The Host

Julie Rovner KFF Health News @jrovner Read Julie's stories. Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

Public health, one of the more misunderstood concepts in the health world, is about the health of entire populations, rather than individuals. As a result, public health is closely tied to things like the environment, nutrition, and safety.

One commonality among many of President-elect Donald Trump’s picks to manage federal health agencies is their distrust of the nation’s public health system. With major concerns such as bird flu looming, that sentiment could translate into efforts to undermine those of public health workers.

To illuminate the importance and nuances of public health — and recognizing that public health is best explained at the local level — KFF Health News has partnered with Civic News Company to launch a project called Healthbeat.

In this special episode of KFF Health News’ “What the Health?”, chief Washington correspondent Julie Rovner is joined by KFF Health News public health correspondent and Healthbeat national reporter Amy Maxmen, Healthbeat editor-in-chief Charlene Pacenti, and Healthbeat New York City reporter Eliza Fawcett.

Panelists

Amy Maxmen KFF Health News and Healthbeat Read Amy's stories. Charlene Pacenti Healthbeat Read Charlene's bio. Eliza Fawcett Healthbeat Read Eliza's stories.

Among the takeaways from this week’s episode:

• The covid-19 pandemic revealed the need for a deeper understanding of public health — a data-driven field devoted to the health and well-being of populations. Some of the biggest public health issues of the moment include childhood vaccination rates, and long covid and post-traumatic stress disorder cases among health care workers.
• Bird flu is top of mind for many in public health. While the virus has been around for decades, its transmissibility to cattle is new, and that concerning characteristic emerged in the United States. The outbreak was not contained when it was first observed in a handful of states, and now the question is whether the virus mutates to enable human-to-human transmission — a trait that could make bird flu the next pandemic.
• Many in the public health community are wary of the possibility that Trump and his administration’s officials could gut funding and policies that support the nation’s health — and even non-health policies can hold consequences for health care. For instance, anti-immigration measures could drain the health workforce; many immigrants work as home health aides, nursing home staffers, and more.

Mentioned in this week’s podcast:

• KFF Health News’ “Exclusive: Emails Reveal How Health Departments Struggle To Track Human Cases of Bird Flu,” by Amy Maxmen.
• Healthbeat’s “Georgia Facing Numerous Crises, but Board of Public Health Hasn’t Met Since May,” by Rebecca Grapevine.
• Healthbeat’s “New Yorkers, Meet Your Local Epidemiologist,” by Charlene Pacenti.

Click to open the Transcript Transcript: Public Health and the Dairy Cow in the Room

[Editor’s note: This transcript was generated using both transcription software and a human’s light touch. It has been edited for style and clarity.] 

Julie Rovner: Hello, and welcome back to “What The Health?” I’m Julie Rovner, chief Washington correspondent for KFF Health News, and I’m joined by some of the best and smartest health reporters in Washington. We’re taping this special holiday episode — more on that in a minute — on Wednesday, Nov. 20, at 2:30 p.m. As always, news happens fast and things might’ve changed by the time you hear this. So, here we go. 

Today, I am thrilled to be joined here in our KFF studios by some of the staff of KFF Health News’ newest project, Healthbeat, which we’ve created with another nonprofit, Civic News Company, to cover public health in America. Here with us today, our Healthbeat editor-in-chief, Charlene Pacenti. 

Charlene Pacenti: Hello. 

Rovner: Amy Maxmen, KFF Health News public health correspondent and Healthbeat’s national reporter. 

Amy Maxmen: Hi. 

Rovner: And Eliza Fawcett, New York City reporter. 

Eliza Fawcett: Hi there. 

Rovner: Hello, everyone, and thank you so much for being here. Charlene, I want to start with you. What exactly is Healthbeat, and why do we need it? 

Pacenti: Now more than ever, I would say. Healthbeat was created in the wake of covid when it became very apparent that people needed a deeper understanding of what public health is, the kind of invisible shield that keeps us all safe. And we also needed more news coverage that centers reliable, science-based information so that people could make good decisions about the health of their families, themselves, and the people around them. So we thought part of that coverage should be rooted in communities. It’s been shown that no matter their politics or how they feel about the federal government, people do trust their local public health leaders. And we think that by elevating those voices on timely issues, we can start to win back people’s trust, not only in journalism but in science. 

