Latest / Empathy Affect / S4E7: Can Listening Rebuild Trust in Public Health? Virginia's Commissioner Thinks So

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S4E7: Can Listening Rebuild Trust in Public Health? Virginia's Commissioner Thinks So · Empathy Affect

• 0:05
  They have everything needed to evaluate their patient.
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  The labs, their history, diagnostic codes already.
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  They know more about the patient than almost anyone.
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  They sit down.
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  They look up at the patient and ask, where does it hurt?
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  That question, that posture of listening before acting, placing a person's experience above a data point, is what separates medicine from healthcare.
• 0:36
  And it's also increasingly what separates good public health from the kind people have stopped trusting.
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  In January 2026, Virginia Governor Abigail Spanberger appointed Dr.
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  B.
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  Cameron Webb as the Commonwealth's new state health commissioner.
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  Dr.
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  Webb is a physician.
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  He's an attorney.
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  He's a researcher.
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  He coaches youth basketball.
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  And he served as an advisor in the White House on health policy.
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  On paper, he's one of the most credentialed people to hold this role.
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  But on his first day, he didn't hold a press conference.
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  He started a listening tour.
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  So the first thing is really connecting with the local health district and making sure we're meeting their needs and addressing their concerns.
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  Everyone knows that the better you eat, the better your health is going to be.
• 1:28
  We try to get people connected to mental health, housing, rental assistance, utilities.
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  Food, housing, mental health, utilities, access, the basics.
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  These aren't the headlines we often associate with the State Health Department.
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  That's the thing about public health.
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  It's happening all around you, whether you notice it or not.
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  It's the restroom inspection that kept you from getting sick.
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  The overdose response that kept the neighbor alive.
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  You don't see it when it's working, but then invisibility has a cost.
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  Today we're asking the questions that sit underneath the policy.
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  What does trust in public health actually require?
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  And what does it take to rebuild it once it's broken?
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  What do communities need to feel seen, not just served?
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  And how can we prioritize what people need when resources are scarce?
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  This is Empathy Affect, the Force Marsh Media podcast that explores the human side of government.
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  I'm Melissa Szyzinski, and today we're going to Virginia to find out what happens when a public health leader decides that listening is the strategy.
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  Dr.
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  Webb, welcome to Empathy Affect.
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  It's an honor to have you on the show to discuss your leadership and service to the people of Virginia.
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  Thanks so much for having me.
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  I'm excited to be here today.
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  Of course.
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  So I just want to set the stage by picking your brain on your really amazing background.
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  You're a physician, an attorney, a researcher, and a youth basketball coach.
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  And then now you're the state health commissioner for Virginia.
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  When you think about the through line connecting all of those different identities, what is it?
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  What have you always been trying to do?
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  Yeah, I like to say everybody has to have a true north.
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  I think mine has been about equity and justice.
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  That's kind of been the through line.
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  And um, and I know you you may say, even with youth basketball coaching, but but even there as well, that idea of making sure that everybody everywhere has opportunities.
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  Um, and I'll use the example of basketball, but but um, but we secured funding so that girls from the Petersburg area from parts of Central Virginia could travel with us to these tournaments that are usually cost prohibitive for some kids to participate in, right?
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  So it's about entering that space with an eye of creating access and opportunity for everybody.
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  And I think that for me over the course of my professional career, it's it's really been um trying to find ways to leave communities, you know, one percent better than I than I found them.
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  And more than that, also trying to make sure that I put the community first, that I that I recognize that primacy and how important it is to be beside them or behind them and when when I'm working alongside community.
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  So I think that's that's so huge.
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  But um, but it it was about gaining a skill set that I could ultimately contribute to addressing those needs and concerns.
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  And I feel like that's what I'm on my path to doing.
• 4:38
  Yeah.
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  Um, I appreciate the fact that you brought up your coaching too, because uh as someone who's a student athlete myself and uh felt a lot of mentorship and support professionally, even from those coaches.
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  It matters a lot.
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  So great to see that coming through in your approach, too.
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  You grew up in Spencevania, trained at some of the country's top institutions, worked in the White House even across multiple administrations, and then you came home to Virginia.
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  So, what drew you back and what does it mean to you to serve the state you're from?
• 5:12
  Yeah, I mean, I think I think you just hit the nail on the head.
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  Like that's it's about coming home and supporting home.
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  Uh and you know, my wife, Leanne, she's from Appomattox County.
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  Um, I'm from Spotsylvania.
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  And so, you know, Charlottesville is where we met.
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  That's where we went to college, and it's right in the middle.
