Moving the Conversation Towards Health Equity: A High-Income Country Perspective | UCB Imagine Webinar

Reflecting on our experiences over the last months marked by the COVID pandemic, our purpose to create value for patients now and into the future and our commitments to society are more than ever raising an essential question: how can we contribute to building a brighter and more sustainable society?

At UCB we believe that by exploring complex issues in the most diverse areas (philosophy, sociology, economics, science and medicine, anthropology - and many more) and connecting the dots between sectors and domains, we will be in a better position to drive positive business and societal impact.

The objective of the #imagine webinars is to make all of us reflect about societal questions that are impacting our life as individuals and professionals, connect with experts outside UCB and broaden our perspective on the evolution of society.

Watch the webinar here.

Pandemic Resiliency & Health Equity: Reflections w/ Dr. Sandro Galea | The Institute for Science & Policy

The COVID-19 pandemic has exposed fundamental weaknesses in American healthcare. Systemic racism, socioeconomic inequities, and disjointed processes have contributed to increased mortality from the disease over the past 18 months. But those underlying forces did not take root overnight, and COVID likely won't be the last pandemic we ever face. What would it mean to truly address these challenges? What would it take to build a more inclusive and resilient healthcare future for the U.S.?

In the next episode of our recurring COVID-19 webinar series, we'll sit down with Dr. Sandro Galea, Dean and Robert A. Knox Professor at the Boston University School of Public Health. As a physician, epidemiologist, and author of The Contagion Next Time, he'll discuss the social determinants of health and reflect on lessons learned about the societal consequences of an epidemic that has changed life as we know it. Plus: We'll begin the session with an update from state epidemiologist Dr. Rachel Herlihy on the latest Colorado coronavirus data and what we know so far about the Omicron variant.

This series is presented by the Colorado School of Public Health, the Denver Museum of Nature & Science, and the Institute for Science & Policy.

Our Failed Public Health System Dared COVID to Attack Us | WhoWhatWhy Podcast

If we had a better public health system in America, would the pandemic have been as bad? Would as many people have died? Was the real point of entry for the virus not just our bodies — but a system of public health that in a sense dared the pathogen to attack us? 

With the omicron variant coming at us, this week on the WhoWhatWhy podcast we talk with Dr. Sandro Galea. He is the Robert A. Knox professor and dean of the Boston University School of Public Health, and has been named an “epidemiology innovator” and one of the “world’s most influential scientific minds.”

At the core of our problem, according to Galea, is that we don’t focus on real health care in America. Instead we have sick care. We spend more, almost 40 percent more, on medical care, and get less for it than any other industrial nation, with a lower life expectancy. This explains, says Galea, why we were sitting ducks for the COVID-19 virus.

If we had been a healthier nation to start with, he says, we would have had a very different pandemic. We are overinvested in treating conditions of aging in those over 70, and underinvested in the forces that keep us healthy from a young age.

Galea reminds us that the pandemic is not a singular event that exists in a vacuum. It has exploded, in part, because of 40-plus years of bad public health policy. Still, he thinks this could be a teachable moment. 

The Roots of Covid Vulnerability | Against the Grain

Covid has laid bare the inequities of our society and the dysfunction of our medical system, which focuses at great cost on disease-treatment rather than fostering health. So contends epidemiologist Sandro Galea. He argues that the pandemic provides an opening to rethink medicine, along with housing, wages, and racial and social inequality, and to treat health as a public good.

For more, visit https://kpfa.org/episode/against-the-grain-december-1-2021/.

How social determinants of health play a role in pandemics | The Ohio State University College of Public Health

Health outcomes are shaped by myriad intertwining factors that begin the moment a person is born. 

To illustrate this concept, Dr. Sandro Galea uses the example of Blind Willie Johnson, a Black American blues singer prominent in the 1920s and 30s who died of malaria in 1945. Born in Texas, Johnson is purported to have become blinded in a domestic violence incident at age 7, explained Galea, the dean of Boston University School of Public Health, who virtually visited the College of Public Health on Nov. 15. 

Johnson grew up poor and made a living playing his guitar on the street, eventually settling into a small home with his wife before a fire rendered them homeless. With no alternative shelter, the couple continued living in the burnt shell of the house, shortly after which Johnson contracted malarial fever. The hospital turned him away, likely due to his disability or the color of his skin.  

“What killed Blind Willie Johnson?” posed Galea, author of The Contagion Next Time, during the Nov. 15 event. “I tell this story to illustrate that it wasn’t just malaria that killed Willie Johnson, it was also poverty, racism, domestic violence, homelessness, poor access to care.”

