Here Lies Public Health

Episode zero.

A quick intro to the show, what public health is (supposed to be), your host, and what to expect from Public Health is Dead.

If you’re still not entirely sure what public health is (understandable!) or how it’s meant to protect us, this episode is a short one to share a working definition, set the stage for the show and let you know a bit more about your host, Daniella, your guide on this journey towards better health for all of us! 

Climate change, capitalism, and constant global travel have created a feedback loop and ushered in the era of pandemics. Old-timey diseases are waking up next to new ones, the organizations and leaders who are supposed to be controlling diseases appear to have given up. It looks like it’s up to us. Public health may be dead but we’re not dead yet! 

You'll understand how everything is connected to public health, why we need this podcast now, and why it's  focused on COVID.

Public Health is Dead will gather a bunch of people resisting public health failures to share their knowledge and experiences and hopefully help us survive in these times. This show might be the very thing that helps you through the storms ahead. 

tl;dr

PUBLIC HEALTH is the organized effort to understand, prevent, and mitigate disease and injury on the level of populations or communities.

• It's related to medicine. But it's not the same. All doctors are not automatically public health experts.

The point of public health is to stop having preventable bad sh*t happen to us.

• Eradication and elimination of disease are explicit goals of public health. Knowing this, things are clearly not going the way they’re supposed to. Welcome to Public Health is Dead!

• TRANSCRIPT

  DANIELLA: Dearly beloved, welcome to Public Health is Dead.  This is a short episode zero, an index episode for many more. It’s something to introduce this podcast, myself, let you know what I hope for this series, and also share some of your hopes for the show. You don't need to listen to this episode first, or at all. 

  It's just an introduction if you want to know a bit more background about Public Health is Dead and who I am.

  I'm not making this podcast for everyone. I don't need to. There are plenty of public health podcasts out there, and I've intentionally made this show different.  

  I've made this podcast for people who already know something is wrong in the world of public health. I'm not here to convince you that something's wrong.

  If you truly believe that COVID and other existential threats to our health are no big deal and nothing anyone says will convince you otherwise, then I think you might be in the wrong place.  But if you're willing to sit in  and listen to all the different stories and amazing people on this podcast, then You're more than welcome to. 

  I hope you find this show before you wish you'd found it. 

  There's so much misinformation and disinformation about public health, and this show is here to help fill a void. 

  Misinformation loves the void. 

  The show aims to get information from people who are facing the reality of an ongoing pandemic and can share their experiences and their knowledge with other people who it might really help.

  So, if everything goes according to plan, you'll learn some stuff, hopefully be entertained, and feel connected to other people who also know that we can choose a different way to live. We only get a little amount of time we get on this blue rock. 

  Like many people, I remember exactly where I was when the public health emergency was declared on the 13th of March, 2020. 

  But I have a confession to make, friend. I really, I truly, honestly, did not think this would be a big deal.  I thought it would blow over and we'd be accused of overreacting, but public health would have smugly done its job. 

  Because I lived and breathed public health. I lived and breathed public health. 

  I was a researcher in epidemiology. I'd been working in and around public health promotion and pandemic diseases since I was in high school. One of my first jobs was doing HIV peer education and sexual health.

  So, yeah. But I truly believed the field would just swiftly handle this. Everyone was worried for no reason, I thought. We had public health responses for this. A ton of experts who knew what they were doing. Disease transmission was easy to stop, because by now, we know a heck of a lot more about viruses than we ever did. 

  Of course, it wouldn't become a ginormous, sticky mess of half truths and disinformation and unchecked transmission and millions and millions of deaths and increased disability and long term health problems.  Would it? Not possible, I said.  

  I made little infographics to share on Instagram to help people understand this thing I'd been studying my whole academic career. What R naught was, what pandemics were, how vaccines were helpful, where to get masks, I felt like a human encyclopedia for people's questions. And early on I did just happily repeat what I heard from public health officials because those were the people who’d been my teachers. I trusted they knew what was going on.

  Wash your hands. Keep your distance. Stay home when you don't need to be interacting with other people. But then, some of the things they were saying weren't quite adding up. 

  On one hand, they said masks don't work. But on the other hand, they said, leave the masks for healthcare workers because they need them. If they didn't work,  why would they need them?

  Could they actually be misinforming us?  

  Canada's chief public health officer, Dr. Theresa Tam, finally said we should be wearing masks, and so that seemed to make sense. Our public health leaders said schools were the safest place for children, but then they were publishing papers saying 80 percent of kids had been infected during the school year. 

