FFor many New Yorkers, Dave Chokshi was the face of New York City’s public health response to Covid-19. He appeared often public service announcements in a white lab coat with the text ‘NYC’ in big, bold letters, urging city dwellers to do so mask on, get testedAnd get vaccinated.
Chokshi was appointed New York City’s 43rd health commissioner in August 2020 and was drawn into the city’s fight against the coronavirus just months after it was deemed a problem. epicenter of the pandemic. After those chaotic and harrowing first months in which hundreds of people died every day in overcrowded hospitals and freezer trucks were converted into makeshift morgues, Chokshi was tasked with restoring confidence among residents and steering the city’s vaccination campaign through waves of new variants and the introduction of new boosters.
Chokshi resigned from his position as “city doctor” in 2022 and is now chairman of the newly formed Community Health Coalition, a nonprofit organization that aims to prepare the U.S. health care system for the next crisis by getting public health organizations and health care systems—which Chokshi says typically operate in parallel—to work together before disaster strikes. The coalition in June announced it had signed more than 50 members, including the American Public Health Association, Northwell Health and the Yale School of Public Health.
“People have been talking about uniting medicine and public health for decades, but quite frankly, they have failed,” Chokshi said. ‘I’ve lived on both sides. I have been a leader in healthcare and had the privilege of also leading public health. This is an opportunity for me to serve as that emissary and bring a different way to reimagine our health care system.”
Chokshi was previously head of the population health organization NYC Health + Hospitals, the largest community health care system in the US, and is now a practicing physician at Bellevue Hospital and a lecturer at the City College of New York. He spoke to STAT in June at the Aspen Ideas: Health Festival to talk about his goals for the coalition, lessons learned from the pandemic, and bridging healthcare and public health. This interview has been edited for length and clarity.
I don’t see you on my TV anymore during SNL commercial breaks about masking and vaccines. What have you been doing since leaving the New York City Health Department?
As chair of the Common Health Coalition, I’m building on the memories of the pandemic and turning things not just into “lessons learned” but into “lessons mobilized.” We saw, among all the tragedy and suffering, a huge amount that was positive. We saw the walls fall between healthcare and public health – whether it was through our vaccination campaign or through testing or through any of the other things we did to mobilize this once-in-a-generation pandemic response. This has been one of the inspiring ideas of my career. I’ve spent time in healthcare, and I’ve spent time in public health, and in all of those experiences I always felt like I was some kind of mole for the other side. I was the guy in health care who said, “Why don’t we contact the health department, which is working on these similar problems?” And then vice versa. When I was given the opportunity to lead the New York City Health Department, the question was always, “What can we do to better engage our healthcare partners who see all these people we also want to serve?” It’s about knitting those things together.
What are the biggest ‘lessons to mobilize’ from the pandemic?
I think about it in two ways: relationships and results. Relationships are about how, when we find ourselves in times of peace, we build the connections we know we will rely on in times of crisis. The time to build them is in times like now, when, for example, when it comes to the preparedness of hospitals and a public health department, these have to be shared plans. These should be plans that we think about and organize together, rather than in our separate silos.
Then on the results side. We are no longer in a crisis like the Covid-19 pandemic, but we are facing all these other slower-moving disasters. Whether it’s the opioid crisis or climate change, these are all issues that we know will have catastrophic consequences, but which, if we muster the full will and resources of our healthcare system, can be much more effective. [at addressing] than we are today.
What lessons from the pandemic can we now mobilize for the next major public health crisis?
We know that equality must be baked into our plans from the ground floor. Equity is not an add-on. It’s not an afterthought. It’s the most important event. If that wasn’t clear to you before the pandemic, it must have been in its aftermath. That means that if you are a healthcare leader, it is your responsibility to ensure that when you have a vaccination plan that you are rolling out, that equity is part of that vaccination plan, and that it is not something that is left to comes in a few months. at the end of the road.
I vividly remember that during the Omicron wave of the pandemic, we made great progress in closing the Black-white vaccination gap in New York City by the end of 2021. [through] a lot of rigorous, deliberate work in partnership with community organizations, using community health workers, fighting misinformation, etc. We were proud of that.
Then I remember my team bringing me data showing the difference in hospitalization rates between black and white New Yorkers during the Omicron wave after we closed that vaccination gap, and that black New Yorkers during Omicron were twice as likely to be in the to be hospitalized as white New Yorkers. . To me, this is another lesson in the challenges we face, and the responsibility it takes to get people to say, “If you’ve moved a little bit, you know, towards where you need to go, you can’t be satisfied if you still have the data to show you that there is such great inequality.” So it’s about building that accountability loop in a way that can recognize some of the successes, but also shows when the job isn’t done yet.
What is the Common Health Coalition and what are your goals?
For those who care about this mission to strengthen the partnership between healthcare and public health, we invite them to consider joining the coalition. To do this, you must make a commitment. This is something that I felt very strongly about as chairman, to say that we are not going to be just another organization that puts out a report that sits on the shelf, or makes recommendations that we hope other people will follow. We want to set a good example.
In March we announced our first set of six action areas and 33 concrete actions in these six areas. Any new organization that joins the coalition must either join one of these actions, or say, we’re going to do something different under one of the coalition’s focus areas. These priorities boil down to sort of four areas. We use the abbreviation CARE.
C is about the coordination between healthcare and public health. Again, we do this in times of peace, and not just in times of crisis. A is about emergency preparedness. R is about real-time disease detection. Whether it’s measles or H5N1, how can we quickly understand cases as they are reported so we can respond as quickly as possible. E is about data exchange, especially to promote equality in healthcare.
How has your experience as New York City Health Commissioner prepared you for what you do now?
One of the things I think about a lot is how we ensure that our health conversations end up on the kitchen table. How do we communicate about it in a way that eschews the jargon, that takes us into a realm that is less abstract and much more tangible and concrete. That certainly affects the work that we do with the coalition because, frankly, this can feel quite shaky. If I were to think about this from the perspective of one of my patients, the answer I would get would be, “Why aren’t you two already working together? I didn’t even know this was a problem, that health care and public health don’t work well together.”
The other is just to give voice to some of the stories, not just about what went wrong during the pandemic, but also about what went right. How the largest vaccination campaign in our city’s history simply wouldn’t have happened if we hadn’t had a robust partnership between healthcare and public health. And how much, as the leader of our pandemic response, I had to put my shoulder to the grindstone to make that partnership happen. That largely comes from my experience.
What diseases are you working on now? Are you catching bird flu?
Bird flu is a very important example for us to think about, because we need to be able to communicate what healthcare can contribute, and then link that to not only public health departments, but also to agricultural experts. Bringing all of these things together under one banner is one of the ways we’re trying to contribute to the H5N1 response. Syphilis is something that is on our radar screen, especially because of the very rapid and concerning increase in congenital syphilis. This relates to all the ways in which we need to improve maternal health in this country, but especially to prevent the perinatal transmission of syphilis, which depends on the health care system being able to deliver what we know it works in relation to treating syphilis, particularly latent syphilis, and then ensuring that public health is addressed.
What are the biggest obstacles you face in bridging public health and healthcare systems?
The biggest barriers are often barriers of inertia. We fail to recognize that the pandemic has brought all these cracks in our healthcare system to the forefront. We are suffering from this collective amnesia when it comes to Covid-19. I think the coalition is actually choosing action over amnesia. We’re making progress on that because of the momentum we have.