Dr. Judy Monroe of the CDC Foundation: “Global health security”

Global health security: COVID-19 has shown us again how a health threat anywhere can become a health threat everywhere. Ebola gave us an earlier warning in a more confined way. A key to getting in front of pandemics and health threats is to work in key areas across the world to better prepare health and […]

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Global health security: COVID-19 has shown us again how a health threat anywhere can become a health threat everywhere. Ebola gave us an earlier warning in a more confined way. A key to getting in front of pandemics and health threats is to work in key areas across the world to better prepare health and public health workers to be able to detect, prevent and respond to health threats that arise. So, as a nation, we must work with our key partners to bring in additional funding to work with countries that can be sentinels when outbreaks occur — and they will continue to occur.


The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.

In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.

As a part of this series, I had the pleasure to interview Dr. Judy Monroe.

Dr. Judy Monroe has dedicated her career to protecting people and saving lives. She joined the CDC Foundation in 2016 as the president and CEO following her role as a deputy director of the U.S. Centers for Disease Control and Prevention (CDC) and director of CDC’s Office, State, Tribal and Territorial Support. Prior to CDC, Dr. Monroe served as Indiana’s state health commissioner after several years practicing medicine and as a leader in medical education.


Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?

I have always been interested in science and medicine. My mother had polio before I was born, and her appreciation for the power of vaccines left an indelible mark on me. I pursued a career in family medicine and practiced in rural Appalachia before joining the faculty at Indiana University Medical School. Later, I became the residency program director at St. Vincent Hospital in Indianapolis. My clinical experiences drove home how critical the social determinants of health are — such as where you live, your education, your economic stability and your access to health care, as well as public policy are to good health. Then Governor Mitch Daniels asked me to serve as Indiana’s state health commissioner in 2005, and I transitioned to a career in public health that later took me to CDC where I served as a deputy director of the agency and directed the Office of State, Tribal, Local and Territorial Support. In 2016, I was selected to lead the CDC Foundation as the president and CEO.

Can you share the most interesting story that happened to you since you began your career?

While I have many, perhaps the most interesting story that foreshadowed my future career in public health occurred in 1990 when former Surgeon General C. Everett Koop came to rural Tennessee where I was practicing medicine. He was doing a documentary on healthcare in America and interviewed me during a home visit with a pediatric patient. The infant had been born with a congenital neural tube defect, and I was managing her care. We filmed the interview while walking down a country lane outside of the home. I was nearing the delivery of my third child. The documentary aired on national television a few weeks later, and I received a fair amount of teasing from friends about how I waddled during my interview with Dr. Koop. A few months later, Dr. Koop called me and offered to perform needed surgery on the child we visited with free of charge in Philadelphia, but the parents declined for fear of traveling that far.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

During one of the football seasons early in my career in rural Appalachia the University of Tennessee was having a losing streak. A radio host decided to camp out on the roof of a local business until the Vols won a game. Weeks passed without a win and the weather started to get cold and damp. The radio host developed some respiratory symptoms and requested a physician visit. I was asked by several influential people in the community to see him. I asked that he come into the office for a visit, but he declined because it would disrupt his challenge. Worried about his condition, I agreed to visit him on the roof but learned that the only way up was to climb a ladder.

I climbed up the ladder with my black bag in tow and found him to be moderately ill. To treat him, I needed to make several follow-up visits and in between each visit, I prayed for the Vols to win a game. The story of my visits made it to some major newspapers, and I felt tremendous pressure to assure his well-being. Finally, my prayers were answered, and Tennessee won a game, the radio host finished his challenge, and I was able to get a good night’s rest.

I still believe as a physician that it’s important to meet patients where they are and to make home visits when needed. But I learned that getting caught in the middle of football fans and making “roof calls” was taking that approach to the extreme!

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“This above all, to thine own self be true, and it must follow, as night the day, thou canst not then be false to any man.” Shakespeare

I love this quote and have tried to follow it throughout my life.

Are you working on any exciting new projects now? How do you think that will help people?

Yes, our team has been working to extend CDC’s response to the COVID-19 pandemic and working to support jurisdictional health departments that have been under extreme stress since the pandemic began. While we’re working on a variety of novel projects, one area of focus is working with community-based organizations to help strengthen their capacity to help the audiences that they serve. This has included support from the government and private sectors to assist community-based organizations in reaching into their communities to share trusted information about vaccines as well as to address vaccine misinformation.

How would you define an “excellent healthcare provider”?

An excellent healthcare provider is one that takes time to listen to his/her patients and clearly articulates medical advice. A provider that is approachable, leads with empathy and goes that extra mile for his/her patients. That means meeting patients where they are and not trying to have a one-size fits all approach to connecting with people. If there’s one lesson, we’ve all learned during the COVID-19 pandemic, it’s that you cannot reach and change the behavior of all people by trying only one way.

Ok, thank you for that. Let’s now jump to the main focus of our interview. The COVID-19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?

I’ll give you three examples related to workforce, infrastructure and data collection. From a workforce perspective, we’ve seen the healthcare industry face some extreme shortages in having the staff they need to meet the swelling demands that have been brought about from the various surges in the COVID-19 pandemic. So, we’re going to need to address how we can swell the staffing capacity to meet needs across the nation, particularly when we have a widespread health threat. We’re also going to need to address supply issues and production challenges. You may recall the initial challenges we faced with a lack of personal protective equipment as one example. We need to be creative at how we rapidly shift production — almost a war time approach — to meet rapidly rising needs and incentivize companies, large and small, to convert their production lines to manufacture needed products. A third area is data, which has been challenging from a healthcare and public health perspective. We need to move away from disease-specific surveillance systems and create systems that gather large amounts of information across all health conditions. This will take a commitment of resources and funding and require the private and government sectors to partner together.