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  And so it made a lot of sense for us to come home, for our kids to be connected to our parents and extended families, but also to just pour back into the communities that raised us, that shaped us.
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  And I think that was huge.
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  And it really started off uh just wanting to plant ourselves here and and be a part of the community that mattered so much to us.
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  And really quickly, you just find yourself saying, Hey, I can I can help, you know, I can help on this, I can help on that, and and digging a little bit more.
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  So it's it's powerful.
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  One of the fun things I will say, and and I I started off my time as commissioner doing a listening tour, but the number of times I've run into people who I either played high school sports against, or they knew my basketball coach, or they, you know, my mom was their teacher in Orange County.
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  Like it's just it's so interesting how small Virginia can be.
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  Um, and I think that's also special when you have that personal connection to the place where you're really pouring your heart into your work.
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  I think it's um it's powerful.
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  Yeah, absolutely.
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  Um, as someone who grew up in Jersey and came back myself, you know, my husband's from Jersey too.
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  So I know what it's like to feel rooted back in your community and to give back.
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  Um, so I really love that.
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  You just mentioned the really extensive statewide tour that you were on at the beginning of your time as a commissioner.
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  I think that, you know, starting with a tour like that, listening, um, you know, hearing where people are maybe facing barriers or where you need to, you know, step in and help support is a really deliberate choice.
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  So what were you trying to understand in that tour that briefings or data couldn't just tell you?
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  Um, you know, uh I'm an internal medicine doctor by background.
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  And every time I'm in a hospital or in a clinic, I have data on a patient.
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  I have, I have a chart, I have their vitals, I have their labs, I have their prior medical history.
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  I have all this information on somebody before I ever even meet their gaze, I see their face.
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  But yet and still when I walk in the room, I ask them where it hurts, and I listen for their answer, and then we we work together to find the strategies to help them, right?
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  I think this is similar.
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  Walking into this role, I had a lot of data, I had a lot of information, I had a lot of anecdote.
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  But what was really critical was that I start off by walking into rooms across the Commonwealth and asking people where it hurts, asking what the pain points were, asking what the pride points were, where where people were really excited about what was going on that was good.
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  Um, because that's when you really get the the deeper understanding of an organization, an agency, and how it's connected with community.
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  And so, so yeah, that intentional choice was really rooted in getting what I think is probably the most important data point, which is the the feel for where people are.
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  And there's 8.8 million Virginians.
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  So of course we haven't haven't heard from everybody.
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  It was trying to design a process over the first two and a half months where we could listen intentionally and and get a good starting point.
• 8:34
  And I always say the listening tour will continue, right?
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  That's the posture uh of this agency.
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  That's the posture of my role, my leadership in this agency is that we always want to show up in communities listening.
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  But the other thing I keep in mind is, you know, I I helped lead through the COVID response at the federal level.
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  And and I remember how when we were in a public health crisis, how we were scrambling to build connections in community or to, you know, rapid fire, rebuild trust, where we were like, I know we don't have the best relationship, but just trust me, you need you need this, you know, public health intervention.
• 9:09
  I think that the best time for us to build those bridges, build those connections and hear where people are and see how we can improve our relationships, it's right now, right?
• 9:19
  It's it's it's right in these moments where we're just arriving as an administration and and uh I really want to show that that's for that's first and foremost front and center for us is hearing from community.
• 9:30
  So it's been it's been nice, and I've learned a ton.
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  Um everything I thought I knew about the agency now, I've I put it through a different filter, and it's been really powerful.
• 9:38
  Was there anything in particular from that tour that stood out to you?
• 9:41
  Uh there were a couple of things.
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  I think, you know, I say all the time, people want us to run a really good business.
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  Um, and so when it comes to being public agency, folks want to see you show up as professionals.
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  They want to know they can rely on you in that way.
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  And so that was a universal, we heard it from everywhere.
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  Certainly, uh, we heard people wanted equity to be centered, right?
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  And I think that that's that's interesting if you put it in the national context of conversations around equity.
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  People wanted to make sure that all communities in their area were seen, heard, viewed, and valued.
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  And that came up over and over again.
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  Folks feeling either invisible or feeling like they weren't being regarded or respected or approached when decisions are being made.
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  And that idea of centering community was key.
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  Also connecting with uh some of the social factors that impact health, right?
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  As a public health agency, we heard a lot about housing, about food access, about transportation, about economic stability.
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  And when you put that in the context of the governor's, you know, efforts around affordability, you can see there's some really clear connections there.