  They tried to tell us that COVID vaccines would make things go back to normal because we'd reach herd immunity. They said it was rare to get infections after vaccination, and called them breakthrough infections. But people kept getting sick. Again and again. And they're still getting sick. And that’s not what herd immunity is. 

  They said we had the tools to protect ourselves, but wouldn't provide BC with rapid tests when other provinces were giving them out freely. 

  People I knew started getting long COVID symptoms. The goalposts kept moving. Many of us got increasingly frustrated with our public health leaders.

  People lost trust in them, for a lot of reasons.  And that's how I got to making this show.  Welcome to Public Health is Dead! This show is an invitation to understand what else is possible for public health. If this idea of a revolving door of sickness, disability, and death doesn't really sound like a world you want to live in, I hope this show can be a step towards creating a different reality for all of us.

  So the next part of this is going to answer a couple of questions you might have about the show. 
  
  We’re going to go through a working definition of what public health is, why we're talking about COVID so much. Then I will tell you a bit more about me, your host and guide on this exploration of a podcast. I'll also share some of the things you told me you want from this show.

  If you missed out on that part, you can tell me more at the link in the show notes. I have a plan for the episodes I want to make, at least for season one, but I also want to make something you want to listen to, so let me know what you think. 

  Okay what is public health? 
  
  
  A lot of people actually don't know what public health is. They often get it confused with medicine, or sometimes think it's the healthcare system generally. We don't do a great job explaining, so it's understandable if it's not been entirely clear what public health is even though you've been hearing so much about it over the last five years. Can you believe it's been five years? Oh my god. Anyway.

  So public health is an organized effort to understand, prevent, and mitigate disease and injury on the level of populations or communities. It's related to medicine. But it's not the same. 

  There's a longstanding tension, because sometimes the fields can be at odds with each other.

  Medicine is individual, patient, and treatment focused. But public health has a population and prevention focus. So which is also why doctors or physicians don't always have the best answers to public health questions. All doctors aren't automatically public health experts. Some are trained in it. Many are not. Some place more value on their medical education. And not all public health degrees spend a lot of time on understanding epidemiology. 

  Many of the people involved in public health aren't even physicians at all. 

  They're epidemiologists doing research, observing, and measuring health impacts that can help inform decisions about population health. 

  It's the policy makers reading all this research and deciding what guidelines, policies, and rules to make. Like getting rid of asbestos, for example.  

  It's the knowledge translation experts running communications campaigns to explain research so you understand the main message. 

  Public health is also the engineers making sure that buildings stay upright and sewer and sanitation systems work well.

  There are food safety scientists making sure what we buy at the grocery store isn't full of harmful bacteria. 

  It's the sexual health educators sharing information about how to prevent HIV and other STIs and all kinds of sex.

  It’s people running safe consumption sites and fighting for a safer drug supply so people don’t die from poisoned drugs.

  It's water sanitation professionals making sure that what comes out of the tap won't kill us if we drink it. … In most parts of the country. There are reserves in Canada where Indigenous people still don't have access to clean water, and there are long term drinking water advisories.  

  Access to clean water is fundamental to public health, and we're clearly failing there, too.  At the time of recording this, there are 32 drinking water advisories for First Nations in Canada. 

  Ideally, public health is connected to everything. It's a whole multidisciplinary field that's supposed to keep us all healthier. But it's not working the way many of us hoped, especially when we see the reality of the ongoing COVID pandemic before us.  Which brings me to the next question.

   
  Why is this show so focused on COVID? 

  There are other health issues, aren't there? COVID isn't the only thing happening in public health.  You're right. 

  And something as globally consequential, gigantic, and continues to be shown to impact all organ systems? Yeah, that's not something you can ignore in public health. It's the elephant in the room.  

  We at least have to consider its impact on population health now going forward, especially because it appears to be accelerating and causing a lot of other health issues. So it does take a logical front seat in what we talk about in this show. Not everything will be about COVID, but  a lot of it will. 

  COVID perfectly exposed a lot of problems that already existed. There much talk about this in the beginning of the pandemic. It exacerbates inequality. 

  It showed what we as a society really place value on, like, who's worth protecting and who isn't, who we collectively decided was not worth caring about anymore or “leaving by the wayside” when public health leaders took away mandated protections. 

  It showed up in who got access to vaccines first and who didn't.

  For example, Israel refused to distribute vaccines to Palestinians in Gaza and the West Bank. 

  Rich, Western nations got vaccines before lower income nations did,

  Western manufacturers refused to suspend intellectual property rights so that vaccines could be manufactured everywhere faster. From my perspective, COVID is a perfect lens to examine the world through because everything is connected to public health, including genocide, including racism, including climate change.

