Gregg Masters 00:08
PopHealth Week is brought to you by Health Innovation Media. Health Innovation Media brings your brand messaging alive by original or value added digitally curated content for omni-channel distribution and engagement. Connect with us at www.popupstudio.productions. Welcome everyone. I’m Gregg Masters, Managing Director of Health Innovation Media and the producer and co-host of PopHealth Week. Joining me in the virtual studio was my partner, colleague and lead co-host of PopHealth Week Fred Goldstein, President of Accountable Health, LLC. On today’s show, our guest is Benjamin Ryan, PhD, MPH clinical Associate Professor in the Department of Environmental Science at Baylor University, Dr. Ryan has experienced working, researching and teaching in Environmental Health Science communicable and non-communicable diseases, community resilience, humanitarian assistance and disaster risk reduction. He has led activities in these fields across the indo-Pacific, Europe and North America regions. His field experience includes environmental health assessments in city and rural settings, responses to natural disasters and disease outbreaks, mass casualty incidents, failures of critical business functions, managing projects in indigenous communities and facilitating the delivery of health services to asylum seekers. And with that introduction, Fred, over to you help us get to know Dr. Ryan.
Fred Goldstein 01:44
Thanks so much, Greg. And Ben, welcome to PopHealth Week.
Ben Ryan 01:47
Thank you, Fred. It’s great to be here.
Fred Goldstein 01:49
Yeah, it’s really a pleasure to get you on the show. We’ve obviously known each other now for a little while and did a little bit of work at Baylor, maybe we’ll get into some of that. But let’s start off with give us a little bit about your background.
Ben Ryan 01:58
So my background, as you can probably tell, I grew up in Australia, I worked in local state and federal government there in environmental health and public health. And that’s my trade really is working as environmental health officer. And then from that ventured into, like most people working in public health, one thing leads to another, I ended up doing my Master’s in Public Health, a PhD part time while I worked full time, which led to different activities in Australia and also in different parts of the world, too.
Fred Goldstein 02:26
So give us a little background. I know you’ve sort of been all over the world worked on some pandemics and things like that. Tell us a little bit about some of that work.
Ben Ryan 02:32
Yeah, so I guess the most injury or all of it’s very interesting, it’s very challenging work in environmental health that it really ranges from disaster management, which I did a lot of that back in Queensland, Australia, where we’d get hit by cyclones or hurricanes. And that was public health field assessments. We also had big dengue outbreaks, or Dengo doing some work also in the Solomon Islands, I was the regional assistance mission to the Solomon Islands, or Ramsey, which was around, normally around malaria control was the big thing. And then just other activities that have emerged, there’s been issues for cross border issues with Papa New Guinea and Australia, different diseases that can emerge there as well. And then I got involved in the Ebola outbreak as well with some colleagues. And I was charged with developing some standards for ramping up Ebola treatment centers. And that in involves me working with the World Health Organization, MSF, and other people in the UK, because predominantly Australia supported the UK response, while I had colleagues that went into West Africa on the ground, I was providing information on how they could really ramp up their services to meet the community needs. So there’s been different roles, some administrative field work. And this all sort of dovetails into what we’ve dealt with with COVID in the past 12 months.
Fred Goldstein 03:51
Absolutely. And now you’re a clinical Associate Professor at Baylor, correct?
Ben Ryan 03:56
That’s correct. Yes, a wonderful role and probably unexpectedly ended up working, I guess, operationally or tactically in a way in COVID-19.
Fred Goldstein 04:06
Fantastic. So I’ve looked your stuff on the website, and you’ve been a prolific writer, but along with some other co authors during the pandemic, I think I counted maybe 10 pieces. Is that right? related to COVID?