• 10:45
  And then I I will say, even though the venue was different when I was in Northern Virginia or I was in rural Southwest Virginia, so many of the same issues or concerns are being raised in terms of like core public health challenges, which tells me we have, you know, you don't always have the opportunity to have a rising tide lift all boats, but we do in in some areas have this opportunity to create interventions that work across the state.
• 11:10
  And I think that was really cool to see the commonalities between them, even despite how different regions of the Commonwealth are.
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  Yeah, absolutely.
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  You know, around the time of this recording, too, um the Virginia Department of Health just released a 2025 to 2029 plan for well-being.
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  And it lays in about a five-year roadmap across six priority areas.
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  So infant mortality, substance use, obesity, related deaths in housing and economic stability, which you sort of just touched on.
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  And so it's a really like holistic approach.
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  And what also strikes me about this plan is that it's built on community input, which you were just emphasizing.
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  So, how does a document like this actually function as a living leadership tool?
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  And how will you make sure it drives action, especially after hearing so many fresh concerns and input from Virginians throughout the listening tour?
• 12:03
  Yeah, you know, I think the the you know, Partnership for Healthy Virginia, which is the entity that put pulled together this plan for well-being, um you know, that's it's the Virginia Department of Health, it's uh it's VHHA, so the Hospitals Healthcare Association, but it's it's also so many partners, other agencies, so many folks poured into that document over the course of years, right?
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  And so in some ways, it's a it's a bit of a time capsule.
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  It's a it's a moment in time where you've heard from so many different entities across the Commonwealth who are passionate about health and well-being.
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  And so that that deserves kind of the highest respect.
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  I don't think any leader can walk into this organization and disregard a document like that that captures so many views and opinions, so many facts, so much data.
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  Um, and so in that sense, really a powerful one for us.
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  I think that for years they spent time kind of trying to map out what should our goals be.
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  And goals should be big, they should be audacious, they should be impactful.
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  And I think the plan for well-being has all of that.
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  So, in in that sense, I think the plan um really does give us a great blueprint.
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  It's our state health improvement plan, which is is you know exactly what the document is designed to be.
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  And I want to couple that with other efforts, you know, as an agency, we're creating our strategic plan.
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  So we're starting that strategic planning process, and that's gonna have its own, you know, threads of work.
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  And so when you couple these, when you pull these together, you know, we have all the legislative activity coming out of the General Assembly, the governor's own agenda, and ultimately her budget when that comes around.
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  So you're gonna have all these opportunities to advance policy, but I think this becomes one of those anchors, one of those temples that we look back to and we say, well, this is what communities have asked for.
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  How do we operationalize that?
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  And I think that's that's one of the exciting opportunities.
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  And now you couple that, that's the state health improvement plan.
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  We've got all across the Commonwealth kind of the community health assessments, community health improvement plans.
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  And as they say, all politics is local, all public health truly is local.
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  So even though we can describe kind of what those key themes are across the state, making sure that we're tailoring those to the needs and concerns of individual communities, that's that's also so key as well.
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  Yeah.
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  Speaking of the individual concerns of communities, you were mentioning equity, and you've talked at length before about stark disparities in how health outcomes.
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  There are places like Petersburg that have seen far higher hospitalization rates for diabetes, hypertension, and high blood cholesterol compared to, you know, other communities, maybe like Northern Virginia.
• 14:38
  When you were on your tour and just looking at the data, sitting across from people, even especially in some of those more rural communities, what did they tell you was standing between them and being healthy?
• 14:51
  So a few things I'll say.
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  A lot of times access is what people felt like was standing between them and being healthy.
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  You know, parts of rural Southwest, uh, you know, just not having the number of providers that other parts of the Commonwealth have, whether that's in mental health or in primary care or specialty care, and having to travel sometimes to different states to get that access to care.
• 15:11
  I think that was that was a key.
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  When we talk in public health, a lot of times we talk about prevention.
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  And so sometimes it's access to healthy foods, right?
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  And we're talking about preventing some of these uh obesity-related illness when you talk about hypertension and diabetes and the impact we have there.
• 15:26
  So so it definitely heard access being a theme.
• 15:29
  I want to double-click though on you highlighted Petersburg.
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  And for as much as we can point to Petersburg for some negative health outcomes, I felt so much pride from the community in Petersburg about the way that community groups, organizations, and entities come together to try to take care of their community.
• 15:51
  And I think what they talk about is decades or generations of economic disinvestment.
• 15:56
  Talk about kind of a perfect storm, if you will, of circumstances that can lead to worse health.
• 16:01
  But it's hard to hard to prove the null hypothesis, right?
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  But for some really incredible efforts from community organizations and leaders, you would see an an even more dire story in Petersburg.
