The Pursuit of Health Equity: Leading for Long-term Change: Helene Gayle

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0:00:11.1 DuBois Bowman: Thank you for joining us for Ahead of the Curve, a speaker series from the University of Michigan School of Public Health. My name is DuBois Bowman, and I serve as Dean of the School of Public Health. I'm delighted that we're joined here today by Dr. Helene Gayle, who serves as President and CEO of the Chicago Community Trust, one of the nation's oldest and largest community foundations. This Ahead of the Curve speaker series focuses on conversations about leadership, and throughout the series, we have discussions with contemporary public health leaders who span many sectors, and we do so to hear about their insights, their vision and stories of perseverance. Leadership is a critical component of navigating complex public health challenges and building a better future through improved health and equity. We wanna hear about the important factors that shape great leaders, and we want to learn how they continue to evolve and grow in their own leadership endeavors, and we do this so that we can try to help to train the next generation of leaders. I'm really excited to welcome our guest today because she's had truly remarkable leadership experiences, both in the public and non-profit sectors. So Helene, welcome, and thank you for being here.

0:01:30.8 Helene Gayle: Yeah, it's great to be with you. Thanks.

0:01:33.9 DB: Terrific. So Helene has had an impressive career focusing on public health and equity, which has taken her from the Centers for Disease Control and Prevention to the Gates Foundation, to the humanitarian organization CARE, and now to the Chicago Community Trust. And so we're looking forward to learning more about how Helene has been leading for long-term change and other important leadership lessons spanning her impressive career. So let's go ahead and dive in. And Helene, I'd like to start really just at the beginning of your educational journey and start by talking more about what got you into public health in the first place, and you earned your MD and your MPH around the same time, and then began working at the CDC. And so my question is, did you always plan to work in the field of public health as you were doing your educational training as opposed to, let's say, private practice, and if not, what caused you to pivot and turn your attention to public health?

0:02:32.7 HG: One of the things many people who have had long careers will say that in retrospect, it looks like it all made sense and it was all planned, but most of us know that in the end, so many things that happen in our career are as a result of different circumstances, different things that led you to consider things along the way. I would just say mine was not a planned journey, there was no way that I would have imagined as I trained as a physician that one day I would end up heading a community foundation. I start by going back to, in some ways, my real motivation for going to medicine to begin with. I was raised in a family where making a difference and giving back was incredibly important. I also grew up in a time during a lot of social movements, women's movement, civil rights movement, anti-apartheid movement etcetera, where I got a sense of the importance of change at a population level.

0:03:33.7 HG: And so I wanted to have a career that I could make a tangible difference. I thought medicine was so core to so many things, our health is essential for our economic well-being, our educational well-being, all of those things. So I thought health was a tangible way that I could make a contribution and give back to society, but along the way I started realizing that as an individual clinician, one does an incredible job of helping people one person at a time, but if you wanted to have population impact, then public health was really one of the ways in which to do that. I did my MPH while I was finishing my medical school training, and then went ahead and did a residency in pediatrics, 'cause I also wanted to make sure that I had a grounding in a clinical specialty.

0:04:25.4 HG: But I think that, in some ways, reinforced a lot of the things that I went into medicine as I saw how often the issues that children faced as they came in and out of my clinic, in and out of the emergency room had less to do with their actual access to CARE which is a challenge still in this country, but a lot of it had to do with their social environment, the economic opportunity, and positioning of the family. The fact that we have a system that is in many ways very fragmented. So I think my actual clinical training reinforced to me the importance of thinking about health at a population level, so after I finished my pediatric training... Again, I thought I would hedge my bets. I said I would go to the CDC that had a Epidemiology Training Program, the EIS Training Program, to be able to get practical experience in public health, having already gotten my Master's in public health, and I went for a two-year training program and stayed 20 years.

0:05:28.4 DB: Terrific, and many of the things that you pointed to that helped you make decisions ring as true now as ever, and then also I think a wonderful message just to our students in the audience and even young professionals, how careers are non-linear, and there's even a bit of serendipity involved in that.

0:05:44.4 HG: One of the other things that really struck me, I happen to, while I was in medical school, go to the graduation of one of my brothers. And the graduation speaker that year was DA Henderson, who was the Dean of the School of Public Health at Johns Hopkins. But he had also been one of the architects of the eradication of smallpox campaign, working with the World Health Organization. And as I listened to this man talk about the ability to wipe a disease off the face of the earth by people coming together, joining together in partnership towards this incredible goal, I was deeply inspired. And so I will say that the roles of deans of schools of public health are very important too in terms of shaping people's careers and thoughts about their careers in the future.