Ben Ryan 04:18
Yeah, there’s about 10, 10 peer reviewed pieces that we got out there. And there’s also some policy advice and input. And that was really thinking, my bias is really I look at things from a population centered focus where my clinical friends that I co author with, they’re looking more patient centered. And we think that balance really gives us a nice paper and can really help guide decision so we’re thinking from a whole society perspective. Yeah, it’s a fantastic approach because I too, came sort of from that whole clinical, develop a program around a chronic disease or something like that, into population health management. And your most recent piece that you co authored was called the Global Public Health Database Support to Population Based Management of Pandemics and Global Public Health Crisis. It’s part one and two, and you published it this month, I think in Pre Hospital and Disaster Medicine. So tell us a little bit about that piece. So this piece I need to acknowledge our professor Skip Burkle, a longtime friend and mentor for me, we were discussing different options. And his experience in this area is just amazing. And he said, we really need to do a piece on this, are you interested? And we spoke about it. So I really need to acknowledge his leadership in this area. And he’s been a wonderful mentor. And what we’re really looking at is the best way to think about it. And I think, Fred, you’re coming from understanding how public health units operate, is thinking we almost need a global overarching public health unit type model. We’ve been able to globalize, for example, transport around the world, travel, and also communications, but we haven’t fully globalized public health yet. And that’s what these papers are really about, is laying the foundations and a pathway for us to be able to globalize public health. So the next time we get a pandemic, because it will happen again, we’re better prepared, and we’ve got more real time information. And we can prevent those silos. Because each country’s handled this differently. So there’s silos and try to get some consistency, like what public health units do.
Fred Goldstein 06:10
You talked about this from a global perspective. And you and you talked about some of the deficiencies that have sort of been laid bare by the COVID pandemic, and you discuss what some of those were, and are.
Ben Ryan 06:21
So the deficiencies are really I guess, we’re just learning as we go. Because we haven’t had really a severe pandemic like this since the 50s 60s. And we had 1918. So for us in this generation, this period of time, this is the first big challenge from a pandemic we’ve had, we had 2009 h1, n, one, which we got away with and handle that and Coronavirus, has been listed as a big challenge that we need to think about that this has highlighted that. And some of the challenges is really understanding the data, the information streams that are coming in, but also ensuring that we have a whole of society approach. So it’s, we’re really systematically understanding if we put this intervention measure in here to deal with COVID, there are going to be some other public health consequences. So when we talk about population based management teams, we’re thinking, Okay, if we do this measure, what does this mean for people who may have cancer or heart disease, and other leading causes of death? How does that impact those factors? And that’s where skip was really a Professor Burkle was really focused on we need to come up with a population based model.
Fred Goldstein 07:29
Yeah. And you mentioned these population management teams, and you laid it out in these two articles with regions and around the world. explain to the audience what you mean by a population management team? Who might be composed of what areas might it cover, etc?
Ben Ryan 07:45
Yes, the population base management team really reflects that no individual profession has all the knowledge and I think COVID-19 highlighting that we’re all learning it. As we go on. I know, Fred, you and I have had discussions over the years, just trying to understand COVID, what are the risk factors, there’s no real one place to go. So the concept really is, is that you have your clinicians at the table, you have public health at the table, you have your nurses, epidemiologists, we also have social social workers or social scientists, anthropologists. So you’re really pulling in a broad society. And you’re also having information technology people as well. And then you can also gather data, intel determine what’s needed for that local community. So you can make decisions that best reflect the needs of your community to not only deal with COVID, but other public health risk factors.
Fred Goldstein 08:37
So when you think about it today, and you pointed out in the article, we have 1000s of counties around the United States, each sort of doing their own thing. And taking their data, whatever little data they have. And this would be a more centralized management approach overseeing a larger, broader area, correct?
Ben Ryan 08:56
Yeah, would be looking at bit more of a regional model, very similar to the theme or agent or Federal Emergency Management Agency, that structure, but would really be focused on HHS regions or Health and Human Service regions, that we’ve got the 10 regions in the country. And you’d look to have these teams of multidisciplinary experts from that region. So then you can also come up with intervention measures that you know, people in that region will listen to, because each region is different. And the intervention measure that will be accepted by the community will differ as well, when you go around the United States and other parts of the world.