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  So I think what was really um interesting is that one of the things they have in spades is they have a lot of community engagement and alignment around addressing um health challenges.
• 16:23
  And and I think that that was um that was also interesting and inspiring to see.
• 16:27
  We have different health challenges all across the Commonwealth.
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  I think that ultimately what we want to do as an agency is we want to make sure that we show up for people where they are when they need us, and and that we're always present, we're always um ready to engage and support.
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  We've got amazing local health district leaders who are usually in a lot of instances we call it kind of the chief health strategists for their community.
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  So they're looking at what are the factors locally that are driving negative health outcomes and how can we address them.
• 16:55
  Um and and you know, we touched on some of those factors in the plan for well-being, but every community has slightly different ones.
• 17:02
  So I think it's been, I think it'll be exciting as we move forward to say how can we rally resources to these communities, how can we create efficiencies, how do we create kind of the the laboratory of the of the communities, right?
• 17:14
  Where we share ideas and share experiences, share partnerships.
• 17:18
  Um I think there's a lot of opportunity for sure.
• 17:21
  Yeah, and I really appreciate you also spotlighting their own agency where they're trying to take action, you know, because oftentimes we like to talk about the challenges people are facing, but not necessarily how they're um, you know, looking to address it themselves or how they're, you know, connecting with state agencies to be able to take them on.
• 17:39
  You've previously said the powerful quote that um I was really drawn to.
• 17:44
  The most powerful data isn't a chart or dashboard.
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  It's in lived experience.
• 17:49
  So now that the tour is behind you, you've had a few months under your belt in this position, how are you actually translating what you heard into decisions?
• 17:59
  What does that pipeline from community voice to policy look like in such a large agency?
• 18:05
  Yeah, I think that, you know, what I've learned from, you know, in the past when I was a community organizer, my work in politics and policy spaces, and even in this role, is that it's an iterative process of community engagement.
• 18:18
  And I think that for us, we kind of heard from the community first.
• 18:22
  Um we came back and we we kind of organized that around some different themes of what we heard, but then we reflect that back to the community and we say, Did we get this right?
• 18:31
  Is this what you're telling us?
• 18:32
  And then once we get that confirmation, then the next steps are, well, here are some of our thoughts in terms of strategies statewide that we can that we can lean into.
• 18:42
  What are some of your thoughts?
• 18:43
  So again, that collaborative nature of that of those conversations, I think really that's how it comes to life.
• 18:48
  Um, and then I think um creating spaces where that where that community voice is the last voice in the room or is the loudest voice, and how how do we leverage those?
• 18:58
  So as we build out programs and initiatives, um, because it's it's not all about creating something new.
• 19:03
  Sometimes it's just about improving things that currently exist.
• 19:06
  But how do we how do we make sure that that community voice sharpens and shapes those initiatives that we currently have?
• 19:12
  And the new ones that we're considering, um, I think that's really where where it comes um it comes to life.
• 19:18
  And then finally, um, not hiding here in the Madison building in Richmond, right?
• 19:24
  Every time we show up in the community, we're showing up saying, How are we doing?
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  You know, what was working well for you?
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  Are we delivering on some of the conversations we've had?
• 19:34
  Are we addressing the concerns you've already raised?
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  Are we protecting the things that are important for you?
• 19:39
  And so just by showing up and being present in community, um, that's the other part of this process as we continue to get that feedback.
• 19:46
  You have to do that with a lot of humility, right?
• 19:47
  Like I tell people all the time, like, I'm gonna take some on the chin.
• 19:51
  There are gonna be times where we miss the mark.
• 19:53
  And you just have to recognize that that's part of it.
• 19:55
  It's the humility and how you miss the mark.
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  And you say, we didn't get that right.
• 19:59
  Let's move forward and let's get it right together.
• 20:02
  That's really where I think we want to be.
• 20:03
  And that's the measure of success ultimately.
• 20:05
  It's not that we got it right 100% of the time.
• 20:08
  It's that we always endeavored to put the people first in how we approached it and still heard their voice as we kept trying to iterate toward getting it right.
• 20:17
  Yeah, I really appreciate that sort of humility because you were talking before about how during COVID people felt a lot of mistrust.
• 20:24
  And I think even now, six years later, we are in a moment of rebuilding trust in our public health and health institutions.
• 20:32
  You've said even that people just want to be able to trust the institutions built to serve them.
• 20:38
  So, what has broken trust looked like and uh sounded like in conversations you've been having with folks across the state?
• 20:46
  And how do you think about rebuilding it structurally?
• 20:49
  Man, it's it sounded so many different ways.
