WTHC Season 2 Episode 2 Transcript

Public Health Finds a New Beat

One of the biggest challenges for public health today relates to messaging. How do you get an important message out about disease prevention to a large and diverse population? And how do you know if people trust the message you’re sending?

Polling from earlier this year shows that trust in federal health agencies like the CDC, the NIH and the FDA has dropped to about 61%, down from about 75% in the final year of the Biden administration. And only 5% of Americans say they’re “very confident” that leaders at those agencies are providing trustworthy information to the public. If trust in public health institutions is declining, who do people listen to?

MUSIC

Hi, I’m Michael Sparer, the Director of the Center for Public Health Systems at Columbia

University. You’re listening to “Who the Health Cares,” a podcast about the history, substance and politics of our public health system.

MUSIC

On today's episode, we’re looking at one creative solution to the problem of credible public health messengers developed by Dr. Jide Williams. Jide is a Professor of Neurology and Vice Dean of Community Health at Columbia University.

And back in the early 2000s, Jide noticed something alarming: half his caseload at the hospital he worked at in Harlem was stroke patients. Even more alarming, many of those patients were young – people in their 20s, 30s, and 40s.

Jide: And at the time, we had a treatment which was capable of dramatically improving outcomes from stroke. But the caveat was it needed to be given within three hours of the onset of the very first stroke symptom. The problem we had was that most patients at Harlem were arriving at the hospital 24 hours later, or sometimes a week later, and they would come in with their disabilities and it was just too late.

For Jide, who was born in Lagos, Nigeria, this sort of preventable problem caused by information breakdown was familiar. He had seen it play out before, though in a very different context, as a medical student in Nigeria.

Jide: That experience was very interesting because it was a, a time of great political upheaval. There was a, a lot of civil unrest. There were strikes. My medical school actually was closed for, um, over a year. And so it was, it was a very disrupted education that I experienced at medical school. But interestingly, a lot of my enthusiasm for public health began when I was doing a lot of outreach into the kind of local communities that my–

Michael: Was that work that you were doing when the med school year was closed?

Jide: Yeah, it was interesting actually because it was actually during med school, it was, uh, during the time of the AIDS crisis. There was a lot of misinformation, a lot of stigma. And so I was just moved by the wounds that I saw in my patients. Not just physical wounds from disease, but emotional and psychological wounds from the stigma.

After medical school, Jide applied for residency programs in the U.S. He says it was hard, as a foreign medical graduate from Africa, to get an interview.

Jide: I applied everywhere, but I got very few interviews. But I was very fortunate, uh, because I was offered a position through the match by Harlem Hospital. So, uh, that's how I started my career in this country.

Jide, who’s one of the most well-respected neurologists in the country today, started out as an internal medicine resident at Harlem hospital.

Jide: Neurology wasn't even on the horizon for me.

Michael: Really? And what–

Jide: Wasn’t even on the horizon. I was an internal medicine resident rotating through neurology. And at the time, there was a physician at, at Harlem Hospital, John Brust. And at the end of my neurology rotation, John called me to his office. I thought I had done something wrong. I was like, oh my God, what have I done wrong?

Michael: Like being called into the principal’s office.

Jide: To the principal’s office. And he, um, he said that one of the incoming neurology residents, um, dropped out for family reasons. And he said that they were all very impressed by me and would I be interested in the position? So I'm, I, I kind of see myself as a backdoor neurologist.

Michael: Well, no, it’s, it’s amazing the way faith plays its hands in, in so many decisions, you know, in unexpected ways, but clearly for you in the right way.

Jide: Yeah, I think my whole life has been one of faith, has been one of serendipity and chance and luck.

Serendipity, chance and luck were all at play for Jide years later, after he had completed his neurology residency and was treating stroke patients at Harlem Hospital.

Jide: There was a definable problem. Patients weren't coming to the hospital within the time window required for the treatments that could potentially reverse their disability from stroke. The question was, how do we fix that? How do we design an intervention for a community that typically doesn’t fully trust the healthcare system and a community that also has so many competing interests for their health. You know, they’re struggling to put food on the table, um, they have all of these responsibilities that tend to be just much more acute when you're living below the federal poverty line.

Michael: Right.