Fred Goldstein 09:34
Yeah, it’s fascinating, just to think about that. So you’re in Waco, Texas, and they have their certain approach to how they’re managing this. And I’m in Jacksonville, Florida, and Gregg’s out there in Southern California. And we’re really seeing vastly different approaches, but like you said, Some of that is cultural, regional, etc. So you have to work within the confines of how that population looks in response to various interventions, I guess.
Ben Ryan 09:57
Yeah. And it’s really looking at then coming back to Professor Burkle. On his wonderful leadership and work he’s done over the years, it’s also looking at taking the pressure away from the frontline clinicians, for example, making decisions so that they can focus on patients. So then you can make resource allocation decisions as well. What are your plans for certain areas. Now, a tool to do that systematically is there’s a United Nations public health system scorecard, which I was blessed to be able to help develop, could really be a starting and the entry point and the World Health Organization provided input to this. And that could really be a starting point to really understand your public health system resilience and priority actions for need. And these population based management teams, for example, if you picked up Waco and the more sort of Central Texas region, you can really get a blueprint of understanding what are the priority areas for action in this type of disaster? What do we need to focus on? What are our weaknesses? And what are our strengths?
Fred Goldstein 10:55
And in terms of you brought up data, obviously, population health, as I tell everyone is built on data. You need it, you need the data flowing through the system, and then ultimately measure the outcomes. What are some of the data requirements or the systems you think would need to be brought together to create this? You get into some of that as well in the article?
Ben Ryan 11:13
Yeah, so all the systems are really there. It’s really around infection screening. So that could include for example, simple things is thermometers. And, and what what are you seeing when you’re doing screening of populations, I know my children, we’ve had the schools open here in Central Texas since August, and that seems to have worked quite well. And my children go to school and there’s checking of thermometers, they check their temperatures, or not checking in from home and checking their temperatures, and health screening each time they walk in. So I can see my daughter be dropped off at school. And she gets screened as she goes through. So you can have the initial screening, but you can take that to another level. You have infection screening, for example, health centers, health clinics that can feed in. And we know what came out of Wuhan that we’re able to identify respiratory type illnesses going up. So that’s data that’s already there. I’ve worked in public health units, and we would get weekly reports and what was occurring. So it’s really building in what we’ve got there and centralizing it. So if you have this population health team here in Central Texas, or wherever you have it, you’re getting a centralized database to understand any issues that may be occurring in your region. But you also know your capacities. So you know what your health system can deal with.
Fred Goldstein 12:25
Yeah, so in other words, this group, when you talk about making decisions for the communities, it gets down to risk adjusting individuals from a clinical perspective to say, maybe this one’s too should not get a vent or something like that, it gets into some of that as well. Right,
Ben Ryan 12:42
you could start to break into those areas. And I know Professor Burkle was very big on also triage in not so much the patient but triaging of decisions as well, based on the data and the risk profiles. One of the challenges and beauties of COVID is we know the populations at significant risk. So you can start to focus your intervention measures at those populations. So you’re getting that Intel in early, we’ve had other pandemics, that other populations have been at risk. So you can start to adjust what you need to do. And then you can also bring in contact tracing, which is something that is vital that these teams could understand your contact tracing capabilities. As you know, here at Baylor, we had contact tracing set up about a ratio of one in 400. The recommendation for COVID was one in 1,000. So if you’ve got those capabilities, your intervention measures will also change. Because if you don’t have those capabilities, you’re then limited in what you can do in intervening and stopping the spread of COVID.
Fred Goldstein 13:43
Yeah, one of the things you focused on around that area, which I found really excellent was this idea of equity, you talked about the rural communities and not having resources. And we know lower socio economic groups, you know, the the Hispanic, and the African American populations have been hit worse by COVID. And a lot of it is structural within the communities they live in. So how would you see these groups functioning to try to alleviate some of that? Is it a question of moving resources into those communities, or they don’t have the resources you got to come up with another way to do it.