• 20:51
  You know, broken trust in some instances, it sounds like people saying, Well, at first you told us this, then you told us that, then you told us this.
• 21:00
  Which way is up?
• 21:01
  What's true, right?
• 21:02
  And we saw that a lot during COVID with rapidly evolving science.
• 21:06
  Um, when you say trust the science, trust the evidence, when the evidence is is shifting and evolving and growing, um, I think folks folks felt some consternation there.
• 21:15
  So I think that that idea of how much uh weight to give to kind of the scientific expertise, I think that's what we're seeing in the conversation right now.
• 21:26
  Is like there's some some room to grow and trust.
• 21:30
  I'll say there's still quite a bit of folks who don't really want to engage.
• 21:35
  They'll listen, but they'll say, you know, not really ready to fully trust that you're here for the reasons you say that you're here.
• 21:44
  And with that, I just say you just gotta keep showing up.
• 21:46
  You keep showing up and creating that opportunity.
• 21:48
  And I think over time people say, No, I think I think that's real.
• 21:52
  I think the presence, the way they show up, the way that they it's not just a photo up, it's not just a news story they're trying to create, it's not just a talking.
• 22:00
  They're actually here to listen.
• 22:01
  I think that's a big part of it.
• 22:03
  And then I would say the la the last way that I would see a lack of trust really manifest is a lot of times folks not reaching out to an agency like ours to address health issues, but instead turning other places.
• 22:17
  And it may be because they didn't feel like, you know, the State Health Department was part of the solution.
• 22:23
  I think the reality is we wanted to show up a little bit differently and say, we're not saying we have to be the answer or we have to be the solution.
• 22:30
  What we're saying is that we want to use every tool in our tool belt to help you get the answer and the solution.
• 22:36
  We want to be a ready and willing partner.
• 22:38
  Um and I think that's that's huge.
• 22:40
  But um one of the things we're looking to do is say, how do we measure trust?
• 22:45
  Right?
• 22:45
  How do we measure what trust looks like in data over time?
• 22:49
  So we can track when we're in those low moments and when we're in those high moments, when we can track how things shift based on different external factors.
• 22:56
  Because I think when it comes to health and when it comes to public health in particular, trust is one of the most critical commodities that exists.
• 23:04
  And so the way that we measure that, the way that we capture that, I think that becomes core work for us and a core outcome for us to stay in front of.
• 23:12
  So it's definitely one that's that that's close to me.
• 23:16
  And I think that um because I've worked in and lived in and been a part of so many communities where there is that trust.
• 23:22
  I mean, in the black community, we talk about the Tuskegee syphilis study, and you know, that was public health nurses who were part of that.
• 23:28
  And so, you know, recognizing that the fracture in trust of public health, it's not just based on COVID, it's real, it's you know, multi-generational.
• 23:38
  And the act of repairing it has to be just as big and enduring.
• 23:43
  And I think that's what we're we're embarking on that path.
• 23:46
  Yeah.
• 23:47
  Not only are you trying to build trust and reputation with folks that you're serving, but you know, the department has itself had a pretty genuinely difficult stretch before you arrived.
• 23:59
  There were financial challenges, staffing gaps, marental issues, so a lot of internal hurt too.
• 24:06
  So when you step into an institution that has quite a bit of healing to do, how do you lead with credibility before you've had the time to demonstrate results?
• 24:17
  Yeah, this it all goes back to that listening posture.
• 24:20
  I I found early on um folks have have grace.
• 24:25
  They recognize that we just walked in the door in January.
• 24:29
  And so walking in the door saying, I understand there have been some some tough moments, some tough times, tell me about it because I want to hear what the issues are across the organization so we can create just corrective action plans to address some of those concerns.
• 24:45
  I think that was key for me, trying to identify those low-hanging fruit, the things that you know we certainly can can move on sooner rather than later.
• 24:54
  And I think that was something we aimed to move on and mobilize.
• 24:58
  Even during National Public Health Week uh the other week, we kind of did some things to help support staff based on feedback that we received.
• 25:05
  I think it goes a long way in saying we're listening and we're responsive.
• 25:10
  And ultimately, I, you know, I'll tell you, morale in public health post-pandemic has been an issue across the country.
• 25:19
  I think for us, being full-throated about the stuff that's just core public health work, right?
• 25:25
  Like and not feel like we're not letting the politics get into it.
• 25:29
  We're not letting what's happening or not happening in Washington get into it.
• 25:33
  We're just showing up saying, this is good core public health work, and we want to show up and do that the right way in partnership with you.
