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There aren’t many people who have the breadth of perspective and the depth of accomplishment that this week’s guest brings to the table. Dr. Tony Slonim doesn’t just wear multiple hats. He has lived in multiple healthcare worlds – having earned a nursing degree, a medical degree, a subspecialty board certification, a doctorate in public health; and having served in the public health service as well as in senior executive roles. It is this unique multi-system orientation that enables him to draw distinctions between medical care, public health, community health and population health – distinctions that many of us may not fully appreciate..
In this interview, Dr. Slonim points out that our hospital-based medical healthcare system is not interchangeable with a public health care system. The fallacy that they are interchangeable – and that a public health service is not needed – is a mis-guided national error which has contributed to an American health system which delivers subpar outcomes when compared to other economically developed nations.
By way of formal introduction, Dr. Anthony Slonim is president and chief executive officer of Renown Health in Reno, NV. Modern Healthcare has named Dr. Slonim one of the “50 Most Influential Clinical Executives” in 2019. Before joining Renown Health, he served in executive leadership roles at Barnabas Health in NJ, Carillion Clinic in VA and Children’s National Medical Center in DC. Dr. Slonim holds a diploma in professional nursing. He is a board-certified pediatric intensivist, who also earned a masters and doctorate in public health from George Washington University; and then served four years in the United States Public Health Service in Rockville, MD with the rank of Lieutenant Commander.
In this episode, we’ll cover:
- The difference between the ‘medical mindset’ and the ‘public health mindset’.
- The reframing of our public health system as an “insurance policy” that our country has not invested in over the past few decades.
- Some thoughts on how the defunding of our public health system has contributed to the disparities and inequities in healthcare.
- The “precedent of unkindness” in our society – exacerbated by the stressors of the pandemic and perhaps enabled through social media – that is adding to our psychologic and physiologic strain, and harming the public health.
Dr. Slonim is a kind and humanistic leader, but he is also a demanding leader. He is demanding that we reinvest in a diverse healthcare system that works to keep our communities and the American public healthy. What this interview reveals is that the vast majority of us – who have not been trained in public health – don’t understand its significance and its critical role. We don’t understand the differences between public health, population health and medical care. We don’t understand the unique approaches and tools of the public health system. We are not aware that our public health system has been defunded over the past few decades. Nor do we fully appreciate the implications of that defunding, especially in inner cities and rural counties.
Many of the healthcare problems we’re experiencing today – including some of the devastating fallout of the COVID-19 pandemic – are due to this lack of a robust public health system. These problems include: unsafe drinking water (think Flint Michigan); unsafe air; climate change; the racial disparities in healthcare in which life expectancy between neighboring zip codes can vary by as much as 15 – 20 years; the worsening opioid epidemic; and the epidemic of mental health and suicide in our country. All of these have one thing in common. They could be greatly mitigated by the presence of a strong local public health system in our communities, our towns, our cities, our counties and our states.
The pandemic has taught us many things, not least among them is that we need to rebuild our public health system. One wonders if our political and healthcare leaders have the discernment, conviction and courage to translate this obvious societal need into action by investing not only in the medical system, but also in a public health system. The federal government that the framers created is intentionally organized around checks and balances, informed by multiple perspectives. Our healthcare system needs that same sort of multi-system, multi-perspective reorganization.
Until next time, be safe and be well.
Zeev Neuwirth, MD