The COVID-19 pandemic has brought public health to the forefront of the national conversation. Prior to the crisis, the inner workings of public health and epidemiology — a branch of medicine focused on studying and managing disease in a population — were unfamiliar to most Americans.
To shed light on this critical field, we sat down with Vivian Lee, M.D., Ph.D., M.B.A., president of health platforms at Verily and former CEO of University of Utah healthcare, to learn more about how public health is handled in the United States today, and the role of hospitals and health systems.
Can you tell us about your background, and what drew you to healthcare?
My interest in healthcare is actually directly connected to public health. My mother, a statistician and epidemiologist, was dean of the University of Oklahoma’s school of public health. She conducted research studies, establishing a data coordinating center for large epidemiological projects, focusing on diabetes among Native Americans in Oklahoma, and related complications. I spent summers working with her, trying to grapple with this significant public health problem, including writing papers with her on the complications of diabetes like diabetic retinopathy.
You could say that public health was a bit of a family affair in my household. My father, an electrical engineer, worked in neural networks and computer-assisted diagnostics, a forerunner of what would become the field of artificial intelligence. I had the opportunity to help my parents with a paper they wrote together on computer-assisted diagnosis of diabetic retinopathy. This is an area that Verily would eventually focus on, in collaboration with Google. A full circle moment!
Many people may not be familiar with the organization of the U.S. public health system and how it works. Can you provide an overview and what that means during the current COVID-19 public health emergency?
One thing the COVID-19 crisis has made apparent is the fact that we don’t have a single public health system or infrastructure. Rather, we have multiple agencies, at the federal, state, and local level. Public health departments across the country support research, community-based health programs, and education. There are more than 25,000 local public health departments. In one sense, this means that there are a lot of people out there who are deeply focused on public health, and can enable more tailored initiatives and approaches that align with local needs. On the other hand, with more health authorities, coordinating and sharing information can be difficult.
As it relates to COVID-19, one way we can see this play out is with testing data. While states and local health departments are gathering and publicly reporting their cases, different areas may collect different types of data. As an example, some states and counties are gathering information on healthcare workers who test positive, though this isn’t standardized. In depth data on exposures in a particular community can help inform how public health officials respond to the crisis; for instance, by helping them understand the rate of spread in high-risk communities. Having a set of standards on how to collect, define, and report data may help public officials gain the visibility they need to establish the containment efforts that make the most sense for their communities.
Beyond delivering healthcare to individuals in a community, what role do hospitals and health systems play in public health?
Many academic health systems, which have research, education, and clinical missions, have a department of preventive medicine or public health that focuses on ensuring the community’s health outside the healthcare system. They carry out important research and training of physicians and scientists. Non-academic hospital systems also bear significant responsibility for their communities, leading a wide range of programs, from holding health fairs and health education events to supporting local food banks. They’re an important part of the social fabric of a community.
Public university hospital systems are also state entities, and often collaborate with local health departments. At the University of Utah, one area where we worked closely with state and local agencies was disaster-preparedness. Utah is an earthquake-prone state, and major natural disasters tend to become public health emergencies. As one of the state’s largest healthcare providers, we worked closely with public health officials on earthquake response simulations to ensure that we had plans and resources in place for a comprehensive response.
In healthcare more broadly, we're working on moving from a fee-for-service model — where payment is based on volume of care or services provided — to value-based care. Is there a connection between public health and value-based care?
The impetus for value-based care is based on improving health, often through preventive care, and reducing the enormous costs involved in the U.S. health system. Moving to value-based care essentially means that we pay healthcare providers based on patient outcomes. We reward for being proactive rather than reactive. One of the core advantages to paying for value is that you start to prioritize prevention, because the most cost-effective, highest-value care prevents the disease from happening altogether.
What we’re seeing now with COVID-19 is that investing more deeply in prevention and in public health can help us be better prepared to withstand future health crises. Verily has been investing in these strategies for some time. For example, Debug by Verily is focused on reducing the threat of mosquito-borne illnesses which affect millions of people worldwide. Debug is designed to reduce the Aedes aegypti mosquito, which spreads debilitating diseases like dengue, Zika, and yellow fever. The program works with industry and government partners, and we hope it may serve as an example of approaching persistent public health problems in new ways.
Is there anything specific we've learned from the COVID-19 pandemic thus far that may help us going forward?
COVID-19 has affected nearly every aspect of our lives, and we’re still learning lessons that will undoubtedly shape how we manage public health in the United States. One promising development we’ve seen is a very rapid increase in telemedicine. In radiology, we were early advocates for such approaches. We had the ability to send medical images wherever they needed to go, but we were required to be licensed in the state where a patient resided. Filing the paperwork was a huge burden, and many of these states actually had very similar requirements. It ended up being a huge barrier and cost driver for telemedicine. Now, many of those barriers are being lifted for COVID-19. I’m hopeful that we’ll continue to see a greater investment in remote monitoring as well as public health infrastructure that will not only support us as we fight against COVID-19, but help us foster a healthier population beyond the pandemic.