Jide: And so I was having conversations with the National Stroke Association at the time, and, um, I'm also an electrophysiologist. I do a super exciting procedure called an EMG with nerve conduction study. So I used to do that, I don't do it anymore, but it's a procedure where you, uh, you put electrodes on the nerves of patients and then you also take these tiny needles, then we insert the muscle that's being supplied by the nerve and we look for any damage to the muscle that's coming from the nerve or damage that's coming from the muscle itself. So it's a really exciting procedure, but patients don't typically like it because, you know, nobody likes to be shocked with electricity and nobody likes being stuck with needles.

And so I was walking to my lab and sitting outside my lab, uh, there was a gentleman who had his headphones on and he was beatboxing. And I stopped, you know, before I turned the corner 'cause I was really enjoying his beatboxing. He was really good at beatboxing. And then I walked and he saw me and he stopped and I said, ‘No, don't stop, continue, please continue, you're amazing.’ We went into the lab and he was so nervous. He goes, ‘You're the doctor that's gonna shock me. You're the doctor that's gonna shock me. I've heard it's horrible. I've heard that–’ So I said – I didn't even want to talk about the procedure. I wanted to talk about beatboxing.

Michael: Yeah. Yeah.

Jide: So I was like, ‘Are you famous?’ And he looked at me and smiled and he said, ‘Well, doc, do you know hip hop?’ And, you know, I gotta say, you know, I am a hiphop librarian, Michael. *LAUGHING* You know, in another life, I would’ve been a rapper, Michael. So anyway, he, um, told me that he was part of a group from the 80s. And he goes, ‘I know you'd never heard of it, but I'm, I'm from this group.’ And I was like, no way. No way! And I started I started quoting some of the songs from his group from back in the 80s, and he lost his mind. So I said, who did you learn to beatbox from? And he goes, ‘I learned from the master, doc. I learned from the master.’ And we all know who the master is.

Michael: Yeah.

Jide: Do you know who the master is, Michael?

MUSIC: THE SHOW

Michael: Yeah, I do.

Jide: Doug E Fresh.

For those who don’t know, Doug E Fresh is a hip-hop legend known as the “original human beatbox.” He rose to prominence in the 1980s and played a major role in shaping the sound and style of early rap music.

Jide: Doug was always been one of my heroes.

Michael: Yeah.

Jide: You know, I grew up to La-Di-da-Di, The Show, All the Way to Heaven. I mean, Doug was a master.

Michael: I mean, a legend.

Jide: A legend. And so when he said he knew Doug, the first thing I thought was, wouldn’t he be good for the hip hop stroke program?

As part of his work with the National Stroke Association, Jide had been researching how hip-hop could be used to teach kids about neurological conditions. Hip Hop Stroke was an NSA program he’d been involved with prior to crossing paths with his beatboxing patient. That was just good timing.

Michael: So did you ask him to introduce you at that point?

Jide: That's exactly what I said. I said, ‘I wanna meet him, I wanna meet him!’ And um, about a week later, he came back to the hospital with Doug E’s manager's business card. And so I called immediately and I said, ‘I wanna speak to Doug E.’ ‘What about?’ And I said, ‘Well, I want Doug E to write a rap song about stroke.’ ‘So what’s your budget?’ And I said, ‘I don’t have a budget.’ She goes, ‘Well, why don't you call me when you have a budget?’

Jide really didn’t have a budget. But he kept calling, every week for months. He offered Doug E’s manager free neurology consultations to sweeten the deal.

Jide: Six months it took to break her down. And in the end, she said, ‘Okay, I can't deal with you anymore. I'm gonna set up a meeting with Doug.’ And that's what happened. And I met Doug and, and the rest is history.

In 2006, Jide and Doug released “The Stroke,” a song and music video designed to help kids recognize the signs of a stroke.

MUSIC: The Stroke

It was taught in public schools around Harlem Hospital.

MUSIC: The Stroke

Jide: Anyone crazy enough to take a genre that’s controversial, that a lot of folks believe children shouldn't be anywhere near, you know, hip hop back then had, you know, was very notorious. It was associated with gangs, you know, there was the east coast, west coast, shootings–

Michael: So let me ask, in, in that context, what kind of feedback were you getting from your academic supervisors and people at the hospital?