Rovner: That sounds like a very uphill battle. 

Pacenti: Yes, as you mentioned, but we are part of Civic News Company, which you mentioned, whose model has been developed over the past 10 years covering schools with Chalkbeat. And so we’re trying to leverage the success they’ve had with the local plus national reporting. So for Healthbeat, we’re partnering with KFF Health News, which has a long tradition of excellent health reporting, to handle national coverage. And then we’ve opened two local bureaus to start. We’re in New York and Atlanta with a third location to come next year. 

Rovner: Cool. Amy, you’re our public health expert at the table. How is public health different from what we think of as regular health care or medical care in general? 

Maxmen: I am excited to answer that question, because I’m really into public health. So whereas you think about health care as what happens in a clinic. An individual is sick, and they’re treated within a hospital system. Public health really focuses on preventing illness and improving health at a population level through population-level interventions. So for example, infectious disease outbreaks are often a big component of public health, and that’s because they spread in communities. 

So even though a person is treated in a hospital — say if you have somebody who has measles, now the person’s treated for measles in a hospital — but public health officers actually go into communities. They figure out how the virus is spreading. They might go to schools or to hospitals or to a shopping mall, wherever that person was. Similarly, if a person is shot, they go to an emergency room and they get health care in that emergency department. But public health is going to look at the surrounding issues. How does gun violence affect the whole neighborhood? What does it mean to grow up with stress? Does it mean you can exercise as much if the neighborhood’s dangerous? So that’s sort of why also a big component of public health is about collecting a lot of data and analyzing that data. 

Rovner: I feel like people kind of misunderstand this a lot. They think of public health, they think of health care as something that’s between a health practitioner and you, the patient, whereas public health is bigger than that, and you are not the focus of public health, right? It’s everybody around you. 

Maxmen: Yeah, that’s the public part. Yeah, and it’s fun because it’s out there in the world. 

Rovner: But why do people — I feel like people really misunderstand that, and I feel like that’s the source of a lot of the frustration that people get with public health. It’s like, Well, that might not be good for me. 

Maxmen: Yeah, that’s the tricky thing because I think at its root, you have to believe in societal goods. You have to believe that having a cleaner neighborhood is good for everyone and not just because you have to take out your trash or not. I don’t know if that’s the best comparison. 

Rovner: Eliza, how’d you get into public health? 

Fawcett: I started as a reporter at the Hartford Courant during the start of the covid pandemic. I became really interested in covering health and also mental health during that time. And I grew up in New York, and it’s been really exciting to be the first New York reporter for Healthbeat, really getting into community health issues and understanding the sprawling New York City health department, which is one of the biggest in the country. And since I grew up in New York, it’s been really exciting to be doing this work. 

Rovner: Charlene, what kinds of stories is Healthbeat pursuing? 

Pacenti: Well, as you can imagine, public health is very broad, and we’re just getting started. We just officially launched Aug. 30, so we’ve just had the last of our reporters come aboard for right now. So we’re trying to narrow it down a little bit, and we’re kind of focusing on three key buckets for our coverage. One is infectious diseases, which Amy’s doing such a great job on bird flu right now, but also we’re looking at that locally, too. What are the flu numbers right now? We’re going into flu season. What are the covid numbers? How’s RSV [respiratory syncytial virus] ramping up? And those sorts of things, and the community’s preparedness to deal with outbreaks. 

Accountability is another really big thing that we’re focused on. What many people may not realize is that public health funding, even at the local level, comes from Washington. It’s coming from CDC [the Centers for Disease Control and Prevention]. It’s coming from HHS [the Department of Health and Human Services]. And so we’re looking at how those dollars flow down to the local communities and how they are spent, and also just officials who are in charge of public health policy. In Georgia already, we’ve seen some pretty good impact in our reporting just by showing up, frankly. Our first Atlanta reporter, Rebecca Grapevine, she got on the job the first week and realized that the Board of Public Health in Georgia had not held a public meeting in five months. So we wrote about that, and the story got a lot of attention. And by golly, in November they had a meeting. So that was really great. 