• 25:40
  I think even just that statement was a breath of fresh air to a lot of our team because they were just like, that's why we're here.
• 25:47
  We just want to help our communities.
• 25:49
  And so just saying, well, then what more can we do?
• 25:51
  How can we support you in helping your communities?
• 25:53
  And I think just showing up, the listening tour, and and I didn't know this on the front end, but just being there and talking to folks, I can't tell you how many people were just like, I've never seen a commissioner, I've never talked to a commissioner.
• 26:04
  And it it was it was surprising to me because these are people within this organization.
• 26:09
  Um, but I recognize this is an organization with over 3,200 staff at any given time, right?
• 26:14
  So there's a lot of people to touch.
• 26:17
  So just being present, showing up, um, I think that that goes a long way.
• 26:21
  Yeah.
• 26:21
  Just want to give a moment to shout out those public health workers.
• 26:25
  Many people haven't met them, they're truly invisible sometimes, and uh love and appreciation goes a long way.
• 26:30
  Yeah, and and to that point, I just want to flag, you know, I've heard this phrase over and over again.
• 26:36
  They say, you know, public health is working when you don't see it.
• 26:40
  And that historically had been a point of pride that that like good public health work happens in the background, happens in the shadows.
• 26:47
  But I think that that's hard for a staff, especially given what they've gone through.
• 26:52
  So one of the things we want to do is we really want to highlight the good public health work that's happening in communities, kind of the public health that's happening all around you.
• 26:59
  We want to tell those stories.
• 27:01
  We want to kind of call out those unsung heroes because we're just like, you know, if people don't know that you are there in the background, keeping them safe and keeping them healthy and protecting their well-being, they don't know to advocate for what you need, whether it's resources, whether it's supports.
• 27:18
  Um, you know, and I think it's it's been a big thing for us to make sure that people know what public health is, what it does here in the Commonwealth, and why I feel like we've got the most incredible group of public servants uh in the Commonwealth is right here in public health.
• 27:32
  So I think that just telling that story is a big part of what we want to do.
• 27:35
  Heck yeah.
• 27:38
  One thing that I can't go without asking about state health departments are being asked to do a lot more with less at a moment when federal support feels really uncertain amid this moment when you've already been in a moment of trying to rebuild and uh gain trust and navigate the historical challenges of the department.
• 27:59
  How are you planning on navigating this moment?
• 28:03
  With transparency.
• 28:04
  I mean, I tell people, you know, just like people know when they're in their own budgets, um, if you don't have it, you don't have it, right?
• 28:12
  I think we had to be really clear about advocating for the resources that we need federally, looking for grants, and then also at the state level in our engagement with the General Assembly.
• 28:22
  So we we have to be really clear about what we need and ask for those things.
• 28:26
  But when we don't have the resources to do things and do them well, communicate early and often with the people who are most impacted and say, here's where we are, here's where we need to be, or where we would need to be in order to do that well.
• 28:39
  And here's what we don't have, here's the gap.
• 28:41
  And and then enlist them in that process of saying, here's what we're thinking about our next steps.
• 28:46
  How does that land for you?
• 28:47
  How does that fit with the work that you're doing?
• 28:49
  I think that collaborative nature is a key here, uh, especially because this is rapidly evolving.
• 28:55
  We've got you know, ongoing federal challenges where, you know, a grant may disappear on a Friday night just cuz, and then it may reappear on a Monday.
• 29:05
  And so, you know, that's a lot of uncertainty to deal with.
• 29:09
  Um, so just making sure that people understand that's the environment that we're in right now.
• 29:13
  And here's how we're planning on navigating that, but how does that land for you?
• 29:17
  I think what I've found is people have a tremendous amount of grace when they realize all of the challenges public health is facing.
• 29:23
  The other thing I want to share, Melissa, is that um we had to do a whole exercise when we think about what are the the core services or the foundational public health services, the things that, you know, if we had to pull back to doing only those essential things that only we can do in communities, what are those?
• 29:41
  And so just that process of looking through what that is, I think is an important one for us.
• 29:46
  We certainly don't want to limit our work to what those kind of core public health services are.
• 29:52
  Um, you know, it comes from something called the foundational public health services model.
• 29:56
  And I always remind folks, I'm like, you know, the foundation of a house is not something you can live in alone, right?
• 30:03
  Like it's the foundation.
• 30:05
  You need the foundation in order to build the house.
• 30:08
  But a foundation alone is not sufficient.
• 30:10
  So it's not saying we only want to do those core services.
• 30:13
  It's just saying if we had to retreat to them for financial reasons, these are the things that we want to never lose track of because our communities will be in a really bad place without them across the board.