Jide: They said, ‘Jide, you'll never make tenure.’

Michael: That’s terrible.

Jide: And they were being really sincere. ‘Jide, you won't make tenure, you know, basically working with rappers. It's not something that we see as an academic trajectory for you.’

Michael: Yeah.

Jide: But I, I had already kind of seen where this could go. I knew that the public health efforts out there around stroke were not penetrating the least among us in Harlem. And, um, I knew we had to tear up that playbook and start anew.

Michael: And you had to reach the audience.

Jide: We had to reach the audience, and I could not get it out of my head that hiphop was the ideal communication vehicle for this community at that time. So I wrote the different hypotheses and we started doing pilot studies and we started publishing, uh, some of the results of our pilot studies. And then I was fortunate enough to get a randomized control trial funded by the NIH. Uh, and it was the first percentile. And I keep telling Doug E that he's probably the first hip hop artist on an NIH grant.

Michael: Yeah, to be top 1%.

Jide: To be top 1%.

Michael: And he said, ‘I’m always 1%.’

Jide: Exactly. He goes, ‘You know, doc, I’m the greatest entertainer, what do you think? I'm Doug E Fresh.’

When an NIH study is ranked in the first percentile, it means that funding for your research is practically guaranteed.

Jide: Everything I believed, the reviewers validated. They said this was highly innovative, great chance for success, new model, new approach, disruptive. And that’s really when the work I was doing in Harlem started resonating nationally. We had delegations sent from all over the world to try to learn about this model that uses hip hop to build stroke awareness in a way that translated into more treatment for stroke patients because they were now coming to the hospital within that three hour window.

MUSIC: The Stroke

One of the people interested in learning more about Jide’s model was Rob Shepardson. Rob’s a political consultant and the two of them first met at a public health conference where Jide was the keynote speaker.

Jide: And Rob, at the time, was involved with Let's Move with former First Lady Michelle Obama. And so after I spoke, Rob came up to me at the podium and – you gotta hear this.

Michael: Okay, I’m ready.

Jide: Are you ready?

Michael: I’m ready.

Jide: He said, ‘Jide, would you like to present this to Mrs. Obama and her team at the White House? We're in the process of putting together Let's Move and all of these Let's Move initiatives and we think this will really help inform a lot of the work that we're trying to do with the First Lady.’ And so that's how Doug and I ended up going to the White House. Um, and that's also how Hip Hop Public Health was born because we were asked to do a full album for the Let's Move Campaign.

MUSIC: U R What U Eat

The album was called Songs for a Healthier America and it was released in 2013. It has 19 tracks, features big name artists like Ariana Grande and Ashanti, and it highlights the importance of healthy eating and exercise.

MUSIC: U R What U Eat

After putting out the album, Jide realized he had something special on his hands.

Jide: The model that we had created was larger than the stroke domain. It was a model that we could apply to almost any area in health. So recognizing that, we decided that we were going to set up a non-profit that would enable us to take the model and scale it across so many other public health conditions.

Over the past decade, Jide’s nonprofit Hip Hop Public Health has produced songs about vaccines…

MUSIC: COMMUNITY IMMUNITY

Nutrition…

MUSIC: LET’S TALK ABOUT SALT

Diabetes…

MUSIC: STICK TO THE C.O.D.E.

Even the importance of cancer screenings.

MUSIC: GET SCREENED FOR COLON CANCER

Michael: I saw a quote of yours that struck me. I can't remember where I saw it, but it said, uh, ‘Just like we learn our ABCs through song, we can also use music to learn how to better care for ourselves and our community.

Jide: You know, I always like to say that music occupies twice as much real estate in our brain than language itself. Imagine that. You and I are talking, right? We're using half the real estate the music uses when it's engaging us. That’s why it’s so powerful, Michael, if you think about what music does to our lives, music can destress us. You know, you could have a horrible day, come on, put on a song.

Michael: Oh yeah.

Jide: And your breathing slows, your heart rate slows, you feel relaxed. Music can help us learn. You know, think of our nursery rhymes. You know, I remember with my kids, when I used to get my kids excited about cleaning up.

Michael: How’d you do that?