And then the third thing is really community. We really want to center our coverage on the people on the ground who are working on public health from many aspects. It can be social workers. It can be your local epidemiologist at the health department. It can be volunteers at a house of worship who has a ministry trying to help with homelessness or maternal mortality or any of those things. We’re really trying to be a platform and a voice for those people. At Civic News Company, we call people like that civic catalysts. They’re out there doing the work, and we really want to shine a light on them. 

Rovner: So Amy, obviously we’re going to talk about bird flu separately in a few minutes. What are the other public health, big national public health stories that you’re watching right now? 

Maxmen: I think we’ll keep an eye on vaccination rates. You can expect those to unfortunately drop. And I’m not talking about just the covid vaccine but childhood vaccination rates. It’s important to keep in mind the majority of adults, around 70%, still say that childhood vaccines are really important. But remember, going back to what’s public health, the power of vaccines is in herd immunity effect. So children are being protected with, say, a measles vaccine, but we want to have high rates above 90% of vaccinations so that teachers who are immunocompromised, children who are immunocompromised, infants too young to be vaccinated, so that they’re all protected, too. And what we’re going to see, if we see RFK [Robert F. Kennedy] Jr. as the head of HHS, there’s some rumors floating that Joseph Ladapo might have a role in the administration as well. 

Rovner: He’s the Florida surgeon general who we’ve talked about a lot on the podcast, who himself is kind of vaccine agnostic, if you will. 

Maxmen: Yeah. Exactly. And so we’re seeing a lot of signs that we’re going to hear a lot of terms like “choice” and “consent” when it comes to vaccines. And those sound like great words, but what it ultimately means is that we’ll see a loosening of mandates around having children be vaccinated before they go to public school, and that combined with misinformation. So we’ll probably see lower vaccine rates among children. So that’s something to watch because it means more outbreaks. Outbreaks are costly to contain in money and in lives lost. So that’s definitely one story. 

There’s certainly others besides even the bird flu, which I’ll talk about. I write a lot about occupational health, so there’s lots of health care workers who lost their lives in covid, but also I’ve covered how many are facing long covid and PTSD [post-traumatic stress disorder] because they weren’t very well protected when they were at work during the pandemic, during the peak of the pandemic. I’ve written about how farmworkers and construction workers and landscapers have had heat-related illness and injuries. There was a law that the Occupational Safety and Health Administration has been working on, but it will almost certainly stall under a Trump administration. So we’re not going to have national regulations on heat. So those are some of the other things I’ll be thinking about. 

Rovner: What are the big stories in New York, Eliza? 

Fawcett: Well, a lot of them are the same as what Amy mentioned, and we’re trying to see how the big changes coming down the pike with the second Trump administration will impact us locally. Obviously that is in big part about funding and whether CDC funding stays the same, is reduced, etc. Same for NIH [the National Institutes of Health] and other federal agencies that deal with health issues. The way that local health departments work, even really big ones like New York City, is that they do get a lot of money from the federal government, obviously. And so any small changes could have a really big impact on work on the ground, whether that’s making sure that kids can get vaccines. The Vaccines for Children Program is responsible for making sure that many, many, many children in the United States get vaccinated. 

Rovner: I’m, of course, so old that I covered the Vaccines for Children Program when it began in the 1990s. But yes, that is how most kids get vaccinated now, is through the federal government’s Vaccines for Children Program. One thing that obviously we are looking towards, the possibility with Republicans back in control of the Congress and the White House, is health care budget cuts. I assume New York is assuming that there will be less money in a Trump administration. 

Fawcett: Yeah, I think it’s a real concern for public health leadership in the city, and it’s been interesting to see what the response has been from city and state officials after the election. They’ve kind of made this point of saying that New Yorkers will be protected, whether that’s reproductive rights or vaccinations. And there’s this feeling of kind of pulling up the drawbridge, that New York has a pretty robust public health infrastructure. And so whatever happens on the federal level, we’ll be OK. But obviously things are a lot more complicated and intertwined than that. The city does get a lot of its funding from, or the New York City public health department does get a lot of its funding from the city and from the state but also from the federal government. And so if there are major changes there, that could have a big impact on the kinds of community-led programs that do good public health work in the city. 

