

But we were creating opportunities for animals with coronaviruses to move into humans, and then for humans to carry that around the planet, and then to rub shoulders with so many other people so that it spreads explosively.

It's a colonial conquest.

The fate of the planet has been profoundly influenced by our species.

Things like climate change, deforestation, and habitat loss crush the world's wildlife into an ever tighter fist, and viruses then come pouring out.

Our fate as humans is going to be deeply influenced by the rise and reemergence of viral diseases.

COVID was just part of that.

And it's not going to be the last such threat that we face.

We have this amnesia about this larger picture.

We imagine ourselves living in this sanitized place in which we are the dominant species that can control, you know, every aspect of it.

"We are not vulnerable to nature and other animals anymore."

That's the fantasy that we live in.

We can't think of our health as isolated from the rest of the planet.

We have to think about that whole system, not just the individual, not just one society plucked in isolation from the rest of it.

It's all connected.

I had an interview in 2019.

And the first question was, What keeps you up at night?

And then I said, you know, I'm really worried that any pandemic can just, you know, occur.

That kept me up at night then, it still keeps me up at night now because we're not yet prepared.

During this pandemic, we have failed in many things.

Many countries were hoarding vaccines and having problems with sharing data.

We didn't have a kind of global obligation to help each other to fight the pandemic.

I would like to have the world to agree to common principles, respect them, and then prepare for the next pandemic.

Everybody was taken hostage because of this virus.

We lost three years of our life.

To really prevent the same thing from happening, then we need to really grow up and have a common agenda.

And it's just from humanity coming together.

We're really good here about having our parades.

But we won't help our neighbor, or... or we won't look beyond what it's going to take to improve our communities.

People suffering from addiction is a public health issue.

It impacts everything about our future and our ability to move forward.

I mean, what are we doing?

I think we have to redirect values.

You simply cannot practice public health in an individualistic society.

You have to have some sense of community for effective public health.

Public health should be one of humanity's crowning achievements and not just because of the clean air and water that we enjoy or the defeat of specific diseases.

It is about acting for the collective interest and rising above our base individualistic tendencies.

A lot of people in Okanogan County don't like government interference.

They moved out here for a reason.

And they are very resistant when government tells them they have to.

I think we have been repeatedly pushed away from that kind of collective thinking towards a much more individualistic form of risk analysis.

And I think because of that, we lost the way.

That kind of anger that was unleashed during COVID towards authority was something that was unanticipated.

You did not listen to we the people!

She needs to be fired.

Over masking and vaccination?

How many of you have had personal threats against you?

A person posted something to the effect-- F her, F them, let's start shooting.

I've had colleagues retire early.

I've had them say, I've had enough.

I can't take this anymore.

56% of the governmental public health workforce have at least one symptom of PTSD, and 26% have three or more.

This is a workforce that has been beaten and abused.

It's like Public Health Vietnam.

I started to hear about how other colleagues that were working in public health had their cars broken into, had been followed home, had rocks thrown through the building.

We're losing institutional knowledge.

So next time we have a pandemic, everyone will be green and we'll be starting from scratch.

One thing that's inspiring is that we're seeing record applications to schools of public health.

We're seeing students more motivated than ever.

I think they look around during the pandemic and they say, you know, something didn't work here.

How can I be part of the solution?

There is a man by the name of Harlan Cleveland who had been in political science all of his life.

And toward the end of his life, he became interested in global health.

And he was always dumbfounded by the audacity of people in global health.

And he said the fuel of global health is unwarranted optimism.

Now, 60 years ago, I could not find people interested in global health.

And now, every university finds this is the way to attract new students.

My focus, originally, has been on women's sexual and reproductive health.

With this pandemic though, my interests have really broadened.

I hope to work at a more global level.

There are vaccine disparities all over the world.

But I want to focus on everything and be able to work on so many different aspects, like, how can we reduce cardiovascular disease and cancers and other diseases that are so prevalent globally?

You kind of have to create your own position when it comes to public health.

And there are things that I've lived through and that I've seen with respect to children that I just really want to make an impact on.

I worked in a semi-rural hospital in South Africa and I saw a lot of, like, malnutrition cases.

So that was really heartbreaking to see, and I struggled with that quite a lot.

I want to partner with an organization or start my own organization concerning children.

I just feel like they're vulnerable.

And I kind of want to be a voice for them.

Everyone should have access to food.

I have great hope when I see my students because they break down the silos so that we have students of public health that also have degrees in theology or anthropology.

These people are going to do things that are better than anything we've ever done in the past.

It's easy for people to throw their hands up at a big problem and say, it's bigger than me, I can't do anything about it.

And then you throw your whole life into it, and maybe you can chip away at it.

That's been my mentality.

I'm now fully invested in working in the humanitarian world because I see so many problems that can be fixed.

I think it would be very easy for people to come to the conclusion after the coronavirus pandemic that we should keep politicians out of public health.