Many parallels can be drawn between the story of Blind Willie Johnson and the inequities the U.S. has experienced in COVID-19-related deaths, Galea said, such as the fact that Black, Indigenous and Latinx Americans were all significantly more likely to die from COVID-19 than white Americans. These populations also have disproportionate rates of diseases including diabetes and high blood pressure, are less likely to be employed in high-income jobs with paid sick leave or the option to work remotely, and are less likely to have access to affordable medical care.

“Our understanding of Blind Willie Johnson in this country is that his cause of death was malaria … when the other conditions that shaped his life were just as important and more important in what caused his death than the pathogen itself,” Galea said. 

In addition to exploring the striking health inequities of the pandemic, Galea’s talk also considered what went right in the U.S. response to COVID-19 — such as clinical care and rapid, effective vaccine development. He speculated why America spends more on health care than other high-income countries yet experiences worse health outcomes, how public health can move toward meeting communities where they are and the role of science in spreading information and informing societal values.  

“All of this is inseparable from the history of marginalization and disadvantage that particular groups have been subjected to in this country,” Galea said.

This event was part of Dean Amy Fairchild’s Changing the Conversation: Dean’s Public Health Thought Leader Lecture Series. 

As the battle against COVID continues, should we also look ahead to the next pandemic? | Greater Boston

Dr. Sandro Galea, epidemiologist and dean of Boston University’s School of Public Health, warns the United States should be preparing for the pandemic after coronavirus, and address the longstanding health and structural inequities that exacerbated this one. He lays out his argument in his new book ‘The Contagion Next Time,' and joined Jim Braude to explain.

The next pandemic is coming – here’s a plan | KERA Think with Krys Boyd

The Covid-19 pandemic has exacerbated the failings of the American health care system. Dr. Sandro Galea is a physician, epidemiologist and Dean and Robert A. Knox Professor at the Boston University School of Public Health. He joins host Krys Boyd to discuss how we can strengthen public health resources to not only respond to the next pandemic but strive for equity in the way we approach the health of the nation. His book is called “The Contagion Next Time.”

Dr. Sandro Galea tells us in his book "The Contagion Next Time” lessons from this pandemic so that we can prevent another one | CityLine WCVB Boston

The Dean of the Boston University School of Public Health Dr. Sandro Galea tells us in his book "The Contagion Next Time” that we need to learn lessons from this pandemic so that we can prevent another one. He argues that economic inequality and lack of access to healthcare for all must be addressed.

Preparing for the next pandemic and improving the health of all | NPR for the Cape, Coast & Islands

The United States is beginning to emerge from the COVID 19 pandemic, as more people are vaccinated and cases are declining. After more than 18 months of life with COVID, many are ready to put the pandemic behind them and move on. Dr. Sandro Galea argues that instead of thinking our work is done, now is the very time we need to take steps to be better prepared for the next pandemic. Dr. Galea is an epidemiologist and professor at Boston University School of Health. We talk with him about his new book that outlines what it will take to be prepared. It’s titled The Contagion Next Time.

Listen at https://www.capeandislands.org/show/the-point/2021-11-04/preparing-for-the-next-pandemic-and-improving-the-health-of-all.

Priorities for Health in the Post-COVID-19 Era | MEDiversity Week 2021, University of Utah

The triumphs and tragedies of COVID-19 present opportunities to address missteps and invest differently to create a more equitable post-pandemic health system, said Dr. Sandro Galea, physician, author, dean, and Robert A. Knox Professor at Boston University School of Public Health. 

Galea shared these insights during his virtual keynote address on October 29 to kick off the University of Utah’s 2021 MEDiversity Week.

In keeping with this year’s theme, “Intersectionality in Health Education and Care,” MEDiversity Week participants explored how recognizing and understanding intersectional identities can help health care providers better serve their patients. The week wrapped up with the Inclusive Excellence Awards on November 5. 

Using charts to underscore his points, Galea began his talk on a positive note, highlighting what went right during the pandemic. He shared how the healthcare system quickly adapted to the new disease and got better at treating it. The biggest triumph was the development of two vaccines with a more than 90 percent efficacy rate within eight months of the onset of the virus. The successes reflect the nation’s longtime investment in hospitals, medicine, and health systems, he said.

“I think it serves us well to recognize where we did go right,” Galea said. “This was a really rapid development of outstanding life-saving technology. But it wasn’t, of course, just eight months. In fact, it had been years and decades of investment that goes into these vaccines.”

Amid all that went right, Galea pointed out that a lot went wrong.