And even on vaccinations, that’s an interesting question, too. Because while the CDC provides recommendations, they don’t actually provide mandates. That’s a states issue. If the CDC starts changing its messaging around vaccinations, particularly if RFK Jr. is running HHS, which is a big concern, that can still have a trickle-down impact on what New Yorkers think about getting vaccinated in general, which has already been a big concern for folks. So I think it’s been interesting to see this dynamic starting to play out in the city, where on the one hand, there’s this strong progressive leadership that is vowing to keep up the good fight. But we’ll see the extent to which they can really protect themselves from any large changes that are going to happen. 

Rovner: Let’s talk about bird flu, because it’s sort of the elephant or the dairy cow in the room. We’ve been watching all year, and I guess health authorities have been watching with some alarm as we’re seeing bird flu spreading in dairy cattle herds and then occasionally to people, to dairy workers, and now to some people who are apparently not dairy workers. What is your feeling about where we are with bird flu? And what has the Biden administration done about it? And what do you anticipate that the incoming Trump administration might do differently? 

Maxmen: Yeah, so I think the past, looking back on the past year with bird flu — the huge disappointment, appalling if you talk to researchers, sort of frustrating if you talk to public health officials — is we failed to contain it when the bird flu outbreak was confined to just a handful of states. That would be when it was smaller. It’s like putting out a fire when it’s small versus once there’s a huge forest fire. It’s harder to put out. So now it’s in at least 15 states, and the number might be higher because a lot of farms, maybe the majority of farms, haven’t tested at different periods during the year. There’s 52 cases among people in the U.S., mainly among farmworkers. But yeah, as you just mentioned from the case in California, there’s a few cases that have been mysterious, people who have no contact, no known contact with farm animals. 

These unknowns are actually kind of what’s as staggering as also the growth of the epidemic. We’ve sort of lost track of what’s going on. So what this means is, I’ve talked to so many experts at this point, and nobody thinks we’re going to eliminate this on dairy farms. And to be clear, bird flu has been around for 30 years. But the bird flu in cattle spreading among mammals, that’s new and that’s in the U.S. So what does this mean? This means best-case scenario, millions if not billions of dollars in losses for the dairy and poultry industry. It means farmworkers are going to continue to get the bird flu, which is not comfortable. And then it also means we just have this kind of ominous constant threat that maybe the virus will evolve in a way where it spreads between people easily. And that’s when you could get a pandemic. 

Rovner: That’s been the big fear about a pandemic. 

Maxmen: That’s the fear. 

Rovner: I mean but that was a fear even before the covid-19 pandemic. What everybody was afraid of was a bird flu pandemic, was an avian flu that mutated to pass from person to person. 

Maxmen: Exactly. It’s been on the — because humans don’t have a lot of experience with the bird flu. It’s novel. We may or may not have some partial immunity to it, so it could be very bad. So there’s a chance it will never mutate in a way that has it spread easily between people. But if it does, it could be horrible like on the scale of what we saw during covid. And so that’s why everyone I talked to, I guess the big question is: Why are we taking a gamble on this? But that’s what we’ve done this past year essentially — intentional, not intentional. I could get into — I’ve reported a lot on why this is, but that’s where we’re at. 

Rovner: Some of this, I know, comes back to the whole trust issue, which is that the CDC couldn’t get onto some of the dairy farms to test, because the dairy farmers didn’t trust the government. What has the Biden administration been able to accomplish in terms of dealing with the bird flu? 

Maxmen: Well, yeah, so on a local level, this is really left to local public health departments a lot of the time. So that’s really who’s doing the work here. Sometimes it’s state health departments, but on the ground we’re talking about veterinarians, farmers, and local health officials. I actually FOIA-ed [through the Freedom of Information Act] a lot of health departments and some agriculture departments to learn what’s even happening. The system of surveillance is a voluntary system, so when there’s mistrust or also just fears, right, so farmers would be afraid of, if they say they have the bird flu, of losing their entire milk market, which is a big one because then they lose the whole farm. So there’s a lot of concerns about their own privacy. 