  Inequity just breeds inequity. 

  COVID also seems to be the first widespread disease that public health as a field has just washed its hands of, so to speak, in the last couple of centuries. 

  Disease elimination and eradication are the ultimate goals of public health. That's not disputed. 

  The field exists so that we, the humans with the big brains and the huge dreams, could stop being so beholden to nature and diseases and injuries by preventing and mitigating them.

  That's it. That's the entire purpose of the field, is to stop having preventable bad shit happen to us. 

  Obviously, those benefits have never been shared equally because capitalism, racism, all the isms.  But theoretically, public health exists so that we can live better lives as humanity. 

  COVID came around, and somehow, public health as a field said “nah, you do you though.” 

  You do you is the opposite of public health. It's impossible to individualize a collective health threat, that's absurd. Overall, the values of protection, access to health, and healthy environments all seem like they were booted out the window when COVID came around.  And now We're just supposed to live with a new virus and do nothing about it?

  This wasn't an acceptable approach in the past. We'll have episodes about this too. 

  But we have AIDS zero goals. We have zero TB goals. What changed? 

  This podcast is a response to a system that's failing us. And I hope by examining those past failures and some of our successes, hopefully we can chart a path to doing things differently.

  The vision for this podcast is health liberation for all. That means full, unrestricted opportunities for good health for everyone. And that requires a lot of stuff to change. It's connected to a lot of things, like the climate emergency, it's connected to ending genocide and bombing, it's connected to trans rights, it's connected to Black liberation. You see where I'm going with this? 

  
  Why did I call this show Public Health is Dead? 

  It's simple. It's provocative. It stands out. Go big or go home, I guess. But seriously, people's eyes light up when I tell them the name. They start nodding and say, “yes, we need a podcast like this”. People often whip their phones out asking how to find it online even though there were no episodes out yet. 

  So I think we've hit on something here. It's very clear this show is not for everyone. 
  I was even told not to call it Public Health is Dead because it would turn people off. But I don't think those are the people this show's trying to reach. There are other things for that. 
  For the people who it is for, they love it. It's a phrase I've heard over and over and I've said many times myself because, from where many of us are, it feels like public health has abandoned its supposed goals and values. 

  Of course, its goals and values come with all the caveats I mentioned, We need a new plan.  

  but when leaders seemed more interested in the economy than human lives,  when they've repeatedly failed to inform the public about serious harms from COVID,  while the media reports baffling, stunning, and confusing impacts that are very likely connected to repeat COVID infections (if you read any of the published literature), it just feels like watching scenes from a movie we've seen before. That we really should have learned from.

  Why do we need to go through prevention and protection and the precautionary principle again and again and again? We've learned these lessons through other pandemics and other diseases that came before. Why are we acting brand new? 

  For a long time, I felt frustration and anger. Mostly anger. Still anger.
  
  But, I'm using it to build this show.

  This is meant to be a critical public health podcast that might help move us out of apathy and despair, something that can connect us so that we can find the other people who want a serious overhaul of how we do things in public health and everything it touches. 

  This show exists to try to do some of the public health communications that we actually deserve.  

  On another level, this podcast exists to trouble the conscience of public health leaders. And decision makers, who've led us into a mess at a truly unfathomable scale. On this show, I'll talk to people who are equally as frustrated, and a lot smarter than I am, trying to find reasons for this. We'll question the priorities of the field of public health. And fundamentally, I hope this podcast can help move the people in power – people making bad decisions, to push them to either be accountable and fix this, or get out of the way so that we can. This podcast is me rolling up my sleeves, calling up the people I know, and the people I don't know yet, who want to fight for something better.

  I'm taking a swing at doing something that might just help us collect some information to survive this.
  
  I hope this show will bring together the people doing good work. 

  So what can you expect?  I have an incredible roster of folks who have graciously agreed to join this scrappy little show because I think they might be feeling some of the same things I am. There will be frank conversations with them about what they're doing to resist denialism and bad public health decisions, and their assessment of what needs to happen next. There will also be some episodes that get into some of the fascinating stories and histories of this particular field of disease control. There will be monsters.  We'll figure out how public health lost its subversive spark, is what I call it, it’s the thing that drew me to public health in the first place.

  Last question you may have is who the hell am I, um, and who the hell am I, and why am I qualified to do this show? 
  