Here is the primary question of our discussion. As a healthcare leader can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

Health equity: The COVID-19 pandemic has laid bare the health inequities of our society, which have existed since our nation’s founding. Critically, the pandemic has affected communities of color and other marginalized communities in greater proportion. Our collective future depends on all of our communities having an equitable opportunity for health, wellbeing and economic vitality. To make this vision a reality, it will take creative, sustainable and multisector partnerships and solutions to emerge from the pandemic. For this reason, we should focus on three priorities: support a strong, trusted, diverse public health sector, led by a workforce with the skills and capacities necessary for leading in the 21st century; build the capacity of community-based organizations to promote vibrant, healthy and resilient communities through effective partnerships, strong multi-sector collaborations and systems level approaches; and enhance the integration of the public health and other sectors, including, health care, human services and the private sector, to build a movement for transformation in community health.

Rebuild public health infrastructure: Our health care professionals have been rightfully elevated during the COVID-19 pandemic. They have done hero’s work. But we cannot forget our public health professionals either. A Trust for America’s Health report notes that the United States spent 3.8 trillion dollars on health in 2019, but with just 2.6 percent directed toward public health and prevention — the smallest share since at least 2000. Importantly, the public health system has gone through spells of underinvestment with increased but delayed funding when emergencies arise. Staffing and an ongoing investment in training has been another critical need in health departments. Even before the pandemic and related recession, state health agencies, according to the Trust for America’s Health, lost nearly 10 percent of their full-time equivalent workforce from 2012 to 2019. In addition, local health departments lost about 16 percent of their staff from 2008 to 2019.

Updated technology and systems/data modernization: COVID-19 has shown just how deficient our health data systems are. Whether we’re trying to track cases of COVID-19 infections, deaths or hospitalizations. At the beginning of the pandemic, we had inconsistent health systems that, in some cases, continued to function by fax machine. That’s not a workable solution to meet the needs of just-in-time, 21st century threats. We must move away from disease-specific surveillance systems and create systems that gather large amounts of information across all health conditions. This will take a commitment of resources and funding and require the private and government sectors to partner together.

Climate change: Climate change is the greatest health threat of our time. We see the impacts from the spread of diseases that once were confined to certain areas of the world spreading in places where they have never been recorded. We see it in more dangerous storms, wildfires, flooding and droughts. In addition to putting in place better infrastructure to help fend off the threats of a changing climate, we need to treat climate change as our most serious health threat. That means working with communities most at risk to bolster their health and public health systems and ensuring that these communities have the funding and tools needed to address the health impacts.

Global health security: COVID-19 has shown us again how a health threat anywhere can become a health threat everywhere. Ebola gave us an earlier warning in a more confined way. A key to getting in front of pandemics and health threats is to work in key areas across the world to better prepare health and public health workers to be able to detect, prevent and respond to health threats that arise. So, as a nation, we must work with our key partners to bring in additional funding to work with countries that can be sentinels when outbreaks occur — and they will continue to occur.

Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages?

There are many ways to help with the primary care shortage in the U.S. One important step needed is to boost enrollment at medical schools and understand how we can lower student debt. Government can play a role here. It could provide incentives for accelerated degrees as well as some of the other medical fields that support physicians that are also experiencing shortages such as physician assistants, nurses, pharmacists, etc. In addition, residency programs can increase the number of slots available.

How do you think we can address the issue of physician diversity?

To begin, we must adopt a policy of zero tolerance racism in the physician ranks. This ranges from hiring, leadership to the day-to-day practice of patient care. Next, we need more diversity at our medical schools — from the professors to the boards to the administration. We must also center our understanding and reckoning with historic and current systemic racism. This means acknowledgement, recognition and reckoning with structural obstacles to health and wellbeing, including systemic racism and other forms of structural bias that permeate health care, economic, cultural and political institutions, policies and practices. This requires us to examine and address the structural root causes of the intertwined health and social problems we see to eliminate.

How do you think we can address the issue of physician burnout?

This is a very real problem especially now during this pandemic, and there is not a quick and easy fix due to the culture of patient care and what we are taught in medical school. Physicians got into this field to develop the relationship with their patient — not spend their time with administrative tasks or dealing with insurance carriers for reimbursement. We must commit to change at all levels, beginning at medical school, in order for physicians to be able to practice what they love most.

What concrete steps would have to be done to actually manifest all of the changes you mentioned? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

Individuals can become active in their local community hospitals. Invest in their local public health systems.

Corporations can instill workforce wellness plans to inspire their employees to take good health seriously thus having an impact on their community’s health. In addition, corporations can get involved with their local hospital systems and public health foundations and local/state government.

Communities can work with community-based organizations, community partners and local government to aid in making their communities equitable in regard to housing, jobs, schools, transportation and more.

Leaders should support achieving a strong, trusted public health sector with the skills and capacities necessary for leading in the 21st century.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

The world faces a tremendous challenge to repair and rebuild after the devastating social, economic and health impact of the COVID-19 pandemic and in many countries — including in the Unites States — this is occurring at a time of important reckoning of systemic racism. We cannot afford to have anyone sidelined from the effort by health or other inequities.

Investing in the social, economic and physical wellbeing of all people in the U.S. will improve both individual and population health and lay the foundation for the nation to achieve a bold vision of a thriving, healthy and prosperous future for everyone.

How can our readers further follow your work online?

You can follow the CDC Foundation, which I lead at www.cdcfoundation.org. You can also follow us on social media — Twitter(@CDCFound), Facebook (@CDCFoundation), LinkedIn (www.linkedin.com/company/cdc-foundation). You can follow me on LinkedIn (www.linkedin.com/in/drjudymonroe/) and Twitter (@DrJudyMonroe).

Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.

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