• 30:24
  And so going through those kind of exercises, it doesn't feel good, but it also feels responsible.
• 30:29
  And I think we wanna, we want to do that.
• 30:32
  Yeah, I really like that metaphor because it's it's like how people say we don't want to just survive, we want to thrive.
• 30:37
  You know, you want you want a house that will protect you and make you feel like home, welcome, um, safe.
• 30:43
  If you did have to get down to that foundational level, what would you say are some of those like top-level priorities we must protect elements of public health?
• 30:52
  Yeah, I mean, I think our our uh public health nursing, the efforts we have in communities, I think that's a it's a unique role and a unique part of the safety net.
• 31:01
  I think the epidemiology uh work that we do, you know, monitoring infectious trends and and following up on those, that's something that our communities, you know, seriously need us to do and will continue to do.
• 31:13
  The environmental health work that we do to protect communities, again, that's that's kind of at its core.
• 31:19
  It's one of those things that, again, people don't really notice it or even know that it's public health.
• 31:23
  But making sure that the establishments where you eat are safe and healthy, right?
• 31:28
  Like I think that's that's work that, you know, that's that's at the core of of what we're here to do is make sure that you have that peace of mind that when you step out into community, you're gonna be safe.
• 31:38
  And so those are those are some of them.
• 31:40
  Again, it's it really every community will tell you there there are different elements that are most important to them.
• 31:47
  But I think for us, it's it's always making sure like the emergency preparedness stuff, we've we've got that.
• 31:52
  We we make sure that we're ready to support communities' immunization programs, right?
• 31:56
  Like I feel bad listing them off because I'm like, I don't want to leave anybody out.
• 32:00
  It's like picking a favorite child.
• 32:02
  Yeah, I know.
• 32:02
  Like, you're all my favorite children.
• 32:04
  But but I I do think that, you know, when I go back to it, I'm just like, what are the things that if we didn't do it, it wouldn't get done?
• 32:11
  And those are the things that, you know, we'll go to the mat on.
• 32:15
  Uh we'll I'm like, you know, we we've got to continue to support this, we've got to continue to fund this, we've got to continue to invest in this.
• 32:21
  And there's so much even be above and beyond that.
• 32:24
  Uh, you know, if you look in the um maternal health space right now, there's a ton of really critical public health work being done all across the Commonwealth that without it, the infrastructure currently doesn't exist to support the needs of expecting mothers.
• 32:39
  But I think that's where we say that's a that's core work for so many of our communities.
• 32:43
  Some of the work to address health inequities, right?
• 32:46
  Like, you know, some of the core programmatic stuff that's, you know, doing some preventive health work, that that's core.
• 32:52
  It's critical to us.
• 32:53
  Some communities need more of that than others, but they don't have as much of a primary care footprint.
• 32:57
  So so it does shift a little bit by the locality, but I think that across the board, we just want to make sure that we are supporting that that core, that foundation the best we can, and then building on that to provide good health.
• 33:10
  Yeah, absolutely.
• 33:12
  I know we've covered a lot of ground.
• 33:13
  We just talked about, you know, trying to pick one out of the foundation or like, you know, what really matters.
• 33:19
  You know, everything does matter, but um, you know, time is limited, resources are limited.
• 33:23
  So if you had to nail down what you want to tackle most in a few priority areas, maybe like say you had a magic wand that could, you know, get it addressed, what would those priority areas be?
• 33:35
  Yeah.
• 33:35
  I mean, I think if I were to say priority areas, we kind of touched on them a little bit.
• 33:41
  And one of them is rebuilding trust in public health.
• 33:44
  And I say that as something that cuts across so many of the other the other work that we do.
• 33:49
  But if we could really spend some time in communities rebuilding that trust, that's a foundation that's going to allow great public health work to happen and to meet community needs.
• 33:59
  The second one I would say is is certainly in the equity space, it's that um there are a lot of communities that have been left behind historically.
• 34:08
  And using this moment to say who doesn't feel seen, who doesn't feel you know, heard or valued, and how can we reverse that?
• 34:17
  How can we show up and show up authentically with a lot of humility and say, how can we help?
• 34:23
  You know, I think that's that's something where um if we could use these next couple of years to make sure all communities have a connection, have an opportunity to share their needs, I think that would be really huge.
• 34:35
  And then the last one, you know, I think kind of across the board, and this ties in with equity, but I think there are so many preventable causes for folks of not just you know poor health outcomes, but even, you know, premature death.