Jide: And they learned – there was a song that they learned in kindergarten called Cleanup Time. And it goes, ‘Cleanup time, cleanup time, time to put your toys away.’ And so I'll start singing this song with my kids and they'll go crazy cleaning up. They'll be like grabbing stuff up the ground and arranging them. Just music did that. I could have, like, ‘Go clean your room!’ And also music helps us remember. You know, you can probably remember a song that you loved when you were 13, but if I asked you to recite the pages of a book you read when you were 13, you, there's no way you’d remember. And so this is the neurobiological power of music. I believe music is a health literacy superpower. And I think that if there’s ever a time to explore the possibility of leveraging music as a powerful health messenger, this is the time.

Michael: You know, speaking of messaging, you communicate through so many different kind of messaging techniques. I have here, actually, and I've actually read it, Stroke Diaries.

Jide: Yes.

Michael: A book you wrote back in 2010.

Jide: Yeah, I wrote that book for stroke survivors, um, for their caregivers and for the patients themselves. And I wrote that book because, um, I really believe in the power of storytelling. You know, a lot of patients have read that book and they've come back to me and told me how much they've learned from that book. And I, I just think that as human beings, if you think about how we, how history survived before the written word, right. In Yoruba culture, I'm Yoruba Tribe, Yoruba ethnic group in Nigeria, and the written word came to us with the missionaries. Before that, we didn’t have the written word, but we had stories.

Michael: Yeah.

Jide: And we had song. And we put stories into song. It's actually called the Oriki. It's like a legacy and history of an individual that's sung. And it’s sung from generation to generation.

Michael: And it’s passed on.

Jide: So all the major accomplishments that you have, that your father has, that your father's father have, you add it to the song.

Michael: What a beautiful thing.

Jide: So the Oriki gets longer and longer and longer. And that's how we pass down stories from the beginning of our lineage. And so I, I truly believe we need to go back to these basic approaches to communicating with one another because time has already tested the efficacy. We don't need a randomized control trial to know that the story is impactful.

Michael: Yeah. And particularly in an era in which trust in many communities is declining in public health, in science, in government more generally, on both sides of the political aisle, you know, among low-income communities, among marginalized communities, among suburban White MAHA moms. You know, I mean, there's a growing lack of trust and so many of us end up speaking to those who just think the same things that, that we think and just figuring out how to break through those barriers, I mean, you're doing a lot of work these days with what we call community health workers. Maybe tell us a little bit about that work and how, how that work is trying to get at this, this issue of trust and, and the loss of trust that people have in, in the healthcare community.

Jide: Um, I think that the future of healthcare must lean more heavily on community health workers if we are ever going to bridge the trust gap. You know, healthcare has become so fragmented and so siloed, so specialized, that the human touch is gone. We have a 15 minute window with which to see patients. How do you develop a relationship when you only have 15 minutes to see a patient? It's very hard to do.

It's even harder to do, Michael, when you're not–you don't share that patient's lived experience. It's even harder to do when there's suspicion between you and the patient. When the patient looks at you and says, ‘I don't trust you,’ and you look at the patient and go, ‘I don’t get you,’ right? And, and so I call it mutual invisibility. We don’t see one another. And then you have the power dynamics between physicians and patients, and then you have the fact that we like to use medical jargon. Just intimidates the hell out patients.

And so the patient-doctor interaction is not just constrained by time. It's constrained by all these other barriers. And I don’t think we can do it alone as physicians. I think we need a team. And part of that team is the community health worker. The community health worker is special because they are specifically folks with the same lived experience as the patient. They speak the same language. They share the same heritage. They know the patients, the patient knows them, and they trust the patients. So when they now break down the patient's condition or the patient's treatment plan, they’re more likely to adhere to it. They're more likely to connect to it. They're more likely to trust it.

You know, I like to say that credibility is the cornerstone of persuasion. And while physicians are intellectually credible, I don't think we are as emotionally credible as we think we are. And I think that for a treatment to travel the full distance with a patient, you need both intellectual and emotional connectivity. And I think that's where these community health workers, these credible messengers, come in.

But I also think that, um, you know, I’m a big proponent of trauma-informed care. It’s a paradigm shift in the way we approach patients. And so instead of asking what is wrong with the patient, we ask what happened to the patient. A patient might be angry, but that anger is the manifestation of fear of whatever's going on in the patient's body. The patient might be coming from domestic violence, from a child who's sick, from incredible trauma. But if we only see the symptom, if we’re only asking what is wrong with the patient and we don't ask what happened to the patient, that empathy that's required for a successful bidirectional encounter would be, would be lost.