The pandemic exposed and exacerbated longstanding disparities, which hit minorities, particularly Black, Latinx, and Native Americans, the hardest. Mitigation efforts that protected some people from the coronavirus left others at increased risk of contracting the disease. 

For example, Galea noted that White Americans and people in higher income brackets were more likely to have jobs that they could work from home. But Black workers, who were more likely to have low-wage and frontline jobs, such as cashiers and food processing plant workers, did not. Moreover, Black Americans tend to have more underlying health conditions, such as diabetes and hypertension, which put them at higher risk of more severe COVID-19 illness. 

“The more income you have, the less likely you are to have underlying conditions making you vulnerable to COVID,” Galea said. “This all reflects the legacy of decades and centuries of marginalization faced by groups in this country, particularly Black Americans. It all goes back to slavery, Jim Crow laws, and other policies like redlining.”

As a result, Black Americans had more than twice the risk of death than white Americans from COVID-19, and Black men had a three-year loss of life expectancy. 

“These deeper inequalities are the direct result of the type of efforts we took to mitigate COVID-19,” Galea said. “We are actually putting in place things that are further disadvantaging [vulnerable populations], which is really troubling and sad.”

The disparities reflect the nation’s underinvestment in what makes people healthy and what keeps them healthy if a crisis occurs, he said. The United States spends more on medicine than on determinants of health, such as nutrition, exercise, physical environments, social supports, income, and education. 

To close health gaps, Galea stressed the need for increased investment in public health and the well-being of people. 

“We need to address the conditions,” Galea said. “The vast majority of health issues are preventable.”

Galea also challenged the “blue-leaning” health and science establishment to reflect on their bias and intolerance of different opinions and beliefs.

“We’ve made the mistake of casting alternative perspectives on what we should be doing during COVID as a red provocation, when in fact it really simply represents the plurality of ideas that we should be tolerating to get to a better place that fully understands the whole country,” he said.

In closing, Galea urged the audience “to seize this COVID-19 moment of opportunity” to understand what makes and maintains a healthy community, then advocate for investing differently to achieve it. He then offered three approaches to improving better health for all – humility, compassion, and reform through reason.

Humility reflects an awareness of one’s limits in understanding, knowledge and importance. However, arrogance “can blind us to the need to make sure that what we are doing reflects the needs of diverse populations in an inclusive manner,” he said.

Secondly, Galea encouraged the practice of “radical compassion,” emphasizing that compassion is not charity but recognition of our shared humanity. To illustrate the compassionate approach, Galea returned to his example of COVID-19 mitigation efforts. Compassion would have prompted decision-makers to consider the impact of stay-at-home orders on low-wage, frontline workers and do more to protect them. “And we utterly didn’t do that,” he said.

In explaining his third approach, Galea said reform through reason recognizes that it takes a radical vision to create a healthier world, but it happens through pragmatism and incremental, inclusive progress that brings everyone along, regardless of their political views.

“I think that those of us in health have a particular responsibility, a real moral responsibility, to articulate the causes of health so that we can create a healthier world,” he said.

After his talk, Galea joined a panel of Utah healthcare experts to discuss “Priorities for Health in the Post-COVID Era.” 

Panelists shared their thoughts on centering intersectionality, navigating political and ideological divides, the importance of community engagement, and moving forward to advance health equity.

Moderator Jessie Mandle, deputy director and senior policy analyst at Voices for Utah Children, asked how to create a narrative to convince people what it takes to be healthy.

“Health is equally of concern to red people and blue people,” said Mandle, referring to political party affiliations. “If only blue people are listening, we’re doing something wrong.”

Valerie Flattes, Ph.D., a faculty member in the University of Utah College of Nursing, spoke of issues affecting the Black community, such as misinformation, promotion of vaccines, and working from home. 

“People in the community can tell us what the issues are and the problems are,” Flattes said. “It has to be the right approach if you want to get the community engaged.”

José E. Rodríguez, M.D., associate vice president for health equity, diversity, & inclusion and professor in the Department of Family and Preventive Medicine, reflected on the intersection of underinvestment and disparities affecting Black populations. “We are choosing to fund health inequities,” Rodíguez said.

Ivette A. López, Ph.D., said her students give her hope for positive change as they engage with diverse communities. 

“They see that there’s a need for transformation of systems,” said López, professor of public health in the Department of Family and Preventive Medicine and deputy director of the Utah Area Health Education Centers. “They see a need for more diversity among themselves.”

This is the personal website of Sandro Galea. All photos are taken by Sandro Galea.