Lessons from a Pandemic: Leading with Science: Joneigh Khaldun

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0:10.6 DuBois Bowman: Good afternoon and thank you for joining us for Ahead of the Curve, a new speaker series from the University of Michigan, School of Public Health. I'm delighted that we're joined today by Dr. Joneigh Khaldun, who's the Chief Medical Executive for the State of Michigan, and Chief Deputy Director for Health in the Michigan Department of Health and Human Services or MDHHS. My name is DuBois Bowman, and I serve as Dean of the School of Public Health. This is our third event in the inaugural season of Ahead of the Curve, a new speaker series that focuses on conversations about leadership. Throughout the series, we'll have discussions with contemporary public health leaders spanning many sectors to hear about their insights, their vision and stories of perseverance. Leadership is critical for navigating complex public health challenges and for building a better future through improved health and equity.

01:06.8 Bowman: And so we wanna hear about those important factors that shape great leaders, and we wanna learn how they continue to evolve and grow even in their current leadership roles, and to do so, so that in turn, we can help to think about how to train the next generation of leaders. Public health leadership has been absolutely critical throughout the last year, as we've been living through a public health challenge of historic proportions, the COVID-19 pandemic, and as we've confronted persistent issue of racism and the intersection of these which has given rise to widespread health inequities, across the country. I'm really excited to welcome our guest today because she's been at the forefront of leading the state of Michigan through the pandemic. So Joneigh, welcome and thank you for being here.

01:55.8 Dr. Joneigh Khaldun: Oh, thank you. Thank you for having me. I'm looking forward to our conversation.

01:58.8 Bowman: Absolutely. In her role, Dr. Khaldun provides overall medical guidance for the State of Michigan as a cabinet member for the governor, and she oversees public health programs. Many of you joining us today may be familiar with Dr. Khaldun, because you've seen her during the governor's press conferences or on local news or making other public appearances. It seems as though she's been just about everywhere over the last year. And we're really looking forward to learning more about how Joneigh has been leading with science throughout the pandemic and other important leadership lessons spanning her career. So excited to dive in today. Joneigh, I'd like to begin just by really discussing your personal and career journey that has brought you to this point in your career. So you're from Ann Arbor?

02:49.8 Khaldun: Yes.

0:02:51.3 Bowman: You're an alum of the University of Michigan, and actually a graduate of our school's summer enrichment program. You've had several educational and professional stops along the way, including medical school and dual positions as a practicing physician and leading health departments, and now you're a leader at the Michigan Department of Health and Human Services. And so as you think about that long journey, what do you think about in terms of those factors that have impacted your educational and professional growth?

03:19.8 Khaldun: I think what has really motivated me in my career, I think it really goes to things that I experienced early in my life, and I'm really talking about in my own family even. I told this story before, but my grandmother, may she rest in peace, on my mother's side, she had a lot of health problems when I was growing up. I was very close to her. She lived... My parents are from Detroit, I grew up in Ann Arbor, but my parents are from Detroit. But every weekend I'd be visiting with my grandparents, but my grandmother had a lot of health problems and she also smoked and she smoked a lot. My earliest memories quite frankly, are of me trying to hide her cigarettes, and so literally I'd hide them under the couch.

04:02.9 Khaldun: For me, I was really putting together, there's a habit, there's something going on [chuckle] when it comes to cigarettes, it's making my grandma be sick. So we've gotta do this prevention, we've gotta prevent her from getting sick, and for me that meant hiding her cigarettes, which obviously didn't work. But I think when I tell that story, because I think I've always been committed to really saying that with prevention you can actually improve the health of communities. Again, parents grew up in Detroit, East side of Detroit, and all the things that come with inner city, fewer resources, many medical conditions that are preventable. I think that's something that excited me throughout my early years, and then I just continued to seek out opportunities to grow, to learn, I think I've always followed what my passion was and what I was interested in, and I've also just had a lot of just amazing coaches, mentors, throughout my entire educational and professional career, which I am incredibly grateful for.

05:06.3 Bowman: That's terrific and really fascinating how you've been able to find a career that you're passionate about, really through personal experiences in your life and your family and your community, and ultimately leading you to a way to figure out how to have the biggest impact, and you certainly have been doing that on behalf of all of us in the State of Michigan. And so if I can probe a bit further, thinking about how you approach leadership at this stage, and some of those people who you mentioned who have had a significant impact on your careers, I'm sure many who recognize they have, but maybe many others who haven't, but are there a couple of people or experiences that have really shaped how you approach leadership in your current role?