Michael: But can you do that in 15 minutes?

Jide: You know what, that's a great question, but you can. Kindness, I have found, steals time. Sometimes I've been to see a doctor and that doctor's so kind, I feel so seen, that that 15 minute feels like an hour because of the kindness and the attention and the centering that I felt during that encounter. So I think kindness can disrupt time, kindness can steal time, and I think the less time you have the kinder you have to be. I think they’re inversely proportional.

Michael: Yeah. I'm in a school of public health. I teach public health students. I also do some work with medical students, uh, as well. Is there a message that you would have for, for our public health students listening in?

Jide: You know, I think this is what I typically tell students in general. I tell them to find out why it is that they went into medical school or why it is that they went into public health school. And usually it's the same answer. We wanna make the world healthier, safer, happier place. What I don't like seeing is the loss of idealism. I think being idealistic is what makes the world more beautiful sometimes. Especially noble ideals, like wanting to save the world, like peace on earth. I think those types of aspirational goals, never lose sight of those goals.

You know, I, I came to this country with the same aspirations. I wanted to make the world healthier. I wanted to make communities healthier and safer. And I think that it's really important for us to recognize that we can be additive on the journey to better health by the things that we do. But in order to do that, we have to embrace those aspirations that brought us into public health because it's becoming harder and harder to embrace your aspirations because the distractions are getting exponentially to do that, we have to embrace those aspirations that brought us into public health because it's becoming harder and harder to embrace your aspirations because the distractions are getting exponentially more and it's easy to get jaded. It's easy to be disappointed. You look at the political environment, you look at, you know, what happening in society. You look at all the injustice around us, and we forget that we can only control what we do with our lives. And that's what we should focus on optimizing.

Michael: On that note, I really wanna thank you for spending some time with us today. It's just been an absolute pleasure to have you here with me, and, uh, keep doing the work you're doing because you have made an incredible difference. Thank you.

Jide: Thank you so much, Michael. And so have you.

MUSIC

That was Jide Williams, the neurologist who founded HipHop Public Health, the nation’s most

impressive and important effort to use music, in this case HipHop, to reach and teach needed

health information to young people, both here in New York City and across the globe.

Couple of thoughts before I close out.

First point: Politics and social media are generally blamed for declining trust in government and

science, but there are other important factors as well. One such factor that Jide emphasized is the changed relationship we now have with our physicians, as doctors have limited time with patients and often focus on treating the symptom, rather than the person in front of them.

Second point: In this context, we need new ways of providing needed health information. Jide’s

brilliant insight is that music can do so, especially for young people. Using HipHop to both

entertain and educate is just such a compelling idea.

Third point: HipHop artists are one example of a credible messenger, but there are others. At

the top of that list are community health workers, persons who are part of a care team, but

who are from the patient’s community, who share much of their lived experience, who speak

the same language. Who are trusted. We can and we should greatly increase the role of the

community health worker.

Fourth point: While medical expertise is important, kindness and respect are also essential. In the new world we live in, doctors may have only fifteen minutes with their patients, but if they are kind and respectful, if they truly listen, they can make a connection that will lead to a better outcome. In Jide’s words, sometimes kindness can steal time.

Finally, I loved Jide’s final message to our public health and medical students. Don’t lose your

sense of idealism. Embrace your aspirations and don’t forget we can only control what we do

with our own lives.

Join me in two weeks when we revisit many of the themes discussed today with Chelsea

Cipriano, the Managing Director of the Common Health Coalition, an organization working hard to bridge the gaps between our health and public health communities.

Till then, this is Michael Sparer, signing off from the Center for Public Health Systems at Columbia University.

This episode was produced by Grace Rubin.

Our sound engineer is Zoe Denckla.

Alex Weaver is our social producer.

Fact-checking by Monica Stanovic.

Rachel Ferat is the Program Manager for the Center for Public Health Systems

And Rebecca Sale is the Head of Strategy and Partnerships for the Center for Public Health Systems.

Thanks to all of you!