How Are You Feeling About Entering a Career in Public Health?

Ashish Jha: 00:00:05

Hey folks. Ashish Jha here coming to you from Providence, Rhode Island. It's a sort of a gray, gloomy day in Providence, which happens every once in a while, but excited to be back for episode number six of a moment in health, where we talk about one data point, we discuss one study and then we answer one question. So let's get started. Data Point 47% about half. That's the number. That's the number. When you look at non elderly adults who have opioid use disorder in America, about half of them, 47% of them are covered by Medicaid. Now why is this important? So first of all, if you have been paying attention recently, you will know that there has been, for the first time in years, a real decline in opioid use overdose deaths, that 25 30% decline in deaths, huge progress. So what's driving that progress? A lot of it is people are getting into treatment. And what's driving people getting into treatment? Medicaid. Medicaid has actually played a really important role. So half the people out there who have an opioid use disorder, they're on Medicaid. This comes from a kff Kaiser Family Foundation study from 2023 when a lot of Americans were on Medicaid during the pandemic. And Medicaid remains absolutely essential, not just for in general, for people who are on it, but it's a really important part of how we combat the opioid use disorder, the opioid overdose epidemic that our country is facing. So again, the number today is 47% Medicaid provided coverage to nearly half of all non elderly adults with opioid use disorder.

Ashish Jha: 00:01:57

Okay, let's now talk about a study. The study for this week comes from the New England Journal, May 11 issue of the New England Journal, and the study is trizepatide as compared with semaglutide for the treatment of obesity. Now this is a phase three randomized controlled trial, or randomized trial of two drugs. You guys probably know these two drugs. One is ozempic, the other one is Zep bound. There are two different drugs that we use to treat obesity, and the study compared the two and asked the question, is one better than the other? And what they found was that treatment with tirzepatide or Zep bound was superior to the treatment with ozempic or wegovi in terms of how much of an impact it had. The study had about 750 people. These are all people who are obese but don't have diabetes, and it was a pretty broad group of individuals. And basically what they found that people who were on Zep bound lost on average, 50 pounds, 22.8 kilograms, over about 72 weeks, so over about, you know, little over a year. And while those who took wegovi lost about 33 pounds, still pretty remarkable weight loss, but not as much. All right, so why did I pick this study? I'm talking about it for two reasons. One is it really does look like Zep bound is a is superior to wegovy in terms of weight loss, but they're both remarkably good at weight loss. And it gets to a broader national debate that we are having about obesity and what's driving it, and how do we deal with it. And you know, we have seen the obesity epidemic increasing, really, for 30 years, as the food industry has gotten better and better at making food cheaper and more and more difficult to resist, and that has been a major contributor, in my mind, and I think in most people's minds, of why we've had this huge obesity epidemic. By the ways, it's not just an American problem. We're seeing this now across Europe. We're seeing this in places like India and China and so obviously we need better and smarter food

Ashish Jha: 00:03:57

policy, and you've been hearing some of that out of Washington. But we also now have, now have these remarkable drugs that dramatically reduce obesity. They dramatically cut things like heart attacks, strokes. They help with liver disease that can come with obesity. Increasingly, we're seeing huge benefits of these drugs, and I feel very strongly that we have got to come up with a strategy for making these drugs more widely available, cheaper, just generally easier to get, for more Americans who could benefit from them. So the study of the week is comparing these two drugs for weight loss, but the bigger picture point here is both of them are terrific. One looks like it's a bit better than the other, but they're both very valuable in terms of really generating weight loss, and that's important for all of the health benefits that addressing obesity gives you, all right, so that's your study of the week,

Ashish Jha: 00:04:54

all right. And now for the one question, and for the one question, we actually have two guests. This week, two people graduating from the Brown School of Public Health this year. The first up is Aliza Kopans. She is a graduating senior from Arlington, Massachusetts, not far from where I live. So I'm pretty excited about Eliza joining us, and I'm also excited about Akashleena Mallick joining us. She's from Kolkata in India, where actually my mom grew up. So there's a connection there as well. Broadly, thank you for for joining me and for the one question of the day.

Unknown: 00:05:29

Bing, thank you for having us

Ashish Jha: 00:05:30

all. Right, so here's a question. You're both graduating. How are you feeling about entering a career in public health? Aliza, to you. First, excited

Aliza Kopans: 00:05:39

and scared. Excited and scared say more public health can be connected to everything. And to be 21 years old right now, and in a state of world that is very, very uncertain, and more so than it has been in recent years, in some ways, and to think about what is my responsibility to take this amazing education that I've had and go make the world a better place in a time where there feels like a lot of forces working against that. Yeah, and I feel so, so grateful to be equipped with the people that I've met here and the knowledge that I've gained here, and to also have amazing role models that have shown me what it's like to go out into the community and to do good work and to do hard work. And Dean Jha, hearing you speak time and time again, of we have to come back to our communities. And the position that I will be engaging in post grad is a community based policy fellowship work, and so to be working at that intersection of getting to engage with people on the ground and hear what their needs and wants are, and then think about, how can we change the systems to better support our human beings is really, really exciting. And

Ashish Jha: 00:06:46

I guess for the heart of what public health is exactly, I love that. Akashleena, how are you feeling about entering a career in public health? You're a physician, so you have had a career in medicine, but what about public health? How are you feeling about