05:52.7 Khaldun: Oh, absolutely, I'll start with high school. I ran track at Pioneer High School, and my high school track coach, Mr. Bryan Westfield, who many in an Ann Arbor, I think his [chuckle] name is familiar to a lot of folks. When you ran track for Bryan Westfield, it wasn't just about track. He really cared about the entire person. He met with my parents, he cared about what I was doing in class, he knew that I was interested in medicine, he would give me opportunities to explore my options, he would be calling colleges on his lunch break trying to get me more opportunities to go to different schools. And what I really learned from him was just about being a leader, being a coach, being a mentor is just so important, and I really try to emulate that in my life. There's another individual named Richard Schnaut, who I also say is famous in the Ann Arbor community. I had the opportunity when I was in college to work at the University of Michigan Transplant Center as a perfusionist, which basically meant that I traveled around with transplant surgeons, getting organs.

07:01.6 Khaldun: And so I was very young, I didn't have much clinical experience, I was very, I think overwhelmed by the job, but Richard Schnaut took an interest in me in that he thought I had something special, I guess. [chuckle] He thought I had something special, he trained me, still the way I scrub in today in the operating room is because of the way that he taught me. He kind of pushed me and said, "Joneigh, you're gonna go to medical school. You're gonna do great things." And another thing I really learned from Richard Schnaut is I remember walking the halls of the University of Michigan hospitals and Richard would know every person in the hospital. He knew everyone, he knew how they were doing, he knew their children's names. It didn't matter if you were in environmental services or if you were the chair of a department, he knew everyone and he cared and he was quite committed to his job, but also to the people in the community. And those are two people, again going back, that I really think about when I think about my leadership style and how I really try to lead by example, care about people as I'm doing the work that I do.

08:06.3 Bowman: Thank you so much. And it's, I think, a testament to how our experiences really shape who we are and how we approach things, and those experiences are not just from your training, but so many factors, again, in your personal life. I am also from Ann Arbor and knew Mr. Westfield, the person who you mentioned first, in fact, grew up in a neighborhood that he also lived in and used to see him at the park and so much respect for him and what he accomplished over the years. If I can now dig in just to your current role, so COVID response is of course the most visible part of your job right now, but you wear many hats in your role as Chief Medical Executive for the state and Chief Deputy Director for Health for MDHHS. How would you describe all of the hats that you wear in your current position?

08:57.6 Khaldun: I do a lot of different things every day, so, yes, absolutely, I do a lot of public speaking engagements [chuckle] and press conferences, but I also work on a lot of the behind-the-scenes operational details and strategy when it comes to COVID-19. So our vaccination response, our testing response, all of the kind of details that go into the public health response. So that's COVID, but I also oversee large teams that really run everything as it relates to public health in the state, epidemiology, tobacco program. All of those things have budgets, they have staff, they have goals, they have grants that they have to administer. We're always tracking other public health threats, some that are kind of ongoing threats, like our lead program, for example. But also more broadly as the Chief Deputy for the department, our Medicaid program, so how we are working with our Medicaid health plans to be able to make sure people are getting access to care and quality care, our behavioral health system, our state hospitals, there's so much that I'm... Any given day I'm in meetings really talking about strategy, making sure the operational work is going smoothly, understanding how public health, Medicaid, behavioral health, all those systems kind of come together. That's me any given day, it's a lot of public-facing, but also internal-facing things that I'm doing.

10:24.5 Bowman: Terrific, and so that's such a big portfolio, and I'm sure would present challenges to managing in any time, but carrying such an extensive portfolio during a pandemic of historic proportions, I imagine has to be particularly challenging and you're already spread so thin on the COVID front. How do you go about setting priorities, even budgeting your time, leading your team to ensure that you're able to accomplish what you need to on behalf of the people in Michigan?

10:58.1 Khaldun: Absolutely, so I can say first and foremost, it starts with having a great team. So I mentioned all of those responsibilities, but really we have amazing senior deputies, bureau directors, other senior level career managers in the department who really make sure the minutia details are getting taken care of, and managing programs, so I'm incredibly grateful for all of them who really are the ones who are doing the day-to-day work. But you're absolutely right, with COVID-19, and I remember early on speaking to someone about COVID-19 and what it could be, even in February, I was speaking to someone about what the department could look like as far as staff, and I think at one point I said, "This entire department might be working on COVID-19 [chuckle] any week now," and sure enough, that is what's occurred.