Ben Ryan 14:13
That would be part of the work of these population health based teams or population management teams is you can apply, for example, the public health system, resilience scorecard, I spoke of it, then you can identify priority areas for action. And again, the beauty of these teams, they’re going to represent the local community. And we’ve seen this with COVID. That’s really those minorities that have been severely impacted, you can start to understand what their needs for treatment care and services are. And then that group can start to develop some strategies to deal with those. And for example, if you’re dealing with COVID, again, straight away that team will know which regions in their or their specific areas or locations in their region are at most at risk from a certain type of condition. And we know for example, in the US about 60% of people have an underlying health condition. 40% have two or more. And that varies by community and community. And that’s something these population based teams would know about is who’s at greatest risk? And where do we need to really put all our resources. Because if we get the vulnerable populations under control, and we can help them whole of society is going to be in a much better position.
Fred Goldstein 15:19
Absolutely. And by by looking at as populations, you point out, you’re looking for overall benefit. We want to create the greatest overall benefit for that community, that country, that region, wherever we’re working in. The other thing that was interesting was you talked about evidence based medicine, and how evidence base is different for each of these various groups. Could you walk the group through that?
Ben Ryan 15:41
Yeah, so I come from a public health background. So my evidence base is different to a clinicians evidence base. And I think that’s where these papers that have been written Professor Burkle the clinicians written he knows the clinical evidence base, I know public health evidence bases, where we’re looking at all these different factors, making really whole society decisions based on the social determinants of health, such as access to education, health care services. Also, I would propose considering some aspects of the Maslow hierarchy of needs, what a community needs and human behavior. So when you’re in public health, and you’ve studied this area, you can really understand if you put this type of intervention in and you know that community, there’s going to be a consequence with every intervention as cause and effect. And there’ll be some sort of reaction in human behavior, then you move over to disaster management, which is got a completely different mindset of thinking in really looks at maximum benefit with the resources available, because I do that in disasters. And if you can get that group working together with anthropologists, social scientists, I think you’re really then in a position to make the best decisions based on the challenge you’re faced with that represents that region that that population based management teams working
Gregg Masters 16:58
in, if you’re just tuning into PopHealth Week, our guest is Benjamin Ryan, PhD, MPH, clinical Associate Professor in the Department of Environmental Science at Baylor University.
Fred Goldstein 17:10
At the end of the day, you’ve got to measure outcomes. And I guess there’s not really yet some, as I was reading through it, there’s not been some way to standardize what it is you’re trying to measure as the outcome of your program is that good assumption there,
Ben Ryan 17:28
that that is a good assumption, this is really a discussion, we need to have end up World Health Organization has said, this is our, we don’t want to go back to how we used to do things the old way, because the old way didn’t help us deal with COVID. So this is a proposed method to come up with a solution in terms of outcomes. The way you can measure that is, for example, if you apply this scorecard I was talking about which is an an addendum or an attachment, the disaster resilient scorecard for cities, which has been applied in over 4,300 cities around the world, in a different form or another shows you we’ve got a process the outcomes, you could measure the priority, you could complete the scorecard, identify priority areas of action for that region, and then your outcome could be you’re delivering on resolving each one of those priorities for action based on what’s the priority for that area, and you may have three to five, and that would be a that would allow you to track your success over three and five year period.
Fred Goldstein 18:27
And so when you say your priorities, are those priorities related to process measures? In other words, while we were going to do a bunch of education programs to get people to wear masks, or something, or are they are could you take it further and say, given if we had done nothing, we projected x? We did ABCDE and we got y, which was better it could you do that? Or is that something you’re thinking about?
Ben Ryan 18:53
That’s what we would be thinking about. And as you’d be aware of Fred, with a lot of other colleagues trying to forecast COVID and other aspects, has been a real challenge. So it’s really focusing on what we can and can’t control. That’s the real big factor. What we can control here is, for example, the the relationship with the community, the ability to get messages out to the community. So one of the measures might be that you want to increase community engagement, or come up with different strategies. And here in Central Texas, one of the best ways to do that may be through the local church, for example, a faith based organization, your engagement method, and Indonesia would be different. So you’d be wanting to build up those trust mechanisms. And that could be one key action area, is that you really want to understand your measures. And you could do that, for example, I work people wearing face masks in certain areas, and maybe there’s compliance and non compliance. Maybe the messaging needs to change.