So basically a lot of the cooperation has kind of fallen apart with that. What could the CDC do? I think there’s a lot of disappointment for the CDC and the USDA [Department of Agriculture] from the experts that I speak with, because although, yes, they can’t just storm onto farms, they haven’t actually been using the bully pulpit to say: This is what’s going wrong. We’re really concerned. This is how we can do it better. This is how we can get around some of these problems like farmers being afraid of losing their milk market or farmworkers being afraid of losing their job. 

They haven’t really been very open about the problems, and they also haven’t acted with urgency. So the response on the high level has seemed slow and uncoordinated. They’ll announce that they will be doing outreach to farmworkers, but then there will be months passed with no outreach. They’ll say that they’re going to be working on having other groups be able to test for the bird flu virus, but we still don’t see any group besides the CDC having that ability. So there’s a lot of people who are aggravated with the response under the Biden administration, and some of it’s not just because of leadership. There’s internal issues within the U.S. We have a voluntary system in a lot of ways, so for better or worse, this might be the way it is. 

Rovner: And what would you expect from an incoming Trump administration even? We obviously don’t know a lot about what to expect from an incoming Trump administration, but based on their handling of covid, what would you expect? 

Maxmen: Exactly. So based on their handling of covid, one is, I can say: Time-wise, OK, what’s on our side? The plus is as outbreaks continue, people often get better at figuring out what to do. So on the plus side, maybe farmers will start to have a little bit more trust that they’re not going to have huge losses and that therefore they’ll be a little bit more open. Maybe vets will get a better handle on how to control this. So that’s the plus side. The downside is also pretty huge. So during covid, the CDC basically stopped holding press briefings. So right now, at least there are press briefings. Here, I was critical of the CDC, but I might completely lose all contact with them under a Trump administration. 

Another one that’s quite big is there’s a study that showed that we’re missing a lot of cases among farmworkers, and I expect us to have more bird flu cases among people and miss more of them. And that’s bad because it’s bad for the people who have the bird flu, but also it means we might miss the moment if this starts to spread between people. If a person spreads it to their kids or other family members, we might miss those moments. And the reason why we’ll miss them — this happened during covid — is when there’s huge threats of deportations and when there’s just a lot of anti-immigrant rhetoric. I did a lot of reporting in the Central Valley around meatpacking plant workers and farmworkers. 

When there’s a lot of threats like this, people are maybe … There’s a lot of people in that community who are immigrants, and maybe some are undocumented. You also have people on temporary work visas whose visa is tied to their employers. Maybe they have family members who aren’t legally here, so they don’t want to risk even the threat of deportation by going to a clinic when they’re sick. They don’t want to complain if work conditions are really unsafe. If they’re given, say, no protection wall taking care of sick cattle, there’s no incentive to complain about the employer if you think you might actually be deported. So stigma tends to drive infectious diseases underground, and that’s sort of what we can expect. 

Rovner: And obviously immigration is one of those issues that we don’t cover generally as a health issue, but in New York, it is a health issue, right? 

Fawcett: Yeah, absolutely. I think that’s another thing that we’ll be looking at closely as this Trump administration gets going. Obviously, there are a lot of concerns among migrant communities in the city about mass deportations, which Trump has vowed to fulfill. And New York has a really large and fairly effective system for taking care of people regardless of immigration status or insurance, particularly through the municipal hospital system, NYC Health and Hospitals. And leadership there has said that migrants’ access to health care will be protected, but there is a lot that remains to be seen about how those communities will be impacted. 

Rovner: And Amy, which is the bigger threat out in the rest of the nation, the idea of people who could potentially spread misinformation about public health at the national level or the threat of not having enough money? 