11:50.0 Khaldun: There's been a lot of people, whoever's been able to do work and has a skill set, we've pulled them into COVID-19 often, but I also, from a leadership perspective, I can say, and people who have reported to me in the past know this, I believe in getting a strong team, getting experts around you and then letting them lead. Just because you're not at the top or you don't have a senior position, doesn't mean that you can't lead every day in your particular role. So I really believe in empowering my staff, I believe in any decision that my staff can make on their own that does not need me necessarily to approve it, I really believe in delegating and empowering staff making sure everyone's on the same page. And in my role, often just helping to think about strategy and helping to remove barriers from my team to be able to get their work done.

12:39.6 Bowman: Yeah, it's such a wonderful approach to leadership that allows growth of individuals, but also I think best outcomes because you have contributions from so many different perspectives. And now I'd like to transition and just to ask you about, you've been well known in public health for many years, but since the pandemic, you've been just extremely visible across our state, again at press conferences, on the news, on a nightly or weekly basis, on the national front, names like Fauci are now household names and your work has a national layer but certainly for us here in Michigan, you're a household name. And so I'd just like to ask you just about what that experience has been like for you and to find yourself on stage participating in these national press conferences or other kinds of events?

13:29.1 Khaldun: Yeah, so certainly when I took this job, or even I think about five years ago, when I moved back from the East Coast back home to Michigan, I knew it was to do public health work. And when I asked my husband, who's not from Michigan, here's an opportunity for me to come back home, well he... And I asked him would he come back to Michigan with me? He said, "Absolutely Joneigh, because I know this is your heart when I met you," and I met him back when I was in medical school. And he said, "When I met you," he said, "You were doing all of this work and you wanted to be a doctor, so you could go back home and help the people where you're from," and so the past five years, Detroit, as the Health Director there, and now as the Chief Medical Executive for the state, I'm doing exactly what I think I've always felt that I wanted to do and that I needed to do, and so I'm just incredibly grateful for this opportunity. And even though there's, had no idea there would be a pandemic, I do feel that the stars have aligned and I feel that it's part of my life's work.

14:27.2 Khaldun: I guess I was supposed to be here at this time, and I'm truly trying to give it my all every day. When it comes to the, I guess, the fame. [chuckle] It's taking some getting used to. I'm not really someone who's ever looking for attention really, so it's been somewhat humbling. I'm still quite frankly, trying to get used to it. I'm more than happy to be behind-the-scenes, to be honest, and I can do that too. I will say the one thing that's been the most different is just me being recognized out in public. A couple of months or a month, whatever, into the pandemic, when we'd been doing those, I think at one point daily press conferences or at least three times a week, people really started noticing me, and I have a signature hairstyle, [chuckle] so going to the grocery store, going anywhere just became a thing where people would recognize me, and it has impacted my personal life, not that I go to many places because of the pandemic, but I'm very aware of people recognizing me. Sometimes when I go out, I might have a disguise on, I'll just say that. [laughter] So that people don't notice me and I can just get my groceries and go back home.

15:40.5 Bowman: If I can ask you just to elaborate on the professional aspect of that as you are making remarks. You know every word is going to be heavily scrutinized, and that there may be something in your words that people find encouragement in and something else in your words that someone may take issue with for various reasons. So from a communication perspective, just over the last year any lessons or strategies that you might offer on just generally how to approach that kind of thing for the audience?

16:13.9 Khaldun: Especially as the Director of the Detroit Health Department I've done some press conferences and interacted with the media, but certainly not at this level where you're on TV multiple times a week, or interacting with media, radio, written media multiple times a day. I think I have learned, hopefully, maybe people who were judging me can say I've gotten better [chuckle] over the past year. But I think I have learned, I've watched, I'll be honest with you, I've watched the governor, she's a great role model. In the beginning, I didn't even know how to put my own microphone on for the various [chuckle] events so I had to ask her, but I've learned, I think I've gotten more comfortable with the camera. But I also think part of public health leadership is really communication, and as people are going through their training and understanding and growing into leadership roles, even if they're already in the public health department, I think public health communication is just a really critical skill.

17:12.9 Khaldun: Whether you're communicating with your boss, when I'm communicating with the governor, whether I'm communicating with the media or the general public, it's just really an important skill to be able to communicate facts, communicate them quickly, to let people know that sometimes you don't know everything, which is important to say as well, if you don't know something, and also trying... So what I try to do is just make things very simple, and including... I used to work in the ER, when I'm speaking to my patients, I can't give them all this medical jargon, I try to keep things very simple so people understand the issue, they understand the risk, and they understand what they can do to protect themselves. So that succinct communication, I think is also really important, and again, I hope I've improved throughout the past year.