0:06:33.6 DB: Absolutely, and I'll take that as a charge and I'll share it with other [0:06:35.0] ____ colleagues of schools of public health around the country. Now, thinking even back to early days as you actually enter the workforce and the profession of public health and using the COVID as an example. Sometimes difficult to fully appreciate the historical significance of a time period while you're in it, that is while history is unfolding. And so you started your work at the CDC focusing on HIV and AIDS in the 1980s, and this was a period that the epidemic was beginning in the United States. And in those early days, there were many unknowns about the virus, harmful misconceptions that were spreading, and I just wonder if you can tell us about the work that you were doing at that time, and then maybe also talk about how you navigate it, the challenges of that time and continue to be able to push your work forward.

0:07:27.6 HG: Yeah, and I actually didn't start in HIV when I first came, and it's actually a bit of an interesting... And it goes back to your comments about where we were back then, when I came to do the Epidemiology Program at CDC, we go and we interview with different departments. And many people said, "Don't go and work on this thing called... " At that time, it was AIDS not HIV. Don't go work on this. It's not a very important public health issue, and it will be gone. Go work on something that's more central to public health. Well, obviously, I had other interests, and I actually started my work in Global Nutrition, but clearly, as I stayed on, after I finished my Epidemiology Training Program, realized in fact that HIV and AIDS was the central public health issue of our times.

0:08:21.0 HG: And I think early on, even people within the CDC were frightened of this, didn't know where to put it, didn't understand how this was going to evolve. And so it wasn't until I had been there a couple of years that I realized in fact the critical importance and I think also as an agency and as a nation, we were starting to realize the real impact that HIV and AIDS would have. And so I started out focusing... Because my background is pediatrics, I started out in pediatric and adolescent HIV AIDS. It was really an incredible opportunity to both think about the domestic issues, but also a lot of the global issues, because a lot of pediatric HIV, which was based on heterosexual transmission, was actually more prevalent in Africa and other parts of the world.

0:09:10.0 HG: And so it gave me the opportunity to both have one foot in the domestic arena, one foot in the global arena, and really think about how this was evolving, and the fact that whether it was in our country or around the world, HIV was exposing the social fault lines around the world. And recognizing that while this was a virus that anyone was biologically susceptible to, the social drivers were really very much a part of why HIV disproportionately impacted people of color, people who were stigmatized, people who were poor, etcetera, here and around the world. And so for me, I think this intertwining of social issues with health and medical issues has really always been somewhat of a hallmark of my career, and I think continue to evolve as I looked at what were the underlying causes often times, particularly of disproportionate impact of diseases, just like we're seeing with COVID.

0:10:12.0 DB: Absolutely, I was thinking the very thing is, although very, very different viruses, we've seen many of the health inequities play out along those same fault lines that you mentioned with HIV and AIDS. At the CDC, you worked with the late Doctor Bill Jenkins, who was a long-time epidemiologist and bio-statistician at the agency and the leader in HIV and Minority Health. When I think of Dr. Jenkins, when I say his name, a smile often comes to my face because he actually is the person who introduced me to public health as an undergraduate student and then became really a life-long role model and mentor of mine. He had a deep commitment to fostering the next generation of public health leaders, increasing diversity in the field of public health, and my question to you is, were there any mentors who played a significant role in your life? And then now that you're a very established leader in your own career are there ways that you try to act as a mentor to students or other young professionals?

0:11:14.7 HG: Well, first, I have to also acknowledge the role of Bill Jenkins and I too have to smile and oftentimes laugh. Bill was a character, anyone who knew him. And in many ways we co-mentored each other, even though he was at the CDC before me. We worked together, he worked on my team, he was just an incredible human being, and as you said, he was determined to make sure that the next generation of public health, particularly people of color was on the radar screen. We are much better about thinking about formal mentorship these days than when I was coming along, and what I often did was I looked at people who I considered to be role models. And I did have people along the way who maybe didn't do formal mentorship in the way that we often do now, where you have a monthly discussion with somebody or what have you, but I had people who I think saw something in me and opened up doors for me that wouldn't have been there otherwise. And I can mention as an example, Dr. Bill Foege, who was the other co-lead for the eradication of smallpox.