  Well, hi! My name is Daniella. I cut my teeth in the world of HIV, one of the newer pandemics in our history which still causes massive harm and damage to populations who are left out of mainstream public health activities, of course. HIV is not a pandemic of the past. HIV has impacted my family,  and HIV prevention is a normal and reasonable thing to talk about. Nobody's suggesting we should all just live with the idea that everyone will eventually get HIV, so shut the hell up about it. 

  As we now know, public health’s job is to try to prevent and mitigate the impacts, to prevent disease.

  So when it comes to COVID, we've categorically failed.  And I actually feel a deep betrayal from the field that I've spent so long studying and colleagues that I thought were in the same page.  Like I said, I've had jobs doing sex ed in high school, I've been a researcher, I've been a researcher. Um, interviewing sex workers, mostly about their experiences of systemic violence and looking at how that's linked to health outcomes.

  I have an MSc and BSc in Epidemiology and Health Science respectively. I've published a handful of peer reviewed papers, so I know my way around the scene, but I'm not an expert. That's why I'm bringing other people on the show who know a lot of things and will be able to help us understand how we got out of this. 

  I've been making podcasts for close to 10 years now. The last ones have been for a pretty big NGO, and  A small indie show for indigenous actors. We've won awards for that one and podcasting is something I really love doing and I thought, why not put these two things I care about together? So here we are. 

  Other things about me: I am Black. I'm queer. I'm a woman. I'm an immigrant from Zimbabwe. I'm also hearing impaired. So very much elbowed my way into audio production, and I need help sometimes but I have some awesome people on board to help me with that. So if things sound weird to you occasionally, that might be why. I will be providing transcripts for every episode to include more people who are deaf or hearing impaired, or people who have audio processing issues, or who people who have long COVID and can't listen to audio comfortably anymore. When everyone was wearing masks, actually, it was when I discovered I needed hearing aids sometimes because I didn't realize before that that I was kind of lip reading a lot. Not being able to hear well did not make me anti mask though, so people who can and say they can't hear people when they're wearing masks really grind my gears. And for people who do actually really struggle, maybe if we as public health did anything, besides nothing, we could make things a whole lot more inclusive and accessible. COVID can seriously damage our hearing, too. 
  
  I've been around public health ideas my whole life. My mother is an immunologist. Lucky me. Her immunology PhD was in TB. She's the person who first suggested COVID might be airborne to me, and if you know anything about TB, it's one of the few diseases we widely accept as being airborne, without waffling about it. She sent me a couple of articles about airborne spread that sent me down this whole spiraling path. Thanks, mom. It made me think, could these people I trusted to know what to do, maybe not be sure of what they were doing? Talk about someone who's usually right.

  She's the only reason I thought science was an avenue I could take because I saw another black woman doing science every day next to me. She helped me understand my homework a lot, and maybe she will help us with our immunology homework on this show too. 

  With Public Health is Dead, I'm trying to make a platform for accessible, good, and accurate information. Nobody's right all the time. That's the point of science. Iteration for better understanding and better action. Being wrong and acknowledging it is hard, but those are the people I trust the most. So if I mess something up, please tell me. Constructive feedback is welcome. And that brings us to th end - some of what you hope for the show. 

  I sent a pre-listener survey out to people who signed up for the show's mailing list after I shared about it on Twitter. Um, thank you so much for filling it in. I learned a lot. Two things stood out. One, that you really love the idea of a podcast like this. It's been missing and you want it. 

  And two, I don't know if this surprised me, but it definitely moved me to see it come from so many different people in my n of 15. 

  Most people who responded said they hoped this show would make them feel less lonely. 

  That people are tired of seeing public health's failures and feeling alone, like they've been let down, and feeling that nobody around you is willing to face  reality. People want to be connected to other people who think living in this world another way is possible.

  
  If you'd like to join the ranks of Public Health is Dead, please do. We've saved a spot for you. 

  And my final point, it's a bad idea for anyone to take medical advice from podcasts. Good thing this show does not offer medical advice. The point of this show is to share experiences and information that might help public health as a field and increase our collective knowledge. As always, if you have particular medical concerns of your own, you should talk to your own medical providers about it because I am just a voice in your headphones. 

  Public Health is Dead is created, hosted, written, and produced, and edited by me, Daniella Barreto. Content editing support from Lauren M. I'd also like to dedicate this whole series to someone very special to my family, named Maureen Fowler. She passed away in mid November, and this show is for her. 

EPISODE CREDITS

Public Health is Dead is created, hosted, produced, written and edited by Daniella Barreto
Content editing by Lauren M.

Public Health is Dead runs on listener support! If you liked this episode or learned something from it, please share it with a friend. And if you’d like to contribute to ongoing production of Public Health is Dead, please support the show!