17:56.5 Bowman: Terrific. So from an observer, you do a terrific job. I tune in [chuckle] whenever I can catch you. And certainly informative for many of us in the state. So there was so much packed into what you said, and I'll come back and maybe try to flesh out some of your remarks a bit more, but now I'm transitioning. You mentioned your role as an ER doctor, you bring perspectives from both public health and as a medical doctor, and I wonder how training in both fields have really been helpful for you in your work and even thinking about young health professionals, what would you say to them just about approaching a career and flexibility, and maybe even how to combine interests in a way that might allow you to have an impact that aligns with your passion.

18:51.5 Khaldun: Yeah, I think, of course, I've got a resume and I've got different jobs, but this wasn't necessarily intentional. I had no idea what a Chief Medical Executive was, even when I moved back home to Michigan, quite frankly, didn't know what the job was or what it did, but I can say, again going back to when I was a young girl, when I decided to become a doctor, I did all kinds of volunteer work in medical school, I was always doing something in the community related to community health, and I think I also noticed pretty quickly in medical school that there's only so much you can do in your individual one-on-one interactions with a patient, and I really saw kinda these systemic changes. Someone having a stroke because they ran out of their medication and they couldn't get to it or they're homeless, all of those kind of things that are really societal issues. We talk about social determinants of health, right? So those things are... They happen outside the walls of a hospital, and I think one thing I've always tried to do is seek places and seek to be engaged in places where I thought I could have an impact and where...

19:58.5 Khaldun: That's the problem. If you fix that problem, that's where you'll be able to have an impact. So I like fixing problems really, really upstream, but I also like fixing problems in the ER where you have that, I don't know, sometimes, if you can, kind of instant gratification, intubating someone, sewing up a laceration, kind of instant ratification things. So I think I just like helping people heal, whether that's individually as my patient or whether it's fixing the entire system. I would encourage people in their professional endeavors to think about not the job title that you want, but the type of work and the type of legacy and the type of impact that you want to have and get engaged in those things immediately. It may be volunteering, I did a lot of volunteering early on. I would just show up and I would be like the only doctor in the room. I was working with a lot of public health folks, and just, and said, "I'm interested in this too." So I think it's just keeping an open mind and not focusing so much on a degree or a title, but the actual work.

21:02.8 Bowman: Absolutely, and those experiences actually helping you to refine what you ultimately wanna do, so I appreciate that really sage guidance, particularly again, for our young public health professionals. Thinking now about the broader landscape of public health, the pandemic has prompted a focus on the field, and it's drawn attention to the state of public health infrastructure in the US, which I would submit was not as strong and sound as we would want it at the outset to be able to face a pandemic. And so I wanna ask you as a public health leader, what do you think should be done to strengthen our local, state and federal public health systems?

21:45.4 Khaldun: I think overall, the United States has struggled with addressing this pandemic for many reasons, but I think the main reason is a lack of public health infrastructure and an investment in that infrastructure, disinvestment in staff, not having enough staff, even in Michigan, there are some health departments don't even have an epidemiologist. I think people now understand how important epidemiologists are, maybe they even know what that is, where they didn't a year and a half ago, but some health departments didn't even have one. Contact tracers, right? We all know what that is now, but some health departments had one for, or don't even have any, for all things infectious disease. So COVID-19, contact tracing isn't new, you do it for COVID-19, but you also do it for other infectious diseases where there might be exposures.

22:32.7 Khaldun: And so just the lack of staff, the lack of investment in IT systems, I think early on in the pandemic and people kinda got used to it, and we started building our data systems. People thought that somehow if you just push two buttons, again, this is my interpretation, I'm simplifying this, but I get the sense that people thought if you just push two buttons you would know where every case was, you would know the exact place where they got the virus, you would know what school they went to, you would know how many people associate with the outbreak, all this detailed data, we don't have that. There are still health departments that are using fax machines. Often our healthcare system, electronic health records don't connect in a robust way to our state health department data systems. We had to use SurveyMonkey to even get information from our local health departments. So those things, the lack of investment in workforce, in infrastructure, in IT, all of those things really had a significant impact in our ability to be able to respond, particularly in the very early days as quickly as we needed to, as we should have.