0:12:22.0 HG: He was the head of CDC right before I came on, but was still there when I came on and because of my interest in global health, he kinda took me under his wings. And then I had the fortunate of having Dr. David Satcher as the Director of CDC in the last job that I have, and David clearly was willing to be a real friend, mentor, take my hand, open up opportunities that would never have been there. And then I guess the other person that I would call out is Dr. Lou Sullivan, who is also a real giant in the medical field at the time when I was Head of the HIV work for CDC, he was the Secretary of Health and Human Services. And again, many times, he was there to kind of reach back and make sure that I had access and opportunities and his ear when it was necessary, and so I think to those folks I'd also add to that list, Donna Shalala, who was also a Secretary of Health and Human Services when David Satcher was the CDC Director. So all along my career, I've had people who have really served both as role models and also were willing to give me a chance perhaps when others might not have.

0:13:34.0 DB: Terrific, terrific. And then picking up on some comments that you just made in responding to the question, your two year stint at CDC turned into a very long and impressive career, and then you went to the Bill and Melinda Gates Foundation, and have become Director of the HIV/AIDS and Tuberculosis Program. And so if you can talk more and maybe elaborate on what prompted you to move from the public sector to the non-profit and NGO space.

0:14:01.1 HG: I've worked in multiple different sectors, and I've actually never thought of it as I'm moving from one sector to the other. And again, it's one of those things that in retrospect, I realise how important it has been to understand different sectors, how they work and how to partner with them, frankly, because I think so much of the work that we do in partnership was so critical. But as I mentioned, Dr. Bill Foege, who had been at CDC, was one of the architects of the global health program for the Bill and Melinda Gates Foundation. He started asking me if I would think about coming to the Bill and Melinda Gates Foundation, because they had made HIV/AIDS their highest global health priority.

0:14:42.8 HG: And this was in the very early days when the foundation was first being created, and they wanted to establish an HIV program and they wanted somebody who had credibility and experience, particularly in the global arena. It actually took almost a year for me to decide to leave CDC. That was my professional home. It was what I knew, I thought that the public sector was the center of the universe. I barely knew what Microsoft and computers and Bill Gates, it just wasn't my world. Interestingly, I said to people at the Gates Foundation, I'm not really ready to leave my role, I feel like it's very impactful, but I'll recruit for you. And as you start recruiting and you start talking to somebody else about the value of a role, you start saying, "Well, wait a minute, maybe I should think about it." And it's one of the best decisions I've made in my life.

0:15:42.9 DB: Terrific. That then gave way after having much success at the Gates Foundation, you later ended up becoming CEO of CARE, one of the world's largest humanitarian organizations that's dedicated to fighting global poverty and at CARE, health was one part of the work that you focused on, but there were many other areas that the organization addressed as well. And so thinking about that next step for you, similar question, what made you wanna make a move into an organization with an expanded mission that went beyond just health?

0:16:16.7 HG: Well, I think it goes back to one of the things I was saying earlier, that when I started working in HIV and AIDS and recognizing how intertwined these social issues of economics, of adequate nutrition, of access to quality education. All these things that we now call the Social Determinants of Health, working in HIV really taught me a lot about that and a great appreciation for how, if you wanna really tackle the root causes of a lot of the health disparities that we see, a lot of that is rooted in non-health solutions and things that are outside of our health tool kit. And so the more I worked in HIV and AIDS and at Gates, I was focused primarily globally, and you really saw this interconnection of poverty and the role, particularly because women were so impacted, and the role that poverty and women and how people ended up putting themselves at risk because they didn't have the economic wherewithal to make the kind of choices or protect themselves adequately. So when I was asked to consider the role at CARE, not only was it an incredibly iconic organization, but I think it also gave me the opportunity to expand beyond what we have in our health toolkit and really practice and focus on some of the broader, the social and economic aspects that are really the underpinning of health disparities here as well as around the world.

0:17:52.6 DB: Terrific and CARE you took the baton and you ran with it, you made significant changes during your time there and refocussed really the mission of the organization. And for many leaders, there's an appreciation for the difficulty and the complexity in making change, and so can you talk more just about what some of those changes were and how you went about making them, and at the heart of the question is really, how do you effectively lead change at a large complex organization?