Fred Goldstein 19:49
I think it’s a fantastic concept. It really is and I’m not sure how and not haven’t been involved in policy on that side. Do you? Do you think this is something that is going to begin to resonate with the public health officials, the United States and some of the leadership to maybe begin to set these up, are you working on that as well,
Ben Ryan 20:06
I don’t know if we’re there yet. The reason I say that is I think a lot of people are preoccupied with, let’s just get over COVID, then look at the future, where this paper is trying to provide a pathway to look at the future because the CDC system in the US, can work very well. And if that’s replicated in other parts of the world, and fed up to the World Health Organization, for example, then you’ve got like a global public health department that can allow us to have really good insights and support that allow us to share information. So you might have some parts of the world that may have similar challenges. We have it here in Central Texas, and you can share those findings. And there’s some friends and colleagues in another part of the world that are looking to ramp up and do large testing of a city, they’ve reached out through a network I’m in and ask for everybody, what’s your input on how can we test X number of people? So that’s the type of system this could create is rapid sharing of that type of information as well.
Fred Goldstein 21:05
Yeah, I think that would be fantastic. I know is I haven’t worked with Medicaid populations. And and in that group for years, it’s always fascinating that we in the United States tend to sort of insulate ourselves and think, well, all our answers can come from right here. And you can get incredible solutions out of Africa, Australia, Asia, where they are trying unique and different approaches that we can then apply back here. So being able to share their data would be wonderful.
Ben Ryan 21:33
I think that’s the key being able to learn and share the data. And it could be in real time and as quick as possible. And what you could do is the population based teams would be working all the time as well, that’d be helping improve standards within counties or regions, such as central Texas. And that way, when we hit the next pandemic, we know what our weak areas are, for example, we might have sufficient hospital capacity that’s higher than other parts of the United States. So we know that putting in an alternate, theoretically, they’re putting an alternate care side in that part of the country is not going to be needed in comparison to other areas. So then it’s not one shoe fits each other at all, we have different tailored responses. And I think that’s where this could be unique and allow us to really also use what we are able to use within our capabilities.
Fred Goldstein 22:24
I’m sure you also keep up with what’s going on in your in Australia, how is their approach been the same or different than what we’ve done. And
Ben Ryan 22:33
the approach has been different. And I think it’s in some ways reflection that different cultures. Haven’t been involved in discussions with colleagues in Australia in the approach they’re taking. But they’ve done pretty hard border closures where there’s a lot of citizens that aren’t able to get back to Australia and haven’t been able to since April. So that there’s a cause and effect. Again, this is what I mean, there’s a cause and effect. And what I say to my students and other people I talk about is whatever decision a leader makes, if they consider all implications of whatever decision they make, it’s generally the right decision for those people. So the response Australia is taking is working in Australia as well supported there. Whether that works in other parts of the world is debatable, because there’s about 40,000 Australians that can’t get back to Australia. So I don’t know if many nations will accept that. But that seems to work well in Australia. And here’s the approach they’re taking, and is one of the reasons why they got such low COVID numbers as well.
Fred Goldstein 23:30
Right. And we’re obviously seeing still really high numbers here. And hopefully now, we’ll start to see some of that trend down. So, briefly, you know, we’ve done some work at Baylor, and been involved with some of that. You have a fantastic group of people at that university and expertise like yourself, you have physicians and others that have really come together it looks like as they’ve worked on this issue.