• 34:49
  And I think that that's a huge opportunity for us to lean into and say, like, if we know these are preventable causes, and we touched on some of them with the plan for well-being, we talked about you know, firearm deaths, but like, what are those areas where it's just like we don't have to be losing folks in our communities to these problems?
• 35:04
  You know, cancer mortality that can be prevented with some screening, uh maternal mortality challenges.
• 35:11
  Um, there are a lot of areas where it's just like, you know, overdose deaths, where we can we can dig in a little bit deeper and say, what more can we do to keep our loved ones here?
• 35:20
  And and I think those are areas where um just thinking of it more broadly in those terms, I think we can do a lot of good.
• 35:26
  Absolutely.
• 35:28
  I really appreciate those three areas.
• 35:30
  I think they're they're big and ambitious, but so important and foundational to, you know, making sure that people trust public health, that public health works for people.
• 35:40
  And along that line, as we wrap up here, what do you want Virginians who have given up on public health institutions to know about what you're trying to build?
• 35:51
  Yeah, I I think that um, you know, public health has a long and rich history in society.
• 35:58
  So when we say folks have given up on public health institutions, I think that um, you know, it's gonna be a part of your community, it's gonna be part of your community life.
• 36:06
  Let's make it work for you.
• 36:08
  And that's really what it's what it's for.
• 36:10
  I don't have any desire of imposing the will of any agency on on folks, what I do have a desire is to be an agency and an entity that people can look to and rely on.
• 36:20
  And that's not just me.
• 36:22
  You know, I have to give a shout out to to Dr.
• 36:24
  Karen Shelton, who was the commissioner before me.
• 36:26
  Um, she shared that heart and that spirit.
• 36:28
  And I think that if regardless of what political party is in leadership in this Commonwealth, if the heart of public health is always there, we want people in communities to always feel supported, loved, cared for, you know, again, seen, heard, viewed, and valued.
• 36:43
  If if that's where we are, and I feel like that that is something that that's nonpartisan at its core.
• 36:50
  And so I like the idea of removing a lot of the politics in public health and and getting folks to realize that hey, we just want to build with you.
• 36:57
  We want to build safer, healthier communities with you.
• 36:59
  And we recognize it takes some time, but we're we're here for the long haul, right?
• 37:03
  It's that that's what's been really fun for me is that I tell folks all the time the longest serving commissioner in the history of Virginia served for 25 years.
• 37:12
  Wow.
• 37:13
  Yeah.
• 37:13
  And and I will not be serving for 25 years.
• 37:16
  Like I make no bones about it.
• 37:19
  Um, and so I I enter into this with the expectation that I'm handing this baton to somebody to keep running.
• 37:25
  And that person may be of you know one political party or another.
• 37:30
  It doesn't matter.
• 37:31
  I'm handing it to a public health servant who's passionate about the health and well-being of communities.
• 37:36
  And I want to make sure that we're moving in a direction where the Commonwealth can grow.
• 37:39
  And so I think that, you know, if we keep that posture, we're gonna do, we're gonna do our right.
• 37:42
  And um, and I think we'll be able to rebuild that trust and those relationships with the community.
• 37:47
  Yeah, thank you so much for sharing this.
• 37:49
  I think we've learned a lot about the power of listening and learning, building together, looking at public health through the greater arc of history.
• 37:59
  This was such a wonderful conversation, Dr.
• 38:01
  Webb.
• 38:02
  And I really wanted to thank you for taking the time to share a little bit about your approach and how you're serving the people of Virginia.
• 38:08
  Well, it's my pleasure.
• 38:08
  Thanks so much for having me.
• 38:09
  This is a lot of fun, and um, and thanks for all you all are doing.
• 38:15
  Dr.
• 38:15
  Webb said something early in our conversation that I keep coming back to.
• 38:20
  He said that he'd walk into a room with all the data, the chart, the labs, the history, but he'd still ask where it hurts.
• 38:28
  And he's still asking money, leading by listening for all Virginians.
• 38:33
  This kind of leadership philosophy makes the difference between an institution that talks about people, and one that actually builds with them.
• 38:42
  And in a moment when public health is under pressure from every direction, budget comes, political headwinds, the workforce still recovering from the weight of the pandemic.
• 38:52
  That philosophy might just be what reminds us all why we should trust Republic Health officials.
• 38:58
  If you want to learn more about the Virginia Department of Health or the fun of your plan for well-being, you can find them in the show notes.
• 39:05
  In the meantime, make sure to follow and review Empathy and Effect wherever you listen to podcasts, and share the episode with a friend.
• 39:12
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• 39:14
  Thanks y'all.
• 39:16
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• 39:19
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• 39:26
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