0:18:22.0 HG: Carefully. So we're not... CARE for those who don't know CARE's history, CARE is the organization that brought us the CARE package after World War II, CARE was one of the lead organizations helping in the effort to rebuild Europe after the destruction of much of Europe, after World War II. After that period, CARE then took on a much more global mission and particularly focusing on areas where there were emergencies, whether it was based on natural disasters or human warfare, etcetera. So it was very much a humanitarian and emergency relief organization, but like many organizations that have oftentimes a shorter term mission, CARE began to investigate how could it really have a longer term, more sustained impact on the circumstances that often led to some of the turmoil that we see and in some of the crisis that we see around the world, and really thinking about how to really focus on eliminating extreme poverty, which is at the core of so many of the issues we face around the world.

0:19:36.4 HG: And so when I got there, we started thinking about what were the ways in which we could have the greatest impact on global poverty and do it in a way that was sustained, enabled communities and nations and empowered individuals to make a difference in their lives, and we looked at who was most impacted by poverty around the world. Clearly girls and women bear the brunt of poverty around the world, and who are the greatest change agents for eliminating poverty, and again, we recognize that if you can invest in the life of a girl or a woman, give her an education, she is more likely to marry later, have fewer children, earn an income, contribute to the family, and you create this virtuous cycle of change. So we said we would really focus our mission around the proposition that investing in the lives of girls and women was the way to create long-term sustainable change in reducing global poverty, but it wasn't easy, this was a 60-plus-year-old iconic organization that operated in over 80 countries, a workforce that was global, we had multiple different arms of CARE.

0:20:51.5 HG: So many of the countries in Europe that had been recipients of CARE's generosity were themselves now, partners in this effort. So it took a lot of working to create a vision together, and I think as most leaders know, it doesn't work when you come in with a vision and hand that to an organization and say, "Now do it." So we took a lot of time to actually create a shared vision, one that people could rally around and then figure out what were the best ways in fact to make sure that was implemented. And I think also recognizing that as you were to try to change a large complex organization like that takes time, and being able to have both short-term as well as long-term goals, so that as you are trying to turn a big complex ship, understanding that it will take time, but also understanding that in the process, there are things that you can do to that give you short wins and give people a sense of momentum while you're continuing to try to make some of the larger long-term changes that are necessary.

0:22:02.9 DB: Terrific, terrific. And so that brings us to your present role, and as you've just talked about the steps in your career, it's clear that there are many complementary pieces that stem from your various leadership experiences, and so after spending many years on issues of global health and well-being, you moved to the Chicago Community Trust and now have a domestic focus on the Chicago region, and so what was appealing about that change and how was your significant global experiences, how have they helped you in your work in Chicago?

0:22:37.1 HG: So I think around the time that I was contacted about this role, we were going through a lot here in this country, we'd gone through what was a fairly contentious election, it was very clear that we were a much more divided country that I think we recognized, issues like wealth inequality were becoming more and more apparent, and so I really felt that after 30 or so years of doing a lot of work focused around the world, that I could take a lot of the skills that I had gained from the different roles and as you mentioned the different sectors that I'd worked in to really bring that back home. I felt like being in a city like Chicago, that is one of the largest cities in America, but kind of in the heart of the country, and often is seen as a model and as an example, for other large urban areas, if we could do some things in Chicago that could make a difference on some of the issues of the day here in this country, then we could not only make a difference for Chicago, but perhaps we could create some models that could be used nationally as well, so I just felt this real pull to come back, use the skills that I had gained to do something that could make a difference at a time where I think the issues of how we come together as a country couldn't be more critical.

0:24:00.5 DB: Absolutely. And so you've led strategic planning in the organization.

0:24:02.3 HG: Or it's led me. [chuckle]

0:24:04.5 DB: Or it led you, and the organization announces as the number one goal, closing the ratio in ethnic wealth gap, and we know you alluded to the social determinants of health earlier, but financial well-being is tied to your health impacting where you live, the food you have access to, the type of care you can afford and have access to, etcetera, and so can you tell us about how you arrived at that decision to focus on closing the ratio in ethnic wealth gap?

0:24:34.9 HG: Yeah, so when I came in, I was new to Chicago, I was also new to the community foundation world, and I thought that it was smart and important to take some time and listen and learn and hear what was on people's minds. I also feel like when you're developing a strategic plan, it's also important to lead with data, and so we spent a good amount of time really thinking about where could we have the greatest, most sustained impact on the Chicago region, and when I came the Trust like so many foundations was organized in different areas, different sectors, there was an arts portfolio, an education portfolio, a health portfolio, etcetera, but there wasn't one unifying theme that the organization could really rally around and that we felt could have a sustained impact. The community trust has been around for 100 years.