And that's the wrong conclusion because public health is dependent on the politicians appropriating money.

Even during the pandemic, you would get the sense that our state legislators didn't like public health.

But there wasn't a single legislator I met, when I met with them one on one, who wasn't actually passionate about something in public health.

They didn't know it was public health.

This legislator was interested in aging and what was happening in nursing homes in his community.

The next one was interested in health outcomes for children.

We had suffered from an opiate epidemic.

We were really suffering from diseases of despair.

And so all the legislators just didn't know that was something public health did.

We should get public health people going into politics.

And I often say to students, when we get the same number of public health people in Congress as we have lawyers, then we have a chance.

The consequences of the pandemic are very much still with us.

Throughout the pandemic, many of us have longed to return to normal.

We wanted to bounce back to life as it was before the coronavirus started knocking on our door.

And yet, normal led to this.

Normal wasn't this halcyon era of wonderful health.

Normal was a set of baseline conditions that made us vulnerable.

Our failure in response to COVID really has led to a new endemic virus.

And that was a failure of us not being prepared and not being able to respond decisively.

And now it's here to stay.

Very early on in the pandemic, this textbook understanding of COVID somehow accrued out of nowhere, that it was either a disease that you got over within two weeks or that landed you on a ventilator.

And that completely left behind all of the people in this vast hinterland in the middle who neither died nor recovered, and then didn't recover, and then didn't recover for months and for years.

The CDC estimates that around 15 million people in this country alone have long COVID.

One of the most common symptoms of long COVID is crushing fatigue.

People talk about feeling as if all of their joints have been weighed down with lead.

They might have cognitive fatigue, where even acts of thinking can be painful and impossible.

I think long COVID poses a massive inconvenience to those who would want to claim that the pandemic is over.

To ignore COVID, you have to ignore the people who must live with COVID now.

It is very easy and reasonable to be cynical.

We have made many mistakes in the pandemic.

We kept on making the same mistakes again and again.

And I would argue that we are in the same state of preparedness that we faced going into COVID.

That said, I think nihilism is a luxury that we cannot afford.

There is always the possibility to strengthen public health, to work better as a community.

And I think the seeds of those changes have indeed been planted.

At times when people in power have failed their societies, ordinary groups of people have risen up and taken the mantle of public health onto their own shoulders and fought for their own communities.

We in public health have to stop being afraid of getting out of our lane.

And we have to stop thinking that we can only talk about vaccines and therapeutics and testing.

We need to also talk about housing, our environment.

We can all raise our voices and begin to talk more fully about what it means to have a healthy life.

We need to create a new playbook.

We'll need chief health strategists, people from all walks of life with life experiences that represent all of us.

We need the best data systems and data analytics that are cutting-edge, and these systems need to talk to one another.

We learn so much about communication, brutal honesty, vulnerability, and empowerment.

And my greatest fear is that we won't learn the lessons.

We have to co-create our civilization generation after generation.

The issues from burnout and stress for public health officials is very real.

Physically, emotionally, people are being stressed out.

We have to address basic needs in the state of Washington.

Hey, Laurie, how are you doing?

It's good to see you.

We can't have people quitting because they're burned out.

We don't have enough public health people.

We cannot afford to lose more.

Everybody who works in public health is mission-driven.

We believe in this stuff.

One of the most incredible things about the public health system in this country is the dedication and expertise of our public health employees at the county, the state, the city, and the national level.

And when you see people like that who are so dedicated, you can't help but be optimistic.

This pandemic is not over.

You can tell me it's over when I don't know about a single infection in the American Indian community.

And until that happens, I'm going to be doing everything I can to get my people the resources that they need.

My ideal future of public health is that it truly is seen as a value.

A value such that we put resources into the workforce.

That we support, we champion.

We cheer on those very public health folks that have been busting their rears for all this time, not just for this pandemic, but well beyond.

They are heroes.

When we look at the broad sweep of the last 200 years, there is so much cause for optimism.

There really has been a miraculous set of advances in our health.

But that doesn't mean we've eliminated all the problems, and it doesn't mean new problems are not going to arise.

So the work is not to sit back and say, look at all the progress we've made over the last hundred of years.

The work is to say, well, that progress shows us that we are capable of solving these problems if we put our minds to them.

We all want to be able to have a flourishing life, where we live to our potential, where we can give our gifts, where our family can thrive.

And this is something we can do.

This is our wake-up call.

This is our chance to rebuild, repair, reconnect.

Let each of our citizens know that their lives matter and that they can contribute.

And we're going to have to do this together.

We, as human beings, need to understand our oneness, that we're the same.

Every single person is a public health entity.

This is the point-- to progress as a society.

And we have the greatest privilege to get up every day and help people live healthier lives.

And I don't know if there's a better mission to get up for.

We're interconnected because you can't be closed off to people.

We're one big community.

Public health, that's the thing you cannot see that is an integral part of society.

It's like the air that we breathe.

Without it, you know, we can't live.

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