23:37.5 Bowman: Yeah, and so critical for prevention, containment, mitigation, to have that information and infrastructure that ultimately affect decision-making that allow you to impact and achieve the greatest protection of health of Michiganders. So I now wanna return just to... We talked a little bit just about you on the public stage and the awareness that you're on the public stage. Diving into that a little bit more, public health has been politicized during the pandemic in ways that we haven't really seen before. Public health workers at local, state, and federal levels have had incidents of mistreatment and threatening behavior just for doing their jobs and all with the intent of serving a public good. And we've seen pushback from some about adopting Public Health Guidelines. You've talked about the importance of moving beyond politics and focusing on the policies ultimately that'll help keep people safe and healthy, and so as a leader, I'd like to prompt you to learn about the strategies that you found to be effective in navigating this terrain and re-focusing the conversation on public health policy.

24:48.2 Khaldun: Absolutely, I think, and it goes back to my earlier comments, I'd say even about communication. As a medical doctor, as a public health leader, we are put into our particular positions because of the expertise that we have, and the onus is on us to be able to, one, just know the data, be on top of the data and the science, of course, but also being able to communicate that effectively to people who are not public health professionals, which is very, very important. Words like social determinants of health and mitigation strategy. A lot of people don't understand what that means. A lot of elected officials are not doctors or public health professionals, they may be lawyers, they may be business professionals, they need to understand information, they need to have it presented to them in a succinct way, in a way that helps them see pros, cons of their particular decisions. And they hire us, when we're in these public health roles, they hire us to give public health advice. I am not, and I tell my governor this, I'm not a political advisor, I'm not an economic advisor.

25:55.0 Khaldun: I do, of course, understand that public health and the economy are very intertwined, they don't oppose each other, but I come to work every day doing the best I can to understand the data, understand the science, and make sure the people that I'm working for understand that as well, as they're having to make very tough decisions. In medicine I take care of people who are in the ER perhaps because they were in some type of altercation where perhaps they have been accused of doing something bad. Someone was in an altercation, they shot somebody and somebody shot them or whatever, but when I'm taking care of someone, I don't use that lens, I use the lens of I have a human being in front of me, I have special training to be able to help this human being, and I'm gonna use my special training to make that human being be as healthy as they can. And I really bring that same approach to my role in public health as well.

26:49.5 Bowman: And kind of thinking about your role being grounded in the science, does that help at all to sort of buffer, again, from some of the criticism that comes in living in a divided society, or even outside of the divided society, issues and decisions that people will have different perspectives or opinions about? I'm just wondering if that has allowed you to maintain some conviction in your guidance and to be firm in what you're suggesting?

27:18.5 Khaldun: I think so, some people may disagree, but I don't engage in the political. I know people, I'm obviously an appointee of the governor who is Democratic, but the things that I am recommending and talking about data and science and public health policies, these are for public health regardless of your political affiliation. Obviously, unfortunately, COVID-19 has become very political. Basic things like wearing a mask, even getting a vaccine now. There's some data that shows that maybe there's Republicans who are more likely to not wanna get a vaccine. I think it's unfortunate that basic just us helping each other and helping to get through this pandemic as quickly as possible has become political, but I think I continue to make sure my main goal as the Chief Medical Executive particularly, is to provide guidance to the governor on medical and public health matters, and that is what I stick to every day.

28:13.6 Bowman: Terrific, and some of your earlier remarks relate to something that I've read from you, that you turned multilingualism, and as I think about your work, and part of the challenge is you have to be so effective at working with people from different backgrounds and disciplines, and even spanning to communication effectively with the public in communities. Can you talk about multilingualism and even define it and tell me why it's important for the work that you do?

28:48.2 Khaldun: Sure, yeah. So I wrote about this in an article earlier in the pandemic, this kind of professional multilingualism, and I think it's something that I've certainly learned throughout my career, whereas if you're talking to a physician, for example, you may use all kinds of medical jargon terms, and that's okay, we know what that means, but, and this is what teach my medical students and residents, when you're writing discharge instructions for a patient, don't throw your medical jargon in there. Say things like you came in for stomach pain, say arm, say very basic things that the general public who does not perhaps have medical training would understand. So I think it's the same thing when you are a public health leader, making sure you are saying things in very simple ways where people can understand the issues.