0:25:30.1 HG: Good Partner has funded incredible organizations, but the long-term impact wasn't as clear, nor was the identity of the foundation as clear as I think we felt could have a greater impact. And so, in stepping back and thinking about the many different issues that the city faced, whether it's violence, whether it's the life expectancy gap, which is one of the largest ones in the country, access to quality education, etcetera, we recognized that, again, thinking about what were the root causes, what were the drivers? And so much of the drivers really were rooted in the economic inequity, and the economic inequity in Chicago, like so many other cities around our nation, is also linked to the racial past and present of extreme segregation. Chicago is one of the most segregated cities in the nation, and that segregation has had a cost.

0:26:24.2 HG: Right before I came, one of the research groups that we partner with had done a study talking about the cost of segregation and recognized that if Chicago could just lessen its segregation to be at the average of the nation, it would add 4 billion dollars annually. So the cost of segregation doesn't just hurt the people who are impacted by it, it was actually hurting our whole economy, so we recognized that if we could have a sustained impact on this issue of wealth inequality, and recognize that some of this was really tied to some of the issues of race and racism and structural factors that kept particularly black and Latinx residents of our city behind, that we could have an impact not only for those residents, but for the whole city and for the region more broadly.

0:27:18.6 DB: That's terrific. And so thinking about addressing some of the discriminatory laws and practices that have contributed to the wealth gap in this country over its history, policy change becomes a big part of undoing some of those past harms, and that requires advocacy and advocacy training isn't something that's typically delivered in medical school, and so how did you learn to be an effective advocate and do you have any advice, maybe for our listeners of people who might be stepping into careers where advocacy or activism is required and perhaps is their first experience in those domains?

0:27:55.5 HG: Yeah, no, it's a great question. And one of the things that we did when we developed our strategy was to say that while we're a foundation and we contribute money and we help support programs that because so much of the root causes of the issues around wealth inequality were based in poor policies, that really working in the policy and advocacy arena was an important part of how we could create structural change, and so when I think about it, in many ways, the way I became an advocate was because I worked in government for 20 years, and people used to advocate to me, and I learned who was most effective, and I think what creates an effective advocate is first of all, the passion for the issue, they gotta have the passion for the issue, but I think it's the combination of head and heart, we're all raised to believe that data is king or queen.

0:28:53.0 HG: If you got the right facts, you can convince anyone. Well, we all know that oftentimes, it's not just the data that moves people, it's also people hearing other people's stories, people listening, people being proximate to the issues and understanding beyond just the facts and figures, but also understanding the stories of real people, so I always say that advocacy is a combination of head and heart, I still think about... When I was at CARE, we had a volunteer advocacy corps, and we were on the Hill talking to congress people about a child marriage law that we were trying to get passed, an anti-child marriage law, and we had several conservative congress people who just weren't going to budge on this issue, but we happened to have in the group that I was in, a young 13-year-old girl who was able to talk to these Congress people about what her life would be had she been robbed of being a 13-year-old girl, if she had had been entered into a marriage at age 13, what would that do? And what does that look like? And so I think it is this combination of data and head, but also heart and being able to tell stories of people in ways that are incredibly captivating, that combination wins at every time.

0:30:21.8 DB: To get things done and to be effective, we often need to work with others outside of our organization and develop effective partnerships, and I'm sure that this holds true for Chicago, what's been your experience in developing relationships and learning to navigate some of the networks embedded in Chicago, whether they're formal or informal networks, and those could be community-based, those could be from a political perspective, etcetera.

0:30:49.7 HG: Back to your earlier questions about being in different sectors, one of the things that I think I've learned is to speak the language of different sectors, different types of organization, and really find where are those areas of common ground, because I think people come together when there's a common ground, and I think people come together when there's common goals. So oftentimes, we talk about collaboration and coordination, but that can be such a lofty concept, and it's also time consuming. It's so much easier to stay in your own lane and do your own thing, but we all know that if you can find organizations that complement what you do, you really get... The whole is greater than the sum of the parts. And so I think part of it is taking the time upfront to establish what are people most passionate about, what do people want to see happen, establishing those kinds of common goals, and then working out together, how do we each contribute our part in ways that contribute to the greater good.

0:31:53.0 HG: And then also what incentivizes people differently, because we're all incentivized for different things, if you're a non-profit that is looking for money, money and being able to have enough resources, is maybe what incents you. If you're a public sector organization and the complexity of getting work done through the public sector may be the impediment, if you're in the private sector, and clearly your engine is economic returns and revenue, so figuring out what are the different incentives and how do you play to those so that everybody feels like their needs are being met, what they need to get out of it, if you will, for their own work is also being taken into consideration, but ultimately being able to paint a picture of how working together is going to improve what we're trying to bring about better than if we did it by ourselves.

