Covid Injustice : What do you know about Public Health and Social Justice?

Did you know that social justice plays a role in providing universal access to pandemic vaccines? This may be hard to imagine since both the Biden and Baker administrations made sure that everyone who wanted to get vaccinated had access to vaccines, free of charge. However, in reality, where you live, which is more or less directly correlated to your socioeconomic status, determines how and when you can be vaccinated. The pandemic exposed the disparities involved in public health access. I had the opportunity to talk to Jeneczka Roman, Advocacy and Coalition Manager of the Massachusetts Public Health Association (MPHA), to shed more light on this and other related topics.

First off, according to their website, “the MPHA is a nonprofit organization that promotes a healthy Massachusetts through advocacy, community organizing, and coalition building.” Their charter is also to “create health equity by addressing the root causes of health and wellness.” According to Ms. Roman, the MPHA’s “current streams of work focus around housing stabilization, transportation justice, equitable public health services, vaccine equity, and a little bit of everything in between.” In other words, social justice, in all its myriad forms, is a big part of what they do. They do that via tie-ins with other similar groups.

MPHA builds partnerships with other organizations - typically grassroots groups or organizations directly representing impacted communities - on a “variety of cross-cutting issues.” At a fundamental level, a lot of the issues boil down to “imbalances of power.” Marginalized communities, especially those that have dealt with decades of structural racism, do not have access to power and hence are at a severe disadvantage when they need to shape policies that directly impact their health and that of their communities. By partnering with these organizations, MPHA is better able to identify issues, develop solutions, and “lead policy campaigns to address those issues.” One of the things they do, for example, is look at data at a non-aggregate level. At that level, they are able to better discern how the pandemic affects a particular community in terms of the number of cases, hospitalizations, and deaths.

The pandemic “exposed and deepened existing social inequities.” As Ms. Roman explained, there are a number of pandemic response policies that appear “race-neutral” on the surface but have a devastating impact on people of color. For instance, when the state moved towards a mass vaccination strategy, they did so by having large vaccination sites. However, those sites were situated far away from communities where people of color reside and would require a car to get to. Additionally, these sites did not have any language interpreters for non-English speaking people. This was yet another issue that exacerbated the fundamental mistrust that communities of color have against the public health system.

Another challenge faced by people is the decentralized health system in the state. As a result, there are 351 local boards of health - one for every city and town in the state of Massachusetts. This has created deep inequities in healthcare across the state. A small rural town or a less affluent city may not have the same resources to invest in their healthcare as a wealthier community. Unfortunately, as Ms. Roman observed, “COVID and other diseases don’t respect municipal boundaries.” As a result, many of the cities and towns worst affected by the pandemic were the ones that did not have the resources to fight it.

When asked how the MHPA would incorporate the lessons learned, she replied, “the pandemic has shown the gaps and inequities that exist in the public health system, which requires the system to be strengthened.” An important goal going forward is to make sure that those who have been impacted the most by the pandemic have “a seat at the table” when it is time to advocate for new policies and strategies. Let us hope that they are very successful in their endeavors since a strong public health system benefits all of us and not just those impacted.

A Career Well-Served as a Doctor and Administrator

Recently, I had the pleasure of re-interviewing Dr. Rick Weiner, the outgoing President of Winchester Hospital. He started his career as a vascular and general surgeon, and in 2008 he moved over to hospital administration. Dr. Weiner came to the Boston area, from Southern California, for his residency at Tufts University and never left. Three kids, all of whom graduated from WHS, and a grandson later, he is an entrenched member of the Winchester community.

When asked about the current state of the pandemic, he summed it up by saying that things were looking better than they were a couple of years ago, but “we are definitely not out of the woods.” The fact that today we have a better understanding of the virus, how to treat it, how to prevent it, and, most importantly, that we have vaccines all make the situation much better than what it used to be. He stresses the importance of vaccines as they reduce the chances of getting COVID-19, and even if you do, the symptoms are not that severe and rarely require hospitalization. Eventually, he opines that COVID-19 vaccines/boosters will resemble flu shots - something that is taken annually. As to when that will be, his prediction was “anytime between now and two years.”

Weiner has also seen firsthand the effects of technology in healthcare delivery. Some of those changes were already in place; the pandemic just accelerated those trends. The most obvious is telehealth, whereby one can remotely consult with his or her doctor without visiting the hospital. Hospital design is another significant change. New rooms will have “negative pressure,” which means that the airflow will be from the hallway, under the door, into the room (it is the other way right now). This means that if a patient has a communicable disease, his or her germs won’t leave the room. On the other hand, the operating room, which we want to be germ-free at all times, will have a “ positive airflow.”, wherein the air flows out of the room. There will be greater use of plexiglass, in addition to separate entrances and exits. The pandemic has also increased hospital efficiency, particularly throughput, mostly due to increased hospitalizations and staffing challenges.

Looking back at his illustrious career, Weiner felt that his most satisfying moments were when the surgeries that he performed were directly responsible for saving a person’s life. He felt most gratified when a patient thanked him for something he did, even if it was not anything major. On the flip side, Weiner also endured painful moments when he could not save somebody’s life. However, that made his successes even more meaningful to him as he realized not everything is in his control as there are no guarantees. As President, he loved to lead an organization of almost 2,600 people, including setting the culture, dealing with issues as they arise, and creating a workplace where everybody is treated fairly and appreciated.”We have some amazing people here.” As for the challenges he faced, the pandemic ranked the highest due to the sheer number of resource constraints it brought forth. For instance, there was a severe shortage of nurses during the peak of the pandemic for a variety of reasons. As a result, Winchester Hospital had to hire nurses through an outside agency, adding another layer of administrative responsibility in addition to all the logistics already being juggled. All things being said, Dr. Weiner concluded he is happy that he was able to have the opportunity to be both a surgeon and an administrator.

As to why he is retiring, he felt that “it was time” and that he wanted to spend more time with his family. That said, he wants to be involved in many things, “some of which I haven’t even thought of yet.” One of those things is to teach medical students, something he enjoys immensely. While Weiner will not be involved in the delivery of healthcare, he may still be associated with charitable organizations that are related to healthcare delivery. Weiner may also choose to sit on some boards. Continuing education on topics that he is interested in is another activity on his wishlist, while the role of golf as a major activity during his retirement has diminished considerably due to all his other interests. In his own words, Weiner does not want to be “uni-dimensional.” Life is short, and “there is no luggage rack on a hearse.” So there is no point in putting things off - pearls of wisdom we can all live by.