Ben Ryan 23:53
It’s been a really unique approach. I wouldn’t say unique in that one person I spoke with early on was Professor Skip Burkle, and I was telling him about the challenge we faced. And he said, The main thing is to set up an interdisciplinary team that has this population based focus and come up with solutions. And that will put you in the best possible position really to sustain and get through the semester in the fall semester. And part of that was working with you Fred getting input from everywhere, including the local health department, and other areas. And we were continually looking for blind spots. We did exercise and exercise. We ended up in a position where we had a couple outbreaks last year, clusters last semester, but we’re able to jump on those very quickly and keep things going and compared to what we had in the surrounding community. We were really almost a green area compared to other areas in that we’re able to maintain our services while maintaining safety and wellbeing for our students, faculty and staff.
Fred Goldstein 24:56
And I know having a son in his fourth year in college, that whole experience has been tough, really tough on the students, obviously, the faculty etc. and trying to make the best of it. And I think you know, the work you’ve done and the others have done has been, as seen in the some of the local articles and things has been very well received. So that’s fantastic. Do you think, you know, obviously, you’re looking at different countries and approaches, you’ve mentioned Australia, and their approach probably wouldn’t be accepted here. But at the end of the day, it always seems we have something big happen in public health, we go bonkers. And try and get it done. And then we forget. And we just stopped funding public health or shrink it back down again, is this finally gonna be the one because it’s so worldwide, that we set up groups like you’re talking about and then keep them funded?
Ben Ryan 25:44
That’s what would be fantastic if it does happen. And I think that’s where we really need to highlight the benefits, because maybe this was due to success over the years is why we are where we are now. Because we dealt with 2009, H1N1. And I know talking to colleagues, so we need to think about a pandemic, we need to be ready, we can deal with them, if we’re ready, they’re not going to be a significant issue. If we’re ready, and we can deal with it. They’re like, I know, we don’t need to do do that. Look what happened in 2009, then the last major pandemic or severe pandemic was in the 60s, and we had one in the 50s. So I think people were starting to think, look, that’s not an issue now, as we’re developing and we’re modernized now. And I think maybe this success over the years has led us to a position where investments across the world in public health infrastructure has reduced because the need wasn’t seen there by some decision makers. We’re now I think it’s come to front and center. And I know, Fred, you and your team have looked at some different parts and models used in other areas in the world in less wealthy countries that have been very effective in controlling localized outbreaks because their community outreach, and not focusing so much just on patient treatment and care, the hospital side, doing the holistic health approach. And I think that’s the area we need to go to. And we can see that in Taiwan, South Korea in areas impacted by SARS, how effective they’ve been at stomping on COVID. And dealing with it because they’ve had this in their face in recent history.
Fred Goldstein 27:14
Hopefully, as we’ve seen, this becomes something that allows us to once again, create the infrastructure we probably will need for the next one. And obviously there have been incredible improvements in population health in public health, around you know, over the years that have allowed us to live longer to be healthier, etc. And, but it’s amazing to watch this whole thing go worldwide and the impact it’s had. So I’d like to thank you really, it’s been fantastic having you on the show, Ben.
Ben Ryan 27:42
Oh, thank you for that honor to be here. And thank you for all your work. And I guess one message I think we need to consider is that over the last year, we’re expecting 100 million people around the world to move into poverty because of the response that we collectively across the globe have had to COVID. So next time we have a pandemic, we need to think about a better way to deal with a pandemic so we don’t lose all the gains and development we’ve had over the last 20 to 30 years.
Fred Goldstein 28:07
That’s absolutely a great way to finish the show. Thank you so much, Ben, and back to you, Greg,
Gregg Masters 28:12
and thank you Fred that as the last word for today’s broadcast. I want to thank Benjamin Ryan, PhD, MPH, clinical Associate Professor in the Department of Environmental Science at Baylor University, or his time and insights today. For more information on Dr. Ryan’s work at Baylor go to www.baylor.edu/environmentalscience. And finally our closing appeal here at PopHealth Week. Please everyone we can get through this pandemic only together. So do mask up in public. Practice social distancing, and pay attention to personal hygiene. We can slow the spread of this deadly virus. Bye now.