29:40.9 Khaldun: In the very beginning I was giving trainings on, again, what contact tracing means, speaking about things like social determinants of health, people don't understand that term often, and often policy makers who are in control of where dollars go, don't understand what social determinants of health means. But they do understand, if someone's homeless, it's very difficult for them to take their medication and get a job and they may keep coming into the ER and that might increase hospital costs or health plan costs. People understand that, but they may not understand things like upstream social determinants of health. So I think really being able to pivot in whatever environment you're in and being able to almost, I feel like I'm almost translating on a daily basis between my MD, my public health role, speaking to other public health professionals, and then speaking to the general public, and then other political leaders who have to make really tough decisions. I think maybe I enjoy it a little bit, but it is really translating important information to leaders in a way that they can understand and be able to make good decisions.

30:47.8 Bowman: Absolutely, so I'm gonna pick your brain for a moment as we think about the pandemic, the journey that we've experienced and then projecting things forward. So there have been so many twists and turns in the road, if you will, as we think about the pandemic, hard for us to project at any given time what things are gonna look like six months ahead or a year ahead. We're experiencing some of those twists and turns in widespread transmission of new variants, lots of promising progress to date in terms of vaccines, despite some hiccups along the road that happened. And I'd just like to ask you, as you distill all of that, what do you think needs to happen for us to make significant progress toward ending this pandemic?

31:36.4 Khaldun: Yeah, you know, we're all tired. I even sigh a little bit, as I say that, really since January of 2020, public health professionals have been working on this response. And so what do I think we need to do as a society? I think we need to focus in on the things that we know work. Masks, again, people hear this all the time, but I'll just say it again, masks, avoiding large gatherings, washing hands, social distancing, getting a vaccine. It's very simple, actually. These are just the things that we have to do to get out of this pandemic as quickly as we can. And I think it's also important for people to understand vaccines are the way to freedom, if you will. There are so many things, the CDC has come out with some, I'm sure they'll come out with more, about things you can do once you get vaccinated, so gathering in your home with other fully vaccinated people without a mask, not needing to be tested before traveling across the country, not needing to quarantine if you've been exposed and don't have symptoms.

32:35.9 Khaldun: So things that you can do. And quite frankly, even for me, I'm grateful to be fully vaccinated, just traveling, going on about your life without feeling so concerned that you're gonna get COVID and potentially end up in the hospital. Even if you get COVID, if you've been vaccinated and that is a possibility still, it's highly unlikely that you'll be hospitalized or lose your life. So I think, again, it's these basic things, I think we all need to focus on in our personal lives and think about it in the sense of what we do have control over, and the things that we actually can do.

33:09.2 Bowman: Absolutely, and the importance for us to do it collectively as a society, so individual choice matters, but as we think about an infectious disease and population health, that we need to really have buy-in from all. So now I'd like to focus specifically on something that we've experienced in COVID-19, and that's the spotlight that has been shined really on the stark health inequities that we have in this country. That didn't start with COVID, but COVID has certainly shined a light on them. And we have intersecting public health crises of an infectious disease by way of the pandemic and continued manifestations of racism that foster inequity. You've been heavily engaged in furthering efforts to promote health equity in the state, and then recently were appointed, I guess earlier in the year, to a presidential, a task force, and congratulations on that.

34:04.3 Khaldun: Thank you.

34:06.7 Bowman: But I'd like to just ask you for a moment to tell us about some of that work that you've been involved in.

34:11.5 Khaldun: Absolutely. So, as you mentioned, it's really no surprise that COVID-19 has impacted communities of color in the way that it has, and if you just think very simply about COVID-19, an infectious disease, a virus that you get if you're exposed to someone else, and you think about the fact that Black and Brown people are more likely to live in poverty because of historical policies and racism and lack of resources in communities, lack of educational opportunities, more likely to live in poverty, which means when a lot of people, a year ago, were able to maybe work from home, they had paid leave, or they had their own individual car, things that really come with wealth and privilege, Black and Brown people were less likely to have that wealth and privilege, which meant that they're more likely to be exposed if you gotta take the bus, if you have to come out working when everyone else who's concerned about getting the virus can be in their home, if you have unstable housing, if you may live in multi-generational housing, all of those things contributed to COVID-19 spreading.

35:17.2 Khaldun: Initially, the CDC guidance says, "If you have COVID-19, isolate and use a separate bathroom," well, everyone doesn't have two, three, four bathrooms in their home to isolate. That is how we ended up seeing these disparities throughout the pandemic. And so one of the first things, one of the rules is, if you don't measure it, you can't identify it and then you can't implement solutions. And so I decided with my epidemiology team, when we're looking at data, and they knew this from before the pandemic, don't show me any data if you haven't looked at it by race and ethnicity the best you can. So sure enough, we were one of the first states to actually look at COVID-19 cases and deaths by race and ethnicity, and we found a stark disparity. African-Americans, 14% of the population, 40% of deaths. We looked at that data, we published it, and then working with the governor and Lieutenant governor, just amazing leaders, they went into action. So we have a race disparities task force that we formed, I'm grateful to be a part of that. And we implemented, brought together community members, which I think is really important to not sit in that bubble in a leadership position, but really engage the community.