Maxmen: Oh, I don’t like binaries. Having misinformation at a very high level is pretty terrifying. It’s pretty terrifying. And I think also, I always keep in mind big-picture stuff. As a reporter, if you’re constantly combating every new little piece of misinformation, it’s a bit exhausting. It’s great to fact-check what people say, the big picture. Speaking about RFK Jr., he’s endorsed a lot of conspiracy theories. And there’s studies showing that if you believe in multiple conspiracy theories, there’s a good chance you’re going to believe in another one. So to have a conspiratorial mindset at a high level of government or even in very influential positions, that’s pretty scary. Yeah. 

Fawcett: I think the other aspect to this conversation as well is just that, broadly speaking, the public health system is kind of beleaguered right now coming out of covid. A lot of the federal money that was there to support this work has dried up, and there are budget holes that need to be filled now, and people are burnt out. So I think that’s another aspect here. Will folks be ready to have any fight that needs to happen under another Trump administration? 

Rovner: Charlene, one of the things you said at the beginning is that one of the efforts here is to help rebuild trust in public health. Public health has been, I think, of everything, of all of the parts of American society where the public has lost trust, public health is way up towards the top. And also it’s way up towards the top in terms of the misinformation that’s been spread. So how do you combat those two things? It’s something that we talk about all the time on the podcast, and I don’t know how to fix it. 

Pacenti: It’s really tough. I think that one way that we really look at it is elevating local voices. To your point about immigrants and immigration status as a social determinant of health, we had a report just yesterday that came out in Georgia that laid out all the things that Amy and Eliza were just talking about in Georgia as well — the stigma, the not asking for help, because you fear about getting involved with the authorities in some negative way. But there are a lot of community organizations that are a safe space that do work to provide culturally sensitive care and speak the language and offer the help to people so that they’re not threatened. So I think by highlighting those resources, that’s one thing that we can do. 

And another one is just highlighting people who know what they’re talking about, scientific experts in the community, particularly local ones. One really exciting thing that we’re doing in New York is we’re kind of combining two of those concepts through a partnership with Your Local Epidemiologist. This is a newsletter that is run by Katelyn Jetelina, who back in 2020 started an email. She was teaching at the University of Texas. She’s an epidemiologist, and she was just writing an email to her students and her family and friends to explain the science behind what was going on with covid. And it has snowballed, and four years later, it’s really huge. So we have partnered with her to bring that concept to Healthbeat readers in New York. So every week we have our own epidemiologist. Her name is Marisa Donnelly, and she does an email newsletter every week that kind of breaks down what we call the community health forecast. And it’s all kinds of really great, science-driven information with nice little charts that just lays it all out for you. 

Rovner: It’s like the weather forecast, but for health? 

Pacenti: Exactly, exactly. So I think that’s one way. Just lay it out for people. Give them the rationale behind it, the science behind it, and I think that work like that over time, hopefully, will help regain some trust. 

Rovner: Well, I want to thank the panel. This has been really inspiring. I’m hoping that we can come back to you periodically to see how public health in general and Healthbeat in specific are doing. So thanks for joining us. 

OK, that is this week’s show. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review. That helps other people find us, too. Special thanks this week to our producer, Taylor Cook, our editor, Emmarie Huetteman, and KFF Health News enterprise editor Kelly Johnson. As always, you can email us your comments or questions. We’re at whatthehealth, all one word, at KFF.org, or you can still find me at X, @jrovner, and increasingly at Bluesky, @julierovner.bsky.social. Do you hang around on social media any place, Amy? 

Maxmen: You know I’ve just started. I’ve joined the Bluesky trend. I just sort of came over there. It’s kind of one of those moments where there’s a lot of journalists and health people and researchers, so yeah, I’ve— 

Rovner: Do you have a handle? 

Maxmen: My handle is amymaxmen.bsky.social. 

Rovner: Excellent. Charlene? 

Pacenti: I’m most active on LinkedIn, where all the health people are. 

Rovner: There you go. Eliza? 

Fawcett: I am also on Bluesky newly, under my name, elizafawcett, and still kind of lurking on Twitter. 

Rovner: There you go. We’ll be back in your feed next week. Until then, have a very happy holiday weekend and be healthy. 

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KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.