0:32:48.8 DB: I would like to quickly transition in thinking about the economic impact of the pandemic, and one of the things that we've seen is it's actually widened the wealth gap, and while many at the higher end of the income scale might be doing fine, the poorest Americans have suffered significantly. And so how do you think about economic recovery from Covid through an equity lens?

0:33:14.2 HG: So we've actually devoted a fair amount of focus to this issue. During the height of the pandemic and in the very early days when people were just hurting for food and shelter and cash to pay their bills, we put together a fund to get dollars out to the community. We raised about $35,000,000, got dollars out quickly and helped people with their basic needs, but we quickly realized that we needed to pivot to recovery because the communities that were most harmed by this pandemic, both health as well as economically, were the ones who entered into it economically fragile, and if past recessions and past economic crises are any predictor, clearly many of those communities that went in fragile, were not going to recover at the same pace as you mentioned, and so we put together this effort that we're calling, 'we rise together' to really look at recovery, but from a lens of Equity.

0:34:09.7 HG: And it is a multi-sector, we have business, we have philanthropy, we have non-profit policy, people sitting around the table and really thinking about how do we make sure that the communities that were most harmed have the opportunity to restart their economic engine through small business development, through neighborhood investment, through jobs, all these things, it really can make a big difference for the communities that were most hard hit, and how do we do that? That again, to your earlier question, utilizes the different strengths that we bring, so the private sector, are they looking for employing people who come from neighborhoods that were hard hit? Can we interface with the government that is now getting the federal dollars that are coming down the pipe from the relief bills? How does that intersect with what the philanthropic community is doing, and how do we put all those things together so that the kind of investment in neighborhoods and in people who are in communities that were most hard-hit are not, again, further left behind?

0:35:17.3 DB: Terrific. And you've done so many remarkable things in addition to and even outside of your exemplary leadership at the Trust, and we won't have time to touch on many of them today, but one of the things I do wanna ask, in January, you testified in front of US House Representative sub-committee on preparing for the next pandemic, and you made the important point that the emergence of the next crisis is a matter of when, not if, that's a, I think a very powerful and compelling statement that should resonate. What are some of your thoughts on how we can, or perhaps even how we should prepare for the next public health challenge?

0:35:58.6 HG: Well, first of all, I think we have to recognize, as you said, that it's not if, it is when. And I think we were really caught off guard and we should not have been caught off-guard by covid, we have had so many emerging infections whether it's SARS and H1N1, Ebola etcetera. So we knew that there would be another one coming around the corner, and I think the biggest lesson is that we should be prepared and that we should not be waiting until a crisis hits, we should really have preparedness in place. And while I don't like to necessarily make military analogies, we know that pandemics are likely to cause more chaos, and we saw from this one then perhaps some of the things that we more conventionally worried about in terms of military conflicts, etcetera, we would never think about waiting until there was a conflict to make sure that our military was prepared, but that's how we treat our public health workforce, our public health infrastructure.

0:36:57.6 HG: So we need to make sure that we are keeping our public health infrastructure ready for the next pandemic, and I guess I can could go on with a lot of things, but I guess the only other big one is that we should continue to recognize that these pandemics are going to continue to be global, and that unless we're thinking about this from a global perspective and making sure that we are working with colleagues around the world, and that the United States as the wealthiest nation, is thinking about its responsibility to the rest of the world, not just because it's the right thing to do, but because it's the smart thing to do, we can't expect that viruses respect borders, we know that. And so it is also in our own best interest to make sure that we're thinking about how the rest of the globe tackles these pandemics.

0:37:46.6 DB: Absolutely, and also just underscoring some of your earlier remarks regarding your experience with HIV and AIDS and Covid, to ensure that we're addressing some of those structural underpinnings so that a future public health challenge doesn't shine a light and exacerbate some of those inequities. So we're just about out of time now, for Ahead Of The Curve, and I'd like to thank you, Dr. Helene Gayle for taking the time to be with us today and for sharing some really great insights about leadership and your career. I have certainly learned a lot in this session, and it's been wonderful having this conversation with you. So, thank you again, Dr. Gayle, and thanks to all of you for joining. Be well, stay safe and forever go blue.