Akashleena Mallick: 00:06:57

that? I think there's a sense of responsibility and urgency, and that's because, as Eliza mentioned, you know, there's too many things happening, forces governmental and non governmental, which seems to be acting against it. So I think the onus and the responsibility is much more on us, on how we meet the communities where they are, rather than expecting them to understand our language or our work. So I think that responsibility comes with a sense of hope as well as with a sense of urgency. And primarily because, as Aliza said, you know, coming to our communities is one thing, but being trusted by them is hard work. So I hope that being a physician and while working in communities in the US, I can build that collaboration of trust and infrastructure where they know that public health professionals are talking right science and right medicine, and they can reach out to us when they need, you know us to be advocating for them, to be helping them guide through their conditions and their concerns. So

Ashish Jha: 00:08:03

both of you brought up the issue of trust. I last week, talked to Jennifer Nuzzo and asked her, How do we rebuild trust in public health? You both mentioned sort of the community engagement part of that. Why do you think that's so important in building trust? I realize now I'm asking a second question that's totally unrelated to the first. I have a bad habit of doing this, and I'm gonna apologize. But Eliza like, Why do you think community engagement is important to

Aliza Kopans: 00:08:30

trust we're all people, and I think in reading the news headlines, we sometimes forget that. And if we're on the ground at seeing each other's faces and seeing the emotions that we all share, and the shared goal of, can we be happy and healthy and safe? I think it breaks down a lot of the barriers that we feel, regardless of political identity, regardless of background. Here we all are trying to do our best, and I think in a time where even the words public health are really, really fraught. In order to be able to do our work, which is the goal of supporting people in our communities to be healthy and happy and well, we need to be out there and showing that we, too are human beings, and listening and developing that empathy, such that people know we are there to serve them and not to impose an agenda.

Ashish Jha: 00:09:24

Akashleena, what do you think I mean, as a physician, there used to be the sense that, oh, if you're a doctor, you're going to be trusted. I think we can all agree that is no longer quite enough of your sick. So why do you you brought up the issue of community. Why is that so important for a physician trained in public health to think about in terms of trust.

Akashleena Mallick: 00:09:43

I think that's because public health and medicine, they cannot exist in silos. They exist in interdisciplinary collaboration. They exist in serving the communities who we are meant to take care of, right and somewhere down the line, I think we talk about misinformation. Disinformation, but we are also not addressing the information overload. There is accurate information as well. Sometimes we don't know where to look for it, because there's just so many nuances, sources, there's chaos, noise. So I think it's very important for us, who are trained and skilled objectively, to make sure that we can pave the path and guide them, particularly communities who are vulnerable, who don't have access to all of this. How can we guide the most vulnerable in our communities and get it on equitable platform and in that space, that space can only be built with repeated endeavors of trust. I'm not saying we're going to be successful like at the get go. We won't. We clearly have not been over the past few years. It's been evidence. But we are getting better. Even if you're failing, we're feeling better, and I think that's very important for us to know that we are building it.

Ashish Jha: 00:10:57

So what I hear from you both is it takes time, it takes presence, it takes seeing each other as human beings, and it takes a commitment to the individuals you're serving and for them to feel that commitment to really make a big difference. I want to say thank you both for choosing public health. Thank you for coming over to the podcast. I really appreciate it. You are not just two random graduates of our of our program. Aliza is going to was selected as one of the two senior orators for the university ceremony. Congratulations. That's pretty awesome. Thank you. And Akashleena was chosen by the Graduate Student Council as the orator at the master ceremony. So that's pretty awesome. Congratulations on that. Thank you. And I am feeling much more optimistic about the future of public health with both of you guys in public health. So thank you both for being here. Thank you. Thank you. What people didn't see is a little fist bump that just happened, which was pretty fun. All right, so that you that is the one question. How are people feeling about entering a career in public health? And you heard from two graduating senior or graduating students, um, who I think are feeling pretty optimistic while understanding the complexity of the moment we are in. Thank you both very much for being here. Thank

Unknown: 00:12:09

you. Thank you very much.

Ashish Jha: 00:12:17

All right, so there you have it, a moment in health, uh, Episode Six, where we talked about a data point, 47% about half of people with opioid use disorders are on Medicaid. The point here was, we're making progress, finally, on reducing deaths from overdoses, and Medicaid is playing a really important role in that progress. And we talked about a study that compared SEC bound and wegovy for weight loss, and what it found was that zet bound was better than wegovy, but the big picture point is they're both highly effective, and they're both really good, and we need to figure out how to get more people access to that. And then the question of the day was super fun because we got to talk to two terrific graduating Brown students. We heard from Aliza Kopans, who is a graduating senior at Brown who's going to go work at a community based organization in East Boston, who's going to be the undergraduate one of the undergraduate speakers. And then we heard from Akashleena Mallick, who is a physician from India, who is also excited about entering the field of public health. And the reason I wanted to have both of those individuals is I thought it'd be important to hear from young people going into the field right now and at a time when everything feels so uncertain. And what I heard was a commitment to community, a commitment to building trust, a commitment to being present in people's lives in a way that public health is able to do, and I think that is how we're going to make long term impact. So I'm very excited about these two students, but really, the whole group of students across the country graduating into public health, it's a hard time for them, but I think they're going to make an enormous difference in the in the months and years and decades to come. All right, thanks so much for listening, and I'll be back again next week with a moment in health.