36:23.0 Khaldun: We engaged community leaders, implemented policies, put money, resources into communities of color, whether it was mask, testing, communication efforts, so people knew the risks and what to do, and we were able to bring that disparity down. So again, I'm very grateful for the opportunity to be on President Biden's health equity task force, and we are similarly looking at those specific recommendations that if implemented could really impact, not just COVID-19, but other current and future public health challenges.

36:55.8 Bowman: On that note, great suggestions and strategies for tackling some of the inequities that we see and have seen unfolding due to COVID and to try to mitigate them, eliminate them. As we talked about that these inequities didn't arise out of the blue, they were due to existing sort of thought lines, if you will, and so at some point we'll turn the corner from COVID, but there will be future health challenges. How do we as a society and maybe the question is, are you optimistic that we can at least achieve it to actually have some structural change so that in the future as we prevent challenges, we don't see this disproportionate burden of who and how those challenges are experienced?

37:43.0 Khaldun: Absolutely, I am optimistic. I'm optimistic because, one, I think people are paying attention to it now more than they were before COVID-19, including people who are leaders and people who have power to make change, and by power I mean bringing resources, quite frankly, often dollars and changing structures and systems that really are what create these inequities. So I am optimistic. I think that it's still a challenge. These systems have been in place for... You may argue, since the United States came into being. And so what really needs to happen is that at every level of society or of an organization, there needs to be, not just training, so training is one piece, inclusive bias training, I think it's important, I support that, we're doing that at the state, we're mandating it for medical providers as far as a condition of maintaining your license.

38:45.7 Khaldun: With the training, we hope that when people are interacting with someone, for example, in a healthcare environment, they are making decisions about what medications or treatments or tests someone may get, they're seeing past the color of someone's skin or their own biases, and they're giving someone the appropriate treatment, which hopefully, collectively, if everyone does that, we'll start seeing better health outcomes. Leaders in departments who may be able to determine who gets a job or how grants are given to entities, businesses, for example. When you have people in leadership positions who are determining where money goes, how structures are set up, it takes some time, but if you can start changing that now, I'm very hopeful that as years go on, we'll be able to see some of those inequities change. I'm concerned that when COVID-19 goes away, I don't want people to forget the tragedy that we've seen play out with inequities in Black and Brown communities.

39:44.9 Bowman: Absolutely, absolutely, and I view it on the academic side as something that should be embedded in our training, and it has been, but using COVID-19 as a specific example for years to come to underscore that. So let me ask you about crisis leadership. Crisis leadership is a different breed of leadership, if you will, and as I think about it relating to your track background, it feels as though public health leaders over the last year have been running a marathon, but at a sprinter's pace. Are there strategies that you've developed or what are your thoughts about self-care, how you manage your team at moments when there are such urgencies that we have to deliver, but also thinking about overall well-being for members of your team?

40:33.5 Khaldun: Yeah, I was actually just talking to my husband about this. When I was in high school and college, I was a sprinter, long jumper, and hurdler, but I feel like I've been asked to do a marathon and then 10 minutes later start another marathon. It's kind of how I'm feeling right now. But you know, I think for my team and my gosh, I am so grateful for... I know people see me often as the public face of COVID-19 in this state, but we have so many amazing public health leaders. You don't have to be at the top to lead, we have so many amazing public health career professionals, epidemiologists, contact tracers, there's so many people in the department and outside the department as well. Of course, we've had wonderful partnerships with the University of Michigan, School of Public Health and other schools to be able to help get through this pandemic. And people are tired, but there's no question that people are tired. People are retiring, people have needed to take medical leave. As a leader, what I've tried to do is really make sure, again, COVID's been going on, COVID's gonna be here next week, it's important, and even I think some of this comes from my emergency medicine training, while this is absolutely a public health emergency, every single thing we do, every minute of every day is not necessarily an emergency.

41:56.2 Khaldun: So being able to help my team understand and prioritize work, there's so many requests that come down every day, so helping to say, Okay, let's look at your calendar, what are the things that really have to be done today versus next week? I know I asked for this, but it's probably not the thing that has to be done now, so just really being mindful of that as a leader. And also as a leader making sure people know, I don't really expect people to be working through the weekend or into the evening, unless it's absolutely necessary. I always try to cut back on meetings and the timing of meetings, sometimes I figure we still need a meeting so I have to put it back on, but I try to be mindful of that and also encouraging people to take care of themselves. If someone has a doctor's appointment or they have to do something with their child, you don't even have to tell me, I don't even need to know. I just know that you've got life, just like I have a life and I have children, and I'm trying to take care of them as well, I expect people to do that. And I also try to emulate that in my own life.

42:52.9 Bowman: Terrific, do you mind sharing with us an example of one thing you do that serves as an outlet for you?

43:00.0 Khaldun: Yes, so my bike. My husband got me a bike like a year ago, and I do frequent bike rides, and I really enjoy it. Sometimes, especially when it's a particularly stressful day, I might take a 20-minute break in-between meetings and just go on a quick bike ride and it is helpful. Also just taking time to be with my children. Two of my children have been on Zoom school the entire year, including my one that's in elementary school, and that has been a challenge, but I take time. I actually read to his class for reading month, last month, just little things that keep me rounded and dare I say, I know this does not sound like self-care, but working in the ER, actually. It's a little break for me, even as busy as the ERs have been including my shift this past weekend, it's very grounding. The ER is still home, I trained in it, all the staff... When I'm in the ER, I'm not Dr. J, I'm, "Dr. Khaldun, can you order this medication?" [laughter] And I'm just kind of focused on that patient in front of me, so it's grounding and relaxing in many ways for me.

44:12.5 Bowman: Terrific, terrific. Well, continue to exercise self-care, again, you've been delivering so much and I like your analogy of consecutive marathon, so appreciate the tips. I'd like to ask you just about tough leadership moments, and if there are any recent examples of things that you've experienced maybe during this sort of crisis period for us as a nation, as a society, but what leadership lessons have you drawn upon to get you through those tough leadership moments?

44:45.6 Khaldun: Yeah, there's been... I feel like every day is a tough leadership moment, but I think often, just when things happen and so many things seem to happen every day with this COVID response, making sure I'm present for my team, making sure when my team may be getting negative feedback, maybe there's a media story, maybe they made a mistake, I make sure that I let my team know that it's okay, they are human. I try to always bring context to the situation and kind of help ground people and say, "Okay, we have a problem. We have a problem, but here are some specific steps that we're gonna do to get through the problem. It's gonna be bumpy, but I'm here with you and this is what we're gonna do now. This is what we need to do next. And tomorrow will be a new day." To be honest with you the Johnson and Johnson vaccine pause that occurred yesterday, we didn't know that when we went to bed and in the morning we found it out. It was a little hectic yesterday, but we just said, "Okay, this is what we know, this is what we don't know, let's do some communication efforts and move on."

45:53.2 Bowman: Absolutely. Part of those challenges stem from just the evolving nature of science, and so I'd like to ask you, as you think about leadership, as you think about science, as you think about your work, how do you try to stay ahead of the curve, and in situations like the Johnson and Johnson story, it's nothing that we can fully anticipate, but being able to stay abreast and manage as promptly as possible.

46:21.8 Khaldun: Some people who are close to me know my brain just works like this. Maybe it's why I'm a good ER doctor or chose to go into emergency medicine, I think I'm probably always anticipating the worst, not assuming that it's going to happen, but anticipating it. And so I think often there are a few things that are surprises, even with the Johnson and Johnson. We know that there's a very robust monitoring process in place for these vaccines, that's why I feel so good about telling people you should get the safe and effective vaccines, robust monitoring system. We knew that there's a process in place where these types of things may happen, and so yesterday it happened, right? We didn't know what it was, we didn't know when, but it happened, and so we identified the issue, we communicated with our teams, with providers who had the vaccine, and now we're moving forward. I think it's about anticipating, it's about thinking, Okay, if this happens, what are the next one or two even steps that we need to think about? What's some worst case scenario situations where we need to just have a little bit of a back-up plan if something happens? My brain tends to think like that, but I think just anticipating a couple of steps ahead can really go a long way.

47:34.3 Bowman: Terrific. Well, we're just about out of time. So first of all, I wanna give my sincere thanks to you, Dr. Joneigh Khaldun, for taking time to be with us today and for sharing some really great insights about leadership and responding to the pandemic, and even learning more just about your personal and professional journey that I think it will inspire me and many other listeners today. Thank you again to all of you for joining us. Be well, stay